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McCrossan P, Shields MD, McElnay JC. Medication Adherence in Children with Asthma. Patient Prefer Adherence 2024; 18:555-564. [PMID: 38476591 PMCID: PMC10929205 DOI: 10.2147/ppa.s445534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
Asthma is the most common chronic disease in childhood. If untreated, asthma can lead to debilitating daily symptoms which affect quality of life, but more importantly can lead to fatal asthma attacks which unfortunately still occur globally. The most effective treatment strategy for controlling asthma is for the patient to follow a personalised asthma action plan (PAAP) which will invariably include regular use of an inhaled corticosteroid. To examine medication adherence in children with asthma, we collated recent evidence from systematic reviews in this area to address the following 5 key questions; What is adherence? Is there evidence that children are not adhering to preventer medication? Why is adherence poor and what are the barriers to adherence? Does good adherence improve outcomes in asthma? And lastly, how can treatment adherence be improved?
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Affiliation(s)
- Paddy McCrossan
- Paediatric Respiratory Medicine, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | - Michael D Shields
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - James C McElnay
- School of Pharmacy, Queen’s University Belfast, Belfast, Northern Ireland
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Park J, Wu Y, Li Q, Choi J, Ju H, Cai Y, Lee J, Oh YK. Nanomaterials for antigen-specific immune tolerance therapy. Drug Deliv Transl Res 2023; 13:1859-1881. [PMID: 36094655 DOI: 10.1007/s13346-022-01233-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/26/2022]
Abstract
Impairment of immune tolerance might cause autologous tissue damage or overactive immune response against non-pathogenic molecules. Although autoimmune disease and allergy have complicated pathologies, the current strategies have mainly focused on symptom amelioration or systemic immunosuppression which can lead to fatal adverse events. The induction of antigen-specific immune tolerance may provide therapeutic benefits to autoimmune disease and allergic response, while reducing nonspecific immune adverse responses. Diverse nanomaterials have been studied to induce antigen-specific immune tolerance therapy. This review will cover the immunological background of antigen-specific tolerance, clinical importance of antigen-specific immune tolerance, and nanomaterials designed for autoimmune and allergic diseases. As nanomaterials for modulating immune tolerances, lipid-based nanoparticles, polymeric nanoparticles, and biological carriers have been covered. Strategies to provide antigen-specific immune tolerance have been addressed. Finally, current challenges and perspectives of nanomaterials for antigen-specific immune tolerance therapy will be discussed.
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Affiliation(s)
- Jinwon Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Yina Wu
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Qiaoyun Li
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Jaehyun Choi
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hyemin Ju
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Yu Cai
- College of Pharmacy, Jinan University, Guangzhou, 510632, China
| | - Jaiwoo Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Yu-Kyoung Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea.
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Zheng R, Wang F, Huang Y, Xiang Q, Dai H, Zhang W. Elevated Th17 cell frequencies and Th17/Treg ratio are associated with airway hyperresponsiveness in asthmatic children. J Asthma 2020; 58:707-716. [PMID: 32114839 DOI: 10.1080/02770903.2020.1737710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: The elevation of T helper (Th)17 cell frequencies and the imbalance of Th17/regulatory T (Treg) cells occur in asthma pathogenesis. Airway hyperresponsiveness (AHR) is a cardinal feature of asthma, and Th17 responses can promote AHR. We hypothesized that changes in Th17 cells and the Th17/Treg ratio correlate with AHR in asthmatic children.Methods: Twenty asthmatic children and twenty healthy children were included in the study. The peak expiratory flow (PEF) % pred, forced expiratory volume in 1 s (FEV1) % pred and the FEV1/forced vital capacity (FVC) ratio were measured in all subjects. Methacholine challenge test (MCT) was performed in asthmatic children. Flow cytometric analysis was used to determine the proportions of Th17 and Treg cells in peripheral blood mononuclear cells. ELISA was used to assess serum levels of interleukin (IL)-17A and IL-10.Results: Th17 cell frequencies (2.272 ± 0.207% in asthmatics, 1.193 ± 0.131% in controls, P < 0.01) and Th17/Treg ratios (0.371 ± 0.0387 in asthmatics, 0.183 ± 0.020 in controls, P < 0.01) were significantly increased in asthmatic children compared to controls. In asthmatic children, the MCT grade had positive correlations with the Th17 cell frequencies [r = 0.718, P < 0.01], serum IL-17A level [r = 0.753, P < 0.01] and Th17/Treg ratio [r = 0.721, P < 0.01], while the log10PD20-FEV1 value was negatively correlated with the Th17 cell frequencies [r = -0.654, P < 0.01], serum IL-17A level [r = -0.652, P < 0.01] and Th17/Treg ratio [r = -0.625, P < 0.01].Conclusion: Th17 cell, IL-17A and Th17/Treg ratio were positively correlated with AHR in asthmatic children. It may be helpful to monitor Th17 cells and the Th17/Treg ratio as indicators of AHR in clinical practice.
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Affiliation(s)
- Rongying Zheng
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fangmin Wang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yue Huang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiangwei Xiang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huan Dai
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weixi Zhang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Zhang M, Wen ZH, Yang CQ. [A clinical follow-up study of children with well-controlled asthma after withdrawal of low-dose inhaled corticosteroids]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:421-425. [PMID: 31104655 PMCID: PMC7389418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To study the incidence of acute attacks of asthma and dynamic changes in laboratory markers in children with well-controlled asthma after the withdrawal of low-dose inhaled corticosteroids (ICS), and to provide a basis for optimal long-term control regimens for children with asthma. METHODS A total of 63 children with well-controlled asthma were enrolled as subjects. According to their parents' wishes, they were continuously administered with ICS (ICS treatment group; n=35) and without ICS (ICS withdrawal group; n=28). They were followed up for 18 months. The incidence of acute attacks of asthma was evaluated, dynamic monitoring was performed for pulmonary function and fractional exhaled nitric oxide (FeNO), and childhood asthma control test (C-ACT) was performed every three months. RESULTS At 3, 6, 9, and 12 months of follow-up, there was no significant difference in FeNO between the ICS treatment and withdrawal groups (P>0.05). However, at 15 and 18 months of follow-up, the withdrawal group had a significantly higher level of FeNO than the ICS treatment group (P<0.05). There was no significant difference in the C-ACT score between the two groups at all time points of follow-up (P>0.05). At 3, 6, 9, and 12 months of follow-up, there were no significant differences between the two groups in the percentage of forced expiratory volume in 1 second, the ratio of forced expiratory volume in 1 second to forced vital capacity, percentage of predicted maximum mid-expiratory flow (MMEF%), and maximal expiratory flow at 50% of vital capacity (MEF50) (P>0.05), while at 15 and 18 months of follow-up, the ICS treatment group had significantly higher MMEF% and MEF50 than the withdrawal group (P<0.05). During follow-up, 3 children (9%) in the ICS treatment group and 8 (29%) in the withdrawal group experienced acute attacks of asthma (P=0.0495). CONCLUSIONS Continuous inhalation of low-dose ICS can maintain the stability of pulmonary function and reduce acute attacks of asthma in children with well-controlled asthma.
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Affiliation(s)
- Min Zhang
- Department of Pediatrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China.
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Zhang M, Wen ZH, Yang CQ. [A clinical follow-up study of children with well-controlled asthma after withdrawal of low-dose inhaled corticosteroids]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:421-425. [PMID: 31104655 PMCID: PMC7389418 DOI: 10.7499/j.issn.1008-8830.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the incidence of acute attacks of asthma and dynamic changes in laboratory markers in children with well-controlled asthma after the withdrawal of low-dose inhaled corticosteroids (ICS), and to provide a basis for optimal long-term control regimens for children with asthma. METHODS A total of 63 children with well-controlled asthma were enrolled as subjects. According to their parents' wishes, they were continuously administered with ICS (ICS treatment group; n=35) and without ICS (ICS withdrawal group; n=28). They were followed up for 18 months. The incidence of acute attacks of asthma was evaluated, dynamic monitoring was performed for pulmonary function and fractional exhaled nitric oxide (FeNO), and childhood asthma control test (C-ACT) was performed every three months. RESULTS At 3, 6, 9, and 12 months of follow-up, there was no significant difference in FeNO between the ICS treatment and withdrawal groups (P>0.05). However, at 15 and 18 months of follow-up, the withdrawal group had a significantly higher level of FeNO than the ICS treatment group (P<0.05). There was no significant difference in the C-ACT score between the two groups at all time points of follow-up (P>0.05). At 3, 6, 9, and 12 months of follow-up, there were no significant differences between the two groups in the percentage of forced expiratory volume in 1 second, the ratio of forced expiratory volume in 1 second to forced vital capacity, percentage of predicted maximum mid-expiratory flow (MMEF%), and maximal expiratory flow at 50% of vital capacity (MEF50) (P>0.05), while at 15 and 18 months of follow-up, the ICS treatment group had significantly higher MMEF% and MEF50 than the withdrawal group (P<0.05). During follow-up, 3 children (9%) in the ICS treatment group and 8 (29%) in the withdrawal group experienced acute attacks of asthma (P=0.0495). CONCLUSIONS Continuous inhalation of low-dose ICS can maintain the stability of pulmonary function and reduce acute attacks of asthma in children with well-controlled asthma.
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Affiliation(s)
- Min Zhang
- Department of Pediatrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China.
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Sun W, Pan L, Yu Q, Sun Y, Zeng X, Bai X, Li M. The skin prick test response after allergen immunotherapy in different levels of tIgE children with mite sensitive Asthma/Rhinitis in South China. Hum Vaccin Immunother 2018; 14:2510-2515. [PMID: 30047819 DOI: 10.1080/21645515.2018.1482171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND At present, the biomarkers which can predict the clinical efficacy of allergen immunotherapy (AIT) are still much debated. IgE levels are often related to allergic severity. Therefore, this study aimed at relating total IgE (tIgE) levels with the efficacy of AIT assessed by symptoms and drug score and skin prick test (SPT) response. METHODS We evaluated 81 allergic children who had received house-dust mite (HDM) subcutaneous immunotherapy for three years. According to the tIgE levels before treatment, all children were divided into high value, medium value and low value group. Each group according to sIgE/tIgE ratio was divided into subgroups. The efficacy of AIT is assessed by symptoms and drug score. By comparing changes in the grade of SPT in each group, the response of AIT are evaluated. RESULTS The SPT grade changes to determine efficacy had a high degree of consistency with symptoms and drug score judgment (sensitivity 89.7%, specificity 78.3%, Kappa = 0.670, P < 0.001). Compared to ineffective cases, the effective cases had lower tIgE (P < 0.001) and higher ratio of sIgE/tIgE (P < 0.001). The grades of SPT declined the most in the low value group (low value group vs. medium value group, P < 0.05; low value group vs. high value group, P < 0.001; medium value group vs. high value group, P < 0.05). CONCLUSIONS The SPT grade change can be used for efficacy evaluation. Children with lower level of tIgE and higher ratio of sIgE/tIgE that obtain a more satisfactory effect.
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Affiliation(s)
- Wangming Sun
- a Center for Asthma and Allergy Immunotherapy , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , P.R. China
| | - Lingzhi Pan
- a Center for Asthma and Allergy Immunotherapy , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , P.R. China
| | - Qiying Yu
- a Center for Asthma and Allergy Immunotherapy , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , P.R. China
| | - Yan Sun
- a Center for Asthma and Allergy Immunotherapy , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , P.R. China
| | - Xiangyan Zeng
- a Center for Asthma and Allergy Immunotherapy , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , P.R. China
| | - Xiaoli Bai
- a Center for Asthma and Allergy Immunotherapy , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , P.R. China
| | - Mengrong Li
- a Center for Asthma and Allergy Immunotherapy , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , P.R. China
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