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Robin H, Trudeau C, Robbins A, Chung E, Rahman E, Gangmark-Strickland O, Licari FW, Winden DR, Orr DL, Arroyo JA, Reynolds PR. A Potential Role for the Receptor for Advanced Glycation End-Products (RAGE) in the Development of Secondhand Smoke-Induced Chronic Sinusitis. Curr Issues Mol Biol 2024; 46:729-740. [PMID: 38248349 PMCID: PMC10814859 DOI: 10.3390/cimb46010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Chronic sinusitis (CS) is characterized by sinonasal inflammation, mucus overproduction, and edematous mucosal tissue. CS impacts one in seven adults and estimates suggest up to 15% of the general U.S. population may be affected. This research sought to assess a potential role for receptors for advanced glycation end-products (RAGE), an inflammatory receptor expressed in tissues exposed to secondhand smoke (SHS). Human sinus tissue sections were stained for RAGE and S100s, common RAGE ligands. Wild-type mice and mice that over-express RAGE in sinonasal epithelium (RAGE TG) were maintained in room air (RA) or exposed to secondhand smoke (SHS) via a nose-only delivery system five days a week for 6 weeks. Mouse sections were stained for RAGE and tissue lysates were assayed for cleaved caspase 3, cytokines, or matrix metalloproteases. We discovered increased RAGE expression in sinus tissue following SHS exposure and in sinuses from RAGE TG mice in the absence of SHS. Cleaved caspase-3, cytokines (IL-1β, IL-3, and TNF-α), and MMPs (-9 and -13) were induced by SHS and in tissues from RAGE TG mice. These results expand the inflammatory role of RAGE signaling, a key axis in disease progression observed in smokers. In this relatively unexplored area, enhanced understanding of RAGE signaling during voluntary and involuntary smoking may help to elucidate potential therapeutic targets that may attenuate the progression of smoke-related CS.
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Affiliation(s)
- Hannah Robin
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Courtney Trudeau
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Adam Robbins
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Emily Chung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Erum Rahman
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | | | - Frank W. Licari
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Duane R. Winden
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA
| | - Dan L. Orr
- Oral & Maxillofacial Surgery, University Medical Center, Las Vegas, NV 89102, USA
| | - Juan A. Arroyo
- Lung and Placenta Laboratory, Department of Cell Biology and Physiology, Brigham Young University, Provo, UT 84602, USA
| | - Paul R. Reynolds
- Lung and Placenta Laboratory, Department of Cell Biology and Physiology, Brigham Young University, Provo, UT 84602, USA
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2
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Norweg AM, Wu Y, Troxel A, Whiteson JH, Collins E, Haas F, Skamai A, Goldring R, Jean-Louis G, Reibman J, Ehrlich-Jones L, Simon N. Mind-Body Intervention for Dysfunctional Breathing in Chronic Obstructive Pulmonary Disease: Feasibility Study and Lessons Learned. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:156-168. [PMID: 36800224 PMCID: PMC10024272 DOI: 10.1089/jicm.2022.0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Purpose: Dysfunctional breathing behaviors are prevalent in chronic obstructive pulmonary disease (COPD). Although these behaviors contribute to dyspnea, abnormal carbon dioxide (CO2) levels, and COPD exacerbations, they are modifiable. Current dyspnea treatments for COPD are suboptimal, because they do not adequately address dysfunctional breathing behaviors and anxiety together. We developed a complementary mind-body breathlessness therapy, called capnography-assisted respiratory therapy (CART), that uses real-time CO2 biofeedback at the end of exhalation (end-tidal CO2 or ETCO2), to target dysfunctional breathing habits and improve dyspnea treatment and pulmonary rehabilitation (PR) adherence in COPD. The study aim was to test the feasibility of integrating CART with a traditional, clinic-based PR program in an urban setting. Methods: We used a feasibility pre- and post-test design, with 2:1 randomization to CART+PR or control (PR-alone) groups, to test and refine CART. Multi-component CART consisted of six, 1-h weekly sessions of slow breathing and mindfulness exercises, ETCO2 biofeedback, motivational counseling, and a home program. All participants were offered twice weekly, 1-h sessions of PR over 10 weeks (up to 20 sessions). Results: Thirty-one participants with COPD were enrolled in the study. Approximately a third of participants had symptoms of psychological distress. Results showed that CART was feasible and acceptable based on 74% session completion and 91.7% homework exercise completion (n = 22). Within-group effect sizes for CART+PR were moderate to large (Cohen's d = 0.51-1.22) for reduction in resting Borg dyspnea (anticipatory anxiety) and respiratory rate, St. George's Respiratory Questionnaire (SGRQ) respiratory symptoms; and increase in Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and physical activity; all p < 0.05. Conclusions: CART is a new mind-body breathing therapy that targets eucapnic breathing, interoceptive function, and self-regulated breathing to relieve dyspnea and anxiety symptoms in COPD. Study findings supported the feasibility of CART and showed preliminary signals that CART may improve exercise tolerance, reduce dyspnea, and enhance PR completion by targeting reduced dysfunctional breathing patterns (CTR No. NCT03457103).
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Affiliation(s)
- Anna Migliore Norweg
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Yinxiang Wu
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Andrea Troxel
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Jonathan H. Whiteson
- Department of Rehabilitation, and New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Eileen Collins
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Francois Haas
- Department of Rehabilitation, and New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Anne Skamai
- Department of Family and Community Medicine, Downstate Medical Center, State University of New York, New York, NY, USA
| | - Roberta Goldring
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Girardin Jean-Louis
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Joan Reibman
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | | | - Naomi Simon
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, USA
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3
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Lee DY, Kim SD, Lim J, Kim KH, Jin HR, Jung YH. Effectiveness of a perioperative smoking cessation program evaluated over one-year follow-up. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1879290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University Boramae Medical Center, Dongjak-gu, South Korea
| | - Seong Dong Kim
- Department of Otorhinolaryngology Head and Neck Surgery, National Medical Center, Seoul, South Korea
| | - Jaehyun Lim
- Department of Otorhinolaryngology Head and Neck Surgery, National Police Hospital, Seoul, South Korea
| | - Kwang Hyun Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Bundang Jesaeng Hospital, Seongnam-si, South Korea
| | - Hong Ryul Jin
- Department of Otorhinolaryngology Head and Neck Surgery, Dr. Jin’s Premium Nose Clinic, Seoul, South Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, South Korea
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4
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Thorstensen WM, Øie MR, Dahlslett SB, Sue-Chu M, Steinsvåg SK, Helvik AS. Olfaction in COPD. Rhinology 2021; 60:47-55. [PMID: 34647543 DOI: 10.4193/rhin21.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfaction is poorly characterized in COPD. To test the hypothesis that olfaction is reduced in COPD, we assessed olfaction with the "Sniffin' Sticks" test and a questionnaire addressing olfaction in COPD and a corresponding control group in respect to age and sex. We also explored whether there is an association between COPD, chronic rhinosinusitis without nasal polyps (CRSsNP), and other predefined covariates with olfactory function. METHODOLOGY Olfactory function was assessed by the score for threshold (T), discrimination (D) and identification (I), and the composite TDI score in the "Sniffin' Sticks" test and by self-reported evaluation of impaired olfaction and of "decreased sense of smell and taste" in the 22-item Sino-Nasal Outcome Test (SNOT-22) in 90 COPD patients and 93 controls. A clinical interview and ENT-examination with nasal endoscopy, skin prick test and spirometry with reversibility were performed. RESULTS The TDI, D and I scores were significantly lower in the COPD group than in the control group. The T score was not significantly different between the two groups. Hyposmia and anosmia were present in up to 79% of patients with COPD. The prevalence of self-reported impaired olfactory function and for "decreased sense of smell and taste" - was more than two-fold greater in the COPD than in the control group. COPD, higher age, male sex and allergy were associated with a lower TDI score, while CRSsNP was not associated with the TDI score. CONCLUSIONS COPD is associated with olfactory dysfunction and the underlying mechanisms for this dysfunction should be elucidated.
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Affiliation(s)
- W M Thorstensen
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - M R Øie
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - S B Dahlslett
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - M Sue-Chu
- Dept of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Dept of Thoracic Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - S K Steinsvåg
- Dept of Otolaryngology, Head and Neck Surgery, Sørlandet Hospital, Kristiansand, Norway.,Haukeland University Hospital, Bergen, Norway
| | - A S Helvik
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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5
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Hanafi NS, Agarwal D, Chippagiri S, Brakema EA, Pinnock H, Sheikh A, Liew SM, Ng CW, Isaac R, Chinna K, Wong LP, Hussein N, Abu Bakar AI, Pang YK, Juvekar S, Khoo EM. Chronic respiratory disease surveys in adults in low- and middle-income countries: A systematic scoping review of methodological approaches and outcomes. J Glob Health 2021; 11:04026. [PMID: 34221357 PMCID: PMC8248510 DOI: 10.7189/jogh.11.04026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Chronic respiratory diseases (CRDs) contribute significantly towards the global burden of disease, but the true prevalence and burden of these conditions in adults is unknown in the majority of low- and middle-income countries (LMICs). We aimed to identify strategies - in particular the definitions, study designs, sampling frames, instruments, and outcomes - used to conduct prevalence surveys for CRDs in LMICs. The findings will inform a future RESPIRE Four Country ChrOnic Respiratory Disease (4CCORD) study, which will estimate CRD prevalence, including disease burden, in adults in LMICs. Methods We conducted a scoping review to map prevalence surveys conducted in LMICs published between 1995 and 2018. We followed Arksey and O'Malley's six-step framework. The search was conducted in OVID Medline, EMBASE, ISI Web of Science, Global Health, WHO Global Index Medicus and included three domains: CRDs, prevalence and LMICs. After an initial title sift, eight trained reviewers undertook duplicate study selection and data extraction. We charted: country and populations, random sampling strategies, CRD definitions/phenotypes, survey procedure (questionnaires, spirometry, tests), outcomes and assessment of individual, societal and health service burden of disease. Results Of 36 872 citations, 281 articles were included: 132 from Asia (41 from China). Study designs were cross-sectional surveys (n = 260), cohort studies (n = 11) and secondary data analysis (n = 10). The number of respondents in these studies ranged from 50 to 512 891. Asthma was studied in 144 studies, chronic obstructive pulmonary disease (COPD) in 112. Most studies (100/144) based identification of asthma on symptom-based questionnaires. In contrast, COPD diagnosis was typically based on spirometry findings (94/112); 65 used fixed-ratio thresholds, 29 reported fixed-ratio and lower-limit-of-normal values. Only five articles used the term 'phenotype'. Most studies used questionnaires derived from validated surveys, most commonly the European Community Respiratory Health Survey (n = 47). The burden/impact of CRD was reported in 33 articles (most commonly activity limitation). Conclusion Surveys remain the most practical approach for estimating prevalence of CRD but there is a need to identify the most predictive questions for diagnosing asthma and to standardise diagnostic criteria.
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Affiliation(s)
- Nik Sherina Hanafi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Su-May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rita Isaac
- Christian Medical College, Vellore, India
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norita Hussein
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ahmad Ihsan Abu Bakar
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Pusrawi Hospital Sdn Bhd, Kuala Lumpur, Malaysia
| | - Yong-Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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6
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Hutson K, Clark A, Hopkins C, Ahmed S, Kumar N, Carrie S, Erskine S, Sunkaraneni V, Philpott C. Evaluation of Smoking as a Modifying Factor in Chronic Rhinosinusitis. JAMA Otolaryngol Head Neck Surg 2021; 147:159-165. [PMID: 33300989 DOI: 10.1001/jamaoto.2020.4354] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The negative association of smoking with the respiratory tract is well known; however, the association between smoking and chronic rhinosinusitis (CRS) has not been well characterized. Objective To analyze whether active smoking was a risk factor for CRS development, smoking was associated with disease-specific quality of life, and smokers experience an increased symptom burden than nonsmokers. Design, Setting, and Participants This subanalysis of the Chronic Rhinosinusitis Epidemiology Study (CRES), a prospective, questionnaire-based case-control study conducted between October 2007 and September 2013 was conducted across 30 UK tertiary/secondary care sites. Participants were identified at ear, nose, and throat outpatient clinics and classified into CRS phenotypes as per European Position Paper on Rhinosinusitis and Nasal Polyps 2012 criteria. The overall response rate of those identified to take part in the study was 66%. A total of 1535 questionnaires were returned, with 1470 considered eligible for inclusion. Data analysis was conducted in January 2020. Main Outcomes and Measures The CRES was designed to distinguish differences in socioeconomic status, geography, medical comorbidities, lifestyle, and quality of life between patients with CRS and healthy controls. Results A total of 1450 patients completed the smoking question, comprising 219 controls (15.1%; mean [SD] age, 47.3 [14.9] years; 143 women [68%]), 546 participants with CRS (37.7%; mean [SD] age, 51.8 [15.3] years; 259 women [53%]) without nasal polyps (CRSsNPs), and 685 participants (47.2%; mean [SD] age, 56.0 [14.5] years; 204 women [33%]) with CRS and nasal polyps/allergic fungal rhinosinusitis (CRSwNPs+). The mean age was similar, with a greater female preponderance in the control group and male in the CRSwNP group. The greatest number of active smokers was found among control participants (33 [15%]), with a lower rate of smokers in the patients with CRSwNPs+ (9.9%) and CRSsNPs (13.9%), respectively. We found a clinically significant difference in the mean difference in Sino-nasal Outcome Test (SNOT-22) scores between active smokers and nonsmokers for both CRS phenotypes (4.49, 12.25). In both CRS subgroups active smokers had significantly worse SNOT-22 scores than nonsmokers by a mean (SD) magnitude of 10 (18.99, 24.14) points. Nonsmokers also demonstrated a higher percentage of surgical procedures (1 or more), although this was not clinically or statistically different (0.34, 1.10). Conclusions and Relevance This questionnaire-based case-control study demonstrated a clinically significant symptom burden associated with active cigarette smoking, with worse SNOT-22 scores in the smoking cohort by a mean magnitude of 10 points. We could find no demonstrable evidence that smoking increases the likelihood of need for revision sinus surgery. Clinicians should encourage smoking cessation alongside general CRS medical management.
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Affiliation(s)
- Kristian Hutson
- James Paget University Hospital National Health Service (NHS) Foundation Trust, Gorleston, England
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norfolk, England
| | - Claire Hopkins
- Guys & St Thomas Hospital NHS Foundation Trust, London, England
| | - Shahzada Ahmed
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
| | - Nirmal Kumar
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, England
| | | | - Sally Erskine
- James Paget University Hospital National Health Service (NHS) Foundation Trust, Gorleston, England
| | | | - Carl Philpott
- James Paget University Hospital National Health Service (NHS) Foundation Trust, Gorleston, England.,Norwich Medical School, University of East Anglia, Norfolk, England
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Skaaby S, Flachs EM, Lange P, Schlünssen V, Marott JL, Brauer C, Nordestgaard BG, Sadhra S, Kurmi O, Bonde JPE. Chronic productive cough and inhalant occupational exposure-a study of the general population. Int Arch Occup Environ Health 2021; 94:1033-1040. [PMID: 33559749 DOI: 10.1007/s00420-020-01634-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Occupational inhalant exposures have been linked with a higher occurrence of chronic productive cough, but recent studies question the association. METHODS We included participants from two general population studies, the Copenhagen City General Population Study and the Copenhagen City Heart Study, to assess contemporary (year 2003-2017) and historical (1976-1983) occupational inhalant hazards. Job titles one year prior to study inclusion and an airborne chemical job-exposure matrix (ACE JEM) were used to estimate occupational exposure. The association between occupational exposures and self-reported chronic productive cough was studied using generalized estimating equations stratified by smoking status and cohort. RESULTS The population consisted of 5210 working individuals aged 20-65 from 1976 to 1983 and 64,279 from 2003 to 2017. In smokers, exposure to high levels of mineral dust, biological dust, gases & fumes and the composite variable vapours, gases, dusts or fumes (VGDF) were associated with chronic productive cough in both cohorts with odds ratios in the range of 1.2 (95% confidence interval, 1.0;1.4) to 1.6 (1.2;2.1). High levels of biological dust were only associated with an increased risk of a chronic productive cough in the 2003-2017 cohort (OR 1.5 (1.1;2.0)). In non-smokers, high levels of VGDF (OR 1.5 (1.0;2.3)) and low levels of mineral dust (OR 1.7 (1.1;2.4)) were associated with chronic productive cough in the 1976-1983 cohort, while no associations were seen in non-smokers in the 2003-2017 cohort. CONCLUSION Occupational inhalant exposure remains associated with a modestly increased risk of a chronic productive cough in smokers, despite declining exposure levels during the past four decades.
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Affiliation(s)
- Stinna Skaaby
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Peter Lange
- Institute of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark.,Department of Medicine, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, University of Aarhus, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Jacob Louis Marott
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Børge G Nordestgaard
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Om Kurmi
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.,Institute of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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8
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Finocchio E, Locatelli F, Sanna F, Vesentini R, Marchetti P, Spiteri G, Antonicelli L, Battaglia S, Bono R, Corsico AG, Ferrari M, Murgia N, Pirina P, Olivieri M, Verlato G. Gastritis and gastroesophageal reflux disease are strongly associated with non-allergic nasal disorders. BMC Pulm Med 2021; 21:53. [PMID: 33557802 PMCID: PMC7869508 DOI: 10.1186/s12890-020-01364-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/30/2020] [Indexed: 01/10/2023] Open
Abstract
Background Gastroesophageal reflux disease (GERD) has been reported to be significantly associated with chronic rhinosinusitis, but the strength of the association is still debated. Aims To evaluate the strength of the association between gastritis/GERD and non-allergic rhinitis (NAR)/allergic rhinitis (AR)/sinusitis. Methods We investigated 2887 subjects aged 20–84 years, who underwent a clinical visit in seven Italian centres (Ancona, Palermo, Pavia, Terni, Sassari, Torino, Verona) within the study on Gene Environment Interactions in Respiratory Diseases, a population-based multicase-control study between 2008 and 2014. Subjects were asked if they had doctor-diagnosed “gastritis or stomach ulcer (confirmed by gastroscopy)” or “gastroesophageal reflux disease, hiatal hernia or esophagitis”. The association between NAR/AR/sinusitis and either gastritis or GERD was evaluated through relative risk ratios (RRR) by multinomial logistic regression. Results The prevalence of gastritis/GERD increased from subjects without nasal disturbances (22.8% = 323/1414) to subjects with AR (25.8% = 152/590) and further to subjects with NAR (36.7% = 69/188) or sinusitis (39.9% = 276/691). When adjusting for centre, sex, age, education level, BMI, smoking habits and alcohol intake, the combination of gastritis and GERD was associated with a four-fold increase in the risk of NAR (RRR = 3.80, 95% CI 2.56–5.62) and sinusitis (RRR = 3.70, 2.62–5.23) with respect to controls, and with a much smaller increase in the risk of AR (RRR = 1.79, 1.37–2.35).. Conclusion The study confirmed the association between gastritis/GERD and nasal disturbances, which is stronger for NAR and sinusitis than for AR.
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Affiliation(s)
- Eliana Finocchio
- Section of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy
| | - Francesca Locatelli
- Section of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy
| | - Francesca Sanna
- Section of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy
| | - Roberta Vesentini
- Section of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy
| | - Pierpaolo Marchetti
- Section of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy
| | - Gianluca Spiteri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Leonardo Antonicelli
- Department of Internal Medicine Ospedali Riuniti Ancona, Via Conca, 71, 60126, Ancona, Italy
| | | | - Roberto Bono
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126, Torino, Italy
| | - Angelo Guido Corsico
- Department of Internal Medicine and Medical Therapy, University of Pavia, Palazzo Botta, 10, 27100, Pavia, Italy
| | - Marcello Ferrari
- Unit of Respiratory Diseases, Department of Medicine, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazza dell'Università, 1, 06123, Perugia, Italy
| | - Pietro Pirina
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Piazza Università, 21, 07100, Sassari, Italy
| | - Mario Olivieri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Giuseppe Verlato
- Section of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy.
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Moreno ACR, Nai GA, Laurindo CP, Gregorio KCR, Olean-Oliveira T, Teixeira MFS, Seraphim PM. Resistance training prevents right ventricle hypertrophy in rats exposed to secondhand cigarette smoke. PLoS One 2020; 15:e0236988. [PMID: 32764771 PMCID: PMC7413484 DOI: 10.1371/journal.pone.0236988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/17/2020] [Indexed: 11/18/2022] Open
Abstract
Exposure to secondhand cigarette smoke is associated with the development of diverse diseases. Resistance training has been considered one of the most useful tools for patients with pulmonary disease, improving their quality of life. This study aimed to evaluate the effect of resistance training (RT) on the prevention of thickening of the right ventricle wall of rats exposed to secondhand cigarette smoke. Thirty-two Wistar rats were divided into four groups: Control (C), Smoker (S), Exercised (E) and Exercised Smoker (ES). The smoker groups were exposed to the smoke of four cigarettes for 30 min, twice daily, five days a week, for 16 weeks. The exercised groups climbed on a vertical ladder with progressive load, once a day, five days a week, for 16 weeks. The heart, trachea, lung, liver and gastrocnemius muscle were removed for histopathological analysis. Pulmonary emphysema (S and ES vs C and E, P < 0.0001) and pulmonary artery thickness enlargement (S vs C and E, P = 0.003, ES vs C, P = 0.003) were detected in the smoking groups. There was an increase in the right ventricle thickness in the S group compared with all other groups (P < 0.0001). An increase in resident macrophages in the liver was detected in both smoking groups compared with the C group (P = 0.002). Additionally, a relevant reduction of the diameter of the muscle fibers was detected only in ES compared with the C, S and E groups (P = 0.0002), impairing, at least in part, the muscle mass in exercised smoking rats. Therefore, it was concluded that resistance training prevented the increase of thickness of the right ventricle in rats exposed to secondhand cigarette smoke, but it may be not so beneficial for the skeletal muscle of smoking rats.
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Affiliation(s)
- Ana Caroline Rippi Moreno
- Department of Physiotherapy, School of Sciences and Technology, Sao Paulo State University (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Gisele Alborghetti Nai
- Department of Pathology, University of Western Sao Paulo, (UNOESTE), Presidente Prudente, São Paulo, Brazil
| | - Caroline Pancera Laurindo
- Department of Physiotherapy, School of Sciences and Technology, Sao Paulo State University (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Karen Cristina Rego Gregorio
- Department of Physiotherapy, School of Sciences and Technology, Sao Paulo State University (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Tiago Olean-Oliveira
- Department of Physiotherapy, School of Sciences and Technology, Sao Paulo State University (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Marcos Fernando Souza Teixeira
- Department of Chemistry and Biochemistry, School of Sciences and Technology, Sao Paulo State University (UNESP), Presidente Prudente, São Paulo, Brazil
| | - Patricia Monteiro Seraphim
- Department of Physiotherapy, School of Sciences and Technology, Sao Paulo State University (UNESP), Presidente Prudente, São Paulo, Brazil
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10
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Øie MR, Dahlslett SB, Sue-Chu M, Helvik AS, Steinsvåg SK, Thorstensen WM. Rhinosinusitis without nasal polyps in COPD. ERJ Open Res 2020; 6:00015-2020. [PMID: 32665943 PMCID: PMC7335833 DOI: 10.1183/23120541.00015-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022] Open
Abstract
The validity of the united airway disease concept for rhinosinusitis (RS) and chronic obstructive pulmonary disease (COPD) has been questioned because of methodological limitations in previous studies. In this study we investigated the prevalence of RS without nasal polyps (RSsNP) and the severity of sinonasal symptoms in COPD and a corresponding control group. We also evaluated the diagnostic accuracy of these symptoms for RSsNP in COPD. 90 COPD patients and 93 controls were included in an observational cross-sectional study where globally accepted diagnostic criteria of RS and COPD (EPOS 2012 and GOLD) were incorporated; symptomatic and endoscopic criteria for the diagnosis of RS, and spirometry with reversibility for diagnosis of COPD. RS symptoms were identified by responses to the sinonasal outcome test (SNOT-22), nasal endoscopy identified signs of sinonasal disease and discriminated between RS with and without nasal polyps, and visual analogue scales (VAS) rated the severity of sinonasal symptoms. We found RSsNP in 51% of our COPD patients which is threefold greater than in the control group (p<0.001). Nasal discharge (72%) and nasal obstruction (62%) were the two most frequently reported symptoms in COPD. The diagnostic accuracy for RSsNP is better for the composite VAS for rhinological symptoms than for facial symptoms. We conclude that RSsNP is present in 51% of our COPD patients, which is significantly more prevalent compared to a corresponding control group. These results suggest that COPD is associated with RS. Rhinosinusitis is associated with COPD and is significantly more prevalent (51%) compared to controlshttps://bit.ly/2YrIsmm
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Affiliation(s)
- Marte Rystad Øie
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sarah Bettina Dahlslett
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Malcolm Sue-Chu
- Dept of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Dept of Thoracic Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Anne-S Helvik
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sverre Karmhus Steinsvåg
- Dept of Otolaryngology, Head and Neck Surgery, Sørlandet Hospital, Kristiansand, Norway.,Haukeland University Hospital, Bergen, Norway
| | - Wenche Moe Thorstensen
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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11
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Backer V, Klein DK, Bodtger U, Romberg K, Porsbjerg C, Erjefält JS, Kristiansen K, Xu R, Silberbrandt A, Frøssing L, Hvidtfeldt M, Obling N, Jarenbäck L, Nasr A, Tufvesson E, Mori M, Winther-Jensen M, Karlsson L, Nihlén U, Veje Flintegaard T, Bjermer L. Clinical characteristics of the BREATHE cohort - a real-life study on patients with asthma and COPD. Eur Clin Respir J 2020; 7:1736934. [PMID: 32284828 PMCID: PMC7144315 DOI: 10.1080/20018525.2020.1736934] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/24/2020] [Indexed: 01/06/2023] Open
Abstract
Background: The BREATHE study is a cross-sectional study of real-life patients with asthma and/or COPD in Denmark and Sweden aiming to increase the knowledge across severities and combinations of obstructive airway disease. Design: Patients with suspicion of asthma and/or COPD and healthy controls were invited to participate in the study and had a standard evaluation performed consisting of questionnaires, physical examination, FeNO and lung function, mannitol provocation test, allergy test, and collection of sputum and blood samples. A subgroup of patients and healthy controls had a bronchoscopy performed with a collection of airway samples. Results: The study population consisted of 1403 patients with obstructive airway disease (859 with asthma, 271 with COPD, 126 with concurrent asthma and COPD, 147 with other), and 89 healthy controls (smokers and non-smokers). Of patients with asthma, 54% had moderate-to-severe disease and 46% had mild disease. In patients with COPD, 82% had groups A and B, whereas 18% had groups C and D classified disease. Patients with asthma more frequently had childhood asthma, atopic dermatitis, and allergic rhinitis, compared to patients with COPD, asthma + COPD and Other, whereas FeNO levels were higher in patients with asthma and asthma + COPD compared to COPD and Other (18 ppb and 16 ppb vs 12.5 ppb and 14 ppb, p < 0.001). Patients with asthma, asthma + COPD and Other had higher sputum eosinophilia (1.5%, 1.5%, 1.2% vs 0.75%, respectively, p < 0.001) but lower sputum neutrophilia (39.3, 43.5%, 40.8% vs 66.8%, p < 0.001) compared to patients with COPD. Conclusions: The BREATHE study provides a unique database and biobank with clinical information and samples from 1403 real-life patients with asthma, COPD, and overlap representing different severities of the diseases. This research platform is highly relevant for disease phenotype- and biomarker studies aiming to describe a broad spectrum of obstructive airway diseases.
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Affiliation(s)
- Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Ditte K Klein
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory and Internal Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kerstin Romberg
- Health Care Centre, Näsets Läkargrupp, Höllviken, Sweden.,Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Karsten Kristiansen
- Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Ruiqi Xu
- North Europe Regional Department, BGI-Europe, Copenhagen, Denmark
| | - Alexander Silberbrandt
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Laurits Frøssing
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Morten Hvidtfeldt
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Nicolai Obling
- Department of Respiratory and Internal Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Linnea Jarenbäck
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Abir Nasr
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ellen Tufvesson
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Michiko Mori
- Unit of Airway Inflammation, Lund University, Lund, Sweden
| | - Matilde Winther-Jensen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lisa Karlsson
- Unit of Airway Inflammation, Lund University, Lund, Sweden
| | - Ulf Nihlén
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Thomas Veje Flintegaard
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
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12
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Souza ECCD, Pizzichini MMM, Dias M, Cunha MJ, Matte DL, Karloh M, Maurici R, Pizzichini E. Body mass index, asthma, and respiratory symptoms: a population-based study. ACTA ACUST UNITED AC 2019; 46:e20190006. [PMID: 31859815 PMCID: PMC7462679 DOI: 10.1590/1806-3713/e20190006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/01/2019] [Indexed: 11/29/2022]
Abstract
Objective: To estimate the prevalence of respiratory symptoms and asthma, according to body mass index (BMI), as well as to evaluate factors associated with physician-diagnosed asthma, in individuals ≥ 40 years of age. Methods: This was a population-based cross-sectional study conducted in Florianópolis, Brazil, with probability sampling. Data were collected during home visits. Demographic data were collected, as were reports of physician-diagnosed asthma, respiratory symptoms, medications in use, and comorbidities. Anthropometric measurements were taken. Individuals also underwent spirometry before and after bronchodilator administration. Individuals were categorized as being of normal weight (BMI < 25 kg/m2), overweight (25 kg/m2 ≥ BMI < 30 kg/m2), or obese (BMI ≥ 30 kg/m2). Results: A total of 1,026 individuals were evaluated, 274 (26.7%) were of normal weight, 436 (42.5%) were overweight, and 316 (30.8%) were obese. The prevalence of physician-diagnosed asthma was 11.0%. The prevalence of obesity was higher in women (p = 0.03), as it was in respondents with ≤ 4 years of schooling (p < 0.001) or a family income of 3-10 times the national minimum wage. Physician-diagnosed asthma was more common among obese individuals than among those who were overweight and those of normal weight (16.1%, 9.9%, and 8.0%, respectively; p = 0.04), as were dyspnea (35.5%, 22.5%, and 17.9%, respectively; p < 0.001) and wheezing in the last year (25.6%, 11.9%, and 14.6%, respectively; p < 0.001). These results were independent of patient smoking status. In addition, obese individuals were three times more likely to report physician-diagnosed asthma than were those of normal weight (p = 0.005). Conclusions: A report of physician-diagnosed asthma showed a significant association with being ≥ 40 years of age and with having a BMI ≥ 30 kg/m2. Being obese tripled the chance of physician-diagnosed asthma.
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Affiliation(s)
- Elaine Cristina Caon de Souza
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas - NUPAIVA - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Marcia Margaret Menezes Pizzichini
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas - NUPAIVA - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Mirella Dias
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas - NUPAIVA - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Maíra Junkes Cunha
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas - NUPAIVA - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Darlan Lauricio Matte
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas - NUPAIVA - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Manuela Karloh
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas - NUPAIVA - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Rosemeri Maurici
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas - NUPAIVA - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Emilio Pizzichini
- . Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas - NUPAIVA - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil.,. Programa de Pós-Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
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