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Mayorga C, Ariza A, Muñoz-Cano R, Sabato V, Doña I, Torres MJ. Biomarkers of immediate drug hypersensitivity. Allergy 2024; 79:601-612. [PMID: 37947156 DOI: 10.1111/all.15933] [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: 04/13/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
Immediate drug hypersensitivity reactions (IDHRs) are a burden for patients and the health systems. This problem increases when taking into account that only a small proportion of patients initially labelled as allergic are finally confirmed after an allergological workup. The diverse nature of drugs involved will imply different interactions with the immunological system. Therefore, IDHRs can be produced by a wide array of mechanisms mediated by the drug interaction with specific antibodies or directly on effector target cells. These heterogeneous mechanisms imply an enhanced complexity for an accurate diagnosis and the identification of the phenotype and endotype at early stages of the reaction is of vital importance. Currently, several endophenotypic categories (type I IgE/non-IgE, cytokine release, Mast-related G-protein coupled receptor X2 (MRGPRX2) or Cyclooxygenase-1 (COX-1) inhibition and their associated biomarkers have been proposed. A precise knowledge of endotypes will permit to discriminate patients within the same phenotype, which is crucial in order to personalise diagnosis, future treatment and prevention to improve the patient's quality of life.
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Affiliation(s)
- Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina - IBIMA Plataforma BIONAND, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-HRUM, Málaga, Spain
| | - Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina - IBIMA Plataforma BIONAND, Málaga, Spain
| | - Rosa Muñoz-Cano
- Allergy Department, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology, Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Inmaculada Doña
- Allergy Unit, Hospital Regional Universitario de Málaga-HRUM, Málaga, Spain
| | - Maria J Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina - IBIMA Plataforma BIONAND, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-HRUM, Málaga, Spain
- Medicine Department, Universidad de Málaga-UMA, Málaga, Spain
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2
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Campbell RG, Auyeung T, Katsoulotos GP. Pulmonology for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:20-27. [PMID: 37997890 DOI: 10.1097/moo.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW The upper and lower airways are inter-related despite serving different functions and can no longer be considered separately. Rhinologists are becoming increasingly aware of the role the lower airway plays in optimizing outcomes for their patients. This review highlights recent developments in pulmonology that impact rhinologic conditions. RECENT FINDINGS The unified airway concept now supports the multidisciplinary management of respiratory and rhinologic pathologies. Biomarkers, biologics and the concept of treatable traits have permitted the development of personalized and precise treatment of the entire respiratory tract. The concept of corticosteroid stewardship, the introduction of steroid sparing agents for the treatment of respiratory diseases and the development of biomarkers, now forces us to be more considerate and precise with oral corticosteroid (OCS) prescribing and to consider reduction regimens. Finally, current research on climate change and vaping will allow us to better educate and prepare our patients to improve adherence and avoid exacerbations to maintain optimal global respiratory health. SUMMARY The inter-relatedness of the upper and lower airway has encouraged a multidisciplinary focus in respiratory medicine. More research is required to improve the precision respiratory medicine model, particularly in the realm of biomarkers and endotyping. These developments must also consider the impact of climate change, pollution and toxins for us to provide optimum care for our patients.
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Affiliation(s)
- Raewyn G Campbell
- Faculty of Medicine, Health and Human Sciences, Macquarie University
- Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney
| | - Titus Auyeung
- Concord Clinical School, The University of Sydney, Sydney, NSW
| | - Gregory P Katsoulotos
- Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW
- The University of Notre Dame, Sydney, WA
- St Vincent's Clinic, Darlinghurst, NSW
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3
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Cleves D, Vargas P, Acuña-Cordero R, Aguilera-Otalvaro P, Camargo B, Aristizábal-Duque R, Rodríguez-Martínez CE. Association between fractional exhaled nitric oxide and therapeutic adherence to controller management in pediatric asthma patients. Pediatr Pulmonol 2024; 59:121-128. [PMID: 37818776 DOI: 10.1002/ppul.26723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Guidelines for asthma management recommend, before establishing additional therapeutic behaviors, to confirm correct use and adequate therapeutic adherence to treatment. Evidence exists on the use of fractional exhaled nitric oxide (FeNO) values for monitoring therapeutic adherence in adults. It is important to establish whether there is a correlation between FeNO and therapeutic adherence in children. This study aims to provide new knowledge about the relationship between FeNO and therapeutic adherence in asthmatic children. MATERIALS AND METHODS Analytical cross-sectional study including asthma patients 5-18 years of age, attending follow-up at Hospital Militar Central (HMC) between May and November 2022 in Colombia. A sociodemographic survey was carried out, followed by the Pediatric Inhaler Adherence Questionnaire (PIAQ), and asthma control test (ACT) or childhood asthma control test (cACT). We defined adequate therapeutic adherence as not missing a single application of inhaled steroids in the last 15 days according to PIAQ. A poisson regression model was carried out including relevant predictors for therapeutic adherence such as FeNO values, age, tobacco exposure at home, atopy, and time since initiation of use of inhaled controller. RESULTS Eighty-two children with a median age of 10 years (interquartile range: 7-12 years) were included. Adequate therapeutic adherence was reported by 68.3%. After adjusting for age, sex, exposure to cigarette smoke, duration of controller therapy, and atopy, FeNO < 20 ppb was independently associated with adequate therapeutic adherence (RR = 1.5, p = .04, 95% confidence interval: 1.03-2.19). CONCLUSIONS FeNO values seem to be useful to identify pediatric patients with asthma who have adequate adherence to inhaled steroids in a MIC.
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Affiliation(s)
- Daniela Cleves
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Pedro Vargas
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | | | | | - Bethy Camargo
- Department of Pediatrics, Hospital Militar Central, Bogotá, Colombia
| | | | - Carlos E Rodríguez-Martínez
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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4
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Hansen ESH, Rasmusen HK, Hostrup M, Hellsten Y, Backer V. The effect of aerobic exercise training on asthma control in postmenopausal women (ATOM): a randomized controlled pilot study. Eur Clin Respir J 2023; 10:2251256. [PMID: 37674777 PMCID: PMC10478610 DOI: 10.1080/20018525.2023.2251256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To evaluate if high-intensity interval training three times weekly for 12 weeks improves asthma control in overweight, postmenopausal women with uncontrolled, late-onset asthma. Methods The reported study is a randomized clinical pilot study (www.clinicaltrials.gov; NCT03747211) that compared 12 weeks of high-intensity interval training (spinning) with usual care. The five-question Asthma Control Questionnaire (ACQ-5) was used as primary outcome. Secondary measures included systemic inflammation and inflammation of the airways, body composition, and cardiac function during exercise. Results We included 12 women with asthma (mean age 65 years (SD 6); mean body mass index 30 kg/m2 (SD 2)) from whom eight were randomized to exercise and four to control. Baseline ACQ-5 was 1.95 (SD 0.53) in the control group and 2.03 (0.54) in the exercise group. Patients had a mean blood eosinophil level of 0.16 × 109cells/L (SD 0.07) and a mean fraction of exhaled nitric oxide of 23 ppb (SD 25). Mixed models showed that participants in the exercise group reduced their ACQ-5 by 0.55 points (95%CI -1.10 to -0.00; P = 0.08) compared with the control group. The exercise group significantly reduced their mean body fat percentage (-2.7%; 95%CI -4.5 to -0.8; P = 0.02), fat mass (-2.8 kg; 95%CI -5.1 to -0.4; P = 0.044) and android fat mass (-0.33 kg; 95%CI -0.60- -0.06; P = 0.038). In analyses of cardiac measures, we saw no significant effects on right ventricular function (fractional area change), diastolic function or left ventricular function. Conclusions Although changes in ACQ-5 were slightly insignificant, these preliminary findings indicate that aerobic exercise training can be used as a means to improve asthma control in overweight, postmenopausal women with asthma.
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Affiliation(s)
- Erik Sören Halvard Hansen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
- Department of Internal Medicine, Slagelse Hospital, Slagelse, Denmark
| | | | - Morten Hostrup
- Department of Nutrition Exercise and Sports, University of Copenhagen, CopenhagenDenmark
| | - Ylva Hellsten
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, CopenhagenDenmark
| | - Vibeke Backer
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology, Rigshospitalet, CopenhagenDenmark
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Cachim A, Pereira AM, Almeida R, Amaral R, Alves‐Correia M, Vieira‐Marques P, Chaves‐Loureiro C, Ribeiro C, Cardia F, Gomes J, Vidal C, Silva E, Rocha S, Rocha D, Marques ML, Páscoa R, Morais D, Cruz AM, Santalha M, Simões JA, da Silva S, Silva D, Gerardo R, Todo Bom F, Morete A, Vieira I, Vieira P, Monteiro R, Raimundo MR, Monteiro L, Neves Â, Santos C, Penas AM, Regadas R, Marques JV, Rosendo I, Aguiar MA, Fernandes S, Cardoso CS, Pimenta F, Meireles P, Gonçalves M, Fonseca JA, Jácome C. Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment. Clin Transl Allergy 2023; 13:e12210. [PMID: 36825517 PMCID: PMC9930432 DOI: 10.1002/clt2.12210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/27/2022] [Accepted: 09/30/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. METHODS This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). RESULTS A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). CONCLUSIONS Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.
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Affiliation(s)
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal
| | - Rute Almeida
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal
| | - Rita Amaral
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Cardiovascular and Respiratory SciencesPorto Health SchoolPolytechnic Institute of PortoPortoPortugal,Department of Women's and Children's HealthPediatric ResearchUppsala UniversityUppsalaSweden
| | - Magna Alves‐Correia
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal
| | - Pedro Vieira‐Marques
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal
| | - Claudia Chaves‐Loureiro
- Pulmonology DepartmentHospitais da Universidade de CoimbraCentro Hospitalar e Universitário de CoimbraCoimbraPortugal,Clinical Academic Center of CoimbraCoimbraPortugal
| | - Carmelita Ribeiro
- Serviço ImunoalergologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Francisca Cardia
- Unidade de Saúde Familiar (USF) Terras de AzuraraAgrupamento de Centros de Saúde Dão LafõesMangualdePortugal
| | - Joana Gomes
- Serviço de Imunoalergologia, Unidade ICentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
| | - Carmen Vidal
- Servicio de AlergiaComplejo Hospitalario Universitario de SantiagoSantiago de CompostelaSpain
| | - Eurico Silva
- USF João SemanaAgrupamento de Centros de Saúde (ACES) Baixo VougaOvarPortugal
| | - Sara Rocha
- USF Arte NovaACES Baixo VougaOliveirinhaPortugal
| | - Diana Rocha
- USF Sá de MirandaACES Cávado II ‐ Gerês/CabreiraVila VerdePortugal
| | - Maria Luís Marques
- Serviço de ImunoalergologiaHospital da Senhora da OliveiraGuimarãesPortugal
| | - Rosália Páscoa
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Abel SalazarACES GaiaVila Nova de GaiaPortugal
| | - Daniela Morais
- USF CorgoACES Douro I ‐ Marão e Douro NorteVila RealPortugal
| | | | - Marta Santalha
- Serviço de PediatriaHospital da Senhora da OliveiraGuimarãesPortugal
| | - José Augusto Simões
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Caminhos do CértomaACES Baixo MondegoPampilhosaPortugal,Department of Medical SciencesUniversity of Beira InteriorCovilhãPortugal
| | - Sofia da Silva
- USF CuidarteUnidade Local de Saúde do Alto MinhoPortuzeloPortugal
| | - Diana Silva
- Faculty of MedicineUniversity of PortoPortoPortugal,Serviço de ImunoalergologiaCentro Hospitalar Universitário de São JoãoPortoPortugal
| | - Rita Gerardo
- Serviço de PneumologiaHospital Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugal
| | | | - Ana Morete
- Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal,Serviço de ImunoalergologiaHospital Infante D PedroCentro Hospitalar Baixo VougaAveiroPortugal
| | - Inês Vieira
- Unidade de Cuidados Saúde Personalizados Arnaldo SampaioACES Pinhal LitoralLeiriaPortugal
| | | | - Rosário Monteiro
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Homem do LemeACES Porto OcidentalPortoPortugal
| | | | - Luís Monteiro
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Esgueira+ACES Baixo VougaEsgueiraPortugal
| | | | - Carlos Santos
- USF Santo AntónioACES Cávado III ‐ Barcelos/EsposendeBarcelosPortugal
| | | | - Rita Regadas
- USF Aquilino RibeiroACES Douro II ‐ Douro SulMoimenta da BeiraPortugal
| | | | - Inês Rosendo
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Coimbra CentroACES Baixo MondegoCoimbraPortugal
| | | | - Sara Fernandes
- UCSP São João da PesqueiraACES Douro SulSão João da PesqueiraPortugal
| | - Carlos Seiça Cardoso
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF CondeixaACES Baixo MondegoCondeixa‐a‐NovaPortugal
| | | | | | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal,MEDIDA – Medicina, Educação, Investigação, Desenvolvimento e AvaliaçãoPortoPortugal
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal
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Tay TR, Yii A, Chan YH, Choo XN. Interval change in fractional exhaled nitric oxide (FENO) reflects short-term change in adherence following electronic inhaler reminders. J Asthma 2023:1-9. [PMID: 36647191 DOI: 10.1080/02770903.2023.2169931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In asthma, suppression of fractional exhaled nitric oxide (FENO) is a marker of adherence in the short-term. The usefulness of FENO to indicate change in adherence in the longer term is unknown. The aims of this study were to determine the relationship between changes in adherence and corresponding changes in FENO over short (1 week) and long-term (3 month) periods. METHODS After establishing initial ICS adherence using electronic inhaler monitor (EIM) devices, reminders were switched on for 1 week ('short-term') to optimize adherence. Reminders were then switched off and patients followed up after 3 months ('long-term'). FENO was measured at the start and end of each period. Using linear regression, we analyzed change in FENO in relation to change in adherence. RESULTS Forty-two patients contributed complete data for analysis. In the short-term, change in adherence was independently associated with change in FENO (β = -0.36, p = 0.036) even after adjusting for initial adherence and ICS dose. The higher the initial FENO, the greater the decline in FENO with improved adherence. This relationship between change in adherence and change in FENO was not observed in the long-term. CONCLUSION Change in adherence over 1 week following the use of EIM reminders independently predicted change in FENO. This relationship was not maintained at 3 months.
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Affiliation(s)
- Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Anthony Yii
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xue Ning Choo
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
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Understanding the Cellular Sources of the Fractional Exhaled Nitric Oxide (FeNO) and Its Role as a Biomarker of Type 2 Inflammation in Asthma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5753524. [PMID: 35547356 PMCID: PMC9085317 DOI: 10.1155/2022/5753524] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Abstract
Fractional exhaled nitric oxide (FeNO) has gained great clinical importance as a biomarker of type 2 inflammation in chronic airway diseases such as asthma. FeNO originates primarily in the bronchial epithelium and is produced in large quantities by the enzyme inducible nitric oxide synthase (iNOS). It should be noted that nitric oxide (NO) produced at femtomolar to picomolar levels is fundamental for respiratory physiology. This basal production is induced in the bronchial epithelium by interferon gamma (IFNγ) via Janus kinases (JAK)/STAT-1 signaling. However, when there is an increase in the expression of type 2 inflammatory cytokines such as IL-4 and IL-13, the STAT-6 pathway is activated, leading to overexpression of iNOS and consequently to an overproduction of airway NO. Increased NO levels contributes to bronchial hyperreactivity and mucus hypersecretion, increases vascular permeability, reduces ciliary heartbeat, and promotes free radical production, airway inflammation, and tissue damage. In asthmatic patients, FeNO levels usually rise above 25 parts per billion (ppb) and its follow-up helps to define asthma phenotype and to monitor the effectiveness of corticosteroid treatment and adherence to treatment. FeNO is also very useful to identify those severe asthma patients that might benefit of personalized therapies with monoclonal antibodies. In this review, we revised the cellular and molecular mechanisms of NO production in the airway and its relevance as a biomarker of type 2 inflammation in asthma.
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Abstract
ABSTRACT This article discusses recent updates on the clinical management of asthma and outlines ways for nurses to engage patients in the management of their disease.
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Affiliation(s)
- Christine M Galante
- Christine M. Galante has practiced in acute, primary, and long-term care, and has worked in nursing education
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9
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Zaeh SE, Ramsey R, Bender B, Hommel K, Mosnaim G, Rand C. The Impact of Adherence and Health Literacy on Difficult-to-Control Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:386-394. [PMID: 34788658 DOI: 10.1016/j.jaip.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Medication nonadherence and health literacy are key factors that influence the management of difficult-to-control asthma. Adherence, or the extent to which a patient follows a treatment plan, extends beyond asthma medication use and includes an appropriate inhaler technique. Assessment of adherence is critical before making a diagnosis of severe asthma and stepping up asthma therapy but is challenging in the clinical context. Health literacy, or the degree to which individuals can obtain, process, and understand health information and services needed to make health care decisions, is additionally important for asthma management and has been shown to impact medication adherence. Initiatives aiming to improve difficult-to-control asthma should address medication adherence and health literacy. Universal health literacy precautions are recommended while communicating with patients, in addition to the creation of low health literacy asthma action plans. To improve adherence, a comprehensive assessment of adherence should be conducted. Additional evidence-based interventions aiming to improve adherence focus on appropriate inhaler use, improved access to medications, the use of digital platforms, school-based asthma interventions, and the implementation of culturally tailored interventions. Data are limited regarding the use of these initiatives in patients with severe or difficult-to-control asthma.
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Affiliation(s)
- Sandra E Zaeh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Conn.
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bruce Bender
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Kevin Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Cynthia Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md
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10
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Boyle RJ, Shamji MH. Developments in the field of allergy in 2020 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2021; 51:1531-1537. [PMID: 34750898 DOI: 10.1111/cea.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
While 2020 will be remembered for the global coronavirus pandemic, there were also important advances in the field of allergy. In this review article, we summarize key findings reported in Clinical and Experimental Allergy during 2020. We hope this provides readers with an accessible snapshot of the work published in our journal during this time.
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Affiliation(s)
- Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Imperial Biomedical Research Centre, London, UK
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11
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Rupani H, Fong WCG, Kyyaly A, Kurukulaaratchy RJ. Recent Insights into the Management of Inflammation in Asthma. J Inflamm Res 2021; 14:4371-4397. [PMID: 34511973 PMCID: PMC8421249 DOI: 10.2147/jir.s295038] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022] Open
Abstract
The present prevailing inflammatory paradigm in asthma is of T2-high inflammation orchestrated by key inflammatory cells like Type 2 helper lymphocytes, innate lymphoid cells group 2 and associated cytokines. Eosinophils are key components of this T2 inflammatory pathway and have become key therapeutic targets. Real-world evidence on the predominant T2-high nature of severe asthma is emerging. Various inflammatory biomarkers have been adopted in clinical practice to aid asthma characterization including airway measures such as bronchoscopic biopsy and lavage, induced sputum analysis, and fractional exhaled nitric oxide. Blood measures like eosinophil counts have also gained widespread usage and multicomponent algorithms combining different parameters are now appearing. There is also growing interest in potential future biomarkers including exhaled volatile organic compounds, micro RNAs and urinary biomarkers. Additionally, there is a growing realisation that asthma is a heterogeneous state with numerous phenotypes and associated treatable traits. These may show particular inflammatory patterns and merit-specific management approaches that could improve asthma patient outcomes. Inhaled corticosteroids (ICS) remain the mainstay of asthma management but their use earlier in the course of disease is being advocated. Recent evidence suggests potential roles for ICS in combination with long-acting beta-agonists (LABA) for as needed use in mild asthma whilst maintenance and reliever therapy regimes have gained widespread acceptance. Other anti-inflammatory strategies including ultra-fine particle ICS, leukotriene receptor antagonists and macrolide antibiotics may show efficacy in particular phenotypes too. Monoclonal antibody biologic therapies have recently entered clinical practice with significant impacts on asthma outcomes. Understanding of the efficacy and use of those agents is becoming clearer with a growing body of real-world evidence as is their potential applicability to other treatable comorbid traits. In conclusion, the evolving understanding of T2 driven inflammation alongside a treatable traits disease model is enhancing therapeutic approaches to address inflammation in asthma.
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Affiliation(s)
- Hitasha Rupani
- Department of Respiratory Medicine, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Wei Chern Gavin Fong
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight, UK
| | - Aref Kyyaly
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight, UK
| | - Ramesh J Kurukulaaratchy
- Department of Respiratory Medicine, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight, UK.,NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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12
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Hagan JB, Rank MA. Bioassays for Objectively Monitoring Systemic Corticosteroid Use in Severe Asthma: Ready for Precision Medicine? Chest 2021; 160:5-6. [PMID: 34246379 DOI: 10.1016/j.chest.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
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13
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Holmes J, Heaney LG. Measuring adherence to therapy in airways disease. Breathe (Sheff) 2021; 17:210037. [PMID: 34295430 PMCID: PMC8291934 DOI: 10.1183/20734735.0037-2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 12/14/2022] Open
Abstract
Non-adherence to medication is one of the most significant issues in all airways disease and can have a major impact on disease control as well as on unscheduled healthcare utilisation. It is vital that clinicians can accurately determine a patient's level of adherence in order to ensure they are gaining the maximal benefit from their therapy and also to avoid any potential for unnecessary increases in therapy. It is essential that measurements of adherence are interpreted alongside biomarkers of mechanistic pathways to identify if improvements in medication adherence can influence disease control. In this review, the most common methods of measuring adherence are discussed. These include patient self-report, prescription record checks, canister weighing, dose counting, monitoring drug levels and electronic monitoring. We describe the uses and benefits of each method as well as potential shortcomings. The practical use of adherence measures with measurable markers of disease control is also discussed. Educational aims To understand the various methods available to measure adherence in airways disease.To learn how to apply these adherence measures in conjunction with clinical biomarkers in routine clinical care.
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Affiliation(s)
- Joshua Holmes
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Liam G Heaney
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
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14
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Chiabai J, Friedrich FO, Fernandes MTC, Serpa FS, Antunes MOB, Neto FB, Makan G, Hantos Z, Sly PD, Jones MH. Intrabreath oscillometry is a sensitive test for assessing disease control in adults with severe asthma. Ann Allergy Asthma Immunol 2021; 127:372-377. [PMID: 34146698 DOI: 10.1016/j.anai.2021.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asthma control is not well reflected by spirometry, yet this is the most frequently used measure of lung function in asthma clinics. Oscillometry is an alternative technique suitable for those with severe asthma. OBJECTIVE To investigate usefulness of oscillometry in subjects with severe asthma to determine which outcome variables best reflected asthma control. METHODS Adults with severe asthma were recruited from a severe asthma clinic in Brazil. Oscillometry (conventional multifrequency measurements between 6 and 32 Hz; intrabreath tracking at 8 Hz) and spirometry were performed. Asthma control was determined by the asthma control test. RESULTS A total of 60 adults were evaluated; mean age was 56.7 years. There was predominance of women (82%), and most patients (63%) reported onset of asthma symptoms in childhood or adolescence. There were no differences between controlled and uncontrolled asthma in spirometry. Uncontrolled asthma was associated with higher resistance (at 8 and 10 Hz) and more negative reactance (for 6, 8, and 10 Hz) (P < .05) on conventional oscillometry. Intrabreath oscillometry revealed significant differences between controlled and uncontrolled patients with asthma (P < .01 for changes in resistance and reactance between end expiration and end inspiration). The accuracy of the lung function tests in discriminating between controlled and uncontrolled asthma was higher for intrabreath variables (area under the curve = 0.65-0.72). CONCLUSION Oscillometry, particularly the intrabreath technique, better reflected asthma control than spirometry measures. Our findings suggest that oscillometry may be a useful technique to aid management of severe asthma, with a potential to reflect loss of disease control.
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Affiliation(s)
- Joseane Chiabai
- Department of Pediatrics, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil.
| | - Frederico Orlando Friedrich
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Morgana Thaís Carollo Fernandes
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Faradiba Sarquis Serpa
- Department of Internal Medicine, School of Medicine of Santa Casa de Misericórdia of Vitória, Vitória, Espírito Santo, Brazil
| | - Marcos Otávio Brum Antunes
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Firmino Braga Neto
- Department of Internal Medicine, School of Medicine of Santa Casa de Misericórdia of Vitória, Vitória, Espírito Santo, Brazil
| | - Gergely Makan
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Zoltán Hantos
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, South Brisbane, Queensland, Australia
| | - Marcus Herbert Jones
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
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15
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Alahmadi F, Peel A, Keevil B, Niven R, Fowler SJ. Assessment of adherence to corticosteroids in asthma by drug monitoring or fractional exhaled nitric oxide: A literature review. Clin Exp Allergy 2020; 51:49-62. [PMID: 33190234 PMCID: PMC7839457 DOI: 10.1111/cea.13787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/07/2020] [Accepted: 09/24/2020] [Indexed: 01/13/2023]
Abstract
Background Although the efficacy of corticosteroid treatment in controlling asthma is widely accepted, its effectiveness is undermined by poor adherence. However, the optimal method for measuring adherence to asthma therapy remains unclear. Objective To perform a review of the literature reporting biological, objective methods for assessing adherence to inhaled or oral corticosteroids in asthma; we included studies reporting direct measurement of exogenous corticosteroids in blood, or the effect of adherence on exhaled nitric oxide. Design We searched three databases MEDLINE (using both PubMed and Ovid), the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Web of Science for articles published between January 1975 and July 2020. Quality of the studies was assessed using the National Institute of Health checklist. Results From 2850 screened articles, 26 fulfilled the inclusion criteria. Measurement of blood prednisolone with or without cortisol was used in eight studies as a measure of oral corticosteroid adherence, and fractional exhaled nitric oxide (FeNO) in 17 studies for inhaled corticosteroid adherence. Inhaled corticosteroids were measured directly in the blood in one study. By direct measurement of drug levels in the blood, adherence rates to oral corticosteroids ranged from 47% to 92%, although the performance and timing of the test were often not known, making interpretation of findings and serum prednisolone concentrations difficult. FeNO is generally lower in adherent than non‐adherent patients, but no absolute cut‐off can be proposed based on the available data. However, a fall in FeNO following supervised inhaled corticosteroid dosing could indicate previous poor adherence. Conclusions and Clinical Relevance Despite prednisolone and cortisol levels commonly being used as adherence markers in clinical practice, further work is required to assess the influence of the dose and timing on blood levels. The promising findings of FeNO suppression testing should be explored in further prospective studies.
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Affiliation(s)
- Fahad Alahmadi
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester and Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, UK.,Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
| | - Adam Peel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Brian Keevil
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester and Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, UK
| | - Rob Niven
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester and Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephen J Fowler
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester and Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, UK
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