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Carlucci CD, Hui Y, Chumanevich AP, Robida PA, Fuseler JW, Sajish M, Nagarkatti P, Nagarkatti M, Oskeritzian CA. Resveratrol Protects against Skin Inflammation through Inhibition of Mast Cell, Sphingosine Kinase-1, Stat3 and NF-κB p65 Signaling Activation in Mice. Int J Mol Sci 2023; 24:6707. [PMID: 37047680 PMCID: PMC10095068 DOI: 10.3390/ijms24076707] [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: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/07/2023] Open
Abstract
Inflammation is pathogenic to skin diseases, including atopic dermatitis (AD) and eczema. Treatment for AD remains mostly symptomatic with newer but costly options, tainted with adverse side effects. There is an unmet need for safe therapeutic and preventative strategies for AD. Resveratrol (R) is a natural compound known for its anti-inflammatory properties. However, animal and human R studies have yielded contrasting results. Mast cells (MCs) are innate immune skin-resident cells that initiate the development of inflammation and progression to overt disease. R's effects on MCs are also controversial. Using a human-like mouse model of AD development consisting of a single topical application of antigen ovalbumin (O) for 7 days, we previously established that the activation of MCs by a bioactive sphingolipid metabolite sphingosine-1-phosphate (S1P) initiated substantial skin remodeling compared to controls. Here, we show that daily R application normalized O-mediated epidermal thickening, ameliorated cell infiltration, and inhibited skin MC activation and chemokine expression. We unraveled R's multiple mechanisms of action, including decreased activation of the S1P-producing enzyme, sphingosine kinase 1 (SphK1), and of transcription factors Signal Transducer and Activator of Transcription 3 (Stat3) and NF-κBp65, involved in chemokine production. Thus, R may be poised for protection against MC-driven pathogenic skin inflammation.
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Affiliation(s)
- Christopher D. Carlucci
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Yvonne Hui
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Alena P. Chumanevich
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Piper A. Robida
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - John W. Fuseler
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Mathew Sajish
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA
| | - Prakash Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Mitzi Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Carole A. Oskeritzian
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
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Robin C, Vongmany N, Dewitte JD, Lodde B, Larabi L, Lucas D. Asthmes en relation avec le travail chez la femme : comparaison aux données masculines. Étude rétrospective des données issues du Réseau national de vigilance et de prévention des pathologies professionnelles (RNV3P). ARCH MAL PROF ENVIRO 2022. [DOI: 10.1016/j.admp.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Sex, Allergic Diseases and Omalizumab. Biomedicines 2022; 10:biomedicines10020328. [PMID: 35203537 PMCID: PMC8869622 DOI: 10.3390/biomedicines10020328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Gender differences are increasingly emerging in every area of medicine including drug therapy; however, specific gender-targeted studies are infrequent. Sex is a fundamental variable, which cannot be neglected. When optimizing therapies, gender pharmacology must always be considered in order to improve the effectiveness and safety of the use of drugs. Knowledge of gender differences promotes appropriate use of therapies and greater health protection for both genders. Further development of gender research would make it possible to report on differences in the assimilation and response of the female organism as compared to the male, in order to identify potential risks and benefits that can be found between genders. Furthermore, a better understanding of sex/gender-related influences, with regard to pharmacological activity, would allow the development of personalized “tailor-made” medicines. Here, we summarize the state of knowledge on the role of sex in several allergic diseases and their treatment with omalizumab, the first biologic drug authorized for use in the field of allergology.
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Casale T, Molfino NA, Silver J, Bogart M, Packnett E, McMorrow D, Wu J, Hahn B. Real-world effectiveness of mepolizumab in patients with severe asthma and associated comorbidities. Ann Allergy Asthma Immunol 2021; 127:354-362.e2. [PMID: 34038773 DOI: 10.1016/j.anai.2021.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/28/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with severe asthma frequently have associated comorbidities, which can compound existing symptoms, complicating asthma management. OBJECTIVE To describe the real-world effectiveness of mepolizumab in patients with severe asthma stratified by common overlapping comorbidities. METHODS This was a retrospective analysis of patients with asthma from the MarketScan Commercial and Medicare Supplemental Database initiating mepolizumab treatment (index date). Eligible patients had more than or equal to 1 claim (excluding claims for diagnostic tests) with a diagnosis code for more than or equal to 1 of 7 comorbidities (atopic disease, nasal polyps, chronic sinusitis, obesity, respiratory infections, chronic obstructive pulmonary disease, and depression/anxiety) during the 12-month preindex baseline period; these were used to stratify patients into 7 nonmutually exclusive subgroups. Outcomes included asthma exacerbations and exacerbation-related health care resource utilization during the 12-month baseline and follow-up periods. Each patient acted as their own control. RESULTS Of the 639 patients included, the most common comorbidities were atopic diseases (73.2%), respiratory infections (55.6%), and chronic sinusitis (45.1%). Across all 7 comorbidity subgroups, there were significant (P < .05) reductions of 38% to 55% and 57% to 83% in exacerbations and exacerbations requiring hospitalization, respectively, during the follow-up vs baseline period, except for exacerbations requiring hospitalization in the nasal polyp subgroup, owing to the small subgroup sample size. During the follow-up vs baseline periods, mean number of oral corticosteroids claims was significantly (P < .001) reduced by 29% to 38%; 39% to 47% of patients achieved greater than or equal to 50% oral corticosteroids dose reduction. Significant reductions in exacerbation-related health care resource utilization were also observed. CONCLUSION Mepolizumab treatment provided real-world clinical benefits in patients.
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Affiliation(s)
- Thomas Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, Florida
| | - Nestor A Molfino
- US Value Evidence and Outcomes, US Medical Affairs, GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Jared Silver
- US Medical Affairs, GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Michael Bogart
- US Value Evidence and Outcomes, US Medical Affairs, GlaxoSmithKline, Research Triangle Park, North Carolina
| | | | | | - Joanne Wu
- Life Sciences, IBM Watson Health, Cambridge, Maryland
| | - Beth Hahn
- US Value Evidence and Outcomes, US Medical Affairs, GlaxoSmithKline, Research Triangle Park, North Carolina.
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5
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Fereidouni M, Rezapour H, Saharkhiz M, Mahmoudzadeh S, Ayadilord M, Askari M, Karbasi S, Abbaszadeh A, Hoseini ZS, Ferns GA, Bahrami A. A study of the association of cognitive abilities and emotional function with allergic disorders in young women. BMC WOMENS HEALTH 2021; 21:205. [PMID: 34001075 PMCID: PMC8130253 DOI: 10.1186/s12905-021-01345-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/06/2021] [Indexed: 01/31/2023]
Abstract
Background Allergic disorders may have a bidirectional causal relationship with mental disorders. In this cross-sectional study, we aimed to assess the associations between cognitive abilities and emotional function tests and quality of life with the presence of allergic disease in young women. Methods A diagnosis of allergic disorders, comprising allergic rhinitis (AR), asthma and atopic dermatitis (AD), was confirmed by a specialist in allergy. The presence and severity of depression, anxiety, stress, insomnia and sleepiness were evaluated using validated questionnaires. Cognitive abilities and quality of life were assessed using standard instruments. Results Among 181 female young participants, the prevalence of AR, asthma and AD were 26.5%, 2.8%, and 14.9% respectively. The AR group had higher scores than the non-AR group for depression, anxiety, insomnia, and lower scores for physical and mental health-related quality of life. Moreover, the AD cases had higher scores on the depression and stress scale compared to those without it (p < 0.05). Asthmatic patients also had significantly higher insomnia severity and lower physical health-related quality of life than non-asthmatic.
Conclusion There was a high prevalence of psychological/psychiatric disorders that included: anxiety, and sleep problems among allergic women, and a reduced quality of life that may be associated with it.
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Affiliation(s)
- Mohammad Fereidouni
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Hadis Rezapour
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran.,Department of Immunology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mansoore Saharkhiz
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran.,Department of Immunology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Sara Mahmoudzadeh
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran.,Department of Immunology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Malaksima Ayadilord
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran.,Department of Immunology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Masoumeh Askari
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran.,Department of Anatomical Sciences, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Samira Karbasi
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Arefeh Abbaszadeh
- Cardiovascular Diseases Research Center, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Gordon A Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9PH, Sussex, UK
| | - Afsane Bahrami
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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6
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Borges RC, Alith MB, Nascimento OA, Jardim JR. Gender differences in the perception of asthma respiratory symptoms in five Latin American countries. J Asthma 2021; 59:1030-1040. [PMID: 33902380 DOI: 10.1080/02770903.2021.1922914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES To determine the differences between sexes in perceptions of asthma symptoms, asthma control, daily activities, and symptom exacerbation in Latin American countries. METHODS This cross-sectional study was performed using data from the Latin America Asthma Insight and Management (LA-AIM) study (n = 2167) carried out in Argentina, Brazil, Mexico, Venezuela, and Puerto Rico. Face-to-face interviews were conducted, and patients orally completed a 53-question survey assessing five main domains of asthma: symptoms, impact on daily activities, disease control, exacerbation, and treatment/medication. RESULTS Of the 2167 participants, 762 (35.2%) were males and 1405 (64.8%) were females. Male participants smoked more than females, but history of rhinitis and allergies was more common in females (p < 0.05). Women aged 18-40 years had a higher proportion of uncontrolled asthma compared to men of the same age (37.8% and 30.0%, respectively). A higher proportion of symptomatic females reported more frequent symptoms (daytime cough, shortness of breath, breathlessness/wheezing, sputum, tightness in the chest, etc.) than males (p < 0.05). Females also experienced more limitations in sports/recreational activities, normal physical exertion, social activities, sleep, and daily activities. Females consulted with health professionals more often than males (67.8% and 59.6%, respectively; p < 0.05). Asthma caused a feeling of lack of control over life in 42.6% of females and 31.4% of males. CONCLUSION In Latin America, females report more asthma symptoms, poorer asthma control, more impact on their daily activities, and more visits with health professionals than males.
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Affiliation(s)
- Rodrigo C Borges
- Hospital Universitário da Universidade de São Paulo (USP), São Paulo, Brazil
| | - Marcela B Alith
- Hospital Universitário da Universidade de São Paulo (USP), São Paulo, Brazil.,Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil
| | - Oliver A Nascimento
- Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil.,Respiratory Division of EPM/Unifesp, São Paulo, Brazil
| | - José R Jardim
- Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil.,Respiratory Division of EPM/Unifesp, São Paulo, Brazil
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7
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Uncontrolled asthma: a retrospective cohort study in Japanese patients newly prescribed with medium-/high-dose ICS/LABA. NPJ Prim Care Respir Med 2021; 31:12. [PMID: 33654097 PMCID: PMC7925674 DOI: 10.1038/s41533-021-00222-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/03/2021] [Indexed: 01/21/2023] Open
Abstract
Many asthma patients remain uncontrolled despite guideline-based therapies. We examined real-life asthma control in Japanese patients prescribed with inhaled corticosteroid/long-acting β2-agonist (ICS/LABA). Patients (≥12 years) with ≥2 asthma diagnoses, newly initiated on medium-/high-dose ICS/LABA (Japanese asthma guidelines), from 01 April 2009 to 31 March 2015 were included, using Japan Medical Data Center Claims Database. Primary objective: proportion of patients with uncontrolled asthma in the year following ICS/LABA initiation. Secondary objectives: predictors of uncontrolled asthma and healthcare resource utilization. In medium-dose (N = 24,937) and high-dose (N = 8661) ICS/LABA cohorts, 23% and 21% patients, respectively, were uncontrolled. Treatment step up and exacerbation were most common indicators of uncontrolled asthma. Predictors of uncontrolled asthma, analyzed by multivariable Cox model, included systemic corticosteroid use, exacerbation history, comorbidities, and being female. In both cohorts, healthcare resource utilization was higher in patients with uncontrolled asthma. Over 20% patients with persistent asthma who initiated medium- or high-dose ICS/LABA were uncontrolled, highlighting unmet need for novel therapies in these patients.
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8
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Raherison C, Hamzaoui A, Nocent-Ejnaini C, Essari LA, Ouksel H, Zysman M, Prudhomme A. [Woman's asthma throughout life: Towards a personalized management?]. Rev Mal Respir 2020; 37:144-160. [PMID: 32057504 DOI: 10.1016/j.rmr.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022]
Abstract
In a woman's life, asthma can affect her in a variety of ways, with the onset of premenstrual asthma currently under-diagnosed. It is estimated that about 20% of women with asthma have premenstrual asthma, which is more common in patients with severe asthma. Women with asthma are at high risk of exacerbations and of severe asthma. Asthma is the most common chronic disease during pregnancy with potential maternal and foetal complications. Asthma medications are safe for the foetus and it is essential to continue pre-existing treatment and adapt it to the progress of asthma during the pregnancy. Sex steroids modulate the structure and function of bronchial and immune cells. Understanding their role in asthma pathogenesis is complicated by the ambivalent effects of bronchodilating and pro-inflammatory oestrogens as well as the diversity of response to their association with progesterone. Menopausal asthma is a clinical entity and is part of one of the phenotypes of severe non-allergic and low steroid-sensitive asthma. Targeted assessment of the domestic and professional environment allows optimization of asthma management.
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Affiliation(s)
- C Raherison
- Service des maladies respiratoires, pôle cardiothoracique, INSERM U1219, université de Bordeaux, CHU Bordeaux, 146, rue Léo-Saignat, 33604 Bordeaux, France.
| | - A Hamzaoui
- Pavillon B, unité de recherche UR12 SP15, hôpital Abderrahmen Mami, faculté de médecine, université de Tunis El Manar, Ariana, Tunisie
| | | | - L-A Essari
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - H Ouksel
- Département de pneumologie, CHU d'Angers, Angers, France
| | - M Zysman
- UMR_S955, université Paris-Est Créteil (UPEC), 94000 Créteil, France; Inserm, U955, Team 4, 94000 Créteil, France
| | - A Prudhomme
- Service de pneumologie, CHG Tarbes, Tarbes, France
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Colombo D, Zagni E, Ferri F, Canonica GW. Gender differences in asthma perception and its impact on quality of life: a post hoc analysis of the PROXIMA (Patient Reported Outcomes and Xolair ® In the Management of Asthma) study. Allergy Asthma Clin Immunol 2019; 15:65. [PMID: 31708980 PMCID: PMC6833238 DOI: 10.1186/s13223-019-0380-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022] Open
Abstract
Background Gender differences in asthma perception and control have been reported. The PROXIMA observational study assessed these outcomes in a cohort of Italian severe allergic asthma (SAA) patients. This post hoc analysis of the PROXIMA results was aimed at assessing gender differences in SAA in a real-world setting, focusing on disease perception and impact on quality of life (QoL). Methods The PROXIMA study was an observational, multicenter study, consisting of a cross-sectional and a prospective longitudinal phase, including adult outpatients diagnosed with SAA at step 4 requiring a therapeutic step-up. Patients on omalizumab treatment at baseline were included in the 12-month longitudinal phase. Disease control was assessed by the Asthma Control Questionnaire (ACQ) score, patients’ disease perception by the Brief Illness Perception Questionnaire (BIPQ), and QoL by the EuroQoL five-dimensional three-level questionnaire (EQ-5D-3 L) at baseline and after 6 and 12 months. Two regression models were used to evaluate the association between gender and BIPQ total score and EQ-5D-3L score, respectively. Results 357 patients (65% females) were analyzed for the cross-sectional phase and 99 (62.6% females) for the longitudinal phase. The prevalence of perennial and seasonal aeroallergens was similar between genders. ACQ score decreased similarly during omalizumab treatment at 6 and 12 months in both genders; no gender differences were observed in control rates. Asthma perception was worse among females at all study visits reaching statistical significance at 12 months (mean (SD) B-IPQ total score 41.8 (9.4) vs 35.6 (12.0); T test p-value (males vs females) < 0.05). Statistically significant gender differences were observed for some specific items, with males reporting less symptom experience, concern about the disease, and emotional impact at 12-months. The results of the multivariate regression model for repeated measures showed that overall treatment with omalizumab improved disease perception overtime regardless from gender. Males reported a significantly better QoL compared to females at both 6 and 12 months. Conclusions In this real-world setting, females confirmed to have a worse perception of asthma, feel it as more symptomatic and suffer a greater impact on their QoL, even though having similar baseline severity and obtaining similar level of control.
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Affiliation(s)
- Delia Colombo
- 1Novartis Farma S.p.A, Largo Umberto Boccioni, 1, 21040 Origgio, Varese Italy
| | - Emanuela Zagni
- 1Novartis Farma S.p.A, Largo Umberto Boccioni, 1, 21040 Origgio, Varese Italy
| | - Fabio Ferri
- Medineos Observational Research, Modena, Italy
| | - Giorgio Walter Canonica
- 3Department of Biomedical Sciences, Personalised Medicine Clinic Asthma & Allergy, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Multi-Method Molecular Characterisation of Human Dust-Mite-associated Allergic Asthma. Sci Rep 2019; 9:8912. [PMID: 31221987 PMCID: PMC6586825 DOI: 10.1038/s41598-019-45257-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 06/04/2019] [Indexed: 12/14/2022] Open
Abstract
Asthma is a chronic inflammatory disorder of the airways. Disease presentation varies greatly in terms of cause, development, severity, and response to medication, and thus the condition has been subdivided into a number of asthma phenotypes. There is still an unmet need for the identification of phenotype-specific markers and accompanying molecular tools that facilitate the classification of asthma phenotype. To this end, we utilised a range of molecular tools to characterise a well-defined group of female adults with poorly controlled atopic asthma associated with house dust mite (HDM) allergy, relative to non-asthmatic control subjects. Circulating messenger RNA (mRNA) and microRNA (miRNA) were sequenced and quantified, and a differential expression analysis of the two RNA populations performed to determine how gene expression and regulation varied in the disease state. Further, a number of circulating proteins (IL-4, 5, 10, 13, 17 A, Eotaxin, GM-CSF, IFNy, MCP-1, TARC, TNFα, Total IgE, and Endotoxin) were quantified to determine whether the protein profiles differed significantly dependent on disease state. Finally, we utilised a previously published assessment of the circulating “blood microbiome” performed using 16S rRNA amplification and sequencing. Asthmatic subjects displayed a range of significant alterations to circulating gene expression and regulation, relative to healthy control subjects, that may influence systemic immune activity. Notably, several circulating mRNAs were detected in just the asthma group or just in the control group, and many more were observed to be expressed at significantly different levels in the asthma group compared to the control group. Proteomic analysis revealed increased levels of inflammatory proteins within the serum, and decreased levels of the bacterial endotoxin protein in the asthmatic state. Comparison of blood microbiome composition revealed a significant increase in the Firmicutes phylum with asthma that was associated with a concomitant reduction in the Proteobacteria phylum. This study provides a valuable insight into the systemic changes evident in the HDM-associated asthma, identifies a range of molecules that are present in the circulation in a condition-specific manner (with clear biomarker potential), and highlights a range of hypotheses for further study.
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Danger-Associated Molecular Patterns (DAMPs): the Derivatives and Triggers of Inflammation. Curr Allergy Asthma Rep 2018; 18:63. [PMID: 30267163 DOI: 10.1007/s11882-018-0817-3] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Allergen is an umbrella term for irritants of diverse origin. Along with other offenders such as pathogens, mutagens, xenobiotics, and pollutants, allergens can be grouped as inflammatory agents. Danger-associated molecular patterns (DAMPs) are altered metabolism products of necrotic or stressed cells, which are deemed as alarm signals by the innate immune system. Like inflammation, DAMPs play a role in correcting the altered physiological state, but in excess, they can be lethal due to their signal transduction roles. In a vicious loop, inflammatory agents are DAMP generators and DAMPs create a pro-inflammatory state. Only a handful of DAMPs such as uric acid, mtDNA, extracellular ATP, HSPs, amyloid β, S100, HMGB1, and ECM proteins have been studied till now. A large number of DAMPs are still obscure, in need to be unveiled. The identification and functional characterization of those DAMPs in inflammation pathways can be insightful. RECENT FINDINGS As inflammation and immune activation have been implicated in almost all pathologies, studies on them have been intensified in recent times. Consequently, the pathologic mechanisms of various DAMPs have emerged. Following PRR ligation, the activation of inflammasome, MAPK, and NF-kB is some of the common pathways. The limited number of recognized DAMPs are only a fraction of the vast array of other DAMPs. In fact, any misplaced or abnormal level of metabolite can be a DAMP. Sophisticated analysis studies can reveal the full profile of the DAMPs. Lowering the level of DAMPs is useful therapeutic intervention but certainly not as effective as avoiding the DAMP generators, i.e., the inflammatory agents. So, rather than mitigating DAMPs, efforts should be focused on the elimination of inflammatory agents.
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Oh H, Koyanagi A, DeVylder JE, Stickley A. Seasonal Allergies and Psychiatric Disorders in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091965. [PMID: 30205581 PMCID: PMC6164754 DOI: 10.3390/ijerph15091965] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/22/2022]
Abstract
Seasonal allergies have been associated with mental health problems, though the evidence is still emergent, particularly in the United States. We analyzed data from the National Comorbidity Survey Replication and the National Latino and Asian American Survey (years 2001–2003). Multivariable logistic regression models were used to examine the relations between lifetime allergies and lifetime psychiatric disorders (each disorder in a separate model), adjusting for socio-demographic variables (including region of residence) and tobacco use. Analyses were also stratified to test for effect modification by race and sex. A history of seasonal allergies was associated with greater odds of mood disorders, anxiety disorders, and eating disorders, but not alcohol or substance use disorders, after adjusting for socio-demographic characteristics and tobacco use. The associations between seasonal allergies and mood disorders, substance use disorders, and alcohol use disorders were particularly strong for Latino Americans. The association between seasonal allergies and eating disorders was stronger for men than women. Seasonal allergies are a risk factor for psychiatric disorders. Individuals complaining of seasonal allergies should be screened for early signs of mental health problems and referred to specialized services accordingly.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34 th St., Los Angeles, CA 90089-0411, USA.
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Deu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain.
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, 28029 Madrid, Spain.
| | - Jordan E DeVylder
- Graduate School of Social Service, Fordham University, 113 W 60th Street, New York, NY 10023, USA.
| | - Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, 141 89 Huddinge, Sweden.
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo 1878553, Japan.
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Abstract
PURPOSE OF REVIEW In this review, we herein describe the progress in management of severe asthma, evolving from a 'blockbuster approach' to a more personalized approach targeted to the utilization of endotype-driven therapies. RECENT FINDINGS Severe asthma characterization in phenotypes and endotypes, by means of specific biomarkers, have led to the dichotomization of the concepts of 'personalized medicine' and 'precision medicine', which are often used as synonyms, but actually have conceptual differences in meaning. The recent contribute of the omic sciences (i.e. proteomics, transcriptomics, metabolomics, genomics, …) has brought this initially theoretic evolution into a more concrete level. SUMMARY This step-by-step transition would bring to a better approach to severe asthmatic patients as the personalization of their therapeutic strategy would bring to a better patient selection, a more precise endotype-driven treatment, and hopefully to better results in terms of reduction of exacerbation rates, symptoms, pulmonary function and quality of life.
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Boer S, Sont JK, Loijmans RJB, Snoeck-Stroband JB, Ter Riet G, Schermer TRJ, Assendelft WJJ, Honkoop PJ. Development and Validation of Personalized Prediction to Estimate Future Risk of Severe Exacerbations and Uncontrolled Asthma in Patients with Asthma, Using Clinical Parameters and Early Treatment Response. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:175-182.e5. [PMID: 29936188 DOI: 10.1016/j.jaip.2018.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/07/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Current level of asthma control can be easily assessed by validated instruments, but it is currently difficult to assess individuals' level of future risk. OBJECTIVE Develop, and validate, a risk prediction score for level of future risk, including patient characteristics and information on early treatment response. METHODS We used data of 304 adult patients with asthma from a 12-month primary care randomized controlled trial with 3-monthly assessments. With logistic regression we modeled the association between the level of future risk and patient characteristics including early treatment response. Future risk was defined as Asthma Control Questionnaire (ACQ) score of 1.5 or more at 12 months or the experience of at least 1 exacerbation during the final 6 months. We developed a risk prediction score on the basis of regression coefficients. RESULTS Performance of the risk prediction score improved, taking into account data on early treatment response (area under receiver-operating curve [AUROC] = 0.84) compared with a model containing only baseline characteristics (AUROC = 0.78). The score includes 6 easy-to-obtain predictors: sex, ACQ score and exacerbations in the previous year at baseline and at first follow-up, and smoking status and exacerbations in the previous 3 months (indicating early treatment response). External validation yielded an AUROC of 0.77. The risk prediction score classified patients into 3 risk groups: low (absolute risk, 11.7%), intermediate (47.0%), and high (72.7%). CONCLUSIONS We developed and externally validated a risk prediction score, quantifying both level of current asthma control and the guideline-defined future risk. Patients' individual risk can now be estimated in an easy way, as proposed but not specified, by asthma management guidelines.
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Affiliation(s)
- Suzanne Boer
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jacob K Sont
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rik J B Loijmans
- Department of General Practice, Academic Medical Centre, Amsterdam, the Netherlands
| | - Jiska B Snoeck-Stroband
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Centre, Amsterdam, the Netherlands
| | - Tjard R J Schermer
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Persijn J Honkoop
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands.
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15
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Choi BG, Lee YW, Choe YB, Ahn KJ. Total serum immunoglobulin E level and specific allergens in adults with skin diseases. Indian J Dermatol Venereol Leprol 2018; 84:148-152. [PMID: 29376509 DOI: 10.4103/ijdvl.ijdvl_27_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Immunoglobulin E (IgE) plays an important role in allergic diseases. Although several studies have shown the association of serum total IgE and allergen-specific IgE levels with allergic dermatological diseases such as atopic dermatitis, there are few studies addressing this association for skin diseases in general. Aims We sought to evaluate IgE levels in skin diseases and investigate the differences based on the disease type and clinical factors such as gender and age. Methods Data from 2836 patients who visited the dermatologic clinic of the Konkuk University Hospital, Seoul, Republic of Korea for 4 years were reviewed to document IgE levels and clinical information. IgE levels were collated with the type of skin disease, gender, and age. Results Patients with atopic dermatitis had a much higher total IgE level and were more susceptible to allergens as compared to other disease groups. Patients in other disease groups showed no significant differences in IgE levels. Men showed higher total IgE levels but the gender differences decreased with increasing age. Limitations The data were collected from patients at a referral centre and thus may not represent the general population of dermatologic patients. There was a lack of information regarding factors that could potentially influence IgE levels such as smoking history and disease severity. Conclusions The results suggest that there are physiological or environmental differences in IgE-mediated immune responses between males and females. Also, except for atopic dermatitis, there were no clinical differences in the IgE levels among various skin diseases.
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Affiliation(s)
- Byung Gon Choi
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyu Joong Ahn
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
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Stickley A, Sheng Ng CF, Konishi S, Koyanagi A, Watanabe C. Airborne pollen and suicide mortality in Tokyo, 2001-2011. ENVIRONMENTAL RESEARCH 2017; 155:134-140. [PMID: 28219016 DOI: 10.1016/j.envres.2017.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/25/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023]
Abstract
Prior research has indicated that pollen might be linked to suicide mortality although the few studies that have been undertaken to date have produced conflicting findings and been limited to Western settings. This study examined the association between the level of airborne pollen and suicide mortality in Tokyo, Japan in the period from 2001 to 2011. The daily number of suicide deaths was obtained from the Japanese Ministry of Health, Labour and Welfare, with pollen data being obtained from the Tokyo Metropolitan Institute of Public Health. A time-stratified case-crossover study was performed to examine the association between different levels of pollen concentration and suicide mortality. During the study period there were 5185 male and 2332 female suicides in the pollen season (February to April). For men there was no association between airborne pollen and suicide mortality. For women, compared to when there was no airborne pollen, the same-day (lag 0) pollen level of 30 to <100 grains per cm2 was associated with an approximately 50% increase in the odds for suicide (e.g. 30 to <50 grains per cm2: odds ratio 1.574, 95% confidence interval 1.076-2.303, p=0.020). The estimates remained fairly stable after adjusting for air pollutants and after varying the cut-points that defined the pollen levels. Our results indicate that pollen is associated with female suicide mortality in Tokyo.
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Affiliation(s)
- Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge 141 89, Sweden.
| | - Chris Fook Sheng Ng
- Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Shoko Konishi
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Anthropology, University of Washington, Box 353100, Seattle, WA 98195, USA
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujadas,, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Chiho Watanabe
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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17
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Gouder C, Asciak R, Montefort S. Sex differences in the efficacy, safety, and tolerability of omalizumab after 1 year in Maltese patients with asthma. Ann Allergy Asthma Immunol 2017; 118:513-514. [PMID: 28283278 DOI: 10.1016/j.anai.2017.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/13/2017] [Accepted: 01/18/2017] [Indexed: 11/28/2022]
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18
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Patel S, Meher B. A review on emerging frontiers of house dust mite and cockroach allergy research. Allergol Immunopathol (Madr) 2016; 44:580-593. [PMID: 26994963 DOI: 10.1016/j.aller.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/16/2015] [Indexed: 12/28/2022]
Abstract
Currently, mankind is afflicted with diversified health issues, allergies being a common, yet little understood malady. Allergies, the outcome of a baffled immune system encompasses myriad allergens and causes an array of health consequences, ranging from transient to recurrent and mild to fatal. Indoor allergy is a serious hypersensitivity in genetically-predisposed people, triggered by ingestion, inhalation or mere contact of allergens, of which mite and cockroaches are one of the most-represented constituents. Arduous to eliminate, these aeroallergens pose constant health challenges, mostly manifested as respiratory and dermatological inflammations, leading to further aggravations if unrestrained. Recent times have seen an unprecedented endeavour to understand the conformation of these allergens, their immune manipulative ploys and other underlying causes of pathogenesis, most importantly therapies. Yet a large section of vulnerable people is ignorant of these innocuous-looking immune irritants, prevailing around them, and continues to suffer. This review aims to expedite this field by a concise, informative account of seminal findings in the past few years, with particular emphasis on leading frontiers like genome-wide association studies (GWAS), epitope mapping, metabolomics etc. Drawbacks linked to current approaches and solutions to overcome them have been proposed.
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19
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Asthma as a disruption in iron homeostasis. Biometals 2016; 29:751-79. [PMID: 27595579 DOI: 10.1007/s10534-016-9948-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 12/28/2022]
Abstract
Over several decades, asthma has evolved from being recognized as a single disease to include a diverse group of phenotypes with dissimilar natural histories, pathophysiologies, responses to treatment, and distinctive molecular pathways. With the application of Occam's razor to asthma, it is proposed that there is one cause underlying the numerous phenotypes of this disease and that the responsible molecular pathway is a deficiency of iron in the lung tissues. This deficiency can be either absolute (e.g. asthma in the neonate and during both pregnancy and menstruation) or functional (e.g. asthma associated with infections, smoking, and obesity). Comparable associations between asthma co-morbidity (e.g. eczema, urticaria, restless leg syndrome, and pulmonary hypertension) with iron deficiency support such a shared mechanistic pathway. Therapies directed at asthma demonstrate a capacity to impact iron homeostasis, further strengthening the relationship. Finally, pathophysiologic events producing asthma, including inflammation, increases in Th2 cells, and muscle contraction, can correlate with iron availability. Recognition of a potential association between asthma and an absolute and/or functional iron deficiency suggests specific therapeutic interventions including inhaled iron.
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20
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Li K, Ni H, Yang Z, Wang Y, Ding S, Wen L, Yang H, Cheng J, Su H. Effects of temperature variation between neighbouring days on daily hospital visits for childhood asthma: a time-series analysis. Public Health 2016; 136:133-40. [PMID: 27161494 DOI: 10.1016/j.puhe.2016.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/05/2016] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To identify the relationship between temperature variation between neighbouring days (TVN) and hospital visits for childhood asthma in age- and sex-specific groups. STUDY DESIGN An ecological design was used to explore the effect of TVN on hospital visits for childhood asthma. METHODS A Poisson generalised linear regression model combined with a distributed lag non-linear model was used to analyse the association between TVN and hospital visits for childhood asthma. All hospital visits for childhood asthma from June 2010 to July 2013 were included (n = 17,022). Daily climate data were obtained from Hefei Meteorological Bureau. RESULTS A significant correlation was found between TVN and hospital visits for childhood asthma in age- and sex-specific groups. For different gender groups, the effect of TVN on childhood asthma was the greatest at 3 and 5 days lag for males and females. For different age groups, the effect of TVN on childhood asthma was the greatest at 1 and 5 days lag for 0-4 years and 5-14 years children, respectively. A 1 °C increase in TVN was associated with a 4.2% (95% confidence interval 0.9-7.6%) increase in hospital visits for childhood asthma. CONCLUSIONS TVN is associated with hospital visits for childhood asthma. Once the temperature change rapidly, guardians will be urged to pay more attention to their children's health, which may reduce the morbidity of childhood asthma.
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Affiliation(s)
- K Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - H Ni
- Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Z Yang
- Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Y Wang
- Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - S Ding
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - L Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - H Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - J Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - H Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
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21
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Sundbom F, Malinovschi A, Lindberg E, Alving K, Janson C. Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics. J Asthma 2016; 53:398-403. [PMID: 26666333 DOI: 10.3109/02770903.2015.1126846] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma-related quality of life has previously been shown to be associated with asthma control. The aims of the present study were to further analyze this correlation, identify other variables with impact on asthma-related quality of life and investigate the covariance among these variables. METHODS Information was retrieved from a cohort of 369 patients, aged 12-35, with physician-diagnosed asthma requiring anti-inflammatory treatment for at least 3 months per year. Questionnaire data [including the mini-Asthma Quality of Life Questionnaire (mAQLQ), asthma control test (ACT) and Hospital Anxiety and Depression Scale (HADS)], quality of sleep, lung function data and blood samples were analyzed. Linear regression models with the mAQLQ score as the dependent scalar variable were calculated. RESULTS ACT was the single variable that had the highest explanatory value for the mAQLQ score (51.5%). High explanatory power was also observed for anxiety and depression (17.0%) and insomnia (14.1%). The population was divided into groups depending on the presence of anxiety and depression, uncontrolled asthma and insomnia. The group that reported none of these conditions had the highest mean mAQLQ score (6.3 units), whereas the group reporting all of these conditions had the lowest mAQLQ score (3.8 units). CONCLUSIONS The ACT score was the single most important variable in predicting asthma-related quality of life. Combining the ACT score with the data on insomnia, anxiety and depression showed considerable additive effects of the conditions. Hence, we recommend the routine use of the ACT and careful attention to symptoms of insomnia, anxiety or depression in the clinical evaluation of asthma-related quality of life.
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Affiliation(s)
- Fredrik Sundbom
- a Department of Medical Sciences: Respiratory , Allergy and Sleep Research
| | | | - Eva Lindberg
- a Department of Medical Sciences: Respiratory , Allergy and Sleep Research
| | - Kjell Alving
- c Department of Women's and Children's Health , Uppsala University Hospital , Uppsala , Sweden
| | - Christer Janson
- a Department of Medical Sciences: Respiratory , Allergy and Sleep Research
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22
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Abstract
Gender differences in asthma incidence, prevalence and severity have been reported worldwide. After puberty, asthma becomes more prevalent and severe in women, and is highest in women with early menarche or with multiple gestations, suggesting a role for sex hormones in asthma genesis. However, the impact of sex hormones on the pathophysiology of asthma is confounded by and difficult to differentiate from age, obesity, atopy, and other gender associated environmental exposures. There are also gender discrepancies in the perception of asthma symptoms. Understanding gender differences in asthma is important to provide effective education and personalized management plans for asthmatics across the lifecourse.
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Kannan JA, Bernstein DI, Bernstein CK, Ryan PH, Bernstein JA, Villareal MS, Smith AM, Lenz PH, Epstein TG. Significant predictors of poor quality of life in older asthmatics. Ann Allergy Asthma Immunol 2015. [PMID: 26208758 DOI: 10.1016/j.anai.2015.06.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Morbidity and mortality from asthma are high in older adults and quality of life (QOL) might be lower, although standardized measurements of QOL have not been validated in this population. OBJECTIVE To determine predictors of asthma-related QOL in older adults. METHODS Allergy and pulmonary outpatients (n = 164) at least 65 years old with an objective diagnosis of asthma completed the Mini-Asthma Quality of Life Questionnaire (mAQLQ). Demographics, medical history, and mean value for daily elemental carbon attributable to traffic, a surrogate for diesel exposure, were obtained. Regression analysis was used to determine predictors of mAQLQ scores. RESULTS Total mAQLQ (mean ± SD 5.4 ± 1.1) and symptom, emotional, and activity domain scores were similar to those of younger populations, whereas environmental domain scores (4.4 ± 1.7) appeared lower. Poorer mAQLQ scores were significantly associated with emergency department visits (adjusted β [aβ] = -1.3, where β values indicate the strength and direction of association, P < .0001) and with poorer scores on the Asthma Control Questionnaire (aβ = -0.7, P < .0001). Greater ECAT exposure (aβ = -1.6, P < .02), female sex (aβ = -0.4, P < .006), body mass index of at least 30 kg/m(2) (aβ = -0.4, P < .01), gastroesophageal reflux (aβ = -0.4, P < .01), nonatopic status (aβ = -0.5, P < .002), and asthma onset before 40 years of age (aβ = -0.5, P < .004) were significantly associated with poorer mAQLQ scores. CONCLUSION The mAQLQ scores in older adults with stable asthma were similar to those in younger populations and were predictive of other measurements of asthma control, verifying that the mAQLQ is an appropriate tool in older adults with asthma. Traffic pollution exposure was the strongest predictor of poorer asthma-related QOL in older adults with asthma.
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Affiliation(s)
- Jennifer A Kannan
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David I Bernstein
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Clinical Research Center, LLC, Cincinnati, Ohio
| | | | - Patrick H Ryan
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Bernstein Clinical Research Center, LLC, Cincinnati, Ohio
| | - Manuel S Villareal
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew M Smith
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio
| | - Peter H Lenz
- Division of Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Tolly G Epstein
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio.
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24
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Natural progression of childhood asthma symptoms and strong influence of sex and puberty. Ann Am Thorac Soc 2015; 11:939-44. [PMID: 24896645 DOI: 10.1513/annalsats.201402-084oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Asthma prevalence, onset, remission and relapse, and healthcare use have been intensively studied. However, asthma symptom progression through childhood and adolescence has not been well studied, in part due to the challenges in obtaining consistent and robust long-term follow-up data on a large series of subjects with asthma. OBJECTIVES To use the asthma diary symptom data of the Childhood Asthma Management Program placebo group (5 yr, 418 subjects, and total 564,518 records) to establish sex-specific high-resolution time courses of the natural progression of asthma symptoms through childhood and adolescence. METHODS We used the asthma diary symptom code as a measure of daily disease severity. Annual records of Tanner stage were used to determine the influence of puberty on severity. A data alignment technique was used to derive 13-year time courses of mean symptoms and mean Tanner stage. MEASUREMENTS AND MAIN RESULTS Data analyses showed three age- and sex-related phases of asthma symptom progression: Phase 1 (ages 5 and 6 yr)-greater severity in boys; Phase 2 (ages 7 to 9 yr)-no sex difference in severity; and Phase 3 (age 10-17 yr)-greater severity in girls. The continuous decline of symptoms in both sexes stops abruptly at the onset of puberty. CONCLUSIONS The severity of asthma symptoms varies through childhood and adolescence, and patterns differ by sex. Puberty has a strong influence on symptom progression in both sexes. Progression of symptoms is a distinct aspect of asthma epidemiology.
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25
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Shi Q, Kong Y, He B, Chen X, Yan Y, Li Y. Metabolomics study on serum of allergic bronchial asthma rabbits treated by Recuperating Lung decoction. RSC Adv 2015. [DOI: 10.1039/c4ra14710c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study found seven biological markers in the Recuperating Lung decoction, which intervenes in the mechanism of asthma.
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Affiliation(s)
- Qi Shi
- The Key Institute of State Administration of Traditional Chinese Medicine (pneumonopathy chronic cough and dyspnea)
- Beijing Key Laboratory (NO. BZ0321)
- China-Japan Friendship Hospital (100029)
- Beijing
- China
| | - Yanhua Kong
- Beijing University of Chinese Medicine (100029)
- Beijing
- China
| | - Bo He
- Beijing University of Chinese Medicine (100029)
- Beijing
- China
| | - Xinxin Chen
- Beijing University of Chinese Medicine (100029)
- Beijing
- China
| | - Yue Yan
- The Key Institute of State Administration of Traditional Chinese Medicine (pneumonopathy chronic cough and dyspnea)
- Beijing Key Laboratory (NO. BZ0321)
- China-Japan Friendship Hospital (100029)
- Beijing
- China
| | - Youlin Li
- The Key Institute of State Administration of Traditional Chinese Medicine (pneumonopathy chronic cough and dyspnea)
- Beijing Key Laboratory (NO. BZ0321)
- China-Japan Friendship Hospital (100029)
- Beijing
- China
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26
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White GE, Seaman C, Filios MS, Mazurek JM, Flattery J, Harrison RJ, Reilly MJ, Rosenman KD, Lumia ME, Stephens AC, Pechter E, Fitzsimmons K, Davis LK. Gender differences in work-related asthma: surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993-2008. J Asthma 2014; 51:691-702. [PMID: 24673105 PMCID: PMC4697262 DOI: 10.3109/02770903.2014.903968] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To characterize work-related asthma by gender. METHODS We analyzed state-based sentinel surveillance data on confirmed work-related asthma cases collected from California, Massachusetts, Michigan, and New Jersey during 1993-2008. We used Chi-square and Fisher's Exact Test statistics to compare select characteristics between females and males. RESULTS Of the 8239 confirmed work-related asthma cases, 60% were female. When compared to males with work-related asthma, females with work-related asthma were more likely to be identified through workers' compensation (14.8% versus 10.6%) and less likely to be identified through hospital data (14.2% versus 16.9%). Moreover, when compared to males, females were more likely to have work-aggravated asthma (24.4% versus 13.5%) and less likely to have new-onset asthma (48.0% versus 56.5%). Females were also more likely than males with work-related asthma to work in healthcare and social assistance (28.7% versus 5.2%), educational services (11.8% versus 4.2%), and retail trade (5.0% versus 3.9%) industries and in office and administrative support (20.0% versus 4.0%), healthcare practitioners and technical (13.4% versus 1.6%), and education training and library (6.2% versus 1.3%) occupations. Agent groups most frequently associated with work-related asthma were miscellaneous chemicals (20.3%), cleaning materials (15.3%), and indoor air pollutants (14.9%) in females and miscellaneous chemicals (15.7%), mineral and inorganic dusts (13.2%), and pyrolysis products (12.7%) in males. CONCLUSIONS Among adults with work-related asthma, males and females differ in terms of workplace exposures, occupations, and industries. Physicians should consider these gender differences when diagnosing and treating asthma in working adults.
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Affiliation(s)
- Gretchen E. White
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Christen Seaman
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Margaret S. Filios
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Jacek M. Mazurek
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Jennifer Flattery
- Occupational Health Branch, California Department of Public Health, Richmond, CA, USA
| | - Robert J. Harrison
- Occupational Health Branch, California Department of Public Health, Richmond, CA, USA
| | - Mary Jo Reilly
- Division of Occupational and Environmental Medicine, Michigan State University, East Lansing, MI, USA
| | - Kenneth D. Rosenman
- Division of Occupational and Environmental Medicine, Michigan State University, East Lansing, MI, USA
| | - Margaret E. Lumia
- Environmental and Occupational Health Surveillance Program, New Jersey Department of Health, Trenton, NJ, USA
| | - Alicia C. Stephens
- Environmental and Occupational Health Surveillance Program, New Jersey Department of Health, Trenton, NJ, USA
| | - Elise Pechter
- Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA, USA
| | - Kathleen Fitzsimmons
- Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA, USA
| | - Letitia K. Davis
- Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA, USA
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Patel M, Pilcher J, Reddel HK, Qi V, Mackey B, Tranquilino T, Shaw D, Black P, Weatherall M, Beasley R. Predictors of severe exacerbations, poor asthma control, and β-agonist overuse for patients with asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:751-8. [PMID: 25439367 DOI: 10.1016/j.jaip.2014.06.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 05/18/2014] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Predictors of asthma exacerbations, poor asthma control, or extreme β-agonist overuse may be of clinical utility in the management of asthma. OBJECTIVE To investigate characteristics that predict subsequent adverse outcomes in asthma. METHODS An independent 24-week, randomized controlled trial of 303 adult patients with asthma who are at risk, which compared the efficacy of SMART (single budesonide-formoterol inhaler as maintenance and reliever therapy) with a fixed-dose regimen with salbutamol as reliever ("Standard"). Inhaled medication use was measured by electronic monitoring. Baseline characteristics that were predictors of subsequent severe asthma exacerbations, poor asthma control (Asthma Control Questionnaire -5 score ≥1.5), and "extreme" β-agonist overuse (>16 budesonide-formoterol actuations/d in SMART and >32 salbutamol actuations/d in Standard) were assessed by multivariate analyses. RESULTS FEV₁ % predicted (rate ratio [RR] 1.14 [95% CI, 1.03-1.27] per 10% lower), more previous exacerbations (RR 1.15 [95% CI, 1.01-1.31]), Standard therapy (RR 1.62 [95% CI, 1.07-2.47]), and female sex (RR 2.18 [95% CI, 1.29-3.67]) were associated with future severe exacerbations. Asthma Control Questionnaire--5 (regression coefficient 0.20 [95% CI, 0.13-0.27] per 0.5 points higher) and age (regression coefficient 0.09 [95% CI, 0.01-0.17] per decade older) were associated with future poorly controlled asthma. Higher reliever use (RR 1.63 [95% CI, 1.36-1.95] per categorical score in Asthma Control Questionnaire question no. 6), Māori ethnicity (RR 2.20 [95% CI, 1.43-3.38]) and FEV₁ % predicted (RR 1.16 [95% CI, 1.03-1.31] per 10% lower) were associated with future extreme β-agonist overuse. CONCLUSION Future severe asthma exacerbations, poor asthma control, and extreme β-agonist overuse are predicted by different baseline clinical and demographic characteristics and management approaches in at-risk asthma.
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Affiliation(s)
- Mitesh Patel
- Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand; Division of Respiratory Medicine, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Janine Pilcher
- Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand
| | - Helen K Reddel
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Victoria Qi
- Henderson Medical Centre, Auckland, New Zealand
| | - Bill Mackey
- Henderson Medical Centre, Auckland, New Zealand
| | | | - Dominick Shaw
- Division of Respiratory Medicine, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Peter Black
- Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Mark Weatherall
- Capital and Coast District Health Board, Wellington, New Zealand; School of Medicine, University of Otago, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand; School of Medicine, University of Otago, Wellington, New Zealand.
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Cazzoletti L, Corsico AG, Albicini F, Di Vincenzo EMG, Gini E, Grosso A, Ronzoni V, Bugiani M, Pirina P, Cerveri I. The course of asthma in young adults: a population-based nine-year follow-up on asthma remission and control. PLoS One 2014; 9:e86956. [PMID: 24489813 PMCID: PMC3906087 DOI: 10.1371/journal.pone.0086956] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 12/19/2013] [Indexed: 11/19/2022] Open
Abstract
Background Only few longitudinal studies on the course of asthma among adults have been carried out. Objective The aim of the present prospective study, carried out between 2000 and 2009 in Italy, is to assess asthma remission and control in adults with asthma, as well as their determinants. Methods All the subjects with current asthma (21–47 years) identified in 2000 in the Italian Study on Asthma in Young Adults in 6 Italian centres were followed up. Asthma remission was assessed at follow-up in 2008–2009 (n = 214), asthma control at baseline and follow-up. Asthma remission and control were related to potential determinants by a binomial logistic and a multinomial logistic model. Separate models for remission were used for men and women. Results The estimate of the proportion of subjects who were in remission was 29.7% (95%CI: 14.4%;44.9%). Men who were not under control at baseline had a very low probability of being in remission at follow-up (OR = 0.06; 95%CI:0.01;0.33) when compared to women (OR = 0.40; 95%CI:0.17;0.94). The estimates of the proportion of subjects who were under control, partial control or who were not under control in our sample were 26.3% (95%CI: 21.2;31.3%), 51.6% (95%CI: 44.6;58.7%) and 22.1% (95%CI: 16.6;27.6%), respectively. Female gender, increasing age, the presence of chronic cough and phlegm and partial or absent asthma control at baseline increased the risk of uncontrolled asthma at follow-up. Conclusion Asthma remission was achieved in nearly 1/3 of the subjects with active asthma in the Italian adult population, whereas the proportion of the subjects with controlled asthma among the remaining subjects was still low.
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Affiliation(s)
- Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
- * E-mail:
| | | | - Federica Albicini
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | - Eti Maria Giulia Di Vincenzo
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | - Erica Gini
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | - Vanessa Ronzoni
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Pietro Pirina
- Institute of Respiratory Diseases, University of Sassari, Sassari, Italy
| | - Isa Cerveri
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
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McCallister JW, Holbrook JT, Wei CY, Parsons JP, Benninger CG, Dixon AE, Gerald LB, Mastronarde JG. Sex differences in asthma symptom profiles and control in the American Lung Association Asthma Clinical Research Centers. Respir Med 2013; 107:1491-500. [PMID: 23972381 PMCID: PMC3816372 DOI: 10.1016/j.rmed.2013.07.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Important differences between men and women with asthma have been demonstrated, with women describing more symptoms and worse asthma-related quality of life (QOL) despite having similar or better pulmonary function. While current guidelines focus heavily on assessing asthma control, they lack information about whether sex-specific approaches to asthma assessment should be considered. We sought to determine if sex differences in asthma control or symptom profiles exist in the well-characterized population of participants in the American Lung Association Asthma Clinical Research Centers (ALA-ACRC) trials. METHODS We reviewed baseline data from four trials published by the ALA-ACRC to evaluate individual item responses to three standardized asthma questionnaires: the Juniper Asthma Control Questionnaire (ACQ), the multi-attribute Asthma Symptom Utility Index (ASUI), and Juniper Mini Asthma Quality of Life Questionnaire (mini-AQLQ). RESULTS In the poorly-controlled population, women reported similar overall asthma control (mean ACQ 1.9 vs. 1.8; p = 0.54), but were more likely to report specific symptoms such as nocturnal awakenings, activity limitations, and shortness of breath on individual item responses. Women reported worse asthma-related QOL on the mini-AQLQ (mean 4.5 vs. 4.9; p < 0.001) and more asthma-related symptoms with a lower mean score on the ASUI (0.73 vs. 0.77; p ≤ 0.0001) and were more likely to report feeling bothered by particular symptoms such as coughing, or environmental triggers. CONCLUSIONS In participants with poorly-controlled asthma, women had outwardly similar asthma control, but had unique symptom profiles on detailed item analyses which were evident on evaluation of three standardized asthma questionnaires.
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Affiliation(s)
- Jennifer W. McCallister
- Wexner Medical Center at The Ohio State University, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Columbus, Ohio, USA
| | - Janet T. Holbrook
- Center for Clinical Trials, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Christine Y. Wei
- Center for Clinical Trials, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan P. Parsons
- Wexner Medical Center at The Ohio State University, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Columbus, Ohio, USA
| | - Cathy G. Benninger
- Wexner Medical Center at The Ohio State University, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Columbus, Ohio, USA
| | - Anne E. Dixon
- University of Vermont College of Medicine, Division of Pulmonary & Critical Care Medicine, Colchester, VT, USA
| | - Lynn B. Gerald
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - John G. Mastronarde
- Wexner Medical Center at The Ohio State University, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Columbus, Ohio, USA
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Yoo Y. Phenotypes and endotypes of severe asthma in children. KOREAN JOURNAL OF PEDIATRICS 2013; 56:191-5. [PMID: 23741231 PMCID: PMC3668198 DOI: 10.3345/kjp.2013.56.5.191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 12/28/2012] [Indexed: 01/10/2023]
Abstract
Severe childhood asthma is a complicated and heterogeneous disorder with distinct phenotypes. Children with severe asthma have more persistent symptoms despite receiving treatment, more atopy, greater airway obstruction, and more air trapping than those with mild-to-moderate asthma. They also have higher morbidity and substantial airflow limitations that persist throughout adulthood. Identification of the phenotype clusters and endotypes of severe asthma can allow further modulation of the natural history of severe asthma and may provide the pathophysiologic rationale for appropriate management strategies.
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Affiliation(s)
- Young Yoo
- Department of Pediatrics, Allergy Immunology Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Qin P, Waltoft BL, Mortensen PB, Postolache TT. Suicide risk in relation to air pollen counts: a study based on data from Danish registers. BMJ Open 2013; 3:bmjopen-2012-002462. [PMID: 23793651 PMCID: PMC3669712 DOI: 10.1136/bmjopen-2012-002462] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Since the well-observed spring peak of suicide incidents coincides with the peak of seasonal aeroallergens as tree-pollen, we want to document an association between suicide and pollen exposure with empirical data from Denmark. DESIGN Ecological time series study. SETTING Data on suicide incidents, air pollen counts and meteorological status were retrieved from Danish registries. PARTICIPANTS 13 700 suicide incidents over 1304 consecutive weeks were obtained from two large areas covering 2.86 million residents. PRIMARY AND SECONDARY OUTCOME MEASURES Risk of suicide associated with pollen concentration was assessed using a time series Poisson-generalised additive model. RESULTS We noted a significant association between suicide risk and air pollen counts. A change of pollen counts levels from 0 to '10-<30' grains/m(3) air was associated with a relative risk of 1.064, that is, a 6.4% increase in weekly number of suicides in the population, and from 0 to '30-100' grains, a relative risk of 1.132. The observed association remained significant after controlling for effects of region, calendar time, temperature, cloud cover and humidity. Meanwhile, we observed a significant sex difference that suicide risk in men started to rise when there was a small increase of air pollen, while the risk in women started to rise until pollen grains reached a certain level. High levels of pollen had slightly stronger effect on risk of suicide in individuals with mood disorder than those without the disorder. CONCLUSIONS The observed association between suicide risk and air pollen counts supports the hypothesis that aeroallergens, acting as immune triggers, may precipitate suicide.
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Affiliation(s)
- Ping Qin
- National Centre for Register-based Research, Aarhus University, Denmark
- National Centre for Suicide Research and Prevention, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Berit L Waltoft
- National Centre for Register-based Research, Aarhus University, Denmark
| | | | - Teodor T Postolache
- Department of Psychiatry, University of Maryland School of Medicine, Mood and Anxiety Program,Baltimore, Maryland, USA
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Abstract
PURPOSE OF REVIEW One strategy to improve asthma control is to identify risk factors for uncontrolled asthma in epidemiologic studies and then consider those risk factors as potential targets for intervention. This article reviews predictors of impairment based on validated tools and predictors of severe asthma exacerbations. RECENT FINDINGS Indirectly modifiable risk factors for poor asthma control include older age in adults, lower socioeconomic status, and poor perception of dyspnea. Modifiable risk factors for poor asthma control include allergy triggers, low adherence, comorbidities, absence of specialty care, and various aspects of asthma self-management education. SUMMARY Intervention strategies are suggested for predictors that are directly or indirectly modifiable. It is hoped that attention to these factors will improve asthma control and reduce the burden of disease.
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Uekusa Y, Inamine A, Yonekura S, Horiguchi S, Fujimura T, Sakurai D, Yamamoto H, Suzuki H, Hanazawa T, Okamoto Y. Immunological parameters associated with the development of allergic rhinitis: a preliminary prospective study. Am J Rhinol Allergy 2012; 26:92-6. [PMID: 22487284 DOI: 10.2500/ajra.2012.26.3706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many subjects are sensitized to Japanese cedar pollen but do not develop allergic rhinitis (AR). The aim of this study was to examine the immunologic parameters related to the development of AR in sensitized subjects. METHODS The subjects were 33 adults who were sensitized to Japanese cedar pollen, but had not developed as of 2007. Cedar pollen-specific IgE (sIgE) and total IgE (tIgE) in serum, cedar pollen antigen (Cry j 1) Cry j-specific memory Th2 cell clone size, and the Cry j-specific induced regulatory T cell (iTreg) level were examined before and after the season in 2008. RESULTS Eight of the 33 subjects developed cedar pollinosis. The sIgE titers before the season in these eight subjects did not differ from those in the subjects who did not develop pollinosis, but the titers after the season were significantly higher in the group that developed pollinosis. The sIgE/tIgE ratio increased in almost all subjects, but the ratio was significantly higher before the season in the subjects who developed pollinosis. Cry j-specific Th2 cells were detected in all subjects, but the clone size only increased in those that developed pollinosis. The Cry j-specific iTreg population did not differ between the two groups. CONCLUSION A high sIgE/tIgE ratio before the season may be predictive of development of pollinosis, and an increase in the allergen-specific Th2 clone size during the pollen season could be a biomarker for pollinosis. The role of allergen-specific iTreg cells in the development of pollinosis could not be clarified in this preliminary study.
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Affiliation(s)
- Yasuhiro Uekusa
- Departments of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Chipps BE, Zeiger RS, Borish L, Wenzel SE, Yegin A, Hayden ML, Miller DP, Bleecker ER, Simons FER, Szefler SJ, Weiss ST, Haselkorn T. Key findings and clinical implications from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol 2012; 130:332-42.e10. [PMID: 22694932 PMCID: PMC3622643 DOI: 10.1016/j.jaci.2012.04.014] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 02/14/2012] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
Abstract
Patients with severe or difficult-to-treat asthma are an understudied population but account for considerable asthma morbidity, mortality, and costs. The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study was a large, 3-year, multicenter, observational cohort study of 4756 patients (n=3489 adults ≥ 18 years of age, n=497 adolescents 13-17 years of age, and n=770 children 6-12 years of age) with severe or difficult-to-treat asthma. TENOR's primary objective was to characterize the natural history of disease in this cohort. Data assessed semiannually and annually included demographics, medical history, comorbidities, asthma control, asthma-related health care use, medication use, lung function, IgE levels, self-reported asthma triggers, and asthma-related quality of life. We highlight the key findings and clinical implications from more than 25 peer-reviewed TENOR publications. Regardless of age, patients with severe or difficult-to-treat asthma demonstrated high rates of health care use and substantial asthma burden despite receiving multiple long-term controller medications. Recent exacerbation history was the strongest predictor of future asthma exacerbations. Uncontrolled asthma, as defined by the 2007 National Heart, Lung, and Blood Institute guidelines' impairment domain, was highly prevalent and predictive of future asthma exacerbations; this assessment can be used to identify high-risk patients. IgE and allergen sensitization played a role in the majority of severe or difficult-to-treat asthmatic patients.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA 95819, USA.
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Bianchi M, Clavenna A, Sequi M, Bortolotti A, Fortino I, Merlino L, Bonati M. Spirometry testing in a population of Italian children: age and gender differences. Respir Med 2012; 106:1383-8. [PMID: 22749757 DOI: 10.1016/j.rmed.2012.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
Abstract
AIM To estimate how many asthmatic children underwent spirometry testing in one year in a large Italian region, and evaluate sociodemographic determinants. METHODS Data were retrieved from the administrative databases that store all pharmacological and diagnostic prescriptions issued to individuals living in the Lombardy Region. The analysis involved prescriptions dispensed to all 6-17 year olds (1,047,241 subjects) during 2008. Youths were identified as asthmatics by a previously validated strategy. Number of subjects having ≥1 spirometry claims was calculated, and factors associated with the probability of undergoing spirometry were evaluated by multivariate analysis. RESULTS A total of 40,528 (3.9%) asthmatic subjects were identified. Only 30% of them underwent ≥1 spirometry during 2008, with differences between local health units (range 22-45%) and degree of anti-asthmatic use (26-35%). Moreover, in a multivariate analysis, the chance of undergoing spirometry was greater in boys than in girls (OR=2.3). CONCLUSIONS A low percentage of asthmatic children, especially girls (who are more at risk of developing severe disease in adulthood), underwent spirometry during 1-year period. This highlights a low compliance with guidelines in the monitoring of childhood asthma. Educational intervention is needed in order to encourage use of spirometry in primary care settings.
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Affiliation(s)
- Marina Bianchi
- Laboratory for Mother and Child Health, Department of Public Health, Mario Negri Pharmacological Research Institute, via G. La Masa, 19, 20156 Milan, Italy.
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Cloutier MM, Schatz M, Castro M, Clark N, Kelly HW, Mangione-Smith R, Sheller J, Sorkness C, Stoloff S, Gergen P. Asthma outcomes: composite scores of asthma control. J Allergy Clin Immunol 2012; 129:S24-33. [PMID: 22386507 DOI: 10.1016/j.jaci.2011.12.980] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/23/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Current asthma guidelines recommend assessing the level of a patient's asthma control. Consequently, there is increasing use of asthma control as an outcome measure in clinical research studies. Several composite assessment instruments have been developed to measure asthma control. OBJECTIVE National Institutes of Health institutes and federal agencies convened an expert group to propose the most appropriate standardized composite score of asthma control instruments to be used in future asthma studies. METHODS We conducted a comprehensive search of PubMed using both the National Library of Medicine's Medical Subject Headings and key terms to identify studies that attempted to develop and/or test composite score instruments for asthma control. We classified instruments as core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at a National Institutes of Health-organized workshop convened in March 2010 and finalized in September 2011. RESULTS We identified 17 composite score instruments with published validation information; all had comparable content. Eight instruments demonstrated responsiveness over time; 3 demonstrated responsiveness to treatment. A minimal clinically important difference has been established for 3 instruments. The instruments have demographic limitations; some are proprietary, and their use could be limited by cost. CONCLUSION Two asthma composite score instruments are sufficiently validated for use in adult populations, but additional research is necessary to validate their use in nonwhite populations. Gaps also exist in validating instruments for pediatric populations.
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Palmer RK, Hutchinson LM, Burpee BT, Tupper EJ, Pelletier JH, Kormendy Z, Hopke AR, Malay ET, Evans BL, Velez A, Gosse JA. Antibacterial agent triclosan suppresses RBL-2H3 mast cell function. Toxicol Appl Pharmacol 2011; 258:99-108. [PMID: 22036726 DOI: 10.1016/j.taap.2011.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 10/07/2011] [Accepted: 10/11/2011] [Indexed: 11/27/2022]
Abstract
Triclosan is a broad-spectrum antibacterial agent, which has been shown previously to alleviate human allergic skin disease. The purpose of this study was to investigate the hypothesis that the mechanism of this action of triclosan is, in part, due to effects on mast cell function. Mast cells play important roles in allergy, asthma, parasite defense, and carcinogenesis. In response to various stimuli, mast cells degranulate, releasing allergic mediators such as histamine. In order to investigate the potential anti-inflammatory effect of triclosan on mast cells, we monitored the level of degranulation in a mast cell model, rat basophilic leukemia cells, clone 2H3. Having functional homology to human mast cells, as well as a very well defined signaling pathway leading to degranulation, this cell line has been widely used to gain insight into mast-cell driven allergic disorders in humans. Using a fluorescent microplate assay, we determined that triclosan strongly dampened the release of granules from activated rat mast cells starting at 2 μM treatment, with dose-responsive suppression through 30 μM. These concentrations were found to be non-cytotoxic. The inhibition was found to persist when early signaling events (such as IgE receptor aggregation and tyrosine phosphorylation) were bypassed by using calcium ionophore stimulation, indicating that the target for triclosan in this pathway is likely downstream of the calcium signaling event. Triclosan also strongly suppressed F-actin remodeling and cell membrane ruffling, a physiological process that accompanies degranulation. Our finding that triclosan inhibits mast cell function may explain the clinical data mentioned above and supports the use of triclosan or a mechanistically similar compound as a topical treatment for allergic skin disease, such as eczema.
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Affiliation(s)
- Rachel K Palmer
- Graduate School of Biomedical Sciences, University of Maine, Orono, ME 04469, USA.
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Reddel HK, Lim TK, Mishima M, Wainwright CE, Knight DA. Year-in-review 2010: asthma, COPD, cystic fibrosis and airway biology. Respirology 2011; 16:540-52. [PMID: 21338438 DOI: 10.1111/j.1440-1843.2011.01949.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Helen K Reddel
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.
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Abstract
Atopic disease represents a spectrum of disorders characterized by abnormal sensitivity mediated by IgE; approximately 20% of Americans suffer from some form of allergic disease. The sequelae of inhalant and food allergies may present in many organ systems. Manifestations of allergic disease in one site are often associated with symptoms from another site. It is important for clinicians to understand the epidemiology of atopic disease and its causes to facilitate implementation of effective treatment and prevention strategies. This review focuses on the epidemiology of inhalant allergies causing allergic rhinitis and asthma and on IgE-mediated food allergies.
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Affiliation(s)
- Charles S Ebert
- Division of Rhinology, Allergy, and Sinus Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC 27599-7070, USA.
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Abstract
PURPOSE OF REVIEW asthma is a common chronic disease with significant clinical impact worldwide. Sex-related disparities in asthma epidemiology and morbidity exist but debate continues regarding the mechanisms for these differences. There is a need to review the recent findings for asthma care providers and to highlight areas in need of additional research. RECENT FINDINGS recent data illustrate striking sex-related differences in asthma epidemiology and disease expression. Studies show an increased incidence of asthma in women. Data demonstrate that asthmatic women have a poorer quality of life and increased utilization of healthcare compared to their male counterparts despite similar medical treatment and baseline pulmonary function. Research continues to explore hypotheses for these differences including the potential influences of the female sex hormones, altered perception of airflow obstruction, increased bronchial hyper-responsiveness, and medication compliance and technique. However, no single explanation has been able to fully explain the disparities. SUMMARY women are more likely to be diagnosed with asthma and suffer greater morbidity than men. The physiologic mechanisms for these differences are not well understood. Understanding sex-related differences in asthma and providing patients with education geared toward these disparities are important in establishing effective, individualized asthma management strategies for all patients.
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Tesse R, Schieck M, Kabesch M. Asthma and endocrine disorders: shared mechanisms and genetic pleiotropy. Mol Cell Endocrinol 2011; 333:103-11. [PMID: 21134413 DOI: 10.1016/j.mce.2010.11.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 11/23/2010] [Accepted: 11/27/2010] [Indexed: 01/07/2023]
Abstract
Asthma is a common inflammatory disease for which the cause is not yet known. Studies of the epidemiology and natural history of childhood asthma into adulthood demonstrate a change in gender prevalence with age. Hormones and inflammation may interact in asthma pathogenesis and determine its course. The same may be true for some endocrine disorders, including diabetes and obesity. Obesity plays a major role in the development of the metabolic syndrome and has been identified as an important risk factor for chronic diseases such as type 2 diabetes mellitus. The prevalence of asthma has paralleled the rise in obesity, suggesting that shared environmental factors could affect both conditions. In addition, endocrine diseases and asthma may share common genetic determinants. In the first part of this review we assess endocrine influences on asthma and overlaps between endocrine disorders and asthma while in the second part we explore the potential benefit of comparative genetic analyses between asthma and endocrine diseases.
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Affiliation(s)
- Riccardina Tesse
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
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O'Connor RD, Bleecker ER, Long A, Tashkin D, Peters S, Klingman D, Gutierrez B. Subacute lack of asthma control and acute asthma exacerbation history as predictors of subsequent acute asthma exacerbations: evidence from managed care data. J Asthma 2010; 47:422-8. [PMID: 20528597 DOI: 10.3109/02770901003605332] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Monitoring indicators of subacute lack of asthma control (SALAC) may help to reduce asthma morbidity. OBJECTIVE To determine whether SALAC, independent of current asthma exacerbations, is associated with subsequent acute asthma exacerbations. METHODS Administrative claims data from PharMetrics/IMS Health were used to identify patients 12 years or older continuously enrolled in a participating U.S. health plan from 2001 to 2004 with >or=1 asthma claim (International Classification of Diseases, Ninth Revision, Clinical Modification code 493.x), no chronic obstructive pulmonary disease or cystic fibrosis claims, and >or=1 prescription for an asthma medication during 2001-2004. SALAC was defined as more than 4 asthma-related physician visits (or >or=2/quarter) or more than 5 short-acting beta((2))-adrenergic agonist prescriptions during 2001. Effect of asthma control category (Exacerbation Only [EO], SALAC Only [SO], Both Exacerbation and SALAC [Both], Neither Exacerbation nor SALAC [Neither]) in 2001 on acute asthma exacerbations (hospitalization, emergency department visit, or short-term oral corticosteroid use) during 2002-2004 was assessed using logistic regression, adjusting for gender, age, health plan type, and region. RESULTS Of 11,779 patients, 8% were assigned to the EO group, 26% to SO, 12% to Both, and 54% to Neither in 2001. The incidence of exacerbations in 2002-2004 was higher for Both (61.8%) versus EO (55.0%) and for SO (37.3%) versus Neither (31.9%). The risk of exacerbation in 2002-2004 was increased significantly (p < .0001) for Both (3.394; 95% confidence interval [CI] = 3.009, 3.827), EO (2.503; 95% CI = 2.176, 2.879), and SO (1.277; 95% CI = 1.166, 1.399) versus Neither. CONCLUSION In this study, the risk of subsequent exacerbation was greatest in patients with both SALAC and acute asthma exacerbations, followed by those with exacerbations only and those with SALAC only. SO identified an additional 26% of asthma patients at increased risk for subsequent exacerbation. The results from this study demonstrate that SALAC indicators and a history of acute asthma exacerbations are independent predictors of future acute asthma exacerbations and highlight the important role of subacute asthma worsening in predicting and preventing future asthma exacerbations.
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Affiliation(s)
- Richard D O'Connor
- Department of Quality Management, Sharp Rees-Stealy Medical Group, San Diego, California, CA 92101, USA.
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Sundberg R, Torén K, Franklin KA, Gislason T, Omenaas E, Svanes C, Janson C. Asthma in men and women: treatment adherence, anxiety, and quality of sleep. Respir Med 2009; 104:337-44. [PMID: 19910178 DOI: 10.1016/j.rmed.2009.10.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 10/19/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to compare female and male asthmatics with special emphasis on reported adherence, anxiety, and quality of sleep. The study included 470 subjects with current asthma from the Nordic countries, who took part in the European Community Respiratory Health Survey (ECRHS) II. Subjects were investigated with a structured clinical interview, including questions on the presence of respiratory symptoms and therapy. They were also asked to fill in the self-reported Hospital Anxiety Depression scale and the Basic Nordic Sleep Questionnaire. Inhaled corticosteroids (OR=0.55) and a doctor's appointment in the last 12 months (OR=0.54) implied a significantly reduced risk for non-adherence in normal situations. At exacerbation in asthma, women had a significantly decreased risk for non-adherence (OR=0.46). Female gender and anxiety were independent risk factors for both insomnia (OR=3.67 and 2.53, respectively) and daytime sleepiness (OR=2.53 and 2.04, respectively). Women with asthma have a more positive attitude towards their medication, have a higher reported adherence, and use inhaled corticosteroids more often than men. At the same time women report more often anxiety and insomnia than men. Awareness of sex differences in the manifestations and attitudes towards treatment of asthma is important in order to improve asthma management.
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Affiliation(s)
- Rosita Sundberg
- Department of Internal Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg, S-413 45 Sweden.
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Raherison C, Janson C, Jarvis D, Burney P, Cazzoletti L, de Marco R, Neukirch F, Leynaert B. Evolution of asthma severity in a cohort of young adults: is there any gender difference? PLoS One 2009; 4:e7146. [PMID: 19779616 PMCID: PMC2745579 DOI: 10.1371/journal.pone.0007146] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 06/22/2009] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Little is known about the distribution of asthma severity in men and women in the general population. The objective of our study was to describe asthma severity and change in severity according to gender in a cohort of adult asthmatics METHODS Subjects with asthma were identified from random samples of the 22 to 44 year-olds from the general population, screened for asthma from 1991 to 1993 in 48 centers from 22 countries and followed-up during 1998-2002, as part of the European Community Respiratory Health Survey (ECRHS). All participants to follow-up with current asthma at baseline were eligible for the analysis. To assess change over the follow-up, asthma severity at the two surveys was defined using standardized data on respiratory symptoms, lung function and medication according to the Global Initiative for Asthma (GINA) Guidelines. Another quantitative score (Ronchetti) further considering hospitalizations was also analysed. RESULTS The study included 685 subjects with asthma followed-up over a mean period of 8.65 yr (min 4.3-max 11.7). At baseline, asthma severity according to GINA was distributed as intermittent: 40.7%, 31.7% as mild persistent, 14% as moderate persistent, and 13.5% as severe persistent. Using the Ronchetti score derived classification, the distribution of asthma severity was 58% mild, (intermittent and mild persistent), 25.8% moderate, and 15.4% severe. Whatever the classification, there was no significant difference in the severity distribution between men and women. There was also no gender difference in the severity distribution among incident cases which developed asthma between the two surveys. Men with moderate-to-severe asthma at baseline were more likely than women to have moderate-to-severe asthma at follow-up. Using GINA, 69.2% of men vs. 53.1% of women (p = 0.09) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. Using Ronchetti score, 53.3% of men vs. 36.2% of women (p = 0.03) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. CONCLUSIONS There was no gender difference in asthma severity at the two surveys. However, our findings suggest that asthma severity might be less stable in women than in men.
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Affiliation(s)
- Chantal Raherison
- Department of Respiratory Diseases Haut-Lévèque CHU Bordeaux, EA 3672, ISPED, Université Bordeaux 2, Bordeaux, France
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Deborah Jarvis
- Department of Public Health Sciences, Capital House, London, United Kingdom
| | - Peter Burney
- Department of Public Health Sciences, Capital House, London, United Kingdom
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona, Italy
| | - Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona, Italy
| | - Françoise Neukirch
- Epidémiologie des Maladies Respiratoires, INSERM U700, Faculté de Médecine Xavier, Bichat, Paris
| | - Benedicte Leynaert
- Epidémiologie des Maladies Respiratoires, INSERM U700, Faculté de Médecine Xavier, Bichat, Paris
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Melgert BN, Oriss TB, Qi Z, Dixon-McCarthy B, Geerlings M, Hylkema MN, Ray A. Macrophages: regulators of sex differences in asthma? Am J Respir Cell Mol Biol 2009; 42:595-603. [PMID: 19574533 DOI: 10.1165/rcmb.2009-0016oc] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Females are more susceptible to development of asthma than are males. In a mouse model of ovalbumin-induced airway inflammation, with aggravated disease in females compared with males, we studied interactions between immune and resident lung cells during asthma development to elucidate which processes are affected by sex. We studied numbers of regulatory T cells (Tregs), effector T cells, myeloid dendritic cells (mDCs), and alternatively activated macrophages (AAMPhi), and their functional capabilities. Male and female mice had comparable Treg numbers in lung tissue and comparable Treg function, but effector T cells had expanded to a greater extent in lungs of females after ovalbumin exposure. This difference in T cell expansion was therefore not the result of lack of Treg control, but appeared to be driven by a greater number of inflammatory mDCs migrating from the lungs to lymph nodes in females. Resident lung cells can influence mDC migration, and AAMPhi in lung tissue were found to be involved. Artificially elevating the number of AAMPhi in lung tissue increased the migration of mDCs and airway inflammation. We found greater numbers of AAMPhi in female lungs than in males; we therefore postulate that AAMPhi are involved in increased airway inflammation found in female mice.
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Affiliation(s)
- Barbro N Melgert
- University of Pittsburgh Medical Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Pittsburgh, Pennsylvania, USA.
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Sundberg R, Palmqvist M, Tunsäter A, Torén K. Health-related quality of life in young adults with asthma. Respir Med 2009; 103:1580-5. [PMID: 19481434 DOI: 10.1016/j.rmed.2009.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/17/2009] [Accepted: 04/26/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim was to study health-related quality of life, five years after an intervention study among young adults with asthma. METHOD The design was a follow-up study of a cohort of young adults with asthma (n=64) and 248 general population controls. Both groups were investigated at follow-up with a respiratory questionnaire and one generic quality-of-life instrument, and the asthma cohort also completed one-asthma-specific questionnaire. The material was analyzed with multivariate models. RESULTS Female gender and low FEV1 at baseline predicted both a decline during follow-up and a low quality of life at follow-up. The asthma cohort and controls scored similarly regarding generic quality of life. However, in the asthma cohort, females scored significantly lower in the physical dimension of the generic instrument, especially in the domain of general health. CONCLUSIONS There is an association between low FEV1 and a decline in quality of life among young adults with asthma, i.e. low FEV1 predicts a decline in quality of life during a five-year period. Young females with asthma seem to have lower quality of life compared with young males with asthma.
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Affiliation(s)
- Rosita Sundberg
- Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.
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Temprano J, Mannino DM. The effect of sex on asthma control from the National Asthma Survey. J Allergy Clin Immunol 2009; 123:854-60. [PMID: 19181370 DOI: 10.1016/j.jaci.2008.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 12/04/2008] [Accepted: 12/11/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have demonstrated conflicting results with regard to differences in asthma control between the sexes. OBJECTIVE We sought to identify sex differences in short-term and long-term measures of asthma control in adults from the National Asthma Survey. METHODS This study analyzed data from the National Asthma Survey (Four-State sample) sponsored by the National Center for Environmental Health, Centers for Disease Control and Prevention. Asthma control was compared between the sexes based on short-term (recent symptoms, asthma attacks, and albuterol use) and long-term (asthma attacks, work days lost, and urgent-care visits and hospitalizations in the prior year) measures. Composite scores for short-term and long-term control were calculated based on any single measure of poor asthma control and based on a sum of poor asthma control measures. RESULTS Women were more likely to have poor short-term asthma control based on any measure (adjusted odds ratio [OR], 1.20; CI, 1.01-1.44) or sum of measures (adjusted OR, 1.24; CI, 1.08-1.53) compared with men. Women also demonstrated worse asthma control based on any uncontrolled long-term measure (adjusted OR, 1.52; CI, 1.29-1.79) or sum of measures (adjusted OR, 1.68; CI, 1.45-1.93). These findings were present despite higher reported inhaled corticosteroid use and scheduled health care visits for asthma among women. CONCLUSIONS Women demonstrated worse asthma control compared with men with regard to several short-term and long-term measures, despite reporting higher rates of inhaled corticosteroid use and routine asthma care visits. Further studies are needed to elucidate whether these findings are due to differences in health reporting or to pathophysiologic differences in asthma between the sexes.
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Affiliation(s)
- James Temprano
- Department of Internal Medicine, Division of Allergy and Immunology, University of Kentucky, Lexington, KY 40508, USA.
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Gender differences in the prevalence of airway hyperresponsiveness and asthma in athletes. Respir Med 2008; 103:401-6. [PMID: 19027280 DOI: 10.1016/j.rmed.2008.09.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 09/25/2008] [Accepted: 09/29/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although athletes have a high prevalence of airway hyperresponsiveness (AHR) and asthma, little is known about possible gender differences in regard to these features. We looked at the comparative prevalence of AHR, physician-diagnosed asthma and respiratory symptoms during exercise in female (F) and male (M) athletes. METHOD A retrospective analysis was done on 2 groups of athletes: Group 1 (n=100) taking part in a study on the prevalence of AHR to methacholine (PC(20)<16mg/ml) and Group 2 (n=698), taking part in a provincial survey on the prevalence of physician-diagnosed asthma. Subjects from both groups filled the same questionnaire on respiratory symptoms during exercise (breathlessness, wheezing and chest tightness). RESULTS In Group 1, prevalence of AHR was significantly higher in female (60%) compared with male (21.5%, p<0.0001) athletes despite a similar prevalence of physician-diagnosed asthma (F: 17.1%, M: 15.4%, p>0.05). Respiratory symptoms during exercise were more frequently reported in females (37.1%, M: 16.9%, p=0.02); however, when corrected for the PC(20), this difference became non-significant. In Group 2, the prevalence of physician-diagnosed asthma was not different between genders (F: 12.5%, M: 14%, p>0.05) but respiratory symptoms during exercise were more often reported in female (19.4%) than in male (12.2%, p=0.01) athletes. CONCLUSIONS This analysis shows a higher prevalence of AHR and exercise-induced respiratory symptoms in female compared to male athletes, but a similar prevalence of physician-diagnosed asthma. This suggested that the increase in respiratory symptoms in female athletes failed to translate into a higher prevalence of physician-diagnosed asthma.
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