1
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Nguyen H, Nasir M. Management of Chronic Asthma in Adults. Med Clin North Am 2024; 108:629-640. [PMID: 38816107 DOI: 10.1016/j.mcna.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Asthma is characterized by chronic inflammation and respiratory symptoms such as wheezing and coughing. In the United States, it affects 25 million people annually. Chronic smokers, poor adherence to medications, incorrect use of inhalers, and overall poor asthma control are known risk factors that lead to poorly controlled chronic asthmatics. Although asthma is traditionally categorized by severity, treatment by primary care providers is guided by the Global Initiative for Asthma or the National Asthma Education and Prevention Program. As more research is available, shared decision-making between health care providers and patients will lead to improved outcomes in managing chronic asthma.
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Affiliation(s)
- Huong Nguyen
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H154/C1613, Hershey, PA, USA.
| | - Munima Nasir
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H154/C1613, Hershey, PA, USA
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2
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de Lima FF, Dos Santos JMB, Lunardi AC, de Oliveira JM, Freitas PD, Kim FS, Agondi RC, Carvalho-Pinto RM, Furlanetto KC, Carvalho CRF. Physical Activity and Sedentary Behavior as Treatable Traits for Clinical Control in Moderate-to-Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00274-5. [PMID: 38492665 DOI: 10.1016/j.jaip.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Physical activity and sedentary behavior are treatable traits that may impact asthma control in distinct manners, but this impact remains poorly understood. OBJECTIVE To evaluate the influence of physical activity and sedentary behavior on clinical control in adults with moderate-to-severe asthma. METHODS This cross-sectional, multicentric study included 426 individuals with moderate-to-severe asthma. Assessments included physical activity and sedentary time (actigraphy), clinical asthma control (Asthma Control Questionnaire [ACQ]), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), anthropometric data, and lung function. Participants were grouped according to physical activity levels and sedentary behavior. RESULTS Participants who walked ≥7500 steps/day presented better ACQ scores than those who walked <7500 steps/day (P < .05), independent of sedentary status. The percentage of patients with controlled asthma was higher in the active/sedentary (43.9%) and active/nonsedentary (43.8%) groups than in the inactive/sedentary (25.4%) and inactive/nonsedentary (23.9%) groups (P < .02). The likelihood of having uncontrolled asthma according to the treatable traits of physical inactivity (odds ratio [95% confidence interval]: 2.36 [1.55-3.59]), higher anxiety (2.26 [1.49-3.42]), and depression symptoms (1.95 [1.28-2.95]) was significant (P ≤ .002). Obesity and sedentary time were not associated with asthma control. CONCLUSIONS Our results show that ≥7500 steps/day is associated with better asthma control independent of sedentary time in adults with moderate-to-severe asthma. Physical inactivity, anxiety, and depression symptoms are associated with higher odds of uncontrolled asthma. These results suggest that interventions should mainly focus on increasing physical activity rather than reducing sedentary time.
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Affiliation(s)
- Fabiano F de Lima
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Juliana M B Dos Santos
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Adriana C Lunardi
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Joice M de Oliveira
- Biological and Health Sciences Center, UNOPAR Pitágoras University, Londrina, Brazil; Laboratory of Research in Pulmonary Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Patrícia D Freitas
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fabiana S Kim
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rosana Câmara Agondi
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Regina M Carvalho-Pinto
- Pulmonary Division, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Karina C Furlanetto
- Biological and Health Sciences Center, UNOPAR Pitágoras University, Londrina, Brazil; Laboratory of Research in Pulmonary Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Celso R F Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
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Shahid S, Alqahtani SS, Bajwa M, Rashid M, Sana A, Bajwa A, Ali AN, Ariffin AK, Mahmood M, Ahmed F, Mustafa MA. The Effect of Obesity on Severity of Asthma: An Observational Prospective Study from Pakistan. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:38-43. [PMID: 38694965 PMCID: PMC11060623 DOI: 10.4103/jpbs.jpbs_238_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/24/2023] [Accepted: 05/20/2023] [Indexed: 05/04/2024] Open
Abstract
Objective The current research study aimed to access the relationship between obesity and asthma exacerbations and severity among adult patients at the outpatient section of a federal hospital (PIMS) in Islamabad, Pakistan. Methods A cross-sectional research study was carried out on 207 asthma adult patients belonging to different areas and ethnic groups from the country. The study setting was the PIMS hospital, which attracts patients from all over the country due to its facilities and cost-effective treatments. The body mass index (BMI) of asthma patients was calculated using the heights and weights of the study subjects. However, the pulmonary functions were calculated using a computerized spirometer i-e Spirolab III S/N 303681 in line with Winspiro PRO 7.1.version software. It presents the patient's forced vital capacity that expires in the first second of expiration to full (FEV1) in comparison to forced vital capacity (FVC) ratio, that is, Tiffeneau-Pinelli index was also recorded to determine the asthma severity. Results According to recent surveys, the overall prevalence of patients with overweight and obesity was 29.0% and 23.7%, respectively. A Chi-square test was used, and a statistically significant relationship was observed between BMI and asthma severity (P < 0.001). The adult obese female patients presented poor pulmonary functions. The average FEV1/FVC ratio presented significant variance among four different categories of BMI with P < 0.05. This difference was due to the normal BMI category as the Tiffeneau-Pinelli index, that is, FEV1/FVC in the normal BMI group was significantly lower as compared to that in underweight and obese patients. Conclusion The study subjects presented raised asthma severity in accordance with the raised BMI. Obese patients presented comparatively raised asthma exacerbations. Moreover, a statistically significant association of gender difference was observed between obesity and asthma severity. It was concluded that adult asthmatic women with obesity presented raised asthma severity as compared to adult asthmatic males.
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Affiliation(s)
- Sara Shahid
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Saad S. Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Mishal Bajwa
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Mahnoor Rashid
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Anosh Sana
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amna Bajwa
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Abdul N. Ali
- Department of Pharmacy Practice, Geethanjali College of Pharmacy, Cheeryal (V), Keesara (M), Hyderabad, Telangana, India
| | - Ahmad K. Ariffin
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, UniSZA, Besut, Terengganu, Malaysia
| | - Mahgull Mahmood
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Fahad Ahmed
- Faculty of Pharmacy, University of Sargodha, Sargodha, Punjab, Pakistan
| | - Muhammad Abid Mustafa
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
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DeWan AT, Cahill ME, Cornejo-Sanchez DM, Li Y, Dong Z, Fabiha T, Sun H, Wang G, Leal SM. Variants in JAZF1 are associated with asthma, type 2 diabetes, and height in the United Kingdom biobank population. Front Genet 2023; 14:1129389. [PMID: 37377600 PMCID: PMC10291233 DOI: 10.3389/fgene.2023.1129389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Asthma, type 2 diabetes (T2D), and anthropometric measures are correlated complex traits that all have a major genetic component. Objective: To investigate the overlap in genetic variants associated with these complex traits. Methods: Using United Kingdom Biobank data, we performed univariate association analysis, fine-mapping, and mediation analysis to identify and dissect shared genomic regions associated with asthma, T2D, height, weight, body mass index (BMI), and waist circumference (WC). Results: We found several genome-wide significant variants in and around the JAZF1 gene that are associated with asthma, T2D, or height with two of these variants shared by the three phenotypes. We also observed an association in this region with WC when adjusted for BMI. However, there was no association with WC when it was not adjusted for BMI or weight. Additionally, only suggestive associations between variants in this region and BMI were observed. Fine-mapping analyses suggested that within JAZF1 there are non-overlapping regions harboring causal susceptibility variants for asthma, T2D, and height. Mediation analyses supported the conclusion that these are independent associations. Conclusion: Our findings indicate that variants in the JAZF1 are associated with asthma, T2D, and height, but the associated causal variant(s) are different for each of the three phenotypes.
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Affiliation(s)
- Andrew T. DeWan
- Department of Chronic Disease Epidemiology and Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Megan E. Cahill
- Department of Chronic Disease Epidemiology and Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Diana M. Cornejo-Sanchez
- Center for Statistical Genetics, Gertrude H. Sergievsky Centerand the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Yining Li
- Department of Chronic Disease Epidemiology and Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Zihan Dong
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
| | - Tabassum Fabiha
- Center for Statistical Genetics, Gertrude H. Sergievsky Centerand the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Hao Sun
- Center for Statistical Genetics, Gertrude H. Sergievsky Centerand the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Gao Wang
- Center for Statistical Genetics, Gertrude H. Sergievsky Centerand the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Suzanne M. Leal
- Center for Statistical Genetics, Gertrude H. Sergievsky Centerand the Department of Neurology, Columbia University Medical Center, New York, NY, United States
- Taub Institute for Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States
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Selberg S, Karlsson Sundbaum J, Konradsen JR, Backman H, Hedman L, Lindberg A, Stridsman C. Multiple manifestations of uncontrolled asthma increase the risk of severe COVID-19. Respir Med 2023:107308. [PMID: 37271301 DOI: 10.1016/j.rmed.2023.107308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Asthma control is of importance when assessing the risk of severe outcomes of COVID-19. The aim of this study was to explore associations of clinical characteristics and the effect of multiple manifestations of uncontrolled asthma with severe COVID-19. METHODS In 2014-2020, adult patients with uncontrolled asthma, defined as Asthma Control Test (ACT) ≤19 were identified in the Swedish National Airway Register (SNAR) (n = 24533). The SNAR database, including clinical data, was linked with national registers to identify patients with severe COVID-19 (n = 221). The effect of multiple manifestations of uncontrolled asthma was based on: 1) ACT ≤15, 2) frequent exacerbations and 3) previous asthma inpatient/secondary care and evaluated stepwise. Poisson regression analyses were conducted with severe COVID-19 as the dependent variable. RESULTS In this cohort with uncontrolled asthma, obesity was the strongest independent risk factor for severe COVID-19 in both sexes, but even greater in men. Multiple manifestations of uncontrolled asthma were more common among those with severe COVID-19 vs. without: one, 45.7 vs. 42.3%, two, 18.1 vs. 9.1% and three, 5.0 vs. 2.1%. The risk ratio (RR) of severe COVID-19 increased with an increasing number of manifestations of uncontrolled asthma: one, RR 1.49 (95% CI 1.09-2.02), two, RR 2.42 (95% CI 1.64-3.57) and three, RR 2.96 (95% CI 1.57-5.60), when adjusted for sex, age, and BMI. CONCLUSIONS It is important to consider the effect of multiple manifestations of uncontrolled asthma and obesity when assessing patients with COVID-19, as this increases the risk of severe outcomes substantially.
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Affiliation(s)
- Stina Selberg
- Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN-unit, Umeå University, Umeå, Sweden.
| | | | - Jon R Konradsen
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/The OLIN-unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/The OLIN-unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN-unit, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN-unit, Umeå University, Umeå, Sweden
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Nguyen H, Nasir M. Management of Chronic Asthma in Adults. Prim Care 2023; 50:179-190. [PMID: 37105600 DOI: 10.1016/j.pop.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Asthma is characterized by chronic inflammation and respiratory symptoms such as wheezing and coughing. In the United States, it affects 25 million people annually. Chronic smokers, poor adherence to medications, incorrect use of inhalers, and overall poor asthma control are known risk factors that lead to poorly controlled chronic asthmatics. Although asthma is traditionally categorized by severity, treatment by primary care providers is guided by the Global Initiative for Asthma or the National Asthma Education and Prevention Program. As more research is available, shared decision-making between health care providers and patients will lead to improved outcomes in managing chronic asthma.
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Affiliation(s)
- Huong Nguyen
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H154/C1613, Hershey, PA, USA.
| | - Munima Nasir
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H154/C1613, Hershey, PA, USA
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Specjalski K, Romantowski J, Niedoszytko M. YKL-40 as a possible marker of neutrophilic asthma. Front Med (Lausanne) 2023; 10:1115938. [PMID: 36844232 PMCID: PMC9945318 DOI: 10.3389/fmed.2023.1115938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Asthma is a heterogeneous chronic disorder of the airways, with inflammation and bronchial hyperresponsiveness as its major underlying phenomena. Asthmatics vary in terms of inflammation pattern, concomitant pathologies, and factors aggravating the course of the disease. As a result, there is a need for sensitive and specific biomarkers that could facilitate diagnosing asthma as well as phenotyping in everyday practice. Chitinases and chitinase-like proteins (CLPs) seem promising in this field. Chitinases are evolutionarily conserved hydrolases that degrade chitin. In contrast, CLPs bind chitin but do not have degrading activity. Mammalian chitinases and CLPs are produced by neutrophils, monocytes, and macrophages in response to parasitic or fungal infections. Recently, several questions have been raised about their role in chronic airway inflammation. Several studies demonstrated that overexpression of CLP YKL-40 was associated with asthma. Moreover, it correlated with exacerbation rate, therapy resistance, poor control of symptoms, and, inversely, with FEV1. YKL-40 facilitated allergen sensitization and IgE production. Its concentration was elevated in bronchoalveolar lavage fluid after an allergen challenge. It was also found to promote the proliferation of bronchial smooth muscle cells and correlate with subepithelial membrane thickness. Thus, it may be involved in bronchial remodeling. Associations between YKL-40 and particular asthma phenotypes remain unclear. Some studies showed that YKL-40 correlates with blood eosinophilia and FeNO, suggesting a role in T2-high inflammation. Quite the opposite, cluster analyses revealed the highest upregulation in severe neutrophilic asthma and obesity-associated asthma. The main limitation in the practical application of YKL-40 as a biomarker is its low specificity. High serum levels of YKL-40 were also found in COPD and several malignancies, in addition to infectious and autoimmune diseases. To conclude, the level of YKL-40 correlates with asthma and some clinical features in the whole asthmatic population. The highest levels are found in neutrophilic and obesity-related phenotypes. However, due to its low specificity, the practical application of YKL-40 remains uncertain but could be useful in phenotyping, especially when combined with other biomarkers.
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Affiliation(s)
| | - Jan Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
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8
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Moitra S, Simoni M, Baldacci S, Maio S, Angino A, Silvi P, Viegi G, La Grutta S, Ruggiero F, Bedini G, Natali F, Cecchi L, Berger U, Prentovic M, Gamil A, Baïz N, Thibaudon M, Monnier S, Caimmi D, Tanno LK, Demoly P, Orlandini S, Annesi‐Maesano I. Symptom control and health-related quality of life in allergic rhinitis with and without comorbid asthma: A multicentre European study. Clin Transl Allergy 2023; 13:e12209. [PMID: 36825519 PMCID: PMC9893887 DOI: 10.1002/clt2.12209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/26/2022] [Accepted: 09/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is a major non-communicable disease that affects the health-related quality of life (HRQoL) of patients. However, data on HRQoL and symptom control in AR patients with comorbid asthma (AR + asthma) are lacking. METHODS In this multicentre, cross-sectional study, patients with AR were screened and administered questionnaires of demographic characteristics and health conditions (symptoms/diagnosis of AR and asthma, disease severity level, and allergic conditions). HRQoL was assessed using a modified version of the RHINASTHMA questionnaire (30, 'not at all bothered' - 150 'very much bothered') and symptom control was evaluated by a modified version of the Control of Allergic Rhinitis/Asthma Test (CARAT) (0, 'no control' - 30, 'very high control'). RESULTS Out of 643 patients with AR, 500 (78%) had asthma as a comorbidity, and 54% had moderate-severe intermittent AR, followed by moderate-severe persistent AR (34%). Compared to the patients with AR alone, patients with AR + asthma had significantly higher RHINASTHMA (e.g., median RHINASTHMA-total score 48.5 vs. 84, respectively) and a significantly lower CARAT score (median CARAT-total score 23 vs. 16.5, respectively). Upon stratifying asthma based on severity, AR patients with severe persistent asthma had worse HRQoL and control than those with mild persistent asthma. The association was significantly higher among non-obese participants compared to obese ones, with RHINASTHMA-upper symptoms score but not with CARAT. CONCLUSIONS Our observation of poorer HRQoL and symptoms control in AR patients with comorbid asthma supports the importance of a comprehensive approach for the management of AR in case of a comorbid allergic condition.
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Affiliation(s)
- Subhabrata Moitra
- Division of Pulmonary Medicine & Alberta Respiratory CentreDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Marzia Simoni
- Pulmonary Environmental Epidemiology UnitCNR Institute of Clinical Physiology (IFC)PisaItaly
| | - Sandra Baldacci
- Pulmonary Environmental Epidemiology UnitCNR Institute of Clinical Physiology (IFC)PisaItaly
| | - Sara Maio
- Pulmonary Environmental Epidemiology UnitCNR Institute of Clinical Physiology (IFC)PisaItaly
| | - Anna Angino
- Pulmonary Environmental Epidemiology UnitCNR Institute of Clinical Physiology (IFC)PisaItaly
| | - Patrizia Silvi
- Pulmonary Environmental Epidemiology UnitCNR Institute of Clinical Physiology (IFC)PisaItaly
| | - Giovanni Viegi
- Pulmonary Environmental Epidemiology UnitCNR Institute of Clinical Physiology (IFC)PisaItaly
| | | | | | | | - Francesca Natali
- Department of Agrifood Production and Environmental SciencesUniversity of FlorenceFlorenceItaly
| | - Lorenzo Cecchi
- Centre of BioclimatologyUniversity of FlorenceFlorenceItaly
| | - Uwe Berger
- Research Unit Aerobiology and Pollen InformationDepartment of Oto‐Rhino‐LaryngologyMedical University of ViennaViennaAustria
| | - Maria Prentovic
- Research Unit Aerobiology and Pollen InformationDepartment of Oto‐Rhino‐LaryngologyMedical University of ViennaViennaAustria
| | - Amir Gamil
- Institut Desbrest of Epidemiology and Santé Publique INSERM & Montpellier UniversityMontpellierFrance
| | - Nour Baïz
- Institut Desbrest of Epidemiology and Santé Publique INSERM & Montpellier UniversityMontpellierFrance
| | - Michel Thibaudon
- Reseau National de Surveillance Aerobiologique (RNSA)BrussieuFrance
| | - Samuel Monnier
- Reseau National de Surveillance Aerobiologique (RNSA)BrussieuFrance
| | - Davide Caimmi
- Institut Desbrest of Epidemiology and Santé Publique INSERM & Montpellier UniversityMontpellierFrance
| | - Luciana K. Tanno
- Institut Desbrest of Epidemiology and Santé Publique INSERM & Montpellier UniversityMontpellierFrance
| | - Pascal Demoly
- Institut Desbrest of Epidemiology and Santé Publique INSERM & Montpellier UniversityMontpellierFrance
| | - Simone Orlandini
- Department of Agrifood Production and Environmental SciencesUniversity of FlorenceFlorenceItaly
| | - Isabella Annesi‐Maesano
- Institut Desbrest of Epidemiology and Santé Publique INSERM & Montpellier UniversityMontpellierFrance
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Panganiban RAM, Yang Z, Sun M, Park CY, Kasahara DI, Schaible N, Krishnan R, Kho AT, Israel E, Hershenson MB, Weiss ST, Himes BE, Fredberg JJ, Tantisira KG, Shore SA, Lu Q. Antagonizing cholecystokinin A receptor in the lung attenuates obesity-induced airway hyperresponsiveness. Nat Commun 2023; 14:47. [PMID: 36599824 PMCID: PMC9813361 DOI: 10.1038/s41467-022-35739-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
Obesity increases asthma prevalence and severity. However, the underlying mechanisms are poorly understood, and consequently, therapeutic options for asthma patients with obesity remain limited. Here we report that cholecystokinin-a metabolic hormone best known for its role in signaling satiation and fat metabolism-is increased in the lungs of obese mice and that pharmacological blockade of cholecystokinin A receptor signaling reduces obesity-associated airway hyperresponsiveness. Activation of cholecystokinin A receptor by the hormone induces contraction of airway smooth muscle cells. In vivo, cholecystokinin level is elevated in the lungs of both genetically and diet-induced obese mice. Importantly, intranasal administration of cholecystokinin A receptor antagonists (proglumide and devazepide) suppresses the airway hyperresponsiveness in the obese mice. Together, our results reveal an unexpected role for cholecystokinin in the lung and support the repurposing of cholecystokinin A receptor antagonists as a potential therapy for asthma patients with obesity.
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Affiliation(s)
- Ronald Allan M Panganiban
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Zhiping Yang
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Maoyun Sun
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Chan Young Park
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - David I Kasahara
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Niccole Schaible
- Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Ramaswamy Krishnan
- Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Alvin T Kho
- Computational Health informatics Program, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Elliot Israel
- Asthma Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Marc B Hershenson
- Department of Pediatrics and Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Blanca E Himes
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jeffrey J Fredberg
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kelan G Tantisira
- Division of Pediatric Respiratory Medicine, University of California San Diego and Rady Children's Hospital, San Diego, CA, 92123, USA
| | - Stephanie A Shore
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Quan Lu
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
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10
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Louis G, Pétré B, Schleich F, Zahrei HN, Donneau AF, Henket M, Paulus V, Guissard F, Guillaume M, Louis R. Predictors of change in asthma-related quality of life: a longitudinal real-life study in adult asthmatics. Qual Life Res 2023; 32:1507-1520. [PMID: 36595128 PMCID: PMC10123047 DOI: 10.1007/s11136-022-03339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Asthma negatively impacts health-related quality of life (HRQL). The objective is to investigate the longitudinal relationship between HRQL in asthma and disease control, demographic and clinical objective parameters in an adult population in real-life settings. METHODS We conducted a longitudinal study on adult asthmatics recruited from Liege University Hospital Asthma Clinic (Belgium) between 2011 and 2019. We selected those who had two visits and completed two patient-reported outcome measures (PROMs), the asthma control test (ACT) and the mini asthma quality of life questionnaire (AQLQ) (n = 290). AQLQ was the dependent variable. Demographic, functional and inflammatory characteristics, asthma control, and exacerbations were the independent variables. We applied generalized linear mixed models to identify the factors associated with change in AQLQ and its dimensions. RESULTS Median (IQR) time interval between the two visits was 7 (5-19) months. Overall, median (IQR) global AQLQ increased from 4.1 (3-5.1) to 4.6 (3.4-5.9) (p < 0.0001). All AQLQ dimensions significantly improved, apart the environmental one. AQLQ improved in patients who had both step-up and step-down pharmacological treatment as well as in patients reporting no change between the two visits. The fitted models indicated that change in ACT was the main predictor of change in AQLQ (p < 0.0001). A rise in 3 units in ACT predicted an improvement of 0.5 AQLQ (AUC-ROC = 0.85; p < 0.0001). Change in BMI inversely impacted global AQLQ (p < 0.01) and its activity dimension (p < 0.0001). CONCLUSION Asthma control and BMI are key predictors of asthma quality of life acting in an opposite direction. AQLQ may improve without step-up in the pharmacological treatment.
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Affiliation(s)
- Gilles Louis
- Department of Public Health, University of Liège, Liège, Belgium.
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - Florence Schleich
- Department of Pneumology, University of Liège, GIGAI3, Liège, Belgium
| | | | | | - Monique Henket
- Department of Pneumology, University of Liège, GIGAI3, Liège, Belgium
| | - Virginie Paulus
- Department of Pneumology, University of Liège, GIGAI3, Liège, Belgium
| | | | | | - Renaud Louis
- Department of Pneumology, University of Liège, GIGAI3, Liège, Belgium
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11
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Lee SY, Shin J. Association between Electronic Cigarettes Use and Asthma in the United States: Data from the National Health Interview Survey 2016-2019. Yonsei Med J 2023; 64:54-65. [PMID: 36579380 PMCID: PMC9826957 DOI: 10.3349/ymj.2022.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This article aimed to investigate 1) whether electronic cigarette (EC) users are more likely to experience asthma attacks or emergency room (ER) visits due to asthma than non-users and 2) how age and smoking behaviors moderate the effect size of the association. MATERIALS AND METHODS We used National Health Interview Survey data from 2016-2019. Multiple logistic regression analysis was performed to identify the association between current EC use and having an asthma attack and ER visitation due to asthma. Interaction terms were included to explore the moderation effects of age and cigarette smoking status. Subgroup analysis was conducted according to age group. RESULTS Of the 218911 participants, 2.0% of them experienced an asthma attack, and 0.5% visited the ER due to asthma. Current EC use was associated with higher odds of having an asthma attack. In interaction analysis, age and smoking status were identified as a moderator in the relationship between EC use and asthma attacks. Participants in their 20s or 30s showed the highest interaction effect. CONCLUSION Our analysis indicates the potential impact of EC use on public health and the moderating effects of smoking behavior.
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Affiliation(s)
- Seo Yoon Lee
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
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12
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Camarinha C, Fernandes M, Alarc Úo V, Franco J, Mana ºas ME, B Írbara C, Nicola PJ. Determinants associated with uncontrolled asthma in Portugal: A national population-based study. Pulmonology 2023; 29:29-41. [PMID: 33023866 DOI: 10.1016/j.pulmoe.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Asthma is a chronic and heterogeneous disease that affects people of all ages and has a high estimated increase in prevalence worldwide. Asthma control represents a main goal in the disease management. International studies revealed low levels of disease control resulting in a significant burden for healthcare systems, not only in terms of quality of life, but also in terms of health costs. Modifiable and non-modifiable factors have been identified as relating to poor asthma control level. In this study we evaluated the distribution of asthma control levels in Portuguese adult population and examine the determinants associated with uncontrolled asthma. MATERIALS AND METHODS Using a similar methodology to the one employed in the Asthma Insights and Reality in Europe (AIRE) survey, 327 active asthmatic patients were identified by random phone number and completed a questionnaire during 2011 to 2012. Asthma control was assessed by the evaluation of GINA based symptom control, by Asthma Control Test.äó (ACT) and by self-perception of control. To examine the relationship between uncontrolled asthma and its determinants, univariate logistic regression analysis, sequential multivariable regression and population attributable risk percentage were determinate. RESULTS 35.2% active asthmatic patients had uncontrolled asthma, 64.8% partially controlled and none of the individuals had total control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01.Çô1.03), female sex (OR 1.87; 95% CI: 1.15.Çô3.04), educational level (OR 0.5; 95% CI: 0.28.Çô0.89 at high school level or over), occupation (OR 4.92; 95% CI: 2.12.Çô11.42 if looking for a first job or unemployed) (OR 2.51; 95% CI: 1.35.Çô4.65 if being retired), income (OR 0.23; 95% CI: 0.07.Çô0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03.Çô1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56.Çô7.58) and using inhaled corticosteroids (OR 0.44; 95%CI: 0.24.Çô0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms remained significant after multivariate adjustments. CONCLUSIONS Uncontrolled asthma was associated with several determinants. Their identification can contribute to improve asthma care both from clinical and from public health perspectives.
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Affiliation(s)
- C Camarinha
- Epidemiology Unit, Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, Hospital de Santa Maria Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Allergy Center, CUF Descobertas Hospital, Rua M.írio Botas, 1998-018 Lisboa, Portugal
| | - M Fernandes
- CTI Clinical Trial and Consulting Services, Rua Tierno Galvan, Torre 3, Piso 16, 1070-274 Lisboa, Portugal
| | - V Alarc Úo
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, Hospital de Santa Maria Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Environmental Health Institute (ISAMB), Faculty of Medicine, University of Lisbon, Hospital de Santa Maria Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Centro de Investiga.º.úo e Estudos de Sociologia (CIES-IUL) do Instituto Superior de Ci.¬ncias do Trabalho e da Empresa - Instituto Universit.írio de Lisboa (ISCTE-IUL), Av..¬ das For.ºas Armadas, 1649-026 Lisboa, Portugal
| | - J Franco
- Pediatrics Department, Hospital Garcia da Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - M E Mana ºas
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, Hospital de Santa Maria Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - C B Írbara
- Thorax Department, Faculty of Medicine, University of Lisbon, Hospital de Santa Maria Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Environmental Health Institute (ISAMB), Faculty of Medicine, University of Lisbon, Hospital de Santa Maria Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - P J Nicola
- Epidemiology Unit, Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, Hospital de Santa Maria Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Environmental Health Institute (ISAMB), Faculty of Medicine, University of Lisbon, Hospital de Santa Maria Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal.
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13
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Khdour M, Abu Ghayyadeh M, Al-Hamed D, Alzeerelhouseini H, Awadallah H. Assessment of quality of life in asthmatic children and adolescents: A cross sectional study in West Bank, Palestine. PLoS One 2022; 17:e0270680. [PMID: 35767577 PMCID: PMC9242478 DOI: 10.1371/journal.pone.0270680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Asthma is one of the most common chronic illnesses among children and adolescents. It can severely affect their quality of life (QoL). Our study assessed the QoL and analyzed potential risk factors for poor QoL among asthmatic children and adolescents. Methods This was a cross-sectional comparative study. Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was used to measure the QoL and Asthma Control Test (ACT) was used to evaluate asthma control. The Chi-square test and independent t-test were used to compare variables. We used Multivariate logistic regression to identify the association between determinants and outcomes. Statistical significance was set at p<0.05. Results We recruited 132 participants. We found that 47 patients (35.6%) had controlled Asthma and 85 patients (64.3%) had uncontrolled Asthma. When compared to uncontrolled asthma individuals, participants with controlled asthma had improved QoL and scored significantly higher in the symptom domain (P = 0.002), activity domain (P = 0.004), emotional domain (P = 0.002), and overall PAQoL scores (P = 0.002). Hospital admission affects significantly all domains of PAQOL (P<0.05). Poor QoL was significantly associated with hospitalization for asthma (OR = 3.4; CI: 2.77–3.94, P = 0.01), disease severity (OR = 3.0; CI: 2.41–3.61, P = 0.01), uncontrolled asthma (OR = 2.88; CI: 2.21–3.41, P = 0.019), and male gender (OR = 2.55; CI: 1.88–2.91, P = 0.02). Conclusions The results of the present study showed that in children and adolescents, uncontrolled asthma, disease severity, and previously hospitalized patients were associated with poor QoL. These factors must be considered when planning a comprehensive care plan for a better quality of life.
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Affiliation(s)
- Maher Khdour
- Faculty of Pharmacy, Al-Quds University, Abu Deis, West Bank, Palestine
- * E-mail: ,
| | | | - Dua’a Al-Hamed
- Pharmacy department Ramallah & Al-bireh Health Directorate, West Bank, Palestine
| | | | - Heba Awadallah
- Faculty of Pharmacy, Al-Quds University, Abu Deis, West Bank, Palestine
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14
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Andrenacci B, Ferrante G, Roberto G, Piacentini G, La Grutta S, Marseglia GL, Licari A. Challenges in uncontrolled asthma in pediatrics: important considerations for the clinician. Expert Rev Clin Immunol 2022; 18:807-821. [PMID: 35730635 DOI: 10.1080/1744666x.2022.2093187] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite symptoms control being the primary focus of asthma management according to guidelines, uncontrolled asthma is still an issue worldwide, leading to huge costs and asthma deaths at all ages. In childhood, poor asthma control can be even more harmful, as it can irreversibly compromise the children's lung function and the whole family's well-being. AREAS COVERED Given the problem extent, this review aims to discuss the leading modifiable causes of uncontrolled asthma in Pediatrics, giving some practical insights regarding the critical role of families and the main tools for monitoring control and drug adherence, even at a distance. The most recent GINA documents were used as the primary reference, along with the latest evidence regarding the management of asthma control and the impact of the COVID-19 pandemic on asthma. EXPERT OPINION In managing pediatric asthma, a multidisciplinary, multi-determinant, personalized approach is needed, actively involving families, schools, and other specialists. In addition to current strategies for implementing control, electronic health strategies, new validated asthma control tools, and the identification of novel inflammatory biomarkers could lead to increasingly tailored therapies with greater effectiveness in reaching asthma control.
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Affiliation(s)
- Beatrice Andrenacci
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giulia Roberto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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15
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Impact of body mass index on omalizumab response in adults with moderate-to-severe allergic asthma. Ann Allergy Asthma Immunol 2022; 128:553-560. [PMID: 35101644 DOI: 10.1016/j.anai.2022.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Effectiveness of asthma treatment, including biologics, may be different in patients with higher body mass index (BMI). OBJECTIVE To evaluate response to omalizumab (dosed by serum immunoglobulin E level and weight) by BMI category. METHODS Pooled data from 2 randomized, double-blind, placebo-controlled studies of adults with moderate-to-severe allergic asthma were analyzed by BMI category (<25 kg/m2 [normal or underweight], n = 397; 25 to <30 kg/m2 [overweight], n = 330; ≥ 30 kg/m2 [obese], n = 268). Placebo-adjusted exacerbation rate reductions were evaluated by Poisson regression modeling. Changes from baseline in forced expiratory volume in 1 second, beclomethasone dipropionate (BDP) dose, Total Asthma Symptom Score, and Asthma Quality of Life Questionnaire were evaluated by analysis of covariance. RESULTS Greater placebo-adjusted exacerbation rate reductions (95% confidence interval) were observed with increasing BMI (normal or underweight, -37.4% [-69.0% to 26.8%]; overweight, -52.7% [-78.4% to 3.7%]; obese, -71.9% [-86.9% to -39.5%]). There were no differences in forced expiratory volume in 1 second improvement between BMI categories at week 16 (normal or underweight, 76.2 [5.3-147.1] mL; overweight, 98.1 [13.9-182.4] mL; obese, 69.1 [-18.9 to 157.2] mL). No differences in BDP dose reduction (µg) were noted between BMI categories (normal or underweight, 23.0 [15.7-30.3]; overweight, 22.5 [13.5-31.5]; obese, 16.6 [5.8-27.3]). Fewer patients in the higher BMI categories eliminated BDP use. There were trends for smaller improvements with higher BMI in Total Asthma Symptom Score (normal/underweight, -0.52 [-0.82 to -0.22]; overweight, -0.50 [-0.80 to -0.20]; obese, -0.39 [-0.77 to 0.00]) and Asthma Quality of Life Questionnaire (normal or underweight, 0.34 [0.16-0.52]; overweight, 0.34 [0.13-0.55]; obese, 0.15 [-0.08 to 0.39]). CONCLUSION Omalizumab provides benefit to patients with moderate-to-severe allergic asthma, regardless of BMI. TRIAL REGISTRATION Studies 008/009 were conducted before clinical trial registration was required, and therefore clinical trial registration numbers are not available.
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16
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McLoughlin RF, McDonald VM. The Management of Extrapulmonary Comorbidities and Treatable Traits; Obesity, Physical Inactivity, Anxiety, and Depression, in Adults With Asthma. FRONTIERS IN ALLERGY 2022; 2:735030. [PMID: 35387051 PMCID: PMC8974714 DOI: 10.3389/falgy.2021.735030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/19/2021] [Indexed: 12/31/2022] Open
Abstract
Asthma is a complex and heterogenous disease characterized by variability in disease expression and severity. Multiple extrapulmonary comorbidities and treatable traits are common in people with asthma, and there is an increasing appreciation of how these may complicate asthma management. This review will discuss the prevalence and impact of extrapulmonary comorbidities/risk factors or "traits," which have been found to co-exist in asthma (obesity, symptoms of depression and/or anxiety and physical inactivity), the impact these traits have on future outcomes (including exacerbation risk and quality of life) and asthma management, and how we should target treatment in asthma when these extrapulmonary traits are present.
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Affiliation(s)
- Rebecca F McLoughlin
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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17
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Jenkins CR, Boulet LP, Lavoie KL, Raherison-Semjen C, Singh D. Personalized Treatment of Asthma: The Importance of Sex and Gender Differences. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:963-971.e3. [PMID: 35150902 DOI: 10.1016/j.jaip.2022.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
An individual's sex (nominally male or female, based on biological attributes) and gender (a complex term referring to socially constructed roles, behaviors, and expressions of identity) influence the clinical course of asthma in several ways. The physiologic development of the lungs and effects of sex hormones may explain why more boys than girls have asthma, and after puberty, more women than men have asthma. Female sex hormones have an impact throughout the life span and are associated with poor asthma control. Gender may influence exposure to asthma triggers, and sex and gender can influence the prevalence of comorbidities and interactions with health care professionals. Despite widely reported sex- and gender-based differences in asthma and asthma management, these issues frequently are not considered by health care professionals. There is also inconsistency regarding the use of "sex" and "gender" in scientific discourse; research is needed to define sex- and gender-based differences better and how they might interact to influence asthma outcomes. This review outlines the impact an individual's sex and gender can have on the pathogenesis, clinical course, diagnosis, treatment, and management of asthma.
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Affiliation(s)
| | | | - Kim L Lavoie
- Department of Psychology, University of Québec at Montreal and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Chantal Raherison-Semjen
- Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France; INSERM U1219, EpiCene Team, University of Bordeaux, Bordeaux, France
| | - Dave Singh
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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18
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Abstract
Obesity is a major risk factor for the development of asthma, and the prevalence of obesity is higher in people with asthma than in the general population. Obese people often have severe asthma-recent studies in the United States suggest that 60% of adults with severe asthma are obese. Multiple mechanisms link obesity and asthma, which are discussed in this article, and these pathways contribute to different phenotypes of asthma among people with obesity. From a practical aspect, changes in physiology and immune markers affect diagnosis and monitoring of disease activity in people with asthma and obesity. Obesity also affects response to asthma medications and is associated with an increased risk of co-morbidities such as gastroesophageal reflux disease, depression, and obstructive sleep apnea, all of which may affect asthma control. Obese people may be at elevated risk of exacerbations related to increased risk of severe disease in response to viral infections. Interventions that target improved dietary quality, exercise, and weight loss are likely to be particularly helpful for this patient population.
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Affiliation(s)
- Anne E Dixon
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Loretta G Que
- Department of Medicine, Duke Health, Rm 279 MSRB1, Durham, North Carolina
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19
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Louis G, Pétré B, Schleich F, Zahraei HN, Donneau AF, Silvestre A, Henket M, Paulus V, Guissard F, Guillaume M, Louis R. Predictors of asthma-related quality of life in a large cohort of asthmatics: A cross-sectional study in a secondary care center. Clin Transl Allergy 2021; 11:e12054. [PMID: 34504679 PMCID: PMC8414513 DOI: 10.1002/clt2.12054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/26/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022] Open
Abstract
Background In recent decades, asthma-related quality of life questionnaires have joined objective clinical indicators as important outcome measures. In this study, we sought to investigate the predictors of asthma-related quality of life in a large cohort of patients recruited from a secondary care center. Methods We conducted a cross-sectional study on asthmatics (N = 1301) recruited from the Liège University Hospital asthma clinic (Belgium). After performing a descriptive analysis highlighting the distribution of scores from the Mini Asthma Quality of Life Questionnaire (Mini AQLQ) and its four dimensions (symptoms, activity limitation, emotional function, and environmental stimuli), we did multiple regression analysis to identify the independent predictors of AQLQ. Results Multiple regression beta analysis showed that AQLQ and its four dimensions were primarily associated with asthma control (p < 0.0001 in all instances). Female gender was associated with a lower score for the AQLQ's activity and environmental dimensions (p < 0.05 for both), while current smokers had a higher score on the AQLQ's environmental dimension (p < 0.0001). The burden of asthma treatment was associated with a lower score for the AQLQ's emotional (p < 0.05) and environmental (p < 0.05) dimensions. BMI was associated with a lower score in the AQLQ's activity dimension (p < 0.0001), while the opposite was true for the FeNO test (p < 0.0001). Sputum neutrophils were inversely related to the score for the AQLQ's symptom dimension (p < 0.05), whereas post-bronchodilator FEV1 showed a positive relationship for that same dimension (p < 0.05). Conclusion Asthma control is the main predictor of AQLQ score and impacts all its dimensions, but demographic, functional, and airway inflammatory parameters may also influence some dimensions of the AQLQ.
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Affiliation(s)
- Gilles Louis
- Department of Public Health University of Liège Liège Belgium
| | - Benoit Pétré
- Department of Public Health University of Liège Liège Belgium
| | | | | | | | - Aude Silvestre
- Department of Public Health University of Liège Liège Belgium
| | - Monique Henket
- Department of Pneumology GIGAI3 University of Liège Liège Belgium
| | - Virginie Paulus
- Department of Pneumology GIGAI3 University of Liège Liège Belgium
| | | | | | - Renaud Louis
- Department of Pneumology GIGAI3 University of Liège Liège Belgium
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20
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Zaibi H, Ben Jemia E, Kchok H, Dhahri B, Ben Amar J, Aouina H. Particularities of asthma in obese patients. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Kisiel M, Berglund C, Janson C, Hasselgren M, Montgomery S, Nager A, Sandelowsky H, Ställberg B, Sundh J, Lisspers K. Quality of life and asthma control related to hormonal transitions in women's lives. J Asthma 2021; 59:1869-1877. [PMID: 34353223 DOI: 10.1080/02770903.2021.1963768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: The aim was to investigate if menstruation and use of exogenous sex hormones influence self-reported asthma related quality of life (QoL) and asthma control.Methods: The study is based on two asthma cohorts randomly selected in primary and secondary care. A total of 622 female patients 18-65 years were included and classified as premenopausal ≤46 years (n = 338) and peri/postmenopausal 47-65 years (n = 284). Questionnaire data from 2012 and 2014 with demographics, asthma related issues and sex hormone status. Outcome measures were Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) and asthma control including Asthma Control Test (ACT) and exacerbations last six months.Results: Premenopausal women with menstruation related asthma worsening, perimenstrual asthma (PMA) (9%), had a clinically relevant lower Mini-AQLQ mean score 4.9 vs. 5.8 (p < 0.001), lower asthma control with ACT score <20, 72% vs. 28% (p < 0.001) and higher exacerbation frequency 44% vs. 20% (p = 0.004) compared with women without PMA. Women with irregular menstruation had higher exacerbation frequency than women with regular menstruation (p = 0.023). Hormonal contraceptives had no impact on QoL and asthma control. Peri/postmenopausal women with menopausal hormone therapy (MHT) had a clinically relevant lower Mini-AQLQ mean score compared to those without MHT, 4.9 vs 5.4 (p < 0.001), but no differences in asthma control.Conclusion: Women with PMA had lower QoL and more uncontrolled asthma than women without PMA. Peri/postmenopausal women with MHT had lower QoL than women without MHT. Individual clinical management of women with asthma may benefit from information about their sex hormone status.
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Affiliation(s)
- Marta Kisiel
- Uppsala University, Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala, Sweden
| | | | - Christer Janson
- Uppsala Universitet, Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala, Sweden
| | - Mikael Hasselgren
- Örebro Universitet, School of Medical Sciences, Faculty of Medicine and Health, Orebro, Sweden
| | - Scott Montgomery
- Örebro Universitet, Clinical Epidemiology and Biostatistics, School of Medical Sciences, Sweden
| | - Anna Nager
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Stockholm, Sweden
| | - Hanna Sandelowsky
- Karolinska Institutet, Clinical Epidemiology Division, Department of Medicine, Stockholm, Sweden
| | - Björn Ställberg
- Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala, Sweden
| | - Josefin Sundh
- Örebro Universitet, Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Orebro, Sweden
| | - Karin Lisspers
- Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala, Sweden
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22
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Dragomir AI, Boucher VG, Bacon SL, Gemme C, Szczepanik G, Corace K, Campbell TS, Vallis MT, Garber G, Rouleau C, Rabi D, Diodati JG, Ghali W, Lavoie KL. An international Delphi consensus study to define motivational communication in the context of developing a training program for physicians. Transl Behav Med 2021; 11:642-652. [PMID: 32145022 PMCID: PMC7963284 DOI: 10.1093/tbm/ibaa015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Poor health behaviors (e.g., smoking, poor diet, and physical inactivity) are major risk factors for noncommunicable chronic diseases (NCDs). Evidence supporting traditional advice-giving approaches to promote behavior change is weak or short lived. Training physicians to improve their behavior change counseling/communication skills is important, yet the evidence for the efficacy and acceptability of existing training programs is lacking and there is little consensus on the core competencies that physicians should master in the context of NCD management. The purpose of this study is to generate an acceptable, evidence-based, stakeholder-informed list of the core communication competencies that physicians should master in the context of NCD management. Using a modified Delphi process for consensus achievement, international behavior change experts, physicians, and allied health care professionals completed four phases of research, including eight rounds of online surveys and in-person meetings over 2 years (n = 13-17 participated in Phases I, III, and IV and n = 39-46 in Phase II). Eleven core communication competencies were identified: reflective listening, expressing empathy, demonstrating acceptance, tolerance, and respect, responding to resistance, (not) negatively judging or blaming, (not) expressing hostility or impatience, eliciting "change-talk"/evocation, (not) being argumentative or confrontational, setting goals, being collaborative, and providing information neutrally. These competencies were used to define a unified approach for conducting behavior change counseling in medical settings: Motivational Communication. The results may be used to inform and standardize physician training in behavior change counseling and communication skills to reduce morbidity and mortality related to poor health behaviors in the context of NCD prevention and management.
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Affiliation(s)
- Anda I Dragomir
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Vincent Gosselin Boucher
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada
| | - Claudia Gemme
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Geneviève Szczepanik
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - Kimberly Corace
- Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Tavis S Campbell
- TotalCardiology Rehabilitation, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary Canada
| | - Michael T Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Gary Garber
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Public Health Ontario, Ontario Agency for Health Protection and Promotion, Toronto, Canada
| | - Codie Rouleau
- TotalCardiology Rehabilitation, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Jean G Diodati
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - William Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
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23
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Thompson CA, Eslick SR, Berthon BS, Wood LG. Asthma medication use in obese and healthy weight asthma: systematic review/meta-analysis. Eur Respir J 2021; 57:13993003.00612-2020. [PMID: 32943399 DOI: 10.1183/13993003.00612-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Obesity is a common comorbidity in asthma and associated with poorer asthma control, more frequent/severe exacerbations, and reduced response to asthma pharmacotherapy. OBJECTIVE This review aims to compare use of all classes of asthma medications in obese (body mass index (BMI) ≤30 kg·m-2) versus healthy-weight (BMI <25 kg·m-2) subjects with asthma. DESIGN Databases including CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase and MEDLINE were searched up to July 2019 for English-language studies that recorded medication use or dose in obese and healthy-weight adults with asthma. A critical appraisal checklist was utilised for scrutinising methodological quality of eligible studies. Meta-analysis was performed and heterogeneity was examined with the use of the Chi-squared test. This review was conducted based on a published protocol (www.crd.york.ac.uk/PROSPERO CRD42020148671). RESULTS Meta-analysis showed that obese subjects are more likely to use asthma medications, including short-acting β2-agonists (OR 1.75, 95% CI 1.17-2.60; p=0.006, I2=41%) and maintenance oral corticosteroids (OR 1.86, 95% CI 1.49-2.31; p<0.001, I2=0%) compared to healthy-weight subjects. Inhaled corticosteroid (ICS) dose (µg·day-1) was significantly higher in obese subjects (mean difference 208.14, 95% CI 107.01-309.27; p<0.001, I2=74%). Forced expiratory volume in 1 s (FEV1) % predicted was significantly lower in obese subjects (mean difference -5.32%, 95% CI -6.75--3.89; p<0.001, I2=42%); however, no significant differences were observed in FEV1/forced vital capacity (FVC) ratio between groups. CONCLUSIONS We found that obese subjects with asthma have higher use of all included asthma medication classes and higher ICS doses than healthy-weight asthma subjects, despite lower FEV1 and a similar FEV1/FVC %. A better understanding of the factors driving increased medication use is required to improve outcomes in this subgroup of asthmatics.
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Affiliation(s)
- Cherry A Thompson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Shaun R Eslick
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Bronwyn S Berthon
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Lisa G Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
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Hur J, Kang JY, Kim YK, Lee SY, Lee HY. Glucagon-like peptide 1 receptor (GLP-1R) agonist relieved asthmatic airway inflammation via suppression of NLRP3 inflammasome activation in obese asthma mice model. Pulm Pharmacol Ther 2021; 67:102003. [PMID: 33588055 DOI: 10.1016/j.pupt.2021.102003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/29/2020] [Accepted: 02/07/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obesity is a correctable factor for uncontrolled bronchial asthma. However, the effects of glucagon-like peptide-1 receptor (GLP-1R) agonist, a recently approved antiobestic drug, on airway hyperresponsiveness (AHR) and immune responses are not known. METHODS Mice were fed with high-fat diet (HFD, 60% fat) for 8 weeks to induce obesity. Ovalbumin (OVA) sensitization and challenges were performed for 7 weeks. The mice were injected intraperitoneally with GLP-1R agonist 5 times a week for 4 weeks after OVA sensitization. After AHR measurement, expression of Th2, Th17 cytokines, and interleukin (IL)-33 were measured in BALF and lung tissues. Moreover, IL-1β and activity level of nucleotide oligomerization domain-like receptor protein 3 (NLRP3) were analyzed to investigate the mechanism of GLP-1R agonist on asthmatic airway inflammation. RESULTS HFD induced significant weight gain, OVA sensitization and challenge in obese mice made eosinophilic airway inflammation, and increased AHR. Treatment with GLP-1R agonist-induced weight loss suppressed eosinophilic airway inflammation and decreased AHR. Expression of IL-4, 5, and 33 was increased in BALF of obese asthma mice followed by a decrease in response to GLP-1R agonist treatment. Moreover, lung tissue H&E stain revealed that peribronchial inflammation induced by obesity and OVA was effectively suppressed by GLP-1R agonist. Expressions of NLRP3, activated caspase-1, and IL-1β were increased in lung tissues of obese asthma mice and demonstrated a decrease in response to GLP-1R agonist treatment. CONCLUSIONS GLP-1R agonist effectively induced weight loss, suppressed eosinophilic bronchial airway inflammation, and AHR in obese asthma mice. These effects were mediated by suppression of NLRP3 inflammasome activity and IL-1β. GLP-1R agonist is proposed as a novel anti-asthmatic agent targeting the obese asthmatics.
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Affiliation(s)
- Jung Hur
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Young Kang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Kyoon Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sook Young Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwa Young Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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25
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Choi Y, Kim M, Kim SJ, Yoo H, Kim S, Park H. Metabolic shift favoring C18:0 ceramide accumulation in obese asthma. Allergy 2020; 75:2858-2866. [PMID: 32416622 DOI: 10.1111/all.14366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/23/2020] [Accepted: 04/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity associated with various complications has increased worldwide. Body weight gain alters lipid metabolites (especially sphingolipids) contributing to obesity-induced inflammation. However, the significance of the metabolites in the development of obese asthma is not yet clear. METHODS The serum levels of sphingolipids were measured using liquid chromatography-tandem mass spectrometry in obese controls (n = 7) and patients with asthma: the obese group (BMI > 25 kg/m2 , n = 13) vs the nonobese (n = 28) group. To examine the relationship between metabolic changes in sphingolipids and macrophage polarization, public microarray data were analyzed. In addition, the alteration in sphingolipid metabolism was investigated in wild-type BALB/c mice fed a high-fat diet. RESULTS The obese asthma had higher levels of serum C18:0 and C20:0 ceramides than the nonobese asthma group (P = .028 and P = .040, respectively). The value of the serum C18:0 ceramide (184.3 ng/mL) for discriminating the obese asthma from the nonobese asthma group showed 53.9% sensitivity and 85.7% specificity (AUC = 0.721, P = .024). The microarray data showed significantly increased ceramide synthesis and metabolic shift to ceramide accumulation during M1 macrophage polarization in humans. Increased airway hyperresponsiveness, M1 macrophage polarization, and C18:0 ceramide levels were noted in obese mice, but not in nonobese mice. Increased expression of ceramide synthase (CerS) 1 and CerS6 (not CerS2) was noted in lung tissues of obese mice. CONCLUSION Alteration in sphingolipid metabolism favoring ceramide accumulation (especially long-chain ceramides) may contribute to developing obese asthma.
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Affiliation(s)
- Youngwoo Choi
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Minji Kim
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
- Translational Research Laboratory for Inflammatory Disease Clinical Trial Center Ajou University Medical Center Suwon South Korea
| | - Su Jung Kim
- Asan Institute for Life Sciences Asan Medical Center University of Ulsan College of Medicine Seoul South Korea
| | - Hyun‐Ju Yoo
- Asan Institute for Life Sciences Asan Medical Center University of Ulsan College of Medicine Seoul South Korea
| | - Seung‐Hyun Kim
- Translational Research Laboratory for Inflammatory Disease Clinical Trial Center Ajou University Medical Center Suwon South Korea
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
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26
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Vieira CP, de Oliveira LP, Da Silva MB, Majolli Andre D, Tavares EBG, Pimentel ER, Antunes E. Role of metalloproteinases and TNF-α in obesity-associated asthma in mice. Life Sci 2020; 259:118191. [PMID: 32777302 DOI: 10.1016/j.lfs.2020.118191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
Numerous population studies conducted worldwide indicate that the prevalence of asthma is higher in obese versus lean individuals. It has been reported that sensitized lean mice has a better recovery of lung inflammation in asthma. Extracellular matrix (ECM) plays an essential role in the structural support of the lungs regulating the airways diameter, thus preventing its collapse during expiration. ECM renewal by metalloproteinase (MMPs) enzymes is critical for pulmonary biology. There seems to be an imbalance of MMPs activity in asthma and obesity, which can impair the lung remodeling process. In this study, we characterized the pulmonary ECM of obese and lean mice, non-sensitized and sensitized with ovalbumin (OVA). Pharmacological intervention was performed by using anti-TNF-α, and MMP-8 and MMP-9 inhibitors in obese and lean sensitized mice. Activity of MMPs was assessed by gelatinase electrophorese, western blotting and zymogram in situ. Unbalance of MMP-2, MMP-8, MMP-9 and MMP-12 was detected in lung tissue of OVA-sensitized obese mice, which was accompanied by high degradation, corroborating an excessive deposition of types I and III collagen in pulmonary matrix of obese animals. Inhibitions of TNF-α and MMP-9 reduced this MMP imbalance, clearly suggesting a positive effect on pulmonary ECM. Obese and lean mice presented diverse phenotype of asthma regarding the ECM compounds and the inhibition of MMPs pathway could be a good alternative to regulate the activity in ECM lungs of asthmatic obese individuals.
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Affiliation(s)
- Cristiano Pedrozo Vieira
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | - Leticia Prado de Oliveira
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas, 13083-863 CP 6109, Campinas, Sao Paulo, Brazil
| | - Mariana Bombardi Da Silva
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas, 13083-863 CP 6109, Campinas, Sao Paulo, Brazil
| | - Diana Majolli Andre
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Edith Bastos Gandra Tavares
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Edson Rosa Pimentel
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas, 13083-863 CP 6109, Campinas, Sao Paulo, Brazil
| | - Edson Antunes
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Jayakumaran J, Hunter K, Roy S. Outpatient Management of Bronchial Asthma: A Comparative Analysis Between Guideline-Directed Management and Usual Management. J Clin Med Res 2020; 12:362-368. [PMID: 32587652 PMCID: PMC7295549 DOI: 10.14740/jocmr4208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background Bronchial asthma is a common controllable disease that causes a serious economic and social burden. The Global Initiative for Asthma (GINA) was developed to help guide clinicians in appropriate management of asthma. Despite the existence of published guidelines, common practice in many primary care clinics follows usual care based on clinical gestalt. This study aims to determine if there is a statistically significant difference in outcomes between patients receiving guideline-directed therapy when compared to those receiving usual clinician therapy. Methods A total of 300 patients were included in this study. Among them, 139 patients received guideline-directed medical therapy (GDMT group) and 161 received usual medical therapy (UMT group). Logistic regression models were utilized to determine if there was a significant difference in outcomes for patients comparing number of exacerbations and number of hospitalizations. Results More patients in GDMT group suffered from recorded exacerbations in the prior year with 43.9% having one, 3.6% having two, and 0.7% having three, compared to the frequencies of exacerbations in the UMT group (29.2%, 1.9%, and 1.2%, respectively) (P < 0.05). Cumulative number of hospitalizations due to asthma exacerbations in the prior year was also higher in GDMT group compared to the UMT group (one in 5.8% GDMT vs. 3.1% UMT; two in 0.0% GDMT vs. 0.6% UMT) without statistically significant difference (P = 0.349). Conclusions Primary care providers’ adherence to the 2018 GINA guidelines for asthma treatment did not offer benefit to patient outcomes, such as number of exacerbations or hospitalizations, compared to the usual medical care of bronchial asthma. Patient-tailored care may offer reduction in the rates of exacerbations and hospitalization.
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Affiliation(s)
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Satyajeet Roy
- Department of Medicine, Cooper University Health Care, Camden, NJ, USA.,Cooper Medical School of Rowan University, Camden, NJ, USA
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Mhamed SC, Saad AB, Migaou A, Fahem N, Rouatbi N, Joobeur S. [Asthma and obesity: relationship and therapeutic implications in patients with asthma at the Department of Pneumology in Monastir, Tunisia]. Pan Afr Med J 2020; 36:49. [PMID: 32774625 PMCID: PMC7388602 DOI: 10.11604/pamj.2020.36.49.21098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/15/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction L’obésité et l’asthme sont deux maladies chroniques touchant des millions d’individus à travers le monde. La présence d’un lien de causalité est suggérée. L'objectif de notre travail est d'étudier le profil de l’asthmatique obèse et de déterminer la relation entre les différents paramètres de sévérité de l’asthme avec les grades de l’obésité. Méthodes Il s'agit d'une étude rétrospective, monocentrique, analytique menée au Service de Pneumologie et d’Allergologie au CHU Fattouma Bourguiba de Monastir portant sur 450 asthmatiques, ayant un indice de masse corporelle (IMC) ≥ 30 kg/m2 avec un recul d’au moins 6 mois. Résultats L’âge moyen au moment du diagnostic était de 45±12.8 ans. L’IMC moyen était de 34,8±4,2 kg/m2. L’asthme était bien contrôlé chez 55,3% des patients. Des critères de sévérité étaient notés dans 37.4% des cas. Selon GINA 2016, 24,2% sont traités par le palier 4. Deux phénotypes de l’asthme associé à l’obésité étaient notés. Le premier phénotype (52,4%) était caractérisé par un asthme à début précoce, associé à une fréquence plus élevée d’allergie, et des manifestations d'atopie. Le deuxième (47,6 %) était caractérisé par un asthme à début tardif, fréquemment associé au sexe féminin et un taux plus élevé de comorbidités et d’hospitalisations. Les obèses de grade II et III avaient un déficit ventilatoire important (CVF: p = 0,002 et VEMS: p = 0,007). Conclusion L’obésité est l’un des facteurs clefs impliqués dans le mauvais contrôle de l’asthme. Sa prise en charge, qui n'est pas encore codifiée, doit être multidisciplinaire.
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Affiliation(s)
- Saousen Cheikh Mhamed
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1 juin, 5000 Monastir, Tunisie
| | - Ahmed Ben Saad
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1 juin, 5000 Monastir, Tunisie
| | - Asma Migaou
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1 juin, 5000 Monastir, Tunisie
| | - Nesrine Fahem
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1 juin, 5000 Monastir, Tunisie
| | - Naceur Rouatbi
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1 juin, 5000 Monastir, Tunisie
| | - Samah Joobeur
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1 juin, 5000 Monastir, Tunisie
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Bateman ME, Oakland H, Oral E, Nuss H, Fisher P, Udemgba C, Walker C, Daigrepont N, Parada NA. Evaluation of a Multidisciplinary Disease Management Program to Achieve Asthma Control in Seven Safety Net Hospitals in Louisiana. Popul Health Manag 2020; 24:133-140. [PMID: 32096685 DOI: 10.1089/pop.2019.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective was to evaluate a multidisciplinary guideline-driven disease management program focused on achievement of asthma control among sustained patients with confirmed asthma in Louisiana and to assess factors affecting achievement of asthma control. Data were extracted from the electronic health records of 1596 adults with confirmed asthma, sustained care for >1 year in the outpatient setting, and ≥2 recorded Asthma Control Test (ACT) scores. Multivariable logistic regression modeling was used to assess the association of demographic variables, comorbidities, and process measures with the best achieved asthma control as represented by the highest ACT score. Most subjects were female (81.1%) and African American (63.9%). Approximately half of them (48.9%) were able to achieve asthma control (ACT ≥20). The most prevalent comorbidities were hypertension (79.8%), rhinitis (55.3%), and obesity (50.5%). Most patients received pulmonary function testing (PFT) (88.6%), controller medication therapy (85.5%), or written asthma action plans (92.7%). Asthma control was positively associated with presence of PFT (OR = 1.63, 95% CI: 1.13, 2.37) and being a "never" smoker (OR = 1.49, 95% CI: 1.08, 2.04). Asthma control was less likely to be achieved by patients who were African American (OR = 0.68, 95% CI: 0.52, 0.87), had more comorbidities (OR = 0.89, 95% CI: 0.83, 0.96), or were on more medications (OR = 0.79, 95% CI: 0.72, 0.88). Asthma control was achieved in 48.9% of an adult, primarily African American population with the implementation of comprehensive guideline-driven care. Furthermore, this is the first study to observe that the presence of PFT may be associated with asthma control.
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Affiliation(s)
- Marjorie E Bateman
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Hannah Oakland
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Evrim Oral
- School of Public Health, Biostatistics Program, LSUHSC, New Orleans, Louisiana, USA
| | - Henry Nuss
- School of Public Health, Behavioral and Community Health Sciences Program, LSUHSC, New Orleans, Louisiana, USA
| | - Paige Fisher
- School of Public Health, Biostatistics Program, LSUHSC, New Orleans, Louisiana, USA
| | - Chioma Udemgba
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Carl Walker
- Lousisana State University Health Care Services Division, New Orleans, Louisiana, USA
| | - Nathan Daigrepont
- Lousisana State University Health Care Services Division, New Orleans, Louisiana, USA
| | - Nereida A Parada
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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30
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Asthma control and COPD symptom burden in patients using fixed-dose combination inhalers (SPRINT study). NPJ Prim Care Respir Med 2020; 30:1. [PMID: 31911607 PMCID: PMC6946676 DOI: 10.1038/s41533-019-0159-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 11/04/2019] [Indexed: 12/30/2022] Open
Abstract
Previous studies have found suboptimal control of symptom burden to be widespread among patients with asthma and chronic obstructive pulmonary disease (COPD). The Phase IV SPRINT study was conducted in 10 countries in Europe to assess asthma disease control and COPD symptom burden in patients treated with a fixed-dose combination (FDC) of inhaled corticosteroids (ICS) and long-acting beta agonists (LABAs). SPRINT included 1101 patients with asthma and 560 with COPD; all were receiving treatment with an FDC of ICS/LABA, delivered via various inhalers. Data were obtained over a 3-month period, during a single routine physician’s office visit. Asthma control was defined as Asthma Control Test (ACT) score >19. COPD symptom burden was assessed by COPD Assessment Test (CAT), with a CAT score <10 defining low COPD symptom burden. Among patients using any ICS/LABA FDC, 62% of patients with asthma had achieved disease control (ACT score >19) and 16% of patients with COPD had low symptom burden (CAT score <10).
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Guguen C, Launois C, Dormoy V, Dewolf M, Dumazet A, Dury S, Lebargy F, Deslee G, Perotin JM. [Obesity and asthma: Mechanisms and therapeutic options]. Rev Mal Respir 2019; 37:134-143. [PMID: 31864881 DOI: 10.1016/j.rmr.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/22/2022]
Abstract
Asthma and obesity are both common conditions, which lead to a substantial public health burden. The obese-asthma phenotype is characterized by poor asthma control, impaired lung function and decreased efficacy of inhaled treatment. However, this phenotype is highly heterogeneous and involves numerous mechanisms, including systemic inflammation and adipokines. A role for microbiota modifications and genetics has been suggested. Obese-asthma patient management currently consists in weight loss and usual anti-asthmatic treatment. New therapeutic options are being evaluated.
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Affiliation(s)
- C Guguen
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - C Launois
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - V Dormoy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - M Dewolf
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - A Dumazet
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - S Dury
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - F Lebargy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - G Deslee
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - J-M Perotin
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France.
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Stanescu S, Kirby SE, Thomas M, Yardley L, Ainsworth B. A systematic review of psychological, physical health factors, and quality of life in adult asthma. NPJ Prim Care Respir Med 2019; 29:37. [PMID: 31636268 PMCID: PMC6803647 DOI: 10.1038/s41533-019-0149-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Asthma is a common non-communicable disease, often characterized by activity limitation, negative effects on social life and relationships, problems with finding and keeping employment, and poor quality of life. The objective of the present study was to conduct a systematic review of the literature investigating the potential factors impacting quality of life (QoL) in asthma. Electronic searches were carried out on: MEDLINE, EMBASE, PsycINFO, the Cochrane Library, and Web of Science (initial search April 2017 and updated in January 2019). All primary research studies including asthma, psychological or physical health factors, and quality of life were included. Narrative synthesis was used to develop themes among findings in included studies in an attempt to identify variables impacting QoL in asthma. The search retrieved 43 eligible studies that were grouped in three themes: psychological factors (including anxiety and depression, other mental health conditions, illness representations, and emotion regulation), physical health factors (including BMI and chronic physical conditions), and multifactorial aspects, including the interplay of health and psychological factors and asthma. These were found to have a substantial impact on QoL in asthma, both directly and indirectly, by affecting self-management, activity levels and other outcomes. Findings suggest a complex and negative effect of health and psychological factors on QoL in asthma. The experience of living with asthma is multifaceted, and future research and intervention development studies should take this into account, as well as the variety of variables interacting and affecting the person.
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Affiliation(s)
- Sabina Stanescu
- Academic Unit of Psychology, University of Southampton, Southampton, UK.
| | - Sarah E Kirby
- Academic Unit of Psychology, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK
| | - Mike Thomas
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK.,Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Ben Ainsworth
- Department of Psychology, University of Bath, Bath, UK
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Traynor MD, McKenna NP, Habermann EB, Yonkus J, Moir CR, Potter DD, Ishitani MB, Klinkner DB. Utilization of Maneuvers to Increase Mesenteric Length Employed in Children Undergoing Ileal Pouch-Anal Anastomosis. J Laparoendosc Adv Surg Tech A 2019; 29:1285-1291. [DOI: 10.1089/lap.2019.0124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael D. Traynor
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
- Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Elizabeth B. Habermann
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | | | - D. Dean Potter
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
- Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Denise B. Klinkner
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
- Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota
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González-Freire B, Vázquez I, Pértega-Díaz S. The Relationship of Psychological Factors and Asthma Control to Health-Related Quality of Life. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:197-207. [PMID: 31326620 DOI: 10.1016/j.jaip.2019.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Psychological variables (anxiety, depression, and coping strategies) and asthma control (assessed from the patient's perspective or from the physician's perspective) affect health-related quality of life (HRQoL) in asthmatic patients. However, no study has simultaneously evaluated these variables to understand the independent contribution of each one of these factors to HRQoL. OBJECTIVE To determine the impact of anxiety, depression, coping strategies, and asthma control on HRQoL, and to compare the impact of asthma control on HRQoL when it is established by the physician versus when it is considered by the patient. METHODS A total of 373 asthmatics completed the Hospital Anxiety and Depression Scale, Coping Orientations to Problems Experienced Inventory, 36-Item Short-Form Health Survey, and St. George Respiratory Questionnaire. Asthma control was measured by the patient with Asthma Control Test and by the physician with the classification asthma control of Global Initiative for Asthma. Demographic and clinical characteristics were also collected. RESULTS Anxiety, depression, and poor patient-rated asthma control status were associated with worse HRQoL in all dimensions (except Mental Health for asthma control). Physician-rated asthma control was related to worse HRQoL in physical generic and specific dimensions. Among coping strategies, only avoidant coping impacted HRQoL in a few dimensions. CONCLUSIONS Anxiety, depression, and asthma control (especially patient-rated asthma control) were important independent predictors of asthma HRQoL, and all of them should therefore be considered in interventions to improve HRQoL in asthmatic patients.
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Affiliation(s)
| | - Isabel Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Sonia Pértega-Díaz
- Clinical Epidemiology and Statistics Unit, Complejo Hospitalario Universitario, A Coruña, Spain
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Neffen H, Chahuàn M, Hernández DD, Vallejo-Perez E, Bolivar F, Sánchez MH, Galleguillos F, Castaños C, S Silva R, Giugno E, Pavie J, Contreras R, Lamarao F, Moraes Dos Santos F, Rodriguez C, Tobler J, Viana K, Vieira C, Soares C. Key factors associated with uncontrolled asthma - the Asthma Control in Latin America Study. J Asthma 2019; 57:113-122. [PMID: 30915868 DOI: 10.1080/02770903.2018.1553050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This study aimed to estimate asthma control at specialist treatment centers in four Latin American countries and assess factors influencing poor asthma control.Methods: Patients aged ≥12 years with an asthma diagnosis and asthma medication prescription, followed at outpatient specialist centers in Argentina, Chile, Colombia, and Mexico, were included. The study received all applicable ethical approvals. The Asthma Control Test (ACT) was used to classify patients as having controlled (ACT 20-25) or uncontrolled (ACT ≤19) asthma. Frequency and statistical tests were used to assess the association between hospital admissions/exacerbations/emergency department (ED) visits and uncontrolled asthma; multivariate logistic regression was used to assess the association of uncontrolled asthma with clinical/demographic variables.Results: A total of 594 patients were included. Overall controlled-asthma prevalence was 43.4% (95% confidence interval [CI]: 39.0, 47.4). Patients with uncontrolled asthma were more likely to be women (adjusted odds ratio [aOR]: 1.85; p = 0.003), non-white (aOR: 2.14; p < 0.001), obese (aOR: 1.71; p = 0.036), to have a low monthly family income (aOR: 1.75; p = 0.004), to have severe asthma (aOR:1.59; p = 0.26), and, compared with patients with controlled asthma, to have a higher likelihood of asthma exacerbations (34.5% vs. 15.9%; p < 0.001), hospital admissions (6.9% vs. 3.1%; p = 0.042), and ED visits (34.5% vs. 15.9%; p < 0.001) due to asthma.Conclusions: Even in specialist ambulatory services, fewer than half of patients were classified as having controlled asthma. The proportion of uncontrolled patients varied according to clinical and demographic variables.
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Affiliation(s)
- Hugo Neffen
- Centro de Alergia e Inmunología-Santa Fe, Santa Fe, Argentina
| | | | | | | | - Fabio Bolivar
- Instituto Neumologico del Oriente, Santander, Colombia
| | - Marco H Sánchez
- Unidad de Investigación en Salud de Chihuahua SC, San Felipe, Mexico
| | | | - Claudio Castaños
- Hospital Nacional de Pediatría Garrahan, Buenos Aires, Argentina
| | - Rafael S Silva
- Facultad Ciencias de la Salud Universidad Autónoma de Chile, Talca, Chile
| | - Eduardo Giugno
- Centro de Investigacion Clinica Belgrano, Buenos Aires, Argentina
| | - Juana Pavie
- Centro Investigaciones Médicas Integrales, Quillota, Chile
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Jesus JPVD, Lima-Matos AS, Almeida PCA, Lima VB, Mello LMD, Souza-Machado A, Ponte EV, Cruz ÁA. Obesity and asthma: clinical and laboratory characterization of a common combination. ACTA ACUST UNITED AC 2019; 44:207-212. [PMID: 30043887 PMCID: PMC6188692 DOI: 10.1590/s1806-37562017000000034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 12/22/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the relationship between obesity and asthma. METHODS This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. RESULTS Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). CONCLUSIONS Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.
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Affiliation(s)
- Juliana Pires Viana de Jesus
- . Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil
| | - Aline Silva Lima-Matos
- . Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil.,. Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | | | - Valmar Bião Lima
- . Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil
| | - Luane Marques de Mello
- . Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Adelmir Souza-Machado
- . Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil.,. Instituto de Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Eduardo Vieira Ponte
- . Instituto de Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.,. Faculdade de Medicina de Jundiaí, Jundiaí (SP) Brasil
| | - Álvaro Augusto Cruz
- . Núcleo de Excelência em Asma/Programa para o Controle da Asma na Bahia - ProAR - Salvador (BA) Brasil.,. Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
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Wadden D, Allwood Newhook LA, Twells L, Farrell J, Gao Z. Sex-Specific Association between Childhood BMI Trajectories and Asthma Phenotypes. Int J Pediatr 2018; 2018:9057435. [PMID: 30631374 PMCID: PMC6304644 DOI: 10.1155/2018/9057435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Asthma and obesity are two common health problems in the pediatric population. Obesity is associated with several comorbidities which are of great consequence. Excess adipose tissue has been linked to asthma in a number of studies. However, little is known about childhood body mass index (BMI) trajectories and the development of asthma phenotypes. OBJECTIVE The current study aims to investigate the significance of BMI trajectories over childhood and the risk of asthma phenotypes. METHODS The current study is a prospective cohort of children aged 0-2 years who were followed every two years for eight years through cycles one to five in the National Longitudinal Survey of Children and Youths (NLSCY). Statistical analysis: a latent class growth modelling (LCGM) method was used to identify BMI trajectory patterns from cycles one to five. Multiple imputation (number of imputations=5) was carried out to impute children with missing values on height or weight information. Sampling weights and 1,000 bootstrap weights were used in SAS PROC SURVEYLOGISTIC to examine the association between BMI trajectory and asthma phenotypes (persistent or transient asthma) in a multivariate analysis. RESULTS The study consisted of 571,790 males and 549,230 females. Among them, 46% of children showed an increasing trajectory in terms of change in BMI percentile during childhood, followed by the stable-trajectory group (41%) and decreasing-trajectory group (13%). After controlling for confounding factors, females in the increasing BMI trajectory group were four times more likely to be associated with persistent asthma (OR = 4.09; 95% CI:1.04-16.15; p = 0.0442) than females in the stable BMI trajectory group. No such relationship was found in males. The BMI trajectory was not significantly associated with risk of transient asthma for either sex. CONCLUSION We report a female-specific association between increasing adiposity, measured by BMI, and persistent asthma.
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Affiliation(s)
- Danny Wadden
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | - Laurie Twells
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jamie Farrell
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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The asthma-obesity relationship: underlying mechanisms and treatment implications. Curr Opin Pulm Med 2018; 24:42-49. [PMID: 29176481 DOI: 10.1097/mcp.0000000000000446] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Obesity is a worldwide epidemic with a prevalence that has tripled in the last two decades. Worldwide, more than 1.5 billion adults are overweight and more than 500 million obese. Obesity has been suggested to be a risk factor for the development of more difficult-to-control asthma. Although the mechanisms underlying the asthma-obesity relationship are not fully understood, several possible explanations have been put forward. These will be reviewed in this manuscript as well as the implications for the treatment of overweight and obese asthma patients. RECENT FINDINGS Insulin resistance is a possible factor contributing to the asthma-obesity relationship and the effect is independent of other components of the metabolic syndrome such as hypertriglyceridemia, hypertension, hyperglycemia, and systemic inflammation. Obesity has important effects on airway geometry, by especially reducing expiratory reserve volume causing obese asthmatics to breathe at low lung volumes. Furthermore, obesity affects the type of inflammation in asthma and is associated with reduced inhaled corticosteroids treatment responsiveness. SUMMARY Obesity induces the development of asthma with a difficult-to-control phenotype. Treatment targeting insulin resistance may be beneficial in obese asthma patients, especially when they have concomitant diabetes. Systemic corticosteroids should be avoided as much as possible as they are not very effective in obese asthma and associated with side-effects like diabetes, weight gain, and osteoporosis.
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Forte GC, Almeida JC, da Silva DTR, Hennemann ML, Dalcin PTR. Association between anthropometric markers and asthma control, quality of life and pulmonary function in adults with asthma. J Hum Nutr Diet 2018; 32:80-85. [PMID: 30062748 DOI: 10.1111/jhn.12584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of abdominal fat and body fat (BF) in the evaluation of nutritional status in asthma has been considered recently. The present study aimed to evaluate the association between different anthropometric markers and asthma control, pulmonary function and quality of life. A secondary objective was to determine the agreement between the anthropometric markers with respect to assessing obesity in adults with asthma. METHODS This cross-sectional study enrolled adult asthma patients attending an outpatient asthma clinic in southern Brazil. Patients were evaluated regarding sociodemographic data, lung function, asthma control, nutritional status and health-related quality of life (Asthma Quality of Life Questionnaire; AQLQ). Nutritional status was classified by body mass index (BMI), waist circumference (WC) and BF. RESULTS The mean (SD) age of the 198 patients was 56.2 (14.8) years. The prevalence of uncontrolled asthma among subjects who were overweight as diagnosed by their BMI was 64.6% higher than in those who were normal weight. An increase in a measure of BMI (1 kg m-2 ) decreases approximately 44-59% of symptoms, activity limitations and emotional function domains of the AQLQ, whereas an increase in a measure in WC (1 cm) decreases approximately 24-30% of the same domains. Agreement between BMI and BF was 0.566 and that between BMI and WC was 0.597 by Kendall's Tau-b test. CONCLUSIONS The prevalence of uncontrolled asthma is greater in overweight subjects than in normal weight subjects. WC and BMI were negatively associated with symptoms, activity limitations and emotional function domains of the AQLQ. BMI appears to be sufficient to diagnose the nutritional status of subjects with asthma in this population.
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Affiliation(s)
- G C Forte
- Programa de Pós-Graduação em Pediatria e Saúde da Criança da Pontifícia, Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - J C Almeida
- Departamento de Nutrição e Programa Pós-Graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - D T R da Silva
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - M L Hennemann
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - P T R Dalcin
- Faculdade de Medicina, Programa e Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Forte GC, da Silva DTR, Hennemann ML, Sarmento RA, Almeida JC, de Tarso Roth Dalcin P. Diet effects in the asthma treatment: A systematic review. Crit Rev Food Sci Nutr 2018; 58:1878-1887. [PMID: 28362110 DOI: 10.1080/10408398.2017.1289893] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Obesity in asthmatic patients has important relationships with asthma control, pulmonary function, and quality of life. The objective of this study was to conduct a systematic review of the literature on the effect of diet on asthma management in adults. METHODS We searched PubMed, Embase, and Scopus (January 1948-October 2014) for randomized clinical trials that evaluated the effects of diet in adults with asthma. RESULTS Of 12,215 studies identified, 21 were included. A reduction in weight of at least 7.5% from baseline as a result of caloric restriction can be beneficial for improving disease control, quality of life, and pulmonary function in obese patients with asthma. A dietary pattern rich in foods with potential antioxidant effect had an impact in improving asthma control, but with little clinical significance. Studies involving antioxidant supplementation showed improvements in asthma control with magnesium supplementation and less decline in lung function with vitamin C supplementation. Studies of fatty acid supplementation demonstrated effects on weight loss and improvement of asthma control and lung function. Studies of supplementation with propolis and caffeine reported significant increases in FEV1. Conversely, studies of high dietary salt intake reported greater declines in lung function. CONCLUSIONS The evidence shows that, for obese adults with asthma, the best dietary intervention seems to be caloric restriction, regardless of specific dietary components.
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Affiliation(s)
- Gabriele Carra Forte
- a Universidade Federal do Rio Grande do Sul, Programa de Pós Graduação em Ciências Pneumológicas , Porto Alegre , Brazil
| | | | - Maria Luiza Hennemann
- c Universidade Federal do Rio Grande do Sul, Curso de Nutrição , Porto Alegre , Brazil
| | - Roberta Aquiar Sarmento
- d Universidade Federal do Rio Grande do Sul, Serviço de Nutrição e Dietética do Hospital de Clinicas de Porto Alegre e Programa de Pós-Graduação em Ciências Médicas: Endocrinologia , Porto Alegre , Brazil
| | - Jussara Carnevale Almeida
- e Universidade Federal do Rio Grande do Sul , Professora Adjunto do Departamento de Nutrição da Faculdade de Medicina e professora orientadora do Programa de Pós Graduação em Ciências Médicas: Endocrinologia , Porto Alegre , Brazil
| | - Paulo de Tarso Roth Dalcin
- f Universidade Federal do Rio Grande do Sul; Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Pneumológicas , Porto Alegre , Brazil
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Cheng H, Montgomery S, Treglown L, Furnham A. Associations between childhood biomedical factors, maternal smoking, personality traits, Body and Mass Index and the prevalence of asthma in adulthood. Psychol Health 2018; 33:1116-1129. [PMID: 29737224 DOI: 10.1080/08870446.2018.1467014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The study set out to investigate socio-economic, biomedical, health and behavioural and psychological factors in childhood and adulthood associated with the prevalence of asthma in adulthood, drawing data from The National Child Development Studies (NCDS), a birth cohort in the UK. DESIGN The National Child Development Study, a nationally representative sample of 17,415 babies born in Great Britain in 1958 and followed up at 7, 11, 33 and 50 years was used. MAIN OUTCOME MEASURE The prevalence of asthma at age 50 was the outcome measure. The analytic sample consists of 5118 participants with complete data on a set of measures at birth, at ages 7, 11, 33 and 50 years. RESULTS Using logistic regression analyses, results showed that childhood asthma (OR = 6.77: 4.38-10.48, p < .001) and respiratory symptoms (OR = 1.83: 1.18-2.86, p < .01), maternal smoking during pregnancy (OR = 1.26: 1.00-1.59, p < .05), Body and Mass Index (BMI) (OR = 1.03: 1.02-1.05, p < .001), traits Neuroticism (OR = 1.13: 1.01-1.21, p < .05) and Conscientiousness (OR = 0.76: 0.76-0.96, p < .01), as well as sex (OR = 1.49: 1.15-1.94, p < .001) were all significantly associated with the prevalence of asthma in adulthood. CONCLUSION The study shows that both childhood and adulthood psychological and sociological factors are significantly associated with the prevalence of asthma in adulthood, though more work need to be done in this area.
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Affiliation(s)
- Helen Cheng
- a Research Department of Clinical, Educational and Health Psychology , University College London , London , UK.,b ESRC Centre for Learning and Life Chances in Knowledge Economies and Societies , UCL Institute of Education , London , UK
| | - Scott Montgomery
- c Clinical Epidemiology and Biostatistics, School of Medical Sciences , Örebro University , Örebro , Sweden.,d Research Department of Epidemiology and Public Health , UCL , London , UK
| | - Luke Treglown
- a Research Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Adrian Furnham
- a Research Department of Clinical, Educational and Health Psychology , University College London , London , UK.,e BI: Norwegian Business School , Oslo , Norway
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Obesity, diet and lifestyle in 9-year-old children with parentally reported chronic diseases: findings from the Growing Up in Ireland longitudinal child cohort study. Ir J Med Sci 2018; 188:29-34. [PMID: 29728820 DOI: 10.1007/s11845-018-1814-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The incidence and prevalence of childhood chronic disease is increasing worldwide. Obesity, poor diet and lifestyle may be more prevalent in children with a chronic disease than in their healthier contemporaries. The Growing Up in Ireland (GUI) study is a nationally representative cohort study of children living in the Republic of Ireland. The study has collected information from 8568 9-year-old Irish children on their experiences within their families, childcare settings, schools and communities, and how these impact on all aspects of children's development. AIMS This study aims to establish the prevalence of parentally reported chronic disease in children in Ireland and to describe their diet and lifestyle. METHODS This study analyzed data from the Growing Up in Ireland longitudinal child cohort study and compared the diet, lifestyle and prevalence of obesity in children with and without a parentally reported chronic disease. RESULTS Overall, 954 parents in the sample (11.1%) reported that their child had a chronic illness and 43.4% of these children are hampered by it in their daily activities. Respiratory disorders were the commonest type of chronic disease (46%) reported. Children with a chronic illness were more likely to be overweight or obese (32.9% compared to 25.0% of those without a chronic illness, p < 0.001). Children with chronic illness were also found to have a poorer diet, take less exercise and experienced significantly more social isolation than their peers (all p < 0.05). CONCLUSIONS Public health measures to address diet and lifestyle choices need to be cognisant of the needs of children with chronic diseases and tailor activities offered to be inclusive of all children. Medical professionals having contact with children with chronic conditions need to remember to reinforce the importance of diet and lifestyle whenever possible and to explore with families solutions to barriers to making healthy diet and lifestyle choices.
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Arias SJ, Neffen H, Bossio JC, Calabrese CA, Videla AJ, Armando GA, Antó JM. Prevalence and Features of Asthma in Young Adults in Urban Areas of Argentina. Arch Bronconeumol 2017; 54:134-139. [PMID: 29108757 DOI: 10.1016/j.arbres.2017.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the burden of asthma in a young adult population in urban areas of Argentina. DESIGN A nationwide telephone survey in subjects aged 20-44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications. RESULTS In total, 1,521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7-7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1-7.7). Wheezing was reported by 13.9% (95% CI 15.6-12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0-11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with rhinitis (OR 11.1, 95% CI 6.2-19.9) and family history (OR 3.6, 95% CI 2.3-5.5). CONCLUSION Asthma prevalence in young adults in Argentina is similar to Europe. Although attacks and admissions were common, regular use of medications was reported by half of those treated. These results may be useful for other Latin American countries.
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Affiliation(s)
- Sergio J Arias
- Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Carlos Malbran, Ministerio de Salud de la Nación, Santa Fe, Argentina.
| | - Hugo Neffen
- Centro de Alergia, Inmunología y Enfermedades Respiratorias, Santa Fe, Argentina
| | - Juan Carlos Bossio
- Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Carlos Malbran, Ministerio de Salud de la Nación, Santa Fe, Argentina
| | - Carina A Calabrese
- Programa Nacional de Prevención y Control de Enfermedades Respiratorias Crónicas, Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de la Nación Argentina, Buenos Aires, Argentina
| | - Alejandro J Videla
- Programa Nacional de Prevención y Control de Enfermedades Respiratorias Crónicas, Dirección de Promoción de la Salud y Control de Enfermedades No Transmisibles, Ministerio de Salud de la Nación Argentina, Buenos Aires, Argentina; Servicio de Neumonología, Hospital Universitario Austral, Pilar, Argentina
| | - Gustavo A Armando
- Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Carlos Malbran, Ministerio de Salud de la Nación, Santa Fe, Argentina
| | - Joseph M Antó
- Instituto de Salud Global de Barcelona (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España; Hospital del Mar Medical Research Institute, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
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Health-related quality of life in asthma patients - A comparison of two cohorts from 2005 and 2015. Respir Med 2017; 132:154-160. [PMID: 29229090 DOI: 10.1016/j.rmed.2017.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/04/2017] [Accepted: 10/13/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim was to investigate temporal variation in Health-Related Quality of Life (HRQL) and factors influencing low HRQL, in patients with asthma. MATERIAL AND METHODS Questionnaire data on patient characteristics and the mini-Asthma Quality of Life Questionnaire (mini-AQLQ) scores from two separate cohorts of randomly selected Swedish primary and secondary care asthma patients, in 2005 (n = 1034) and 2015 (n = 1126). Student's t-test and analysis of covariance with adjustment for confounders compared mini-AQLQ total and domain scores in 2005 and 2015. Multivariable linear regression analyzed associations with mini-AQLQ scores. RESULTS The mean Mini-AQLQ scores were unchanged between 2005 and 2015 (adjusted means (95% CI) 2005: 5.39 (5.27-5.33) and in 2015: 5.44 (95% CI 5.32 to 5.38), p = 0.26). Overweight (regression coefficient 95% CI) (0.21 (-0.36 to -0.07)), obesity (-0.34 (-0,50 to -0.18)), one or more exacerbations during the previous six months (-0.64 (-0.79 to -0.50)), self-rated moderate/severe disease (-1.02 (-1.15 to -0.89)), heart disease (-0.42 (-0.68 to -0.16)), anxiety/depression (-0.31 (-0.48 to -0.13)) and rhinitis (-0.25 (-0.42 to -0.08)) were associated with lower HRQL. Higher educational level (0.32 (0.19-0.46)) and self-reported knowledge of self-management of exacerbations (0.35 (0.19-0.51)) were associated with higher HRQL. CONCLUSIONS HRQL in Swedish patients with asthma is generally good and unchanged during the last decade. Overweight, obesity, exacerbations, self-rated moderate/severe disease, heart disease, depression/anxiety and rhinitis were associated with lower HRQL, and high educational level and knowledge on self-management with higher HRQL.
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High prevalence of severe asthma in a large random population study. J Allergy Clin Immunol 2017; 141:2256-2264.e2. [PMID: 28939411 DOI: 10.1016/j.jaci.2017.07.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prevalence of asthma severity is not well described at a population level. OBJECTIVE We sought to determine the prevalence of phenotypic signs of asthma severity among asthmatic patients in a general population and to describe risk factors for asthma severity. METHODS We performed an epidemiologic study conducted between 2008 and 2012 (West Sweden Asthma Study). A postal questionnaire was sent to a random population (n = 30,000) in west Sweden, with 18,087 responses. A total of 2,006 subjects were carefully phenotyped. Only subjects with "active asthma" (symptoms or medication in the last year, n = 744) were analyzed in this study to determine the degree of severity of the disease within an asthma cohort. Phenotypes of severity were calculated based on (1) multiple symptoms during the day despite ongoing use of asthma medications, (2) FEV1 of less than 70% of predicted value, (3) daily or almost daily use of rescue medications, (4) nighttime symptoms once a week or more, and (5) oral corticosteroid use/emergency department visits. Asthmatic patients were grouped as having nonsevere disease, 1 sign of severity, or 2 or more signs of severity. RESULTS A total of 36.2% of asthmatic patients expressed at least 1 sign of asthma severity, and 13.2% had 2 or more signs. The group with 2 or more signs was older in age and had higher body mass index, a higher rate of tobacco smoking, and lower lung function. Bronchial hyperreactivity, airway inflammation, and sensitization were significantly different among the 3 groups. At a population level, the prevalence of asthma severity was 3.1% for 1 sign and 1.3% for at least 2 signs. CONCLUSION More than 1 in 3 asthmatic patients show at least 1 sign of asthma severity. The phenotypes of asthma severity are highly diverse, which is important to consider when implementing personalized medicine in asthmatic patients.
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Nygaard L, Henriksen DP, Madsen H, Davidsen JR. Appropriate selection for omalizumab treatment in patients with severe asthma? Eur Clin Respir J 2017; 4:1359477. [PMID: 28815007 PMCID: PMC5553102 DOI: 10.1080/20018525.2017.1359477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 07/19/2017] [Indexed: 12/05/2022] Open
Abstract
Background: Omalizumab improves asthma control in patients with uncontrolled severe allergic asthma; however, appropriate patient selection is crucial. Information in this field is sparse. Objective: We aimed to estimate whether potential omalizumab candidates were appropriately selected according to guidelines, and the clinical effect of omalizumab treatment over time. Design: We performed a retrospective observational study on adult patients with asthma treated with omalizumab during 2006–2015 at the Department of Respiratory Medicine at Odense University Hospital (OUH), Denmark. Data were obtained from the Electronic Patient Journal of OUH and Odense Pharmaco-Epidemiological Database. Guideline criteria for omalizumab treatment were used to evaluate the appropriateness of omalizumab candidate selection, and the Asthma Control Test (ACT) to assess the clinical effects of omalizumab at weeks 16 and 52 from treatment initiation. Results: During the observation period, 24 patients received omalizumab, but only 10 patients (42%) fulfilled criteria recommended by international guidelines. The main reasons for not fulfilling the criteria were inadequately reduced lung function, insufficient number of exacerbations, and asthma standard therapy below Global Initiative for Asthma (GINA) step 4–5. Seventeen and 11 patients completed treatment at weeks 16 and 52, with a statistically significant increase in ACT score of 5.1 points [95% confidence interval (CI) 3.1–7.2, p = 0.0001] and 7.7 points (95% CI 4.3–11.1, p = 0.0005), respectively. Conclusion: Only 42% of the omalizumab-treated patients were appropriately selected according to current guidelines. Still, as omalizumab showed significant improvement in asthma control over time, it is important to keep this drug in mind as an add-on to asthma therapy in well-selected patients.
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Affiliation(s)
- Leo Nygaard
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark
| | - Daniel Pilsgaard Henriksen
- Research Unit of Respiratory Medicine, Clinical Institute, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Hanne Madsen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark
| | - Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.,Research Unit of Respiratory Medicine, Clinical Institute, University of Southern Denmark, Odense C, Denmark.,South Danish Center of Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense C, Denmark
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Stridsman C, Backman H, Eklund BM, Rönmark E, Hedman L. Adolescent girls with asthma have worse asthma control and health-related quality of life than boys-A population based study. Pediatr Pulmonol 2017; 52:866-872. [PMID: 28444980 DOI: 10.1002/ppul.23723] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/07/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Population-based studies investigating health-related quality of life (HRQoL) among asthmatic adolescents are rare. Further, among subjects with asthma, HRQoL may be affected by asthma control and severity. AIM To investigate HRQoL in relation to asthma control and asthma severity among adolescents. METHOD As a part of the population-based OLIN pediatric study, 266 adolescents with current asthma (14-15 yr) were identified. N = 247 completed the DISABKIDS HRQoL asthma module, including the domains impact and worry. The Asthma Control Test (ACT) was used and a disease severity score was calculated based on symptoms and medicine use. RESULTS The prevalence of current asthma was 11%. Well-controlled asthma was reported by 15% of the adolescents, and 53% had partly controlled asthma. The prevalence of uncontrolled asthma was significantly higher among girls than boys (38% vs 25%), and girls also reported lower HRQoL scores. There was a fairly strong correlation between the ACT and DISABKIDS scores. Independent risk factors for low HRQoL impact (a score <67) were female sex (OR 4.66, 95%CI 1.82-9.54) and decreased ACT scores (1.38, 1.18-1.62). Risk factors for low HRQoL worry (a score <70) were female sex (3.33, 1.41-7.86), decreased ACT scores (1.35, 1.16-1.57), severe asthma (6.23, 1.46-16.50), and having current eczema (2.68, 1.00-7.24). CONCLUSION Only a minority of the asthmatic adolescents reported well-controlled asthma, and poor asthma control and female sex were risk factors for low HRQoL. Our results demonstrate that evaluation of asthma control is of great importance for asthma management.
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Affiliation(s)
- Caroline Stridsman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.,The OLIN Studies, Norrbotten County Council, Luleå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | | | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.,Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
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Nowak M, Brożek G, Doniec Z, Olszanecka-Glinianowicz M. The pharmacotherapy preferred by doctors in treatment of patients diagnosed with asthma or chronic obstructive pulmonary disease or allergic rhinitis and concomitant diseases: an epidemiological analysis. Postepy Dermatol Alergol 2017; 34:148-158. [PMID: 28507495 PMCID: PMC5420608 DOI: 10.5114/ada.2017.67081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The clinical course of asthma and chronic obstructive pulmonary disease (COPD) is influenced by the co-occurrence of other chronic diseases and their pharmacotherapy. There are no data associated with the doctors' pharmacotherapy preferences in treatment of patients with asthma, COPD or allergic rhinitis and concomitant diseases. AIM The assessment of doctors' preferences in pharmacotherapy of asthma, COPD or allergic rhinitis in relation to concomitant diseases. MATERIAL AND METHODS General practitioners, pulmonologists, allergists, laryngologists and paediatricians (n = 319) participated in a questionnaire survey concerning their preferences in pharmacotherapy of asthma, COPD and allergic rhinitis in relation to concomitant diseases enrolling 11,310 patients with asthma, COPD and allergic rhinitis. RESULTS The concomitant diseases were reported in 58.5% of patients with asthma, 80.8% of patients with COPD and 46.4% of patients with allergic rhinitis. Patients with asthma were most frequently treated with inhaled glucocorticosteroids. However, in the subgroups with concomitant diseases, an increased usage of inhaled long-acting β2-mimetics was noted. Regardless of comorbidities, patients with COPD were most frequently treated with inhaled long-acting β2-mimetics whereas patients with allergic rhinitis - with nasal glucocorticosteroids and third-generation antihistamines. CONCLUSIONS The co-occurrence of chronic diseases was most frequent among patients diagnosed with COPD. The treatment of asthma, COPD and allergic rhinitis is consistent with international recommendations and the occurrence of concomitant diseases did not significantly influence therapeutic preferences and decisions.
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Affiliation(s)
| | - Grzegorz Brożek
- Department of Epidemiology, College of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Doniec
- Institute of Tuberculosis and Lung Diseases, Rabka Zdroj, Poland
| | - Magdalena Olszanecka-Glinianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland
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Chang C, Lee SM, Choi BW, Song JH, Song H, Jung S, Bai YK, Park H, Jeung S, Suh DC. Costs Attributable to Overweight and Obesity in Working Asthma Patients in the United States. Yonsei Med J 2017; 58:187-194. [PMID: 27873513 PMCID: PMC5122636 DOI: 10.3349/ymj.2017.58.1.187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/22/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. MATERIALS AND METHODS This study was conducted using the 2003-2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. RESULTS Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861-$895] and $257 (95% CI: $251-$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253-$260) and $26 (95% CI: $26-$27) per person per year, respectively. CONCLUSION Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.
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Affiliation(s)
| | - Seung Mi Lee
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Byoung Whui Choi
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jong Hwa Song
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Hee Song
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Sujin Jung
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | | | - Haedong Park
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | | | - Dong Churl Suh
- College of Pharmacy, Chung-Ang University, Seoul, Korea.
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