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Blush RR. β-Adrenergic Agonist-Induced Lactic Acidosis: A Case Report. AACN Adv Crit Care 2024; 35:222-227. [PMID: 39213627 DOI: 10.4037/aacnacc2024787] [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: 09/04/2024]
Abstract
β-Adrenergic agonist medications such as albuterol are the mainstay for treatment of patients with acute asthma exacerbations. Patients who present to the emergency department with severe symptoms are often treated with multiple albuterol doses in sequence to maximize the impact of the medications, relax bronchoconstriction, and relieve their breathlessness. Patients who present with acute dyspnea have numerous potential causes of hyperlactatemia and acidosis including an uncommonly recognized outcome of albuterol administration. This clinical case report outlines a scenario where a patient who was treated for an acute asthma exacerbation had rising lactate levels despite improving clinically. Causes of elevated lactate levels are discussed, particularly related to β-adrenergic agonist use, and considerations for monitoring and withdrawal of albuterol administration are outlined.
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Affiliation(s)
- Raymond R Blush
- Raymond R. Blush III is Clinical Assistant Professor, University of Michigan School of Nursing, Room 2304, 400 SNB N Ingalls, Ann Arbor, MI 48109
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2
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Markus H, Ceneviva GD, Thomas NJ, Krawiec C. Supraventricular tachycardia diagnosis in asthma patients is associated with adverse health outcomes. Pediatr Pulmonol 2024. [PMID: 39185635 DOI: 10.1002/ppul.27219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/27/2024] [Accepted: 08/09/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Supraventricular tachycardia (SVT) can occur during treatment of an acute asthma exacerbation. There are, however, no data on the long-term outcomes of children who are diagnosed with both asthma and SVT. This study aims to analyze the impact of SVT in asthmatic children on mortality and/or cardiac arrest, hypothesizing asthmatic subjects with SVT have increased mortality and/or cardiac arrest compared to asthmatic subject with no-SVT. METHODS This was a retrospective cohort study, utilizing the TriNetX© electronic health record (EHR) database that included asthmatic subjects 2-18 years of age. The study population was divided into two groups (subjects with SVT diagnosis and no-SVT diagnosis). Data related to demographics, diagnostic, procedural, and medication codes were collected. The primary outcome was any death and/or cardiac arrest in a patient after the first asthma diagnosis date. RESULTS This study included 91,066 asthmatic subjects (244 [0.27%] with SVT and 90,822 [99.73%] with no-SVT). Multivariable logistic regression analysis demonstrated that after controlling for demographic and clinical features, the odds of all-cause death and/or cardiac arrest after the first reported asthma exacerbation was significantly higher in asthmatic children with SVT compared to no-SVT (odds ratio [OR]: 4.30, confidence interval [CI]: 2.50-7.39, p < .001). CONCLUSIONS Our large nationwide EHR study suggests that asthmatic pediatric patients with documented SVT diagnosis at any point in their EHR may be at increased risk of adverse health outcomes compared to no-SVT. Further studies are needed to determine the factors contributing to the increased risk of mortality and/or cardiac arrest in children with asthma and SVT.
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Affiliation(s)
- Havell Markus
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Program in Bioinformatics and Genomics, Pennsylvania State University, University Park, Pennsylvania, USA
- Medical Scientist Training Program, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Gary D Ceneviva
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Neal J Thomas
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Conrad Krawiec
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
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3
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Conaway S, Huang W, Hernandez-Lara MA, Kane MA, Penn RB, Deshpande DA. Molecular mechanism of bitter taste receptor agonist-mediated relaxation of airway smooth muscle. FASEB J 2024; 38:e23842. [PMID: 39037554 PMCID: PMC11299423 DOI: 10.1096/fj.202400452r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/24/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
G-protein-coupled receptors (GPCRs) belonging to the type 2 taste receptors (TAS2Rs) family are predominantly present in taste cells to allow the perception of bitter-tasting compounds. TAS2Rs have also been shown to be expressed in human airway smooth muscle (ASM), and TAS2R agonists relax ASM cells and bronchodilate airways despite elevating intracellular calcium. This calcium "paradox" (calcium mediates contraction by pro-contractile Gq-coupled GPCRs) and the mechanisms by which TAS2R agonists relax ASM remain poorly understood. To gain insight into pro-relaxant mechanisms effected by TAS2Rs, we employed an unbiased phosphoproteomic approach involving dual-mass spectrometry to determine differences in the phosphorylation of contractile-related proteins in ASM following the stimulation of cells with TAS2R agonists, histamine (an agonist of the Gq-coupled H1 histamine receptor) or isoproterenol (an agonist of the Gs-coupled β2-adrenoceptor) alone or in combination. Our study identified differential phosphorylation of proteins regulating contraction, including A-kinase anchoring protein (AKAP)2, AKAP12, and RhoA guanine nucleotide exchange factor (ARHGEF)12. Subsequent signaling analyses revealed RhoA and the T853 residue on myosin light chain phosphatase (MYPT)1 as points of mechanistic divergence between TAS2R and Gs-coupled GPCR pathways. Unlike Gs-coupled receptor signaling, which inhibits histamine-induced myosin light chain (MLC)20 phosphorylation via protein kinase A (PKA)-dependent inhibition of intracellular calcium mobilization, HSP20 and ERK1/2 activity, TAS2Rs are shown to inhibit histamine-induced pMLC20 via inhibition of RhoA activity and MYPT1 phosphorylation at the T853 residue. These findings provide insight into the TAS2R signaling in ASM by defining a distinct signaling mechanism modulating inhibition of pMLC20 to relax contracted ASM.
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Affiliation(s)
- Stanley Conaway
- Center for Translational Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, PA, U.S.A., 19107
| | - Weiliang Huang
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, U.S.A., 21201
| | - Miguel A. Hernandez-Lara
- Center for Translational Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, PA, U.S.A., 19107
| | - Maureen A. Kane
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, U.S.A., 21201
| | - Raymond B. Penn
- Center for Translational Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, PA, U.S.A., 19107
| | - Deepak A. Deshpande
- Center for Translational Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, PA, U.S.A., 19107
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4
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Suh DI, Johnston SL. The Wiser Strategy of Using Beta-Agonists in Asthma: Mechanisms and Rationales. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:217-234. [PMID: 38910281 PMCID: PMC11199159 DOI: 10.4168/aair.2024.16.3.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024]
Abstract
Concerns regarding the safety of beta-2 agonists have led to revisions of the major asthma guidelines to better address these issues. Although these updates allow for a combination of previous and current strategies, they may confuse clinical practitioners. Beta-2 agonists are vital for alleviating asthma symptoms by relaxing smooth muscles; however, they also pose significant risks by inducing pro-inflammatory mediators both in vitro and in vivo. In addition to the risks of overuse and symptom masking, the use of beta-agonists alone at therapeutic doses can worsen airway inflammation and enhance virus-induced inflammation during asthma exacerbation. Inhaled corticosteroids (ICS) can effectively prevent these adverse effects. With new insights into the mechanisms of these adverse events, reserving short-acting beta-agonists for acute symptom relief during exacerbations and only for those who are already on ICS or oral steroids represents a careful approach to using beta-agonists with least adverse effects in patients with asthma. However, a major drawback of this approach is the potential non-compliance with ICS, leading to beta-agonist use without the necessary counteraction by ICS. An optimal strategy, both during and outside exacerbations, would integrate beta-agonists into an anti-inflammatory regimen that includes ICS, ideally combined with the same inhaler to ensure their concurrent use where finances allow. This would maintain the beneficial effects of beta-agonists, such as bronchodilation, while preventing the adverse effects from the induction of inflammatory mediators. This method is aligned with diverse clinical settings, maximizes the safe use of beta-agonists, and supports a comprehensive guideline-compliant management strategy.
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Affiliation(s)
- Dong In Suh
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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5
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Baker JG, Shaw DE. Asthma and COPD: A Focus on β-Agonists - Past, Present and Future. Handb Exp Pharmacol 2024; 285:369-451. [PMID: 37709918 DOI: 10.1007/164_2023_679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Asthma has been recognised as a respiratory disorder for millennia and the focus of targeted drug development for the last 120 years. Asthma is one of the most common chronic non-communicable diseases worldwide. Chronic obstructive pulmonary disease (COPD), a leading cause of morbidity and mortality worldwide, is caused by exposure to tobacco smoke and other noxious particles and exerts a substantial economic and social burden. This chapter reviews the development of the treatments of asthma and COPD particularly focussing on the β-agonists, from the isolation of adrenaline, through the development of generations of short- and long-acting β-agonists. It reviews asthma death epidemics, considers the intrinsic efficacy of clinical compounds, and charts the improvement in selectivity and duration of action that has led to our current medications. Important β2-agonist compounds no longer used are considered, including some with additional properties, and how the different pharmacological properties of current β2-agonists underpin their different places in treatment guidelines. Finally, it concludes with a look forward to future developments that could improve the β-agonists still further, including extending their availability to areas of the world with less readily accessible healthcare.
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Affiliation(s)
- Jillian G Baker
- Department of Respiratory Medicine, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Cell Signalling, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
| | - Dominick E Shaw
- Nottingham NIHR Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, UK
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6
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You SH, Lee CN. Dietary Exposure and Risk Assessment of Beta-Agonist Residues in Commercial Beef and Pork in Taiwan. Foods 2023; 12:4052. [PMID: 38002110 PMCID: PMC10670263 DOI: 10.3390/foods12224052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
Beta-agonists (β-agonists) in meat products in one's diet raise concerns about the possibility of foodborne illness. It may also lead to discomfort, such as headaches and occasional irregular heartbeats, which might be linked to a heightened concern for cardiovascular issues. Taiwan's high demand for meat and reliance on imported meat products from certain countries where β-agonists are permitted has raised concerns. Recent import border checks and monitoring of meat products in the market have revealed the concentration of non-compliance with β-agonist residue regulations, which is ten ppb. This study aims to analyze the concentration of β-agonist residues in meat products sold in Taiwan and assess the current levels of exposure and dietary risk for consumers. The study analyzed 1415 samples of domestically produced and imported livestock products from supermarkets, traditional markets, and bulk stores in New Taipei City between 2019 and 2023. The samples were analyzed using the method for detecting 21 β-agonists based on the Taiwan Food and Drug Administration's specifications. Estimated daily intake (EDI) of β-agonists for different age groups and the target hazard quotient (THQ) were used to assess dietary exposure and risk. The results showed that all 1415 samples were compliant with regulations. Among them, 43 beef samples showed residues of ractopamine originating from the United States, with residue concentrations ranging from 1 to 10 μg/kg and an average residue concentration of 3.3 ± 1.9 μg/kg. Under average consumption, the highest EDI for the exposed population was observed in the 6-12 age group, with values of 0.1469 μg/kg/day, 0.0734 μg/kg/day, and 0.0242 μg/kg/day for the three residue concentrations (maximum detected residue, maximum allowable residue, and average detected residue, respectively). The THQs for ractopamine in imported beef samples were all less than 1, indicating no health hazards at the current intake levels of each age group and the residue concentrations in commercially available beef. Despite the findings, traders need to acknowledge regulatory variations between Taiwan and exporting countries when importing meat products. Traders should provide inspection reports to monitor β-agonist residue levels in imports or explore sourcing beef from countries with β-agonist bans.
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Affiliation(s)
- Shu-Han You
- Institute of Food Safety and Risk Management, National Taiwan Ocean University, Keelung City 20224, Taiwan
| | - Chieh-Ning Lee
- Master Program of Food Safety Management, National Taiwan Ocean University, Keelung City 20224, Taiwan;
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7
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Ahn S, Maarsingh H, Walker JK, Liu S, Hegde A, Sumajit HC, Kahsai AW, Lefkowitz RJ. Allosteric modulator potentiates β2AR agonist-promoted bronchoprotection in asthma models. J Clin Invest 2023; 133:e167337. [PMID: 37432742 PMCID: PMC10503797 DOI: 10.1172/jci167337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/06/2023] [Indexed: 07/12/2023] Open
Abstract
Asthma is a chronic inflammatory disease associated with episodic airway narrowing. Inhaled β2-adrenergic receptor (β2AR) agonists (β2-agonists) promote - with limited efficacy - bronchodilation in asthma. All β2-agonists are canonical orthosteric ligands that bind the same site as endogenous epinephrine. We recently isolated a β2AR-selective positive allosteric modulator (PAM), compound-6 (Cmpd-6), which binds outside of the orthosteric site and modulates orthosteric ligand functions. With the emerging therapeutic potential of G-protein coupled receptor allosteric ligands, we investigated the impact of Cmpd-6 on β2AR-mediated bronchoprotection. Consistent with our findings using human β2ARs, Cmpd-6 allosterically potentiated β2-agonist binding to guinea pig β2ARs and downstream signaling of β2ARs. In contrast, Cmpd-6 had no such effect on murine β2ARs, which lack a crucial amino acid in the Cmpd-6 allosteric binding site. Importantly, Cmpd-6 enhanced β2 agonist-mediated bronchoprotection against methacholine-induced bronchoconstriction in guinea pig lung slices, but - in line with the binding studies - not in mice. Moreover, Cmpd-6 robustly potentiated β2 agonist-mediated bronchoprotection against allergen-induced airway constriction in lung slices obtained from a guinea pig model of allergic asthma. Cmpd-6 similarly enhanced β2 agonist-mediated bronchoprotection against methacholine-induced bronchoconstriction in human lung slices. Our results highlight the potential of β2AR-selective PAMs in the treatment of airway narrowing in asthma and other obstructive respiratory diseases.
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Affiliation(s)
- Seungkirl Ahn
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Harm Maarsingh
- Department of Pharmaceutical Sciences, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida, USA
| | - Julia K.L. Walker
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Samuel Liu
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Akhil Hegde
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Hyeje C. Sumajit
- Department of Pharmaceutical Sciences, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida, USA
| | - Alem W. Kahsai
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert J. Lefkowitz
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biochemistry and
- Howard Hughes Medical Institute, Duke University School of Medicine, Durham, North Carolina, USA
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8
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Thomasius F, Pesta D, Rittweger J. Adjuvant pharmacological strategies for the musculoskeletal system during long-term space missions. Br J Clin Pharmacol 2023. [PMID: 37559171 DOI: 10.1111/bcp.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
Despite 2 h of daily exercise training, muscle wasting and bone loss are still present after 6-month missions to the international space station. Some crew members lose bone much faster than others. In preparation for missions to the Moon and Mars, space agencies are therefore reviewing their countermeasure portfolios. Here, we discuss the potential of current pharmacological strategies. Bone loss in space is fuelled by bone resorption. Alendronate, an oral bisphosphonate, reduced bone losses in experimental bed rest and space. However, gastrointestinal side effects precluded its further utilization in space. Zoledronate (a potent bisphosphonate), denosumab (RANKL antagonist) and romosozumab (sclerostin antagonist) are all administered via injection. They effectively suppress bone resorption and are routinely prescribed against osteoporosis. Their serious adverse effects, namely, osteonecrosis of the jaw and atypical femur fractures occur very rarely when the usage is limited to 1 or 2 years. Hence, utilization of one of these compounds may outweigh the bone risks of space travelling, in particular in those with high bone resorption rates. Muscle wasting in space is likely due to hampered muscle protein synthesis. Even though this might theoretically be countered by the synthesis-boosting effects of anabolic steroids, the practical grounds for such recommendation are currently weak. Moreover, they reveal their full potential only when combined with an anabolic exercise stimulus, for example, via strength training. It therefore seems that a combination of exercise and pharmacological countermeasures should be considered for musculoskeletal health on the way to the Moon and Mars and back.
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Affiliation(s)
| | - Dominik Pesta
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Centre for Endocrinology, Diabetes and Preventive Medicine (CEDP), University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University Hospital Cologne, Cologne, Germany
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9
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Beng H, Hu J, Wang S, Liang X, Qin H, Tan W. Effects of R-salbutamol on the inflammatory response and acute lung injury in endotoxemic mice. Int Immunopharmacol 2023; 121:110482. [PMID: 37364330 DOI: 10.1016/j.intimp.2023.110482] [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] [Received: 04/07/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
Salbutamol, which consists of an R-isomer and S-isomer, is an effective and widely used β2 adrenoreceptor agonist that may possess anti-inflammatory properties in addition to its bronchodilator activity. Whether the salbutamol R-isomer has advantages over its racemic mixture and effectiveness in treating endotoxemia and endotoxin-induced lung injury has not been well studied. In this study, we investigated the preventive and therapeutic effects of R-salbutamol (R-sal), S-salbutamol (S-sal), and their racemic mixture (Rac-sal) on a mouse model of lipopolysaccharide (LPS)-induced endotoxemia. Dexamethasone (Dex) was used for comparison. The results showed that R-sal markedly improved the 7-day survival rate of endotoxic mice when administered before and after LPS treatment. Dex was toxic and accelerated the death of endotoxic mice when administered before LPS injection. Histological examination of the lungs revealed that the LPS challenge resulted in acute lung damage, including inflammatory cell infiltration, thickened alveolar septa, and congestion. R-sal pre-treatment effectively inhibited these changes, accompanied by markedly reduced lung myeloperoxidase levels, serum cytokine levels, and lactate release, significant restoration of lymphocyte count, and reduction of monocyte count. This may have occurred through inhibition of M1 macrophage inflammatory responses by enhancement of β-arrestin2 expression and suppression of NF-κB activation. Rac-sal exhibited diminished effects compared to that of R-sal, while S-sal showed enhanced release of some inflammatory cytokines. In addition, R-sal pre-treatment showed a better improvement in prognostic pulmonary function on day 4 compared to that by Rac-sal. Collectively, our results indicate the potential benefits of R-sal in regulating inflammatory responses to endotoxemia and endotoxin-induced lung injury.
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Affiliation(s)
- Huimin Beng
- Post-Doctoral Innovation Site, Jinan University Affiliation, Yuanzhi Health-tech Inc., Hengqin District, Zhuhai 519000, Guangdong, China; Kesi (Shandong) Innovation Service Inc., heze modern medical port, Mudan district, Heze 274009, Shandong, China; Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Junhua Hu
- Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Shanping Wang
- Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Xinglong Liang
- Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Haolong Qin
- Institute of Biomedical & Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China
| | - Wen Tan
- Post-Doctoral Innovation Site, Jinan University Affiliation, Yuanzhi Health-tech Inc., Hengqin District, Zhuhai 519000, Guangdong, China; Kesi (Shandong) Innovation Service Inc., heze modern medical port, Mudan district, Heze 274009, Shandong, China; Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia.
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10
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Boboltz A, Kumar S, Duncan GA. Inhaled drug delivery for the targeted treatment of asthma. Adv Drug Deliv Rev 2023; 198:114858. [PMID: 37178928 PMCID: PMC10330872 DOI: 10.1016/j.addr.2023.114858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/14/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
Asthma is a chronic lung disease affecting millions worldwide. While classically acknowledged to result from allergen-driven type 2 inflammatory responses leading to IgE and cytokine production and the influx of immune cells such as mast cells and eosinophils, the wide range in asthmatic pathobiological subtypes lead to highly variable responses to anti-inflammatory therapies. Thus, there is a need to develop patient-specific therapies capable of addressing the full spectrum of asthmatic lung disease. Moreover, delivery of targeted treatments for asthma directly to the lung may help to maximize therapeutic benefit, but challenges remain in design of effective formulations for the inhaled route. In this review, we discuss the current understanding of asthmatic disease progression as well as genetic and epigenetic disease modifiers associated with asthma severity and exacerbation of disease. We also overview the limitations of clinically available treatments for asthma and discuss pre-clinical models of asthma used to evaluate new therapies. Based on the shortcomings of existing treatments, we highlight recent advances and new approaches to treat asthma via inhalation for monoclonal antibody delivery, mucolytic therapy to target airway mucus hypersecretion and gene therapies to address underlying drivers of disease. Finally, we conclude with discussion on the prospects for an inhaled vaccine to prevent asthma.
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Affiliation(s)
- Allison Boboltz
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States
| | - Sahana Kumar
- Biological Sciences Graduate Program, University of Maryland, College Park, MD 20742, United States
| | - Gregg A Duncan
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States; Biological Sciences Graduate Program, University of Maryland, College Park, MD 20742, United States.
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11
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Paulussen F, Kulkarni CP, Stolz F, Lescrinier E, De Graeve S, Lambin S, Marchand A, Chaltin P, In't Veld P, Mebis J, Tavernier J, Van Dijck P, Luyten W, Thevelein JM. The β2-adrenergic receptor in the apical membrane of intestinal enterocytes senses sugars to stimulate glucose uptake from the gut. Front Cell Dev Biol 2023; 10:1041930. [PMID: 36699012 PMCID: PMC9869975 DOI: 10.3389/fcell.2022.1041930] [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: 09/11/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
The presence of sugar in the gut causes induction of SGLT1, the sodium/glucose cotransporter in intestinal epithelial cells (enterocytes), and this is accompanied by stimulation of sugar absorption. Sugar sensing was suggested to involve a G-protein coupled receptor and cAMP - protein kinase A signalling, but the sugar receptor has remained unknown. We show strong expression and co-localization with SGLT1 of the β2-adrenergic receptor (β 2-AR) at the enterocyte apical membrane and reveal its role in stimulating glucose uptake from the gut by the sodium/glucose-linked transporter, SGLT1. Upon heterologous expression in different reporter systems, the β 2-AR responds to multiple sugars in the mM range, consistent with estimated gut sugar levels after a meal. Most adrenergic receptor antagonists inhibit sugar signaling, while some differentially inhibit epinephrine and sugar responses. However, sugars did not inhibit binding of I125-cyanopindolol, a β 2-AR antagonist, to the ligand-binding site in cell-free membrane preparations. This suggests different but interdependent binding sites. Glucose uptake into everted sacs from rat intestine was stimulated by epinephrine and sugars in a β 2-AR-dependent manner. STD-NMR confirmed direct physical binding of glucose to the β 2-AR. Oral administration of glucose with a non-bioavailable β 2-AR antagonist lowered the subsequent increase in blood glucose levels, confirming a role for enterocyte apical β 2-ARs in stimulating gut glucose uptake, and suggesting enterocyte β 2-AR as novel drug target in diabetic and obese patients. Future work will have to reveal how glucose sensing by enterocytes and neuroendocrine cells is connected, and whether β 2-ARs mediate glucose sensing also in other tissues.
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Affiliation(s)
- Frederik Paulussen
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | - Chetan P. Kulkarni
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,3Functional Genomics and Proteomics Research Unit, Department of Biology, KU Leuven, Leuven, Belgium
| | - Frank Stolz
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | - Eveline Lescrinier
- 4Medicinal Chemistry, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Stijn De Graeve
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | - Suzan Lambin
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | | | | | - Peter In't Veld
- 6Department of Pathology, Free University of Brussels, Brussels, Belgium
| | - Joseph Mebis
- 7Department of Pathology, KU Leuven, Flanders, Belgium
| | - Jan Tavernier
- 8Department of Biochemistry, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,9Center for Medical Biotechnology, VIB, Ghent, Belgium
| | - Patrick Van Dijck
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | - Walter Luyten
- 3Functional Genomics and Proteomics Research Unit, Department of Biology, KU Leuven, Leuven, Belgium
| | - Johan M. Thevelein
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium,10NovelYeast bv, Bio-Incubator BIO4, Gaston Geenslaan 3, Leuven-Heverlee,, Belgium,*Correspondence: Johan M. Thevelein,
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12
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Yamada K, Yamagiwa Y, Masatsugu M, Haranosono Y. Two cases of cartilaginous metaplasia in the sclera of Japanese White rabbits. J Toxicol Pathol 2023; 36:45-48. [PMID: 36683725 PMCID: PMC9837471 DOI: 10.1293/tox.2022-0062] [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: 06/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Spontaneous cartilaginous metaplasia of the sclera has not been reported in rabbits. Herein, we report two cases of spontaneous cartilaginous metaplasia in the sclera of Japanese White (JW) rabbits. Case 1 was noted in a 14-week-old male Kbs:JW rabbit that received a single ocular instillation of 20% isoproterenol (IP) a day before necropsy, and showed no abnormalities in clinical signs, ophthalmological assessments, and necropsy. Case 2 was noted in a 38-week-old male Kbs:JW rabbit that was housed under light-emitting diode (LED) lighting for 26 weeks and showed no effects of LED on clinical signs, ophthalmological assessments, and necropsy. Histological sections of the eyes of both animals were prepared and stained with hematoxylin and eosin (H&E) and Alcian blue, and immunohistochemical staining for vimentin was performed. The H&E-stained specimens showed focal hyaline cartilage-like tissues distributed between the scleral fibers at the posterior pole in both cases. The surrounding scleral fibers were compressed and/or partially destroyed by the cartilage-like tissue. The cartilage-like matrix was stained blue by Alcian blue, and immunohistochemistry showed that chondrocyte-like cells were positive for vimentin. Based on these findings, we diagnosed cartilaginous metaplasia in the sclera of Kbs:JW rabbits. The lesion was farther from the IP administration site in Case 1 and was not accompanied by other ophthalmological or histopathological abnormalities in either of the cases. This implies that the lesions occurred spontaneously owing to the abnormal differentiation of neural crest-derived cells.
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Affiliation(s)
- Kotaro Yamada
- Central Research Laboratories, Senju Pharmaceutical Co.,
Ltd., 6-4-3 Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan,*Corresponding author: K Yamada (e-mail: )
| | - Yoshinori Yamagiwa
- Central Research Laboratories, Senju Pharmaceutical Co.,
Ltd., 6-4-3 Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan
| | - Miki Masatsugu
- Central Research Laboratories, Senju Pharmaceutical Co.,
Ltd., 6-4-3 Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan
| | - Yu Haranosono
- Central Research Laboratories, Senju Pharmaceutical Co.,
Ltd., 6-4-3 Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan
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13
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Marchand TD, Dunham CM, Chance EA, Hileman BM. Trauma center admission risk conditions and the probability for developing alcohol withdrawal syndrome: A retrospective study. Injury 2023; 54:198-206. [PMID: 36096958 DOI: 10.1016/j.injury.2022.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Because the proportion of trauma patients developing alcohol withdrawal syndrome (AWS) is low, AWS risk conditions have not been precisely delineated. We aimed to create multifactor screening strategies to assess probabilities for the likelihood of developing AWS. METHODS We performed a retrospective chart review of 1,011 trauma patients admitted to a Level I trauma center to investigate the associations between AWS and probable AWS risk conditions. Included patients were adults who met trauma registry inclusion criteria and had blood alcohol concentration (BAC) testing performed. Patients were excluded if they had a traumatic brain injury with a Glasgow Coma Score (GCS) ≤ 8, or no BAC testing performed. We defined heavy drinking as daily drinking or >7 per week. RESULTS AWS had univariate associations with heavy drinking history, Injury Severity Score (ISS) ≥15, psychiatric disorders, liver disease, smoking history, in-hospital bronchodilator administration, age ≥45, male sex, Intensive Care Unit (ICU) admission, serum aspartate aminotransferase (AST) ≥40 U/L, and cognitive preservation (GCS ≥13 with BAC ≥100 mg/dL) (all, p < 0.05). ICU admission, AST ≥40 U/L, cognitive preservation, male sex, and age ≥45 had associations with ISS ≥15 or alcohol misuse (all, p < 0.0001). For patients with age ≥45 and heavy drinking history or age <45 and heavy drinking history with ISS ≥15 and ICU admission, the AWS proportion (15.3%) was greater in comparison to other patients (0.3%). The AWS risk score was the sum of the following nine conditions, assigned a zero when the condition was absent and one when present (range 0-9): ISS ≥15, psychiatric disorders, liver disease, smoking history, in-hospital bronchodilator administration, age ≥45, male sex, AST ≥40 U/L, and cognitive preservation. The AWS proportion was greater with a risk score of 5-9 (16.8%) than of 0-4 (1.2%; p < 0.0001). CONCLUSIONS AWS in the setting of traumatic injury is associated with multiple risk conditions. The presence of multiple risk conditions might have additive effects that could contribute toward a clinical manifestation of AWS. The identified risk conditions may be associated with a hyperadrenergic state.
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Affiliation(s)
- Tiffany D Marchand
- Trauma, Critical Care, and General Surgery Services, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States.
| | - C Michael Dunham
- Trauma, Critical Care, and General Surgery Services, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States
| | - Elisha A Chance
- Trauma and Neuroscience Research Department, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States
| | - Barbara M Hileman
- Trauma and Neuroscience Research Department, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH, 44501, United States
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14
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In Silico Drug Repurposing Framework Predicts Repaglinide, Agomelatine and Protokylol as TRPV1 Modulators with Analgesic Activity. Pharmaceutics 2022; 14:pharmaceutics14122563. [PMID: 36559057 PMCID: PMC9781017 DOI: 10.3390/pharmaceutics14122563] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
Pain is one of the most common symptoms experienced by patients. The use of current analgesics is limited by low efficacy and important side effects. Transient receptor potential vanilloid-1 (TRPV1) is a non-selective cation channel, activated by capsaicin, heat, low pH or pro-inflammatory agents. Since TRPV1 is a potential target for the development of novel analgesics due to its distribution and function, we aimed to develop an in silico drug repositioning framework to predict potential TRPV1 ligands among approved drugs as candidates for treating various types of pain. Structures of known TRPV1 agonists and antagonists were retrieved from ChEMBL databases and three datasets were established: agonists, antagonists and inactive molecules (pIC50 or pEC50 < 5 M). Structures of candidates for repurposing were retrieved from the DrugBank database. The curated active/inactive datasets were used to build and validate ligand-based predictive models using Bemis−Murcko structural scaffolds, plain ring systems, flexophore similarities and molecular descriptors. Further, molecular docking studies were performed on both active and inactive conformations of the TRPV1 channel to predict the binding affinities of repurposing candidates. Variables obtained from calculated scaffold-based activity scores, molecular descriptors criteria and molecular docking were used to build a multi-class neural network as an integrated machine learning algorithm to predict TRPV1 antagonists and agonists. The proposed predictive model had a higher accuracy for classifying TRPV1 agonists than antagonists, the ROC AUC values being 0.980 for predicting agonists, 0.972 for antagonists and 0.952 for inactive molecules. After screening the approved drugs with the validated algorithm, repaglinide (antidiabetic) and agomelatine (antidepressant) emerged as potential TRPV1 antagonists, and protokylol (bronchodilator) as an agonist. Further studies are required to confirm the predicted activity on TRPV1 and to assess the candidates’ efficacy in alleviating pain.
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15
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Zhang H, Cui M, Cao JL, Han MH. The Role of Beta-Adrenergic Receptors in Depression and Resilience. Biomedicines 2022; 10:2378. [PMID: 36289638 PMCID: PMC9598882 DOI: 10.3390/biomedicines10102378] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 09/29/2023] Open
Abstract
Norepinephrine is a catecholamine neurotransmitter that has been extensively implicated in the neurobiology of major depressive disorder (MDD). An accumulating body of evidence indicates that investigations into the action of norepinephrine at the synaptic/receptor level hold high potential for a better understanding of MDD neuropathology and introduce possibilities for developing novel treatments for depression. In this review article, we discuss recent advances in depression neuropathology and the effects of antidepressant medications based on preclinical and clinical studies related to beta-adrenergic receptor subtypes. We also highlight a beta-3 adrenergic receptor-involved mechanism that promotes stress resilience, through which antidepressant efficacy is achieved in both rodent models for depression and patients with major depression-an alternative therapeutic strategy that is conceptually different from the typical therapeutic approach in which treatment efficacy is achieved by reversing pathological alterations rather than by enhancing a good mechanism such as natural resilience. Altogether, in this review, we systematically describe the role of beta-adrenergic receptors in depression and stress resilience and provide a new avenue for developing a conceptually innovative treatment for depression.
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Affiliation(s)
- Hongxing Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Mengqiao Cui
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Jun-Li Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou 221004, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou 221004, China
| | - Ming-Hu Han
- Department of Mental Health and Public Health, Faculty of Life and Health Sciences, Institute of Brain Cognition and Brain Disease, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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16
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Perpiñá M, Gómez-Bastero A, Trisán A, Martínez-Moragón E, Álvarez-Gutiérrez FJ, Urrutia I, Blanco-Aparicio M. Expert consensus recommendations for the management of asthma in older adults. Med Clin (Barc) 2022; 159:53.e1-53.e14. [PMID: 34226059 DOI: 10.1016/j.medcli.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 10/20/2022]
Abstract
Asthma is a public health problem in patients of any age, although there is still a tendency to erroneously assume that it is almost always confined to children and young people. Epidemiological studies indicate that, from the sixth decade of life, the prevalence of this disease in countries such as Spain reaches 6-10%, with a higher prevalence among women aged 64 to 75 years. In addition, two-thirds of asthma deaths occur at this stage of life, resulting in a substantial number of hospital admissions, longer hospital stays and, from a finance point of view, significant direct economic costs. Asthma in older adults (65 years or older) is now a matter of great concern, the reality of which is underestimated and undertreated. It is therefore essential to establish appropriate recommendations for the diagnosis and treatment of asthma in the aging population. This consensus, which brings together the latest evidence available, was conceived with this objective. The proposed recommendations/conclusions are the result of a nominal consensus developed throughout 2019 and validated by panellists in successive rounds of voting.
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Affiliation(s)
- Miguel Perpiñá
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Andrea Trisán
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - Isabel Urrutia
- Unidad de Asma y Enfermedades Ocupacionales-Medioambientales, Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, España
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17
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Balbirsingh V, Mohammed AS, Turner AM, Newnham M. Cardiovascular disease in chronic obstructive pulmonary disease: a narrative review. Thorax 2022; 77:thoraxjnl-2021-218333. [PMID: 35772939 DOI: 10.1136/thoraxjnl-2021-218333] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/06/2022] [Indexed: 11/04/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD) and concomitant disease leads to reduced quality of life, increased hospitalisations and worse survival. Acute pulmonary exacerbations are an important contributor to COPD burden and are associated with increased cardiovascular (CV) events. Both COPD and CVD represent a significant global disease impact and understanding the relationship between the two could potentially reduce this burden. The association between CVD and COPD could be a consequence of (1) shared risk factors (environmental and/or genetic) (2) shared pathophysiological pathways (3) coassociation from a high prevalence of both diseases (4) adverse effects (including pulmonary exacerbations) of COPD contributing to CVD and (5) CVD medications potentially worsening COPD and vice versa. CV risk in COPD has traditionally been associated with increasing disease severity, but there are other relevant COPD subtype associations including radiological subtypes, those with frequent pulmonary exacerbations and novel disease clusters. While the prevalence of CVD is high in COPD populations, it may be underdiagnosed, and improved risk prediction, diagnosis and treatment optimisation could lead to improved outcomes. This state-of-the-art review will explore the incidence/prevalence, COPD subtype associations, shared pathophysiology and genetics, risk prediction, and treatment of CVD in COPD.
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Affiliation(s)
- Vishanna Balbirsingh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andrea S Mohammed
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Michael Newnham
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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18
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Adverse Drug Events Related to Common Asthma Medications in US Hospitalized Children, 2000-2016. Drugs Real World Outcomes 2022; 9:667-679. [PMID: 35676469 DOI: 10.1007/s40801-022-00304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The reduction in adverse drug events is a priority in healthcare. Medications are frequently prescribed for asthmatic children, but epidemiological trends of adverse drug events related to anti-asthmatic medications have not been described in hospitalized children. OBJECTIVE The objective of this study was to report incidence trends, risk factors, and healthcare utilization of adverse drug events related to anti-asthmatic medications by major drug classes in hospitalized children in the USA from 2000 to 2016. METHODS A population-based temporal analysis included those aged 0-20 years who were hospitalized with asthma from the 2000 to 2016 Kids Inpatient Database. Age-stratified weighted temporal trends of the inpatient incidence of adverse drug events related to anti-asthmatic medications (i.e., corticosteroids and bronchodilators) were estimated. Stepwise multivariate logistic regression models generated risk factors for adverse drug events. RESULTS From 2000 to 2016, 12,640 out of 698,501 pediatric asthma discharges (1.7%) were associated with adverse drug events from anti-asthmatic medications. 0.83% were adverse drug events from corticosteroids, resulting in a 1.14-fold increase in the length of stay (days) and a 1.42-fold increase in hospitalization charges (dollars). The overall incidence (per 1000 discharges) of anti-asthmatic medication adverse drug events increased from 5.3 (95% confidence interval [CI] 4.6-6.1) in 2000 to 21.6 (95% CI 18.7-24.6) in 2016 (p-trend = 0.024). Children aged 0-4 years had the most dramatic increase in the incidence of bronchodilator adverse drug events from 0.2 (95% CI 0.1-0.4) to 19.3 (95% CI 15.2-23.4) [p-trend ≤ 0.001]. In general, discharges among asthmatic children with some comorbidities were associated with an approximately two to five times higher odds of adverse drug events. CONCLUSIONS The incidence of adverse drug events from common anti-asthmatic medications quadrupled over the past decade, particularly among preschool-age children who used bronchodilators, resulting in substantial increased healthcare costs. Those asthmatic children with complex medical conditions may benefit the most from adverse drug event monitoring.
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19
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Geng C, Feng Y, Yang Y, Yang H, Li Z, Tang Y, Wang J, Zhao H. Allergic asthma aggravates angiotensin Ⅱ-induced cardiac remodeling in mice. Transl Res 2022; 244:88-100. [PMID: 35108660 DOI: 10.1016/j.trsl.2022.01.005] [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: 08/30/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease remains the leading cause of death globally, and heart failure (HF) represents its terminal stage. Asthma, one of the most common chronic diseases, has been reported to be associated with an increased risk of cardiovascular disease. However, the link between asthma and HF has rarely been studied, and the possible mechanisms by which asthma affects HF are unclear. This study aimed to explore the influence of asthma on HF and the possible mechanisms. We analyzed data from the National Health and Nutrition Examination Survey and found a higher prevalence of HF among asthmatic individuals, and identified an independent association between HF and asthma. Subsequently, we produced mice with concurrent ovalbumin (OVA) sensitization-induced allergic asthma and angiotensin Ⅱ infusion-induced cardiac remodeling to explore the effect of asthma on cardiac remodeling in vivo. The results showed that OVA-induced asthma impaired heart function and aggravated cardiac remodeling in mice. We also found that OVA sensitization increased the expression levels of immunoglobulin E (IgE) in serum and IgE receptor (FcεR1) in the heart, and enhanced the activation of downstream signaling molecules of IgE-FcεR1 in the heart. Importantly, blockage of IgE-FcεR1 using FcεR1-deficient mice or an anti-IgE antibody prevented asthma-induced decline of cardiac function, and alleviated cardiac remodeling. These findings demonstrate the adverse effects of allergic asthma on the heart, and suggest the potential application of anti-IgE therapy in the treatment of asthma complicated with heart conditions.
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Key Words
- AKT, protein kinase B
- ANP, natriuretic peptide type A
- Ang Ⅱ, angiotensin Ⅱ
- BALF, bronchioalveolar lavage fluid
- BMI, body mass index
- BNP, natriuretic peptide type B
- BW, body weight
- CAD, coronary heart disease
- COPD, chronic obstructive pulmonary disease
- CVD, cardiovascular disease
- EF, ejection fraction
- FS, fraction shortening
- HF, heart failure
- HW, heart weight
- IgE, immunoglobulin E
- LVAW, left ventricular anterior wall
- LVID, left ventricular internal dimension
- LVPW, left ventricular posterior wall
- NHANES, National Health and Nutrition Examination Survey
- OVA, ovalbumin
- TC, total cholesterol
- TG, triglyceride
- WGA, wheat germ agglutinin
- WT, wild type
- pSmad2/3, phosphorylated small mothers against decapentaplegic 2 and 3
- α-SMA, α-smooth muscle actin
- β-MHC, β-myosin heavy chain
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Affiliation(s)
- Chi Geng
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yufan Feng
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yang Yang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Hongqin Yang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhiwei Li
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yaqin Tang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Hongmei Zhao
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
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20
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Amegadzie JE, Gamble JM, Farrell J, Gao Z. Association between Inhaled β2-agonists Initiation and Risk of Major Adverse Cardiovascular Events: A Population-based Nested Case-Control Study. Int J Chron Obstruct Pulmon Dis 2022; 17:1205-1217. [PMID: 35645559 PMCID: PMC9130098 DOI: 10.2147/copd.s358927] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Despite ample evidence underpinning the efficacy of β2-agonists in asthma and chronic obstructive pulmonary disease (COPD), the occurrence of β1- and β2-adrenoceptors in the heart suggests that β2-agonists may have deleterious cardiac effects. We investigated the association between new users of long-or short-acting β2-agonists (LABA or SABA) or ICS (inhaled corticosteroids)/LABA and major adverse cardiovascular events (MACE). Methods A nested case–control analysis was conducted using the UK Clinical Practice Research Datalink of patients with asthma, COPD or asthma–COPD overlap with initial treatment of LABA, SABA, ICS/LABA, ICS, long-or short-acting muscarinic antagonist (LAMA or SAMA) between 01 January 1998 and 31 July 2018. The primary outcome was MACE, defined as the first occurrence of stroke, heart failure, myocardial infarction, arrhythmia, or cardiovascular death. Each case was matched with up to 10 controls on age, sex, date of cohort-entry, and duration of follow-up. The risk of MACE associated with β2-agonists was estimated using conditional logistic regression after controlling for potential confounders. Results The cohort included 180,567 new users of β2-agonists, ICS, SAMA, or LAMA. Among asthmatics, β2-agonists were not associated with the risk of MACE (SABA vs ICS: HR 1.29 [0.96–1.73]; ICS/LABA vs ICS, HR 0.75 [0.33–1.73]). In contrast, among COPD patients, LABA (HR, 2.38 [1.04–5.47]), SABA (HR, 2.02 [1.13–3.59]) and ICS/LABA (HR, 2.08 [1.04–4.16]) users had an increased risk of MACE compared with SAMA users. Among patients with asthma–COPD overlap, SABA (HR, 2.57 [1.26–5.24]) was associated with an increased risk of MACE compared with ICS. Conclusion In conclusion, initiation of LABA, SABA, or ICS/LABA in COPD or SABA in asthma–COPD overlap is associated with increased risk of MACE. No associations were observed among patients with asthma.
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Affiliation(s)
- Joseph Emil Amegadzie
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - John-Michael Gamble
- Faculty of Science, School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Jamie Farrell
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
- Correspondence: Zhiwei Gao, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John’s, NL, A1B 3V6, Canada, Tel +17098646523, Email
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21
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Colombo M, Plebani A, Bosco A, Agosti M. Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report. J Med Case Rep 2022; 16:160. [PMID: 35449089 PMCID: PMC9026621 DOI: 10.1186/s13256-022-03357-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 03/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background Salbutamol is a selective β2-receptor agonist widely used to treat asthma in both emergency and outpatient settings. However, it has been associated with a broad spectrum of side effects. Lactic acidosis and diastolic hypotension are rarely reported together following intermittent salbutamol nebulization in children, even less so at standard therapeutic doses. Case presentation We present the case of a 12-year-old Italian boy, 34 kg body weight, who experienced a serious drug reaction during a moderate asthma exacerbation with associated dehydration (blood urea nitrogen/creatinine 0.25), following intermittent inhaled (0.2 mg at 3-hour intervals—overall 1.4 mg in 24 hours before arrival) and nebulized treatment (3.25 mg at 20-minute intervals in 60 minutes, overall 11.25 mg in our emergency department). The patient developed hyperglycemia (peak concentration 222 mg/dL), hypokalemia (lowest concentration 2.6 mEq/L), electrocardiogram alterations (corrected QT interval 467 ms), long-lasting arterial hypotension despite fluid boluses (lowest value 87/33 mmHg), and elevated blood lactate levels (peak concentration 8.1 mmol/L), following the third nebulized dose. Infections, liver dysfunction, and toxicity following other medications were ruled out. The aforementioned alterations improved within 24 hours after discontinuation of salbutamol. Conclusions We reinforce the message that even the use of intermittent nebulized salbutamol for acute moderate asthma can lead to severe transient complications in children. Then, healthcare providers should pay attention not only in emergency settings, to achieve prompt recognition and proper management of this adverse reaction. Careful reassessment could prevent similar reactions.
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Affiliation(s)
- Marco Colombo
- Pediatric Emergency Department, ASST Sette Laghi, Ospedale F. del Ponte, Varese, Italy.
| | - Anna Plebani
- Pediatric Emergency Department, ASST Sette Laghi, Ospedale F. del Ponte, Varese, Italy
| | - Annalisa Bosco
- Pediatric Emergency Department, ASST Sette Laghi, Ospedale F. del Ponte, Varese, Italy
| | - Massimo Agosti
- Department of Neonatology and Pediatrics, ASST Sette Laghi, Ospedale F. del Ponte, Varese, Italy
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Use of a Wearable Biosensor to Study Heart Rate Variability in Chronic Obstructive Pulmonary Disease and Its Relationship to Disease Severity. SENSORS 2022; 22:s22062264. [PMID: 35336436 PMCID: PMC8952191 DOI: 10.3390/s22062264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to explore the relationships between heart rate variability (HRV) and various phenotypic measures that relate to health and functional status in chronic obstructive pulmonary disease (COPD), and secondly, to demonstrate the feasibility of ascertaining HRV via a chest-worn wearable biosensor in COPD patients. HRV analysis was performed using SDNN (standard deviation of the mean of all normal R-R intervals), low frequency (LF), high frequency (HF), and LF/HF ratio. We evaluated the associations between HRV and COPD severity, class of bronchodilator therapy prescribed, and patient reported outcomes. Seventy-nine participants with COPD were enrolled. There were no differences in SDNN, HF, and LF/HF ratio according to COPD severity. The SDNN in participants treated with concurrent beta-agonists and muscarinic antagonists was lower than that in other participants after adjusting heart rate (beta coefficient −3.980, p = 0.019). The SDNN was positively correlated with Veterans Specific Activity Questionnaire (VSAQ) score (r = 0.308, p = 0.006) and handgrip strength (r = 0.285, p = 0.011), and negatively correlated with dyspnea by modified Medical Research Council (mMRC) questionnaire (r = −0.234, p = 0.039), health status by Saint George’s Respiratory Questionnaire (SGRQ) (r = −0.298, p = 0.008), symptoms by COPD Assessment Test (CAT) (r = −0.280, p = 0.012), and BODE index (r = −0.269, p = 0.020). When measured by a chest-worn wearable device, reduced HRV was observed in COPD participants receiving inhaled beta-sympathomimetic agonist and muscarinic antagonists. HRV was also correlated with various health status and performance measures.
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Gaudio FG, Johnson DE, DiLorenzo K, Anderson A, Musi M, Schimelpfenig T, Leemon D, Blair-Smith C, Lemery J. Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis. Wilderness Environ Med 2022; 33:75-91. [PMID: 35120856 DOI: 10.1016/j.wem.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 10/01/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
The Wilderness Medical Society convened a panel to review the literature and develop evidence-based clinical practice guidelines on the treatment of anaphylaxis, with an emphasis on a field-based perspective. The review also included literature regarding the definition, epidemiology, clinical manifestations, and prevention of anaphylaxis. The increasing prevalence of food allergies in the United States raises concern for a corresponding rise in the incidence of anaphylaxis. Intramuscular epinephrine is the primary treatment for anaphylaxis and should be administered before adjunctive treatments such as antihistamines, corticosteroids, and inhaled β agonists. For outdoor schools and organizations, selecting a method to administer epinephrine in the field is based on considerations of cost, safety, and first responder training, as well as federal guidelines and state-specific laws.
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Affiliation(s)
- Flavio G Gaudio
- Department of Emergency Medicine, New York Presbyterian-Weill Cornell Medicine, New York, NY.
| | | | - Kelly DiLorenzo
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Arian Anderson
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Martin Musi
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Drew Leemon
- National Outdoor Leadership School, Lander, WY
| | | | - Jay Lemery
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
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24
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Adami PE, Koutlianos N, Baggish A, Bermon S, Cavarretta E, Deligiannis A, Furlanello F, Kouidi E, Marques-Vidal P, Niebauer J, Pelliccia A, Sharma S, Solberg EE, Stuart M, Papadakis M. Cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids in relation to sports: a position statement of the sport cardiology and exercise nucleus of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:559-575. [PMID: 35081615 DOI: 10.1093/eurjpc/zwab198] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023]
Abstract
The use of substances and medications with potential cardiovascular effects among those practicing sports and physical activity has progressively increased in recent years. This is also connected to the promotion of physical activity and exercise as core aspects of a healthy lifestyle, which has led also to an increase in sport participation across all ages. In this context, three main users' categories can be identified, (i) professional and amateur athletes using substances to enhance their performance, (ii) people with chronic conditions, which include physical activity and sport in their therapeutic plan, in association with prescribed medications, and (iii) athletes and young individuals using supplements or ergogenic aids to integrate their diet or obtaining a cognitive enhancement effect. All the substances used for these purposes have been reported to have side effects, among whom the cardiovascular consequences are the most dangerous and could lead to cardiac events. The cardiovascular effect depends on the type of substance, the amount, the duration of use, and the individual response to the substances, considering the great variability in responses. This Position Paper reviews the recent literature and represents an update to the previously published Position Paper published in 2006. The objective is to inform physicians, athletes, coaches, and those participating in sport for a health enhancement purpose, about the adverse cardiovascular effects of doping substances, commonly prescribed medications and ergogenic aids, when associated with sport and exercise.
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Affiliation(s)
- Paolo Emilio Adami
- Health and Science Department, World Athletics, 6-8 Quai Antoine 1er, Monaco 98000, Monaco
| | - Nikolaos Koutlianos
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Thermi, AUTH DPESS, 54124, Thessaloniki, Greece
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, 55 Fruit Street Boston, MA 02114, USA
| | - Stéphane Bermon
- Health and Science Department, World Athletics, 6-8 Quai Antoine 1er, Monaco 98000, Monaco
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica, 79 - 04100 - Latina (LT), Italy.,Mediterranea Cardiocentro, Via Orazio, 2, 80122, Napoli (NA), Italy
| | - Asterios Deligiannis
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Thermi, AUTH DPESS, 54124, Thessaloniki, Greece
| | - Francesco Furlanello
- Aritmologia Clinica e Sportiva, IRCCS Gruppo MultiMedica Elettrofisiologia, Via Milanese 300, 20099, Sesto San Giovanni(MI), Italy
| | - Evangelia Kouidi
- Sports Medicine Laboratory, Aristotle University of Thessaloniki, Thermi, AUTH DPESS, 54124, Thessaloniki, Greece
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Josef Niebauer
- Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Antonio Pelliccia
- Sports Medicine and Science Institute, CONI, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | | | - Mark Stuart
- International Testing Agency-ITA, Av. de Rhodanie 58, 1007 Lausanne, Switzerland
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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25
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Cox C, Patel K, Cantu R, Akmyradov C, Irby K. Hypokalemia Measurement and Management in Patients With Status Asthmaticus on Continuous Albuterol. Hosp Pediatr 2022; 12:198-204. [PMID: 35018439 DOI: 10.1542/hpeds.2021-006265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Status asthmaticus is commonly treated in pediatric patients by using continuous albuterol, which can cause hypokalemia. The primary aim of this study was to determine if serial potassium monitoring is necessary by examining treatment frequency of hypokalemia. METHODS This retrospective analysis was performed in 185 pediatric patients admitted with status asthmaticus requiring continuous albuterol between 2017 and 2019. All patients were placed on intravenous fluids containing potassium. The primary outcome measure was the treatment of hypokalemia in relation to the number of laboratory draws for potassium levels. The secondary outcome measure was hypokalemia frequency and relation to the duration and initial dose of continuous albuterol. RESULTS Included were 156 patients with 420 laboratory draws (average, 2.7 per patient) for potassium levels. The median lowest potassium level was 3.40 mmol/L (interquartile range, 3.2-3.7). No correlation was found between initial albuterol dose and lowest potassium level (P = .52). Patients with hypokalemia had a mean albuterol time of 12.32 (SD, 15.76) hours, whereas patients without hypokalemia had a mean albuterol time of 11.50 (SD, 12.53) hours (P = .29). Potassium levels were treated 13 separate times. CONCLUSIONS The number of laboratory draws for potassium levels was high in our cohort, with few patients receiving treatment for hypokalemia beyond the potassium routinely added to maintenance fluids. Length of time on albuterol and dose of albuterol were not shown to increase the risk of hypokalemia. Serial laboratory measurements may be decreased to potentially reduce health care costs, pain, and anxiety surrounding needlesticks.
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Affiliation(s)
- Courtney Cox
- Divisions of Critical Care Medicine and.,Arkansas Children's Hospital, Little Rock, Arkansas
| | | | - Rebecca Cantu
- Hospital Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and University of Arkansas for Medical Sciences, Little Rock, Arkansas; and.,Arkansas Children's Hospital, Little Rock, Arkansas
| | | | - Katherine Irby
- Divisions of Critical Care Medicine and.,Arkansas Children's Hospital, Little Rock, Arkansas
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26
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Stubbs MA, Clark VL, Gibson PG, Yorke J, McDonald VM. Associations of symptoms of anxiety and depression with health-status, asthma control, dyspnoea, dysfunction breathing and obesity in people with severe asthma. Respir Res 2022; 23:341. [PMID: 36510255 PMCID: PMC9743554 DOI: 10.1186/s12931-022-02266-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anxiety and depression are comorbidities of severe asthma. However, clinical characteristics associated with coexisting severe asthma and anxiety/depression are poorly understood. The study objective is to determine clinical characteristics associated with anxiety and depressive symptoms in severe asthma. METHODS Severe asthma participants (N = 140) underwent a multidimensional assessment. Categorization of symptoms of anxiety and depression were based on HADS scale sub-scores and divided into four groups (< 8 on both subscales; ≥ 8 on one subscale; ≥ 8 on both subscales). Clinical characteristics were compared between subgroups. Multivariate logistic regression determined associations of clinical characteristics and anxiety and/or depressive symptoms in people with severe asthma. RESULTS Participants were (mean ± SD) 59.3 ± 14.7 years old, and 62% female. There were 74 (53%) severe asthma participants without symptoms of anxiety/depression, 11 (7%) with symptoms of anxiety, 37 (26%) with symptoms of depression and 18 (13%) with symptoms of anxiety and depression. Quality of life impairment was greater in participants with symptoms of depression (4.4 ± 1.2) and combined symptoms of anxiety and depression (4.4 ± 1.1). Asthma control was worse in those with symptoms of depression (2.9 ± 1.1) and combined anxiety and depression (2.6 ± 1.0). In multivariate models, dysfunctional breathing was associated with symptoms of anxiety (OR = 1.24 [1.01, 1.53]). Dyspnoea was associated with symptoms of depression (OR = 1.90 [1.10, 3.25]). Dysfunctional breathing (OR 1.16 [1.04, 1.23]) and obesity (OR 1.17 [1.00, 1.35]) were associated with combined symptoms of anxiety and depression. CONCLUSION People with severe asthma and anxiety and/or depressive symptoms have poorer QoL and asthma control. Dyspnoea, dysfunctional breathing and obesity are associated with these symptoms. These key clinical characteristics should be targeted in severe asthma management.
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Affiliation(s)
- Michelle A. Stubbs
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Vanessa L. Clark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Peter G. Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.414724.00000 0004 0577 6676Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW 2305 Australia
| | - Janelle Yorke
- grid.5379.80000000121662407School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL UK ,grid.412917.80000 0004 0430 9259Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX UK
| | - Vanessa M. McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
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27
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Electrochemical Discrimination of Salbutamol from Its Excipients in Ventolin TM at Nanoporous Gold Microdisc Arrays. SENSORS 2021; 21:s21123975. [PMID: 34207616 PMCID: PMC8226559 DOI: 10.3390/s21123975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 02/02/2023]
Abstract
The emergence of specific drug–device combination products in the inhalable pharmaceutical industry demands more sophistication of device functionality in the form of an embedded sensing platform to increase patient safety and extend patent coverage. Controlling the nebuliser function at a miniaturised, integrated electrochemical sensing platform with rapid response time and supporting novel algorithms could deliver such a technology offering. Development of a nanoporous gold (NPG) electrochemical sensor capable of creating a unique fingerprint signal generated by inhalable pharmaceuticals provided the impetus for our study of the electrooxidation of salbutamol, which is the active bronchodilatory ingredient in VentolinTM formulations. It was demonstrated that, at NPG-modified microdisc electrode arrays, salbutamol is distinguishable from the chloride excipient present at 0.0154 M using linear sweep voltammetry and can be detected amperometrically. In contrast, bare gold microdisc electrode arrays cannot afford such discrimination, as the potential for salbutamol oxidation and chloride adsorption reactions overlap. The discriminative power of NPG originates from the nanoconfinement effect for chloride in the internal pores of NPG, which selectively enhances the electron transfer kinetics of this more sluggish reaction relative to that of the faster, diffusion-controlled salbutamol oxidation. Sensing was performed at a fully integrated three-electrode cell-on-chip using Pt as a quasi-reference electrode.
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28
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Sharma P, Penn RB. Can GPCRs Be Targeted to Control Inflammation in Asthma? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1304:1-20. [PMID: 34019260 DOI: 10.1007/978-3-030-68748-9_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Historically, the drugs used to manage obstructive lung diseases (OLDs), asthma, and chronic obstructive pulmonary disease (COPD) either (1) directly regulate airway contraction by blocking or relaxing airway smooth muscle (ASM) contraction or (2) indirectly regulate ASM contraction by inhibiting the principal cause of ASM contraction/bronchoconstriction and airway inflammation. To date, these tasks have been respectively assigned to two diverse drug types: agonists/antagonists of G protein-coupled receptors (GPCRs) and inhaled or systemic steroids. These two types of drugs "stay in their lane" with respect to their actions and consequently require the addition of the other drug to effectively manage both inflammation and bronchoconstriction in OLDs. Indeed, it has been speculated that safety issues historically associated with beta-agonist use (beta-agonists activate the beta-2-adrenoceptor (β2AR) on airway smooth muscle (ASM) to provide bronchoprotection/bronchorelaxation) are a function of pro-inflammatory actions of β2AR agonism. Recently, however, previously unappreciated roles of various GPCRs on ASM contractility and on airway inflammation have been elucidated, raising the possibility that novel GPCR ligands targeting these GPCRs can be developed as anti-inflammatory therapeutics. Moreover, we now know that many GPCRs can be "tuned" and not just turned "off" or "on" to specifically activate the beneficial therapeutic signaling a receptor can transduce while avoiding detrimental signaling. Thus, the fledging field of biased agonism pharmacology has the potential to turn the β2AR into an anti-inflammatory facilitator in asthma, possibly reducing or eliminating the need for steroids.
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Affiliation(s)
- Pawan Sharma
- Center for Translational Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine Jane & Leonard Korman Respiratory Institute, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Raymond B Penn
- Center for Translational Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine Jane & Leonard Korman Respiratory Institute, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA.
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29
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Kruizinga MD, Moll A, Zhuparris A, Ziagkos D, Stuurman FE, Nuijsink M, Cohen AF, Driessen GJA. Postdischarge Recovery after Acute Pediatric Lung Disease Can Be Quantified with Digital Biomarkers. Respiration 2021; 100:979-988. [PMID: 34004601 DOI: 10.1159/000516328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pediatric patients admitted for acute lung disease are treated and monitored in the hospital, after which full recovery is achieved at home. Many studies report in-hospital recovery, but little is known regarding the time to full recovery after hospital discharge. Technological innovations have led to increased interest in home-monitoring and digital biomarkers. The aim of this study was to describe at-home recovery of 3 common pediatric respiratory diseases using a questionnaire and wearable device. METHODS In this study, patients admitted due to pneumonia (n = 30), preschool wheezing (n = 30), and asthma exacerbation (AE; n = 11) were included. Patients were monitored with a smartwatch and a questionnaire during admission, with a 14-day recovery period and a 10-day "healthy" period. Median compliance was calculated, and a mixed-effects model was fitted for physical activity and heart rate (HR) to describe the recovery period, and the physical activity recovery trajectory was correlated to respiratory symptom scores. RESULTS Median compliance was 47% (interquartile range [IQR] 33-81%) during the entire study period, 68% (IQR 54-91%) during the recovery period, and 28% (IQR 0-74%) during the healthy period. Patients with pneumonia reached normal physical activity 12 days postdischarge, while subjects with wheezing and AE reached this level after 5 and 6 days, respectively. Estimated mean physical activity was closely correlated with the estimated mean symptom score. HR measured by the smartwatch showed a similar recovery trajectory for subjects with wheezing and asthma, but not for subjects with pneumonia. CONCLUSIONS The digital biomarkers, physical activity, and HR obtained via smartwatch show promise for quantifying postdischarge recovery in a noninvasive manner, which can be useful in pediatric clinical trials and clinical care.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Allison Moll
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | | | | | - Frederik E Stuurman
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Marianne Nuijsink
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Gertjan J A Driessen
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Maastricht University Medical Centre, Leiden, The Netherlands
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30
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New insights from GINA 2019/2020-Focus on early anti-inflammatory therapy. Wien Klin Wochenschr 2021; 133:1215-1220. [PMID: 33770268 DOI: 10.1007/s00508-021-01830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 02/05/2021] [Indexed: 10/21/2022]
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Corlateanu A, Stratan I, Covantev S, Botnaru V, Corlateanu O, Siafakas N. Asthma and stroke: a narrative review. Asthma Res Pract 2021; 7:3. [PMID: 33608061 PMCID: PMC7896413 DOI: 10.1186/s40733-021-00069-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/04/2021] [Indexed: 02/08/2023] Open
Abstract
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation, bronchial reversible obstruction and hyperresponsiveness to direct or indirect stimuli. It is a severe disease causing approximately half a million deaths every year and thus possessing a significant public health burden. Stroke is the second leading cause of death and a major cause of disability worldwide. Asthma and asthma medications may be a risk factors for developing stroke. Nevertheless, since asthma is associated with a variety of comorbidities, such as cardiovascular, metabolic and respiratory, the increased incidence of stroke in asthma patients may be due to a confounding effect. The purpose of this review is to analyze the complex relationship between asthma and stroke.
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Affiliation(s)
- A. Corlateanu
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - Iu Stratan
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - S. Covantev
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - V. Botnaru
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - O. Corlateanu
- Department of Internal Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - N. Siafakas
- Department of Thoracic Medicine, University General Hospital, Stavrakia, 71110 Heraklion, Crete, Greece
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32
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Reilly C, Stavropoulos-Kalinoglou A, Clifton I, McKenna J, Peckham D, Price OJ. Smartphone pedometers in adults with asthma: a practical approach to physical activity assessment? A pilot validation study. J Asthma 2021; 59:967-975. [PMID: 33504229 DOI: 10.1080/02770903.2021.1882487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE: The aim of this pilot validation study was to determine the accuracy of a smartphone (iPhone®) pedometer in adults with and without asthma. METHODS: Ten adults with asthma and ten healthy controls underwent clinical assessment prior to completing two separate trials. Phase 1. standardized treadmill and self-paced walking tests. Total steps were recorded via: (i) Yamax Digiwalker™ SW800 pedometer positioned on the waistband, (ii) iPhone® pedometer positioned on the upper body, (iii) iPhone® pedometer positioned on the lower body and evaluated against a video-verified manual step-count. Phase 2. step-count was evaluated over seven-days during habitual free-living conditions via Yamax Digiwalker™ SW800 and iPhone® pedometers. RESULTS: During treadmill walking, the iPhone® positioned on the lower body correlated strongly (r = 0.96) and produced the highest level of agreement (mean bias: -11 steps, LOA: -43 to 21 steps) in comparison to video-verified manual step-count. During self-paced walking, all devices provided an excellent step-count estimate. During free-living conditions, no difference was observed between the Yamax Digiwalker™ SW800 pedometer and iPhone® (P = 0.10) and a strong correlation (r = 0.94) and acceptable agreement (mean bias: -343, LOA: -1963 to 1276 steps) was observed. CONCLUSION: Our findings indicate that an in-built iPhone® pedometer offers a practical approach to physical activity assessment in adults with and without asthma. Future research is now required to further validate the precision of this approach and evaluate the efficacy and effectiveness of smartphone pedometers to monitor and promote physical activity when employed during medical consultation and/or clinical research trials.
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Affiliation(s)
- Caroline Reilly
- Clinical Exercise and Respiratory Physiology Research Group, Centre for Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Antonis Stavropoulos-Kalinoglou
- Clinical Exercise and Respiratory Physiology Research Group, Centre for Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Ian Clifton
- Clinical Exercise and Respiratory Physiology Research Group, Centre for Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Department of Respiratory Medicine, Leeds, UK
| | - Jim McKenna
- Clinical Exercise and Respiratory Physiology Research Group, Centre for Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Daniel Peckham
- Clinical Exercise and Respiratory Physiology Research Group, Centre for Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Department of Respiratory Medicine, Leeds, UK
| | - Oliver J Price
- Clinical Exercise and Respiratory Physiology Research Group, Centre for Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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Taha M, Mishra T, Shokr M, Sharma A, Taha M, Samavati L. Burden and impact of arrhythmias in asthma-related hospitalizations: Insight from the national inpatient sample. J Arrhythm 2021; 37:113-120. [PMID: 33664893 PMCID: PMC7896478 DOI: 10.1002/joa3.12452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study aimed to analyze the burden and impact of cardiac arrhythmias in adult patients hospitalized with asthma exacerbation using the nationwide inpatient database. METHODS We used the National Inpatient Sample (NIS) database (2010-2014) to identify arrhythmias in asthma-related hospitalization and its impact on inpatient mortality, hospital length of stay (LOS), and hospitalization charges. We also used multivariable analysis to identify predictors of in-hospital arrhythmia and mortality. RESULTS We identified 12,988,129 patients hospitalized with primary diagnosis of asthma; among them, 2,014,459(16%) patients had cardiac arrhythmia. The most frequent arrhythmia identified is atrial fibrillation (AFib) (8.95%). The AFib and non-AFib arrhythmia group had higher mortality (3.40% & 2.22% vs 0.74%), mean length of stay (LOS) (5.9 & 5.4 vs 4.2 days), and hospital charges ($53,172 & $51,105 vs $34,585) as compared to the non-arrhythmia group (P < .005). Predictors of arrhythmia in asthma-related hospitalization were history of PCI or CABG, valvular heart disease, congestive heart failure (CHF), and acute respiratory failure. Predictors of higher mortality in arrhythmia group were acute respiratory failure, sepsis, and acute myocardial infarction. CONCLUSIONS Around 16% of adult patients hospitalized with asthma exacerbation experience arrythmia (mostly AFib 8.95%). The presence of arrhythmias was associated with higher in-hospital mortality, LOS, and hospital charges in hospitalized asthmatics.
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Affiliation(s)
- Muhanad Taha
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Tushar Mishra
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Mohamed Shokr
- Cardiology Department Leon H. Charney Division of Cardiology, Cardiac Electrophysiology NYU Langone Health New York University Grossman School of Medicine New York NY USA
| | - Aditi Sharma
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Mazen Taha
- Faculty of Medicine Cairo University Giza Egypt
| | - Lobelia Samavati
- Department of Pulmonary Critical Care and Sleep Division Wayne State University Detroit MI USA
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Nanduri R. Epigenetic Regulators of White Adipocyte Browning. EPIGENOMES 2021; 5:3. [PMID: 34968255 PMCID: PMC8594687 DOI: 10.3390/epigenomes5010003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Abstract
Adipocytes play an essential role in maintaining energy homeostasis in mammals. The primary function of white adipose tissue (WAT) is to store energy; for brown adipose tissue (BAT), primary function is to release fats in the form of heat. Dysfunctional or excess WAT can induce metabolic disorders such as dyslipidemia, obesity, and diabetes. Preadipocytes or adipocytes from WAT possess sufficient plasticity as they can transdifferentiate into brown-like beige adipocytes. Studies in both humans and rodents showed that brown and beige adipocytes could improve metabolic health and protect from metabolic disorders. Brown fat requires activation via exposure to cold or β-adrenergic receptor (β-AR) agonists to protect from hypothermia. Considering the fact that the usage of β-AR agonists is still in question with their associated side effects, selective induction of WAT browning is therapeutically important instead of activating of BAT. Hence, a better understanding of the molecular mechanisms governing white adipocyte browning is vital. At the same time, it is also essential to understand the factors that define white adipocyte identity and inhibit white adipocyte browning. This literature review is a comprehensive and focused update on the epigenetic regulators crucial for differentiation and browning of white adipocytes.
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Affiliation(s)
- Ravikanth Nanduri
- Laboratory of Metabolism, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Bianco A, Contoli M, Di Marco F, Saverio Mennini F, Papi A. As-needed anti-inflammatory reliever therapy for asthma management: evidence and practical considerations. Clin Exp Allergy 2020; 51:873-882. [PMID: 33247470 DOI: 10.1111/cea.13795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 01/31/2023]
Abstract
Asthma is a chronic respiratory disease in which airway inflammation is a key feature, even in the milder expressions of the disease. The conventional pharmacological approach to mild asthma has long relied on reliever therapy with as-needed short-acting beta-agonists (SABAs), while anti-inflammatory maintenance with inhaled corticosteroids (ICSs) has been reserved for patients with more persistent asthma. Poor adherence to maintenance treatment is an important issue in asthma management, and can partly explain suboptimal symptom control. Over-reliance on SABA bronchodilators for rapid symptom relief is common in real life and potentially leads to an increased risk of asthma morbidity and mortality. Combined anti-inflammatory and reliever medications in a single inhaler have the potential to overcome these limitations. Recent studies in patients with mild asthma have shown that anti-inflammatory reliever therapy with budesonide-formoterol, given on an as-needed basis, is superior to SABA in ensuring asthma control and non-inferior to budesonide maintenance therapy in preventing exacerbations. To address the implications of these important findings for the management of patients with asthma, Italian specialists convened at a series of meetings held during the second half of 2018 across Italy. This article presents their position on these topics and includes a review of the evidence supporting the use of anti-inflammatory reliever therapy in mild asthma and the implementation of this novel approach in clinical practice.
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Affiliation(s)
- Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Marco Contoli
- Respiratory Medicine, CEMICEF, University of Ferrara, Ferrara, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, Università degli Studi di Milano, Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Saverio Mennini
- CEIS-Economic Evaluation and HTA (EEHTA), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.,Institute for Leadership and Management in Health, Kingston University London, London, UK
| | - Alberto Papi
- Respiratory Medicine, CEMICEF, University of Ferrara, Ferrara, Italy
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Swanson RM, Tait RG, Galles BM, Duffy EM, Schmidt TB, Petersen JL, Yates DT. Heat stress-induced deficits in growth, metabolic efficiency, and cardiovascular function coincided with chronic systemic inflammation and hypercatecholaminemia in ractopamine-supplemented feedlot lambs. J Anim Sci 2020; 98:5840746. [PMID: 32428228 DOI: 10.1093/jas/skaa168] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/13/2020] [Indexed: 01/03/2023] Open
Abstract
Heat stress hinders growth and well-being in livestock, an effect that is perhaps exacerbated by the β1 agonist ractopamine. Heat stress deficits are mediated in part by reduced feed intake, but other mechanisms involved are less understood. Our objective was to determine the direct impact of heat stress on growth and well-being in ractopamine-supplemented feedlot lambs. Commercial wethers were fed under heat stress (40 °C) for 30 d, and controls (18 °C) were pair-fed. In a 2 × 2 factorial, lambs were also given a daily gavage of 0 or 60 mg ractopamine. Growth, metabolic, cardiovascular, and stress indicators were assessed throughout the study. At necropsy, 9th to 12th rib sections (four-rib), internal organs, and feet were assessed, and sartorius muscles were collected for ex vivo glucose metabolic studies. Heat stress increased (P < 0.05) rectal temperatures and respiration rates throughout the study and reduced (P < 0.05) weight gain and feed efficiency over the first week, ultrasonic loin-eye area and loin depth near the end of the study, and four-rib weight at necropsy. Fat content of the four-rib and loin were also reduced (P < 0.05) by heat stress. Ractopamine increased (P < 0.05) loin weight and fat content and partially moderated the impact of heat stress on rectal temperature and four-rib weight. Heat stress reduced (P < 0.05) spleen weight, increased (P < 0.05) adrenal and lung weights, and was associated with hoof wall overgrowth but not organ lesions. Ractopamine did not affect any measured indicators of well-being. Heat stress reduced (P < 0.05) blood urea nitrogen and increased (P < 0.05) circulating monocytes, granulocytes, and total white blood cells as well as epinephrine, TNFα, cholesterol, and triglycerides. Cortisol and insulin were not affected. Heat stress reduced (P < 0.05) blood pressure and heart rates in all lambs and increased (P < 0.05) left ventricular wall thickness in unsupplemented but not ractopamine-supplemented lambs. No cardiac arrhythmias were observed. Muscle glucose uptake did not differ among groups, but insulin-stimulated glucose oxidation was reduced (P < 0.05) in muscle from heat-stressed lambs. These findings demonstrate that heat stress impairs growth, metabolism, and well-being even when the impact of feed intake is eliminated by pair-feeding and that systemic inflammation and hypercatecholaminemia likely contribute to these deficits. Moreover, ractopamine improved muscle growth indicators without worsening the effects of heat stress.
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Affiliation(s)
- Rebecca M Swanson
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Richard G Tait
- Bioinformatics and Biostatistics, Neogen GeneSeek, Lincoln, NE
| | - Beth M Galles
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE
| | - Erin M Duffy
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Ty B Schmidt
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Jessica L Petersen
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Dustin T Yates
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
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Sola P, Krishnamurthy P, Chintamaneni PK, Pindiprolu SKS, Kumari M. Novel drug delivery systems of β2 adrenoreceptor agonists to suppress SNCA gene expression and mitochondrial oxidative stress in Parkinson’s disease management. Expert Opin Drug Deliv 2020; 17:1119-1132. [DOI: 10.1080/17425247.2020.1779218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Piyong Sola
- Department of Pharmacology, JSS College of Pharmacy (A Constituent College of JSS Academy of Higher Education & Research), Ooty, The Nilgiris, Tamil Nadu, India
| | - Praveen Krishnamurthy
- Department of Pharmacology, JSS College of Pharmacy (A Constituent College of JSS Academy of Higher Education & Research), Ooty, The Nilgiris, Tamil Nadu, India
| | - Pavan Kumar Chintamaneni
- Department of Pharmacology, JSS College of Pharmacy (A Constituent College of JSS Academy of Higher Education & Research), Ooty, The Nilgiris, Tamil Nadu, India
| | - Sai Kiran S.S Pindiprolu
- Department of Pharmacology, JSS College of Pharmacy (A Constituent College of JSS Academy of Higher Education & Research), Ooty, The Nilgiris, Tamil Nadu, India
| | - Mamta Kumari
- Department of Pharmacology, JSS College of Pharmacy (A Constituent College of JSS Academy of Higher Education & Research), Ooty, The Nilgiris, Tamil Nadu, India
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Koarai A, Sugiura H, Yamada M, Ichikawa T, Fujino N, Kawayama T, Ichinose M. Treatment with LABA versus LAMA for stable COPD: a systematic review and meta-analysis. BMC Pulm Med 2020; 20:111. [PMID: 32349720 PMCID: PMC7191827 DOI: 10.1186/s12890-020-1152-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inhaled bronchodilators including long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) play a central role in the treatment of stable chronic obstructive pulmonary disease (COPD). However, it is still unclear whether LABA or LAMA should be used for the initial treatment. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of LABA versus LAMA in patients with stable COPD. METHODS We searched relevant randomized control trials (RCTs) with a period of treatment of at least 12 weeks and analyzed the exacerbations, quality of life, dyspnea score, lung function and adverse events as the outcomes of interest. RESULTS We carefully excluded unblinded data and identified a total of 19 RCTs (N = 28,211). LAMA significantly decreased the exacerbations compared to LABA (OR 0.85, 95% CI 0.74 to 0.98; P = 0.02). In St George's Respiratory Questionnaire and transitional dyspnoea index score, there were no differences between LABA and LAMA treatment. Compared to LABA, there was a small but significant increase in the trough FEV1 after LAMA treatment (Mean difference 0.02, 95% CI 0.01 to 0.03, P = 0.0006). In the safety components, there was no difference in the serious adverse events between LABA and LAMA. However, LAMA showed a significantly lower incidence of total adverse events compared to LABA (OR 0.92, 95% CI 0.86 to 0.98; P = 0.02). CONCLUSION Treatment with LAMA in stable COPD provided a significantly lower incidence of exacerbation and non-serious adverse events, and a higher trough FEV1 compared to LABA. TRIAL REGISTRATION (PROSPERO: CRD42019144764).
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Affiliation(s)
- Akira Koarai
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
| | - Mitsuhiro Yamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
| | - Tomohiro Ichikawa
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
| | - Naoya Fujino
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011 Japan
| | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
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Parlar-Chun R, Arnold K. Association of various weight-based doses of continuous albuterol on hospital length of stay. J Asthma 2020; 58:645-650. [PMID: 31994959 DOI: 10.1080/02770903.2020.1723622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Continuous albuterol is a mainstay in management of pediatric status asthmaticus. While the National Heart Lung and Blood Institute Asthma Guidelines suggest 0.5 mg/kg/h as the recommended dosage, there is a paucity of evidence comparing different weight-based rates on hospital outcomes.Methods: Patients requiring continuous albuterol for asthma exacerbation from January 2015 to December 2016 were identified using ICD codes. The concentration of albuterol (5 mg/h-20 mg/h) and the duration of treatment were used to determine total albuterol administration. After dividing by patient weight, average weight-based doses were divided into equal quintiles. Unadjusted and length of stay adjusted for age, initial asthma severity score, and administration of magnesium were compared among the quintiles. The same multivariate analysis was used for duration of continuous albuterol.Results: Five hundred thirty-three hospitalizations for asthma were identified of which 289 received continuous albuterol. Weight-based dosage quintiles ranged from lowest (0.07-0.29 mg/kg/h) to the highest (>0.76-3.2 mg/kg/h). Baseline characteristics were similar aside from age, race, and magnesium administration. There was no difference in adjusted length of stay or adjusted duration of continuous albuterol therapy among the five quintiles.Conclusion: No optimal weight-based dose of continuous albuterol was found. Further investigation is needed to see if lower amounts of continuous albuterol may be as efficacious as higher doses. This could improve cost of status asthmaticus management and limit the number of adverse events associated with high exposure to continuous albuterol.
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Affiliation(s)
- Raymond Parlar-Chun
- Division of Pediatric Hospital Medicine, Department of Pediatrics, McGovern Medical School, Houston, TX, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Houston, TX, USA
| | - Kristen Arnold
- Division of Pediatric Hospital Medicine, Department of Pediatrics, McGovern Medical School, Houston, TX, USA
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Swanson RM, Beede KA, Freeman MD, Eggleston ML, Schmidt TB, Petersen JL, Yates DT. Ractopamine HCl improved cardiac hypertrophy but not poor growth, metabolic inefficiency, or greater white blood cells associated with heat stress in concentrate-fed lambs. Transl Anim Sci 2019; 3:1786-1791. [PMID: 31867572 PMCID: PMC6912170 DOI: 10.1093/tas/txz098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rebecca M Swanson
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Kristin A Beede
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Micayla D Freeman
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Morgan L Eggleston
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Ty B Schmidt
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Jessica L Petersen
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
| | - Dustin T Yates
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE
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Zhang E, Levin AM, Williams LK. How does race and ethnicity effect the precision treatment of asthma? EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2019; 4:337-356. [PMID: 33015363 DOI: 10.1080/23808993.2019.1690396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction Asthma is a common condition that affects large numbers of children and adults, yet the burden of disease is not equally distributed amongst groups. In the United States, African Americans and Puerto Ricans have higher rates of asthma and its complications when compared with European Americans. However, clinical trials and genetic studies have largely focused on the latter group. Areas covered Here we examine what is known regarding differences in asthma treatment response by race-ethnicity. We also review existing genetic studies related to the use of asthma medications, paying special attention to studies that included substantial numbers of non-white population groups. Publicly accessible search engines of the medical literature were queried using combinations of the terms asthma, race, ethnicity, pharmacogenomics, and pharmacogenetics, as well as the names of individual asthma medication classes. The list of articles reviewed was supplemented by bibliographies and expert knowledge. Expert opinion A substantial and coordinated effort is still needed to both identify and validate genetic biomarkers of asthma medication response, as currently there are no clinically actionable genetic markers available for this purpose. The path to identifying such markers in non-white populations is even more formidable, since these groups are underrepresented in existing data.
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Affiliation(s)
- Ellen Zhang
- Center for Individualized and Genomic Medicine Research (CIGMA), Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Albert M Levin
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - L Keoki Williams
- Center for Individualized and Genomic Medicine Research (CIGMA), Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
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Lim S, Park J, Um JY. Ginsenoside Rb1 Induces Beta 3 Adrenergic Receptor-Dependent Lipolysis and Thermogenesis in 3T3-L1 Adipocytes and db/db Mice. Front Pharmacol 2019; 10:1154. [PMID: 31680950 PMCID: PMC6803469 DOI: 10.3389/fphar.2019.01154] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022] Open
Abstract
Obesity is constantly rising into a major health threat worldwide. Activation of brown-like transdifferentiation of white adipocytes (browning) has been proposed as a promising molecular target for obesity treatment. In this study, we investigated the effect of ginsenoside Rb1 (Rb1), a saponin derived from Panax ginseng Meyer, on browning. We used 3T3-L1 murine adipocytes and leptin receptor mutated db/db mice. The lipid accumulation, AMP-activated protein kinase alpha (AMPKα)-related pathways, lipolytic and thermogenic factors were measured after Rb treatment in 3T3-L1 adipocytes. Body weight change and lipolysis-thermogenesis factors were investigated in Rb1-treated db/db mice. Beta 3 adrenergic receptor activation (β3AR) changes were measured in Rb1-treated 3T3-L1 cells with or without β3AR inhibitor L748337 co-treatment. As a result, Rb1 treatment decreased lipid droplet size in 3T3-L1 adipocytes. Rb1 also induced phosphorylations of AMPKα pathway and sirtuins. Moreover, lipases and thermogenic factors such as uncoupling protein 1 were increased by Rb1 treatment. Through these results, we could expect that the non-shivering thermogenesis program can be induced by Rb1. In db/db mice, 6-week injection of Rb1 resulted in decreased inguinal white adipose tissue (iWAT) weight associated with shrunken lipid droplets and increased lipolysis and thermogenesis. The thermogenic effect of Rb1 was possibly due to β3AR, as L748337 pre-treatment abolished the effect of Rb1. In conclusion, we suggest Rb1 as a potential lipolytic and thermogenic therapeutic agent which can be used for obesity treatment.
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Affiliation(s)
- Seona Lim
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
- Department of Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Jinbong Park
- Department of Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Basic Research Laboratory for Comorbidity Research and Comorbidity Research Institute, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Jae-Young Um
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
- Department of Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Basic Research Laboratory for Comorbidity Research and Comorbidity Research Institute, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
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Hung J, Kraft T, Seefried B, Johnson DW, Bailey M, Dersch-Mills D. Potassium disturbance associated with an inpatient childhood asthma pathway. Paediatr Child Health 2019; 25:543-548. [PMID: 33354265 DOI: 10.1093/pch/pxz131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 06/05/2019] [Indexed: 01/22/2023] Open
Abstract
Background Paediatric asthma exacerbations in Alberta are treated via standardized order sets known as the Alberta Acute Childhood Asthma Pathway (ACAP). This pathway is utilized in paediatric tertiary hospitals and in remote and rural locations. Incidence, magnitude, and risk factors for hypokalemia in inpatients receiving salbutamol for asthma exacerbations via this pathway are presently unknown. Objective Establish incidence, magnitude, and risk factors for hypokalemia associated with salbutamol therapy as directed by a paediatric asthma pathway. Methods Retrospective cohort study using visit-level electronic medical data. Inpatients aged <18 years old receiving salbutamol via the ACAP with at least one potassium level were included. Hypokalemia was defined as mild (3.0 ≤ [K+] < 3.5 mEq/L), moderate (2.5 ≤ [K+] < 3.0 mEq/L), or severe ([K+] < 2.5 mEq/L), as measured in serum or blood gas. Binomial logistic regression was utilized to examine risk factors for hypokalemia, route of administration, location of lowest [K+], nil per os (NPO) status during admission, potassium supplementation, gender, and age. Results There were 821 patients screened for analysis and 433 patients were analyzed after exclusions. There was an incidence of hypokalemia of 38.8%. Of patients experiencing hypokalemia, 71.4% were mild, 25.6% moderate, and 3.0% severe. Risk factors included nebulized salbutamol, patient location (emergency department or paediatric intensive care unit), and age (>5 years) although these risk factors may actually represent patients receiving higher doses of salbutamol. Conclusions The majority of the 38.8% of children experiencing hypokalemia associated with the ACAP were mild. Routine monitoring of potassium status in children receiving salbutamol per standardized pathway is recommended for children with described risk factors, and ideally within the first 12 hours of presentation.
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Affiliation(s)
- Jonathan Hung
- Department of Inpatient Pharmacy, Alberta Children's Hospital Calgary, Alberta
| | - Timothy Kraft
- Department of Inpatient Pharmacy, Alberta Children's Hospital, Calgary, Alberta
| | - Brent Seefried
- Department of Respiratory Therapy, Alberta Children's Hospital, Calgary, Alberta
| | - David W Johnson
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta
| | - Michelle Bailey
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta
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Lee C, Alexander E, Lee R, Okorocha N, Manikam L, Lakhanpaul M. Behavioral interventions for asthma self-management in South Asian populations: a systematic review. J Asthma 2019; 58:112-120. [PMID: 31532264 DOI: 10.1080/02770903.2019.1658209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Asthma outcomes are significantly worse for minority groups, including South Asians (SAs), in high-income settings. Despite this, comparatively few existing studies have focused on SAs when studying the effectiveness of behavioral interventions on asthma self-management, and no prior study has synthesized these findings. We review the effectiveness of behavioral interventions on asthma management in adults and children of SA origin across low- (LICs), middle- (MICs), and high-income countries (HICs). METHODS Data sources included EMBASE, MEDLINE, Cochrane Library and Trial registries: WHO, ICTRP and ClinicalTrials.gov. Eligibility criteria: randomized controlled trials (RCTs), quasi-RCTs and non-RCTs (controlled before-after [CBA] studies), published in English, with no publication year or country restrictions in adults and children of South Asian origin. Exclusion criteria: those focusing solely on pharmacological interventions. Search terms were "asthma" and "South Asian". RESULTS We included 33 studies, 27 from MICs and 6 from HICs (education [n = 10], self-management plans [n = 6], yoga/breathing exercises [n = 10]) organizational interventions [n =1], diet therapy [n = 1] and combined interventions [n = 5]). Outcome measures included: blood biochemistry, lung function, healthcare utilization and quality of life. A meta-analysis was not performed due to significant study heterogeneity. CONCLUSION Behavioral interventions for asthma management in SAs are effective. Educational interventions that aim to optimize asthma knowledge, control, and inhaler technique, and yoga/breathing exercises are most effective for improved long-term outcomes in adults and children across LICs and MICs. Further research is needed to evaluate the effectiveness of all behavioral interventions for SAs in HICs to better inform current guidance by policy makers and health care providers.
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Affiliation(s)
- Charlotte Lee
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Whittington Health NHS Trust, London, United Kingdom
| | - Emma Alexander
- School of Medical Education, King's College London GKT, London, United Kingdom
| | - Rachel Lee
- Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, United Kingdom
| | - Nneka Okorocha
- Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, United Kingdom
| | - Logan Manikam
- UCL Institute of Epidemiology and Health Care, University College London, London , United Kingdom.,Aceso Global Health Consultants Limited, London, United Kingdom
| | - Monica Lakhanpaul
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Whittington Health NHS Trust, London, United Kingdom
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Parlar-Chun R, Kakarala K, Singh M. Descriptions and outcomes of cardiac evaluations in pediatric patients hospitalized for asthma. J Asthma 2019; 57:1195-1201. [PMID: 31288567 DOI: 10.1080/02770903.2019.1642353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Patients hospitalized for asthma can exhibit concurrent cardiac symptoms and undergo cardiac work up. We identify patients admitted for asthma that underwent cardiac workup and describe outcomes to evaluate the utility of cardiac testing in this population.Methods: Patients aged 4 to 17 years admitted for status asthmaticus from 2012 - 2016 were screened for EKG, ECHO, or cardiac enzyme obtainment.Results: Out of 1296 patients, 77 (6%) received cardiac testing. The most common reasons for testing were chest pain (25, 32%), blood pressure abnormalities (11, 14%), tachycardia (8, 10%), arrhythmia (6, 8%), and syncope (6, 8%). Sinus tachycardia (43, 66%) was the most common EKG finding. 4 out of 27 patients who underwent ECHOs had abnormalities: 2 with hypertrophic cardiomyopathy (HCM), 1 with vascular ring, and 1 with evidence of pulmonary hypertension. All patients who underwent an EKG to evaluate tachycardia had normalization of heart rate at discharge. Cardiac ischemia was not evident in any patients who underwent workup with cardiac enzymes to evaluate chest pain. All cases of arrhythmias resolved on discharge. Diastolic hypotension (DhTN) was found in 10 out of the 11 blood pressure abnormalities. There was mixed efficacy of fluid bolus in correcting DhTN. All DhTN resolved on discharge. One patient with syncope had a new diagnosis of HCM.Conclusions: While cardiac complications are seen in patients admitted for status asthmaticus, the etiology rarely stems from underlying cardiac disease. EKGs, ECHOs, and cardiac enzymes should have a minimal role in the management of the hospitalized asthmatic patient.
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Affiliation(s)
- Raymond Parlar-Chun
- Department of Pediatrics, Children's Memorial Hermann, Houston, TX, USA.,McGovern Medical School, University of Texas, Houston, TX, USA
| | - Kokila Kakarala
- Department of Pediatrics, Children's Memorial Hermann, Houston, TX, USA.,McGovern Medical School, University of Texas, Houston, TX, USA
| | - Mani Singh
- McGovern Medical School, University of Texas, Houston, TX, USA
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Aparici M, Carcasona C, Ramos I, Montero JL, Otal R, Ortiz JL, Cortijo J, Puig C, Vilella D, De Alba J, Doe C, Gavaldà A, Miralpeix M. Pharmacological Profile of AZD8871 (LAS191351), a Novel Inhaled Dual M 3 Receptor Antagonist/ β 2-Adrenoceptor Agonist Molecule with Long-Lasting Effects and Favorable Safety Profile. J Pharmacol Exp Ther 2019; 370:127-136. [PMID: 31085697 DOI: 10.1124/jpet.118.255620] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/08/2019] [Indexed: 12/12/2022] Open
Abstract
AZD8871 is a novel muscarinic antagonist and β 2-adrenoceptor agonist in development for chronic obstructive pulmonary disease. This study describes the pharmacological profile of AZD8871 in in vitro and in vivo assays. AZD8871 is potent at the human M3 receptor (pIC50 in binding assays: 9.5) and shows kinetic selectivity for the M3 (half-life: 4.97 hours) over the M2 receptor (half-life: 0.46 hour). It is selective for the β 2-adrenoceptor over the β 1 and β 3 subtypes (3- and 6-fold, respectively) and shows dual antimuscarinic and β 2-adrenoceptor functional activity in isolated guinea pig tissue (pIC50 in electrically stimulated trachea: 8.6; pEC50 in spontaneous tone isolated trachea: 8.8, respectively), which are sustained over time. AZD8871 exhibits a higher muscarinic component than batefenterol in human bronchi, with a shift in potency under propranolol blockade of 2- and 6-fold, respectively, together with a persisting relaxation (5.3% recovery at 8 hours). Nebulized AZD8871 prevents acetylcholine-induced bronchoconstriction in both guinea pig and dog with minimal effects on salivation and heart rate at doses with bronchoprotective activity. Moreover, AZD8871 shows long-lasting effects in dog, with a bronchoprotective half-life longer than 24 hours. In conclusion, these studies demonstrate that AZD8871 is a dual-acting molecule with a high muscarinic component and a long residence time at the M3 receptor; moreover, its preclinical profile in animal models suggests a once-daily dosing in humans and a favorable safety profile. Thus, AZD8871 has the potential to be a next generation of inhaled bronchodilators in respiratory diseases.
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Affiliation(s)
- Mònica Aparici
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Carla Carcasona
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Israel Ramos
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - José Luís Montero
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Raquel Otal
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - José Luís Ortiz
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Julio Cortijo
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Carlos Puig
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Dolors Vilella
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Jorge De Alba
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Chris Doe
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Amadeu Gavaldà
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
| | - Montserrat Miralpeix
- Almirall, Research & Development Center, Sant Feliu de Llobregat, Barcelona, Spain (M.A., C.C., I.R., J.L.M., R.O., C.P., D.V., J.D.A., C.D., A.G., M.M.); and Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain (J.L.O., J.C.)
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Shen PT, Wu YY, Chang YT, Cheng CW, Huang MF, Chen Z, Shiue YL, Liang SS. Quantification of the β 2-Adrenergic Feed Additives Ractopamine and Salbutamol by Reductive Amination-Assisted Modification. J Food Prot 2019; 82:696-702. [PMID: 30917042 DOI: 10.4315/0362-028x.jfp-18-499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HIGHLIGHTS A reductive amination-assisted method was used to synthesize standards and internal standards of ractopamine and salbutamol. Standard and internal standard analogs were fabricated by isotopic formaldehydes and sodium cyanoborohydride. A quantitative method of modified ractopamine and salbutamol was successfully validated. The reductive amination-assisted method enhances the signal for MS detection.
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Affiliation(s)
- Po-Tsun Shen
- 1 Health and Technology Center, College of Health Care and Management, Chung Shan Medical University, Taichung, Taiwan (ORCID: https://orcid.org/0000-0003-4556-1648 [P.-T.S.])
| | - You-Ying Wu
- 2 Department of Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Tzu Chang
- 2 Department of Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chieh-Wen Cheng
- 3 Bachelor Program in Interdisciplinary Studies, College of Future, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Mei-Fang Huang
- 2 Department of Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ziyu Chen
- 4 Department of Medicinal and Applied Chemistry, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yow-Ling Shiue
- 5 Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Shih-Shin Liang
- 2 Department of Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan.,5 Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.,6 Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Khakban A, FitzGerald JM, Tavakoli H, Lynd L, Ehteshami-Afshar S, Sadatsafavi M. Extent, trends, and determinants of controller/reliever balance in mild asthma: a 14-year population-based study. Respir Res 2019; 20:44. [PMID: 30819154 PMCID: PMC6394061 DOI: 10.1186/s12931-019-1007-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The majority of patients with asthma have the mild form of the disease. Whether mild asthma patients receive appropriate asthma medications has not received much attention in the literature. We examined the trends in indicators of controller/reliever balance. METHODS Using administrative health databases of British Columbia, Canada (2000 to 2013), we created a population-based cohort of adolescents/adults with mild asthma using validated case definition algorithms. Each patient-year of follow-up was assessed based on two markers of inappropriate medication prescription: whether the ratio of controller medications (inhaled corticosteroids [ICS] and leukotriene receptor antagonists [LTRA]) to total asthma-related prescriptions was low (cut-off 0.5 according to previous validation studies), and whether short-acting beta agonists (SABA) were prescribed inappropriately according to previously published criteria that considers SABA in relation to ICS prescriptions. Generalized linear models were used to evaluate trends and to examine the association between patient-, disease-, and healthcare-related factors and medication use. RESULTS The final cohort consisted of 195,941 mild asthma patients (59.5% female; mean age at entry 29.6 years) contributing 1.83 million patient-years. In 48.8% of patient-years, controller medications were suboptimally prescribed, while in 7.2%, SABAs were inappropriately prescribed. There was a modest year-over-year decline in inappropriate SABA prescription (relative change - 1.3%/year, P < 0.001) and controller-to-total-medications (relative change - 0.5%/year, P < 0.001). Among the studied factors, the indices of type and quality of healthcare (namely respirologist consultation and receiving pulmonary function test) had the strongest associations with improvement in controller/reliever balance. CONCLUSIONS Large number of mild asthma patients continue to be exposed to suboptimal combinations of asthma medications, and it appears there are modifiable factors associated with such phenomenon.
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Affiliation(s)
- Amir Khakban
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, Canada.,Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine and Institute for Heart and Lung Health, Vancouver General Hospital, the University of British Columbia, Vancouver, Canada
| | - Hamid Tavakoli
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, Canada
| | - Larry Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, Canada.,Center for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - Solmaz Ehteshami-Afshar
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, Canada
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, Canada. .,Division of Respiratory Medicine and Institute for Heart and Lung Health, Vancouver General Hospital, the University of British Columbia, Vancouver, Canada. .,Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, Canada.
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49
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Affiliation(s)
- Gary James Connett
- Southampton Childrens Hospital, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Lucy Anne Connett
- Paediatric Nursing, London South Bank University School of Health and Social Care, London SE1 0AA, UK
| | - Mike Thomas
- Depart of Medicine, University of Southampton, Southampton SO17 1BJ, UK
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50
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Wang MT, Lai JH, Tsai CL, Liou JT. Risk of adverse cardiovascular events with use of inhaled long-acting bronchodilators in management of chronic obstructive pulmonary disease. J Food Drug Anal 2019; 27:657-670. [PMID: 31324282 PMCID: PMC9307027 DOI: 10.1016/j.jfda.2018.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 01/01/2023] Open
Abstract
Inhaled long-acting bronchodilators, including long-acting β2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are the mainstay therapy in the treatment of chronic obstructive pulmonary disease (COPD), a disease that poses a heavy burden on morbidity and mortality worldwide. Use of LABAs and LAMAs in patients with COPD, however, has been concerned about an increased risk of adverse cardiovascular events, despite inconsistent findings reported from randomized controlled trials (RCTs) and observational studies. In this review, we detailed the relevant evidence generated from RCTs and observational studies with respect to the risk of cardiovascular disease with use of LABAs and LAMAs in management of COPD, and analyzed the contradictory findings in the literature, as well as recommended future research directions to clear the air regarding the cardiovascular safety of inhaled long-acting bronchodilators.
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Affiliation(s)
- Meng-Ting Wang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
| | - Jyun-Heng Lai
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
| | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Jun-Ting Liou
- Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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