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Liccardi G, Martini M, Bilò MB, Milanese M, Baiardini I, Liccardi MV, Rogliani P. The impact of psychological health in African American young adults on asthma control: why is phenotyping still an unmet need? Suggestions from a multidisciplinary 'Stress-Asthma Working Group'. J Asthma 2024; 61:76-79. [PMID: 37439793 DOI: 10.1080/02770903.2023.2236704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Gennaro Liccardi
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Matteo Martini
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Maria Beatrice Bilò
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Manlio Milanese
- Division of Pulmonology, S. Corona Hospital, Pietra Ligure, Italy
| | - Ilaria Baiardini
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy
- Università di Genova, (DIMI), Genova, Italy
| | | | - Paola Rogliani
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome "Tor Vergata", Rome, Italy
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2
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Arslan B, Çetin GP, Yilmaz İ. The Role of Long-Acting Antimuscarinic Agents in the Treatment of Asthma. J Aerosol Med Pulm Drug Deliv 2023; 36:189-209. [PMID: 37428619 DOI: 10.1089/jamp.2022.0059] [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: 07/12/2023] Open
Abstract
The journey of using anticholinergics in the treatment of asthma started with anticholinergic-containing plants such as Datura stramonium and Atropa belladonna, followed by ipratropium bromide and continued with tiotropium, glycopyrronium, and umeclidinium. Although antimuscarinics were used in the maintenance treatment of asthma over a century ago, after a long time (since 2014), it has been recommended to be used as an add-on long-acting antimuscarinic agent (LAMA) therapy in the maintenance treatment of asthma. The airway tone controlled by the vagus nerve is increased in asthma. Allergens, toxins, or viruses cause airway inflammation and inflammation-related epithelial damage, increased sensory nerve stimulation, ganglionic and postganglionic acetylcholine (ACh) release by inflammatory mediators, intensification of ACh signaling at M1 and M3 muscarinic ACh receptors (mAChRs), and dysfunction of M2 mAChR. Optimal anticholinergic drug for asthma should effectively block M3 and M1 receptors, but have minimal effect on M2 receptors. Tiotropium, umeclidinium, and glycopyrronium are anticholinergic agents with this feature. Tiotropium has been used in a separate inhaler as an add-on treatment to inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA), and glycopyrronium and umeclidinium have been used in a single inhaler as a combination of ICS/LABA/LAMA in asthma in recent years. Guidelines recommend this regimen as an optimization step for patients with severe asthma before initiating any biologic or systemic corticosteroid therapy. In this review, the history of antimuscarinic agents, their effectiveness and safety in line with randomized controlled trials, and real-life studies in asthma treatment will be discussed according to the current data.
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Affiliation(s)
- Bahar Arslan
- Division of Immunology and Allergy, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey
| | - Gülden Paçacı Çetin
- Division of Immunology and Allergy, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey
| | - İnsu Yilmaz
- Division of Immunology and Allergy, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey
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3
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Cazzola M, Page CP, Matera MG, Rogliani P, Hanania NA. Revisiting asthma pharmacotherapy: where do we stand and where do we want to go? Eur Respir J 2023; 62:2300700. [PMID: 37474159 DOI: 10.1183/13993003.00700-2023] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023]
Abstract
Several current guidelines/strategies outline a treatment approach to asthma, which primarily consider the goals of improving lung function and quality of life and reducing symptoms and exacerbations. They suggest a strategy of stepping up or down treatment, depending on the patient's overall current asthma symptom control and future risk of exacerbation. While this stepwise approach is undeniably practical for daily practice, it does not always address the underlying mechanisms of this heterogeneous disease. In the last decade, there have been attempts to improve the treatment of severe asthma, such as the addition of a long-acting antimuscarinic agent to the traditional inhaled corticosteroid/long-acting β2-agonist treatment and the introduction of therapies targeting key cytokines. However, despite such strategies several unmet needs in this population remain, motivating research to identify novel targets and develop improved therapeutic and/or preventative asthma treatments. Pending the availability of such therapies, it is essential to re-evaluate the current conventional "one-size-fits-all" approach to a more precise asthma management. Although challenging, identifying "treatable traits" that contribute to respiratory symptoms in individual patients with asthma may allow a more pragmatic approach to establish more personalised therapeutic goals.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Clive P Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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4
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Ferretti A, Gatto M, Velardi M, Di Nardo G, Foiadelli T, Terrin G, Cecili M, Raucci U, Valeriani M, Parisi P. Migraine, Allergy, and Histamine: Is There a Link? J Clin Med 2023; 12:jcm12103566. [PMID: 37240671 DOI: 10.3390/jcm12103566] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
The relationship between migraines and allergies is controversial. Though they are epidemiologically linked, the underlying pathophysiological connection between them remains unclear. Migraines and allergic disorders have various underlying genetic and biological causes. As per the literature, these conditions are epidemiologically linked, and some common pathophysiological pathways have been hypothesized. The histaminergic system may be the clue to understanding the correlation among these diseases. As a neurotransmitter in the central nervous system with a vasodilatory effect, histamine has a well-documented influence on the allergic response and could be involved in the pathophysiology of migraines. Histamine may influence hypothalamic activity, which may play a major role in migraines or may simply influence their severity. In both cases, antihistamine drugs could prove useful. This review examines whether the histaminergic system, particularly H3 and H4 receptors, may provide a mechanistic link between the pathophysiology of migraines and allergic disorders, two common and debilitating conditions. Identifying their connection could help identify novel therapeutic strategies.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Mattia Gatto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Margherita Velardi
- General and Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Giovanni Di Nardo
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianluca Terrin
- Department of Mother and Child, Gynecological and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, 00185 Rome, Italy
| | - Manuela Cecili
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Pasquale Parisi
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
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5
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Hartman JE, Srikanthan K, Caneja C, Ten Hacken NHT, Kerstjens HAM, Shah PL, Slebos DJ. Bronchoscopic Targeted Lung Denervation in Patients with Severe Asthma: Preliminary Findings. Respiration 2021; 101:184-189. [PMID: 34515243 DOI: 10.1159/000518515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
Treatment options for severe asthma are limited, particularly in those patients who do not meet criteria for biologicals. Targeted lung denervation (TLD) is the bronchoscopic ablation of the peribronchial vagal nerve trunks to reduce cholinergic stimulation of airway smooth muscle and submucosal glands. This report describes the experience of the first 2 asthma patients treated with TLD worldwide. The participants were 54 and 51 years of age, and both had severe asthma (GINA 5) (FEV1: 53% and 113% of predicted; AQLQ scores: 5.3 and 4.4). Both participants were treated with TLD in a single day-case procedure under general anaesthesia. Lung function, health status, and adverse event data were collected at baseline and 12 months after TLD. No treatment-related serious adverse events were reported up to 12 months. Cough symptoms improved in both participants, and 1 participant reported a marked reduction in rescue medication use at 6 months. There were no significant changes in spirometry, lung volumes, or health status. In conclusion, TLD was performed safely in both participants, but more evidence is needed to clarify safety and efficacy of TLD in severe asthma. Therefore, further investigation of the treatment in severe asthma patients would be useful.
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Affiliation(s)
- Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Karthi Srikanthan
- Royal Brompton Hospital, London, United Kingdom.,National Heart & Lung Institute, Imperial College, London, United Kingdom.,Chelsea & Westminster Hospital, London, United Kingdom
| | - Cielito Caneja
- Royal Brompton Hospital, London, United Kingdom.,Chelsea & Westminster Hospital, London, United Kingdom
| | - Nick H T Ten Hacken
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Pallav L Shah
- Royal Brompton Hospital, London, United Kingdom.,National Heart & Lung Institute, Imperial College, London, United Kingdom.,Chelsea & Westminster Hospital, London, United Kingdom
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Indacaterol, glycopyrronium, and mometasone: pharmacological interaction and anti-inflammatory profile in hyperresponsive airways. Pharmacol Res 2021; 172:105801. [PMID: 34363950 DOI: 10.1016/j.phrs.2021.105801] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
LABA/ICS and LABA/LAMA/ICS combinations elicit beneficial effects in asthma. Specific evidence concerning the impact of combining indacaterol acetate (IND), glycopyrronium bromide (GLY), and mometasone furoate (MF) on human airway hyperresponsiveness (AHR) and airway inflammation is still missing. The aim of this study was to characterize the synergy of IND/MF and IND/GLY/MF combinations, both once-daily treatments for asthma, in hyperresponsive airways. Passively sensitized human medium and small airways were stimulated by histamine and treated with IND/MF (molar ratio: 100/45, 100/90) and IND/GLY/MF (molar ratio: 100/37/45, 100/37/90). The effect on contractility and airway inflammation was tested. Drug interaction was assessed by Bliss Independence equation and Unified Theory. IND/MF 100/90 elicited middle-to-very strong synergistic relaxation in medium and small airways (+≈20-30% vs. additive effect, P<0.05), for IND/MF 100/45 the synergy was middle-to-very strong in small airways (+≈20% vs. additive effect, P<0.05), and additive in medium bronchi (P>0.05 vs. additive effect). IND/GLY/MF 100/37/45 and 100/37/90 induced very strong synergistic relaxation in medium and small airways (+≈30-50% vs. additive effect, P<0.05). Synergy was related with significant (P<0.05) reduction in IL-4, IL-5, IL-6, IL-9, IL-13, TNF-α, TSLP, NKA, SP, and non-neuronal ACh, and enhancement in cAMP. IND/MF and IND/GLY/MF combinations synergistically interact in hyperresponsive medium and small airways and modulate the levels of cytokines, neurokinins, ACh, and intracellular cAMP. The concentrations of MF in the combinations modulate the effects in the target tissue.
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7
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Wang L, Deng ZR, Zu MD, Zhang J, Wang Y. The Comorbid Relationship Between Migraine and Asthma: A Systematic Review and Meta-Analysis of Population-Based Studies. Front Med (Lausanne) 2021; 7:609528. [PMID: 33521020 PMCID: PMC7838157 DOI: 10.3389/fmed.2020.609528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/25/2020] [Indexed: 01/11/2023] Open
Abstract
Objective: Recent studies have indicated a pathophysiologic link between migraine and asthma. This meta-analysis aimed to comprehensively estimate the risk ratio for migraine in asthma as well as that of asthma in migraine based on available evidence. Method: We systematically searched the electronic databases including PubMed, Web of Science, and SCOPUS for population-based studies that measured either the odds or the risk of asthma in subjects with migraine as well as that of migraine in subjects with asthma. The titles and abstracts were screened by two independent reviewers to identify eligible studies, and this was followed by full-text review of the included studies. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias of included literature. A meta-analysis was conducted with Review Manager 5.3 Software to calculate the odds ratio (OR) for case-control and cross-sectional studies and either relative ratio (RR) or hazard ratio (HR) for cohort studies, and the source of heterogeneity was assessed. Subgroup and sensitivity analyses were conducted, and the I2 test were used to assess the source of heterogeneity. The funnel plot, Galbraith plot, and Egger's test were used to evaluate publication bias. Results: Fifteen published studies covering a total of 1,188,780 individuals were identified. Pooled analysis indicated that migraine was associated with increased odds (OR = 1.54; 95% CI: 1.34~1.77) and risk for asthma (HR = 1.42; 95% CI: 1.26~1.60), and asthma associated with increased odds (OR = 1.45; 95% CI: 1.22~1.72) and risk for migraine (HR = 1.47; 95% CI: 1.41~1.52). Conclusion: Migraine is a potential risk indicator for asthma, and vice versa, asthma is a potential risk indicator for migraine. However, future prospective cohort studies are warranted to provide more evidence concerning the detailed association between migraine and asthma.
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Affiliation(s)
- Long Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Neurology, The Second People Hospital of Hefei, Hefei, China
| | - Zi-Ru Deng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mei-Dan Zu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Juan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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8
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Bhattacharyya P, Saha D, Sengupta S, De D. Feasibility of testing bronchodilator responsiveness with glycopyrronium in obstructive airway diseases: the initial appraisal of the pilot experience. THE JOURNAL OF ASSOCIATION OF CHEST PHYSICIANS 2021. [DOI: 10.4103/jacp.jacp_34_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Calzetta L, Ritondo BL, Matera MG, Facciolo F, Rogliani P. Targeting IL-5 pathway against airway hyperresponsiveness: A comparison between benralizumab and mepolizumab. Br J Pharmacol 2020; 177:4750-4765. [PMID: 32857420 DOI: 10.1111/bph.15240] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/14/2020] [Accepted: 08/10/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND PURPOSE Airway hyperresponsiveness (AHR) is a central abnormality in asthma. IL-5 may modulate AHR in animal models of asthma, but the available data is inconsistent on the impact of targeting IL-5 pathway against AHR. The difference between targeting IL-5 or the IL-5 receptor, α subunit (IL-5Rα) in modulating AHR remains to be investigated in human airways. The aim of this study was to compare the role of the anti-IL-5Rα benralizumab and the anti-IL-5 mepolizumab against AHR and to assess whether these agents influence the levels of cAMP. EXPERIMENTAL APPROACH Passively sensitized human airways were treated with benralizumab and mepolizumab. The primary endpoint was the inhibition of AHR to histamine. The secondary endpoints were the protective effect against AHR to parasympathetic activation and mechanical stress, and the tissue modulation of cAMP. KEY RESULTS Benralizumab and mepolizumab significantly inhibited the AHR to histamine (maximal effect -134.14 ± 14.93% and -108.29 ± 32.16%, respectively), with benralizumab being 0.73 ± 0.10 logarithm significantly more potent than mepolizumab. Benralizumab and mepolizumab significantly inhibited the AHR to transmural stimulation and mechanical stress. Benralizumab was 0.45 ± 0.16 logarithm significantly more potent than mepolizumab against AHR to parasympathetic activation. The effect of these agents was significantly correlated with increased levels of cAMP. CONCLUSION AND IMPLICATIONS Targeting the IL-5/IL-5Rα axis is an effective strategy to prevent the AHR. Benralizumab was more potent than the mepolizumab and the concentration-dependent beneficial effects of both these monoclonal antibodies were related to improved levels of cAMP in hyperresponsive airways.
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Affiliation(s)
- Luigino Calzetta
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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Matera MG, Belardo C, Rinaldi M, Rinaldi B, Cazzola M. New perspectives on the role of muscarinic antagonists in asthma therapy. Expert Rev Respir Med 2020; 14:817-824. [PMID: 32316778 DOI: 10.1080/17476348.2020.1758069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION There is increasing evidence that tiotropium, a long-acting muscarinic agent (LAMA), is useful in the presence of severe-uncontrolled asthma despite the optimization of therapy with inhaled corticosteroids (ICSs) and long-acting β2 agonists (LABAs) as recommended by the current guidelines. Furthermore, in recent years there have been several preclinical and clinical studies on the pharmacological and therapeutic impact of other LAMAs in asthma. AREAS COVERED We have conducted an extensive search on muscarinic antagonists in asthma therapy throughout several sources and discuss what has emerged in the last 3 years (January 2017-March 2020). EXPERT OPINION New evidence indicates that the effectiveness of adding a LAMA, at least tiotropium, is independent of the degree of the type 2 inflammation and age of patient. Therefore, tiotropium can be administered without the need for patient phenotyping. Umeclidinium and glycopyrronium also appear effective in asthma. Initial treatment with LAMA+ICS for those with mild asthma may be an equally effective therapeutic option as LABA+ICS but this hypothesis should be confirmed by statistically powered trials.
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Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Carmela Belardo
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Michele Rinaldi
- Multidisciplinary Department of Medical-Surgical and Dental Specialities, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Barbara Rinaldi
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata" , Rome, Italy
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He D, Chen H, Zeng M, Xia C, Wang J, Shen L, Zhu D, Chen Y, Wang J. Asthmatic Airway Vagal Hypertonia Involves Chloride Dyshomeostasis of Preganglionic Neurons in Rats. Front Neurosci 2020; 14:31. [PMID: 32082109 PMCID: PMC7005078 DOI: 10.3389/fnins.2020.00031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/10/2020] [Indexed: 11/17/2022] Open
Abstract
Airway vagal hypertonia is closely related to the severity of asthma; however, the mechanisms of its genesis are unclear. This study aims to prove that asthmatic airway vagal hypertonia involves neuronal Cl– dyshomeostasis. The experimental airway allergy model was prepared with ovalbumin in male adult Sprague-Dawley rats. Plethysmography was used to evaluate airway vagal response to intracisternally injected γ-aminobutyric acid (GABA). Immunofluorescent staining and Western-blot assay were used to examine the expression of microglia-specific proteins, Na+-K+-2Cl– co-transporter 1 (NKCC1), K+-Cl– co-transporter 2 (KCC2) and brain-derived nerve growth factor (BDNF) in airway vagal centers. Pulmonary inflammatory changes were examined with hematoxylin and eosin staining of lung sections and ELISA assay of ovalbumin-specific IgE in bronchoalveolar lavage fluid (BALF). The results showed that histochemically, experimental airway allergy activated microglia, upregulated NKCC1, downregulated KCC2, and increased the content of BDNF in airway vagal centers. Functionally, experimental airway allergy augmented the excitatory airway vagal response to intracisternally injected GABA, which was attenuated by intracisternally pre-injected NKCC1 inhibitor bumetanide. All of the changes induced by experimental airway allergy were prevented or mitigated by chronic intracerebroventricular or intraperitoneal injection of minocycline, an inhibitor of microglia activation. These results demonstrate that experimental airway allergy augments the excitatory response of airway vagal centers to GABA, which might be the result of neuronal Cl– dyshomeostasis subsequent to microglia activation, increased BDNF release and altered expression of Cl– transporters. Cl– dyshomeostasis in airway vagal centers might contribute to the genesis of airway vagal hypertonia in asthma.
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Affiliation(s)
- Ding He
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Hong Chen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Ming Zeng
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Chunmei Xia
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Jin Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Linlin Shen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Danian Zhu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yonghua Chen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Jijiang Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
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12
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Gordina AV, Egoshina KA, Eliseeva TI, Vinogradova NG, Ovsyannikov DY, Tush EV, Prakhov AV, Daniel-Abu MI, Khaletskaya OV, Kubysheva NI. The Relationship Between Bronchial Patency and Parameters of ECG Supraventricular Component in Children With Bronchial Asthma. Front Pediatr 2020; 8:576. [PMID: 33042919 PMCID: PMC7524896 DOI: 10.3389/fped.2020.00576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/06/2020] [Indexed: 11/14/2022] Open
Abstract
Background: Uncontrolled asthma (BA) can be complicated by cardiac conduction disturbances and arrhythmias. It is typical mainly for adult asthmatics patients. In asthmatics children the effect of bronchoconstriction on cardiac conduction, including the supraventricular component of the ECG, is currently under discussion. The objective of the research is to analyze ECG parameters of the atrial complex and atrioventricular conduction and to assess their relationship with spirometric indicators in children with BA. Methods: Hundred three patients with BA from the age of 6-17 years were examined. The spirometric parameters were evaluated, including the Tiffeneau index (TI): FEV1/FVC (%), according to the level of which the patient groups were distinguished. Group 1 (G1): with TI more than 85%, (n = 15); Group 2 (G2): with TI from 85 to 75%, (n = 40); Group 3 (G3): with TI <75%, (n = 48). The ECG parameters that characterize supraventricular conduction, including the PQ interval (sec) and the sPQ segment (sec), were analyzed. We had calculated relative PQ (rPQ) by the formula rPQ=PQ/PQmed, where PQ is the patient's PQ, PQmed are the median PQ values of healthy children of age selected. Results: The duration of the PQ in groups G1 and G2 was 0.13 (0.11; 0.14) s; and 0.13 (0.12; 0.14) s, respectively, which is statistically significantly less than in patients of groups G3-0.14 (0.13; 0.15] s, p = 0.01. The duration of the sPQ segment in children of groups G1 and G2 was also generally shorter than in patients of groups G3, and amounted, respectively, to 0.05 (0.04; 0.06) s, 0.04 (0.04; 0.05) s, and 0.06 (0.04; 0.07) s, p = 0.02. The rPQ increased progressively as TI decreased and amounted in G1 to 92.9 (85.7; 106.3) %, in G2 100.0 (92.9; 103.0) %, and in G3 104 (100.0; 107.7) %, p = 0.009. A statistically significant negative correlation between IT and PQ-r = -0.23, p = 0.02; with sPQ-r = -0.20, p = 0.045; and with rPQ-r = -0.25, p = 0.01 was revealed. Conclusion: A decrease in TI in asthmatics children is associated with a prolongation of the PQ. This may indicate a slowdown in supraventricular conduction in patients with uncontrolled asthma and, thus, be considered as a risk for the formation of subsequent supraventricular arrhythmias.
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Affiliation(s)
- Alina V Gordina
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | | | | | - Nadezhda G Vinogradova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia.,City Clinical Hospital No. 38, Nizhny Novgorod, Russia
| | - Dmitry Yu Ovsyannikov
- Department of Pediatrics, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Elena V Tush
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Andrey V Prakhov
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Mojisola I Daniel-Abu
- Department of Pediatrics, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | | | - Nailya I Kubysheva
- Research Laboratory "Clinical Linguistics", Kazan Federal University, Kazan, Russia
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13
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Kim SY, Min C, Oh DJ, Lim JS, Choi HG. Bidirectional association between asthma and migraines in adults: Two longitudinal follow-up studies. Sci Rep 2019; 9:18343. [PMID: 31798009 PMCID: PMC6892888 DOI: 10.1038/s41598-019-54972-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/21/2019] [Indexed: 12/27/2022] Open
Abstract
The objective of this study was to evaluate the bidirectional association between asthma and migraines using control subjects matched by demographic factors. The Korean Health Insurance Review and Assessment Service - National Sample Cohort from 2002 to 2013 was used. In study I, 113,059 asthma participants were matched with 113,059 control I participants. In study II, 36,044 migraine participants were matched with 114,176 control II participants. The hazard ratios (HRs) of migraines in the asthma patients (study I) and asthma in the migraine patients (study II) were analyzed using stratified Cox proportional hazard models after adjusting for depression and the Charlson comorbidity index. In study I, 5.3% (6,017/ 113,059) of the asthma group and 3.4% (3,806/ 113,059) of the control I group had migraines (P < 0.001). The asthma group demonstrated an adjusted HR of 1.47 for migraine (95% confidence interval (CI) = 1.41–1.53, P < 0.001). In study II, 15.4% (5,548/36,044) of the migraine group and 10.6% (15,271/144,176) of the control group had asthma (P < 0.001). The migraine group showed an adjusted HR of 1.37 for asthma (95% CI = 1.33–1.41, P value < 0.001). Asthma and migraines are reciprocally associated.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea.,Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Dong Jun Oh
- Department of Internal medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Sung Lim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea. .,Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea.
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14
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Liccardi G, Calzetta L, Milanese M, Salzillo A, Apicella G, Matera MG, Rogliani P. Anxiety and asthma in inner-city black adolescents: What could be the underestimated, possible connection? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1093-1094. [PMID: 29747978 DOI: 10.1016/j.jaip.2018.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Gennaro Liccardi
- Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy; Postgraduate School of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.
| | - Luigino Calzetta
- Postgraduate School of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy; Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Manlio Milanese
- Division of Pulmonology, S. Corona Hospital, Pietra Ligure, Italy
| | - Antonello Salzillo
- Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Gerardo Apicella
- Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | | | - Paola Rogliani
- Postgraduate School of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy; Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
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15
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Chen X, Zeng M, He D, Yan X, Chen H, Chen Y, Xia C, Wang J, Shen L, Zhu D, Wang J. Asthmatic Augmentation of Airway Vagal Activity Involves Decreased Central Expression and Activity of CD73 in Rats. ACS Chem Neurosci 2019; 10:2809-2822. [PMID: 30913879 DOI: 10.1021/acschemneuro.9b00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The severity of asthma is closely related to the intensity of airway vagal activity; however, it is unclear how airway vagal activity is centrally augmented in asthma. Here we report that in an asthma model of male Sprague-Dawley rats, the expression and activity of ecto-5'-nucleotidase (CD73) were decreased in airway vagal centers, ATP concentration in cerebral spinal fluid was increased, and the inhibitory and excitatory airway vagal responses to intracisternally injected ATP (5 μmol) and CD73 inhibitor AMPCP (5 μmol), respectively, were attenuated. In airway vagal preganglionic neurons (AVPNs) identified in medullary slices of neonatal Sprague-Dawley rats, AMPCP (100 μmol·L-1) caused excitatory effects, as are shown in patch-clamp by depolarization, increased neuronal discharge, and facilitated spontaneous excitatory postsynaptic currents (sEPSCs). In contrast, exogenous ATP (100 μmol·L-1, 1 mmol·L-1) primarily caused inhibitory effects, which are similar to those induced by exogenous adenosine (100 μmol·L-1). Adenosine A1 receptor antagonist CPT (5 μmol·L-1) blocked the inhibition of sEPSCs induced by 100 μmol·L-1 exogenous ATP and that by 100 μmol·L-1 exogenous adenosine, whereas 50 μmol·L-1 CPT converted the inhibition of sEPSCs induced by 1 mmol·L-1 ATP to facilitation that was blocked by addition of P2X receptor antagonist PPADS (20 μmol·L-1). These results demonstrate that in rat, the sEPSCs of AVPNs are facilitated by extracellular ATP via activation of P2X receptors and inhibited by extracellular adenosine via activation of A1 receptors; in experimental asthma, decreased CD73 expression and activity in airway vagal centers contribute to the augmentation of airway vagal activity through imbalanced ATP/ADO modulation of AVPNs.
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Affiliation(s)
- Xingxin Chen
- Department of Neurobiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Ming Zeng
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Ding He
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Xianxia Yan
- Department of Neurobiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Hong Chen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Yonghua Chen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Chunmei Xia
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Jin Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Linlin Shen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Danian Zhu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Jijiang Wang
- Department of Neurobiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
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16
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Liccardi G, Calzetta L, Milanese M, Salzillo A, Manzi F, Ferrari M, Rogliani P. Psychological Stress, Lung Function and Exacerbation Risk in COPD: Is an Increase of Cholinergic Tone a Possible Link? COPD 2018; 15:310-311. [DOI: 10.1080/15412555.2018.1459533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Gennaro Liccardi
- Department of Pulmonology, Haematology and Oncology. Division of Pulmonology and Allergology. High Speciality “A.Cardarelli” Hospital, Naples, Italy
- Post-graduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Luigino Calzetta
- Post-graduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Manlio Milanese
- Division of Pulmonology, S. Corona Hospital, Pietra Ligure (Savona), Italy
| | - Antonello Salzillo
- Department of Pulmonology, Haematology and Oncology. Division of Pulmonology and Allergology. High Speciality “A.Cardarelli” Hospital, Naples, Italy
| | - Filippo Manzi
- Department of Pulmonology, Haematology and Oncology. Division of Pulmonology and Allergology. High Speciality “A.Cardarelli” Hospital, Naples, Italy
| | - Marta Ferrari
- Division of Pulmonology, S. Corona Hospital, Pietra Ligure (Savona), Italy
| | - Paola Rogliani
- Post-graduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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17
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Liccardi G, Calzetta L, Salzillo A, Piccolo A, Apicella G, Rogliani P. Anxiety and asthma in youth. Is a stress-induced increased cholinergic tone the possible link? Pediatr Pulmonol 2018; 53:128-129. [PMID: 29193828 DOI: 10.1002/ppul.23904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/01/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Gennaro Liccardi
- Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy.,Postgraduate School of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Postgraduate School of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Antonello Salzillo
- Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Amedeo Piccolo
- Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Gerardo Apicella
- Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Paola Rogliani
- Postgraduate School of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
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18
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Liccardi G, Calzetta L, Salzillo A, Piccolo A, Pane G, Rogliani P. Can a better patient phenotyping predict the efficacy of tiotropium in asthmatic adolescents? Expert Opin Pharmacother 2017; 18:833-835. [PMID: 28399659 DOI: 10.1080/14656566.2017.1317980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Gennaro Liccardi
- a Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology , High Speciality 'A. Cardarelli' Hospital , Naples , Italy.,b Postgraduate School of Respiratory Medicine, Department of Systems Medicine , University of Rome 'Tor Vergata' , Rome , Italy
| | - Luigino Calzetta
- b Postgraduate School of Respiratory Medicine, Department of Systems Medicine , University of Rome 'Tor Vergata' , Rome , Italy.,c Department of Systems Medicine , University of Rome 'Tor Vergata' , Rome , Italy
| | - Antonello Salzillo
- a Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology , High Speciality 'A. Cardarelli' Hospital , Naples , Italy
| | - Amedeo Piccolo
- a Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology , High Speciality 'A. Cardarelli' Hospital , Naples , Italy
| | - Gloria Pane
- c Department of Systems Medicine , University of Rome 'Tor Vergata' , Rome , Italy
| | - Paola Rogliani
- b Postgraduate School of Respiratory Medicine, Department of Systems Medicine , University of Rome 'Tor Vergata' , Rome , Italy.,c Department of Systems Medicine , University of Rome 'Tor Vergata' , Rome , Italy
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19
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Cazzola M, Ora J, Rogliani P, Matera MG. Role of muscarinic antagonists in asthma therapy. Expert Rev Respir Med 2017; 11:239-253. [PMID: 28140686 DOI: 10.1080/17476348.2017.1289844] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Higher parasympathetic tone has been reported in asthmatics. In general, cholinergic contractile tone is increased by airway inflammation associated with asthma. Nevertheless, the role of muscarinic antagonists for the treatment of asthma has not yet been clearly defined. Areas covered: The use of SAMAs and LAMAs in asthma has been examined and discussed according with the published evidence. Particular attention has been given to the large Phase III clinical trial program designed to evaluate the efficacy and safety of tiotropium respimat added to standard treatment in adults, adolescents and children with persistent asthma across the spectrum of asthma severity. Expert commentary: The current evidence is that in patients with poorly controlled severe asthma despite the use of ICS and LABA, the addition of tiotropium significantly increases the time to the first severe exacerbation and provides a modest but sustained bronchodilation. Identical results should be produced using other LAMAs. In any case, the documentation that, at least in animal or in vitro models, LAMAs show significant anti-inflammatory and anti-proliferative capacities and are able to inhibit airway remodeling induced by allergens makes a strong presumption that the use of LAMAs in asthma may go beyond the simple bronchodilator effect.
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Affiliation(s)
- Mario Cazzola
- a Chair of Respiratory Medicine, Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Josuel Ora
- b Division of Respiratory Medicine, Department of Internal Medicine , University Hospital Tor Vergata , Rome , Italy
| | - Paola Rogliani
- a Chair of Respiratory Medicine, Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy.,b Division of Respiratory Medicine, Department of Internal Medicine , University Hospital Tor Vergata , Rome , Italy
| | - Maria Gabriella Matera
- c Chair of Pharmacology, Department of Experimental Medicine , Second University of Naples , Naples , Italy
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20
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Liccardi G, Salzillo A, Calzetta L, Ora J, Rogliani P. Gastroesophageal reflux and COPD exacerbations: Is cholinergic-mediated oesophago-bronchial reflex a possible link? Respirology 2016; 21:1496-1497. [PMID: 27634491 DOI: 10.1111/resp.12896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/28/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Gennaro Liccardi
- Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A.Cardarelli" Hospital, Naples, Italy. .,Department of Systems Medicine, Postgraduate School of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Antonello Salzillo
- Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A.Cardarelli" Hospital, Naples, Italy
| | - Luigino Calzetta
- Department of Systems Medicine, Postgraduate School of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy.,Unit of Respiratory Clinical Pharmacology Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Josuel Ora
- Department of Systems Medicine, Postgraduate School of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Rogliani
- Department of Systems Medicine, Postgraduate School of Respiratory Medicine, University of Rome Tor Vergata, Rome, Italy.,Unit of Respiratory Clinical Pharmacology Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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