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Akbari F, Vahedi Larijani L, Rajabi Visroodi E, Hakiminia B. Effect of the treatment of iron deficiency anemia on chronic drug-resistant cough: a rare case report. Daru 2024:10.1007/s40199-024-00522-1. [PMID: 38850453 DOI: 10.1007/s40199-024-00522-1] [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: 12/21/2023] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND A persistent difficult-to-treat cough can be exhausting. Iron is an essential element that plays an important role in regulating the production of pro-inflammatory cytokines, and its deficiency may potentiate airway inflammation and dysfunction. There is a paucity of data regarding a link between iron deficiency (ID) and idiopathic cough. OBJECTIVES In this study, a case of persistent non-productive cough, which was unresponsive to targeted treatment approaches but responsive to iron therapy, is reported. METHODS A 53-year-old woman came to a medical clinic with complaints of a chronic and progressive non-productive cough. She underwent a complete clinical and paraclinical evaluation. RESULTS Her vital signs were stable and no abnormalities were found on the physical examination. The results of the spirometry and chest radiography were unremarkable. The laboratory test indicated hypochromic microcytic anemia, with a hemoglobin value of 9.6 g/dL. Her cough was resolved after treatment of iron-deficiency anemia with an oral nutraceutical capsule containing 28 mg of elemental iron (as ferrous bis-glycinate) plus folic acid, vitamin B12, and vitamin C, once daily for six months. CONCLUSION In the case of unexplained chronic cough, resistant to targeted therapies, investigation and treatment of ID may contribute to the resolution of cough.
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Affiliation(s)
- Fatemeh Akbari
- Department of Pharmacognosy, School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran
| | - Lale Vahedi Larijani
- Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ehsan Rajabi Visroodi
- Department of Pharmaceutics, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Bahareh Hakiminia
- Department of Clinical Pharmacy, School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran.
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2
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Gonzalez-Uribe V, Romero-Tapia SJ, Castro-Rodriguez JA. Asthma Phenotypes in the Era of Personalized Medicine. J Clin Med 2023; 12:6207. [PMID: 37834850 PMCID: PMC10573947 DOI: 10.3390/jcm12196207] [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: 07/19/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Asthma is a widespread disease affecting approximately 300-million people globally. This condition leads to significant morbidity, mortality, and economic strain worldwide. Recent clinical and laboratory research advancements have illuminated the immunological factors contributing to asthma. As of now, asthma is understood to be a heterogeneous disease. Personalized medicine involves categorizing asthma by its endotypes, linking observable characteristics to specific immunological mechanisms. Identifying these endotypic mechanisms is paramount in accurately profiling patients and tailoring therapeutic approaches using innovative biological agents targeting distinct immune pathways. This article presents a synopsis of the key immunological mechanisms implicated in the pathogenesis and manifestation of the disease's phenotypic traits and individualized treatments for severe asthma subtypes.
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Affiliation(s)
- Victor Gonzalez-Uribe
- Alergia e Inmunología Clínica, Hospital Infantil de México Federico Gómez, Ciudad de Mexico 06720, Mexico;
- Facultad Mexicana de Medicina, Universidad La Salle México, Ciudad de Mexico 14000, Mexico
| | - Sergio J. Romero-Tapia
- Health Sciences Academic Division (DACS), Universidad Juárez Autónoma de Tabasco, Villahermosa 86040, Mexico;
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
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3
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Wen J, Wang C, Xia J, Giri M, Guo S. Relationship between serum iron and blood eosinophil counts in asthmatic adults: data from NHANES 2011-2018. Front Immunol 2023; 14:1201160. [PMID: 37731511 PMCID: PMC10507334 DOI: 10.3389/fimmu.2023.1201160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Background So far, quite a few studies have revealed that systemic iron levels are related to asthmatic inflammatory reactions. And most studies have focused on the correlation between systemic iron levels and asthma, with inconsistent findings. Yet, few studies have investigated the connection between serum iron and blood eosinophil counts. Hence, we have explored the connection between serum iron and blood eosinophil counts in asthmatics by utilizing data from NHANES. Methods A total of 2549 individuals were included in our study after screening NHANES participants from 2011 to 2018. The linear regression model and XGBoost model were used to discuss the potential connection. Linear or nonlinear association was further confirmed by the generalized additive model and the piecewise linear regression model. And we also performed stratified analyses to figure out specific populations. Results In the multivariable linear regression models, we discovered that serum iron levels were inversely related to blood eosinophil counts in asthmatic adults. Simultaneously, we found that for every unit increase in serum iron (umol/L), blood eosinophil counts reduced by 1.41/uL in model 3, which adjusted for all variables excluding the analyzed variables. Furthermore, the XGBoost model of machine learning was applied to assess the relative importance of chosen variables, and it was determined that vitamin C intake, age, vitamin B12 intake, iron intake, and serum iron were the five most important variables on blood eosinophil counts. And the generalized additive model and piecewise linear regression model further verify this linear and inverse association. Conclusion Our investigation discovered that the linear and inverse association of serum iron with blood eosinophil counts in asthmatic adults, indicating that serum iron might be related to changes in the immunological state of asthmatics. Our work offers some new thoughts for next research on asthma management and therapy. Ultimately, we hope that more individuals become aware of the role of iron in the onset, development, and treatment of asthma.
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Affiliation(s)
- Jun Wen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Changfen Wang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Jing Xia
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Mohan Giri
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
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Solomon Y, Gebeyehu NA, Adella GA, Kassie GA, Mengstie MA, Seid MA, Abebe EC, Gesese MM, Tegegne KD, Anley DT, Zemene MA, Moges N, Bantie B, Feleke SF, Dejenie TA, Dessie AM. Prevalence of anemia and its associated factors among adult asthmatic patients in Northwest Ethiopia. BMC Pulm Med 2023; 23:222. [PMID: 37344827 DOI: 10.1186/s12890-023-02501-9] [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: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Asthma is a heterogeneous disease characterized by chronic airway inflammation. The pathophysiologic processes of asthma can disrupt iron homeostasis, resulting in anemia. However, the association between asthma and anemia among adult asthma patients remains limited. Therefore, the main aim of this study was to determine the prevalence and factors associated with anemia among adult asthmatic patients from May to August 2021. METHODS An institution-based, cross-sectional study was conducted among 291 asthmatic patients in Northwest Ethiopia. A pre-tested structured questionnaire and checklist were used to collect sociodemographic and clinical data. A blood specimen was collected from asthmatic patients for a complete blood count analysis and morphology assessment. The data were entered into the Epi data software and exported to the statistical package for social science version 20 software for analysis. Non-parametric Mann-Whitney U test was used to compare red blood cell parameters among groups with acute and chronic exacerbations. Binary logistic regression models were used to determine the factors associated with anemia. A p-value less than 0.05 was considered statistically significant. RESULT The overall prevalence of anemia in this study was 11% (95% CI: 7.2-14.8%). Acutely exacerbated asthmatic patients had significantly lower median values of red blood cell parameters such as red blood cell count, hemoglobin, and mean cell hemoglobin when compared to chronic exacerbations. In addition, using systemic corticosteroids (AOR = 4.07, 95% CI: 1.126-14.71, p = 0.032) and being hospitalized in the emergency department (AOR = 3.74, 95% CI: 1.26-11.07, p = 0.017) were found to be significantly associated with anemia. CONCLUSION This study demonstrated that anemia was predominant in adult asthma patients. Red blood cell number, hemoglobin level, and mean corpuscular hemoglobin were significantly lower in acute asthma exacerbations. Therefore, appropriate intervention strategies should be undertaken to reduce the prevalence of anemia among adult asthma patients to reduce further complications and provide better monitoring of asthma patients.
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Affiliation(s)
- Yenealem Solomon
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health Nursing, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Iron Deficiency Anemia and COVID-19. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2022. [DOI: 10.52547/jommid.10.4.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Yu Z, Xu C, Fang C, Zhang F. Causal effect of iron status on lung function: A Mendelian randomization study. Front Nutr 2022; 9:1025212. [PMID: 36590211 PMCID: PMC9798299 DOI: 10.3389/fnut.2022.1025212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background The association between systemic iron status and lung function was conflicting in observational studies. We aim to explore the potential causal relationships between iron status and the levels of lung function using the two-sample Mendelian randomization (MR) design. Methods Genetic instruments associated with iron status biomarkers were retrieved from the Genetics of Iron Status (GIS) consortium (N = 48,972). Summary statistics of these genetic instruments with lung function were extracted from a meta-analysis of UK Biobank and SpiroMeta consortium (N = 400,102). The main analyses were performed using the inverse-variance weighted method, and complemented by multiple sensitivity analyses. Results Based on conservative genetic instruments, MR analyses showed that genetically predicted higher iron (beta: 0.036 per 1 SD increase, 95% confidence interval (CI): 0.016 to 0.056, P = 3.51 × 10-4), log10-transformed ferritin (beta: 0.081, 95% CI: 0.047 to 0.116, P = 4.11 × 10-6), and transferrin saturation (beta: 0.027, 95% CI: 0.015 to 0.038, P = 1.09 × 10-5) were associated with increased forced expiratory volume in 1 s (FEV1), whereas higher transferrin was associated with decreased FEV1 (beta: -0.036, 95% CI: -0.064 to -0.008, P = 0.01). A significant positive association between iron status and forced vital capacity (FVC) was also observed. However, there is no causal association between iron status and FEV1-to-FVC ratio (P = 0.10). Similar results were obtained from the liberal instruments analyses and multiple sensitivity analyses. Conclusion Our study provided strong evidence to support that higher iron status is causally associated with higher levels of FEV1 and FVC, but has no impact on airway obstruction, confirming iron status as an important target for lung function management.
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Affiliation(s)
- Zhimin Yu
- Department of General Medicine and Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Chengkai Xu
- Department of General Medicine and Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Chenggang Fang
- Department of General Medicine and Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Fangfang Zhang
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- *Correspondence: Fangfang Zhang
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Samadizadeh S, Masoudi M, Rastegar M, Salimi V, Shahbaz MB, Tahamtan A. COVID-19: Why does disease severity vary among individuals? Respir Med 2021; 180:106356. [PMID: 33713961 PMCID: PMC7934673 DOI: 10.1016/j.rmed.2021.106356] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/25/2021] [Accepted: 02/28/2021] [Indexed: 01/08/2023]
Abstract
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the current pandemic, coronavirus disease 2019 (COVID-19). While all people are susceptible to the SARS-CoV-2 infection, the nature and severity of the disease vary significantly among individuals and populations. Importantly, reported disease burdens and case fatality rates differ considerably from country to country. There are, however, still uncertainties about the severity of the disease among individuals or the reason behind a more severe disease in some cases. There is a strong possibility that the severity of this disease depends on a complicated interaction between the host, virus, and environment, which leads to different clinical outcomes. The objective of this article is to point out the essential influential factors related to the host, virus, and environment affecting the clinical outcome of COVID-19.
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Affiliation(s)
- Saeed Samadizadeh
- Infectious Diseases Research Centre, Golestan University of Medical Sciences, Gorgan, Iran; Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Maha Masoudi
- Infectious Diseases Research Centre, Golestan University of Medical Sciences, Gorgan, Iran; Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mostafa Rastegar
- Infectious Diseases Research Centre, Golestan University of Medical Sciences, Gorgan, Iran; Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Vahid Salimi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Bataghva Shahbaz
- Roberts Research Institute and School of Biomedical Engineering, Western University, London, Canada
| | - Alireza Tahamtan
- Infectious Diseases Research Centre, Golestan University of Medical Sciences, Gorgan, Iran; Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
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8
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Zhao K, Huang J, Dai D, Feng Y, Liu L, Nie S. Serum Iron Level as a Potential Predictor of Coronavirus Disease 2019 Severity and Mortality: A Retrospective Study. Open Forum Infect Dis 2020; 7:ofaa250. [PMID: 32661499 PMCID: PMC7337740 DOI: 10.1093/ofid/ofaa250] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background Various types of pulmonary diseases are associated with iron deficiency. However, information on iron status in coronavirus disease 2019 (COVID-19) is scarce. Methods This study included 50 hospitalized patients with confirmed COVID-19. The role of serum iron in predicting severity and mortality of COVID-19 was evaluated. Results The most common symptoms of COVID-19 patients in this study were cough (82%), fever (64%), and chest distress (42%). Of the 50 patients, 45 (90%) patients had abnormally low serum iron levels (<7.8 μmol/L). The severity of COVID-19 was negatively correlated with serum iron levels before and after treatment and was positively correlated with C-reactive protein, serum amyloid A, D-dimer, lactate dehydrogenase, urea nitrogen, and myoglobin levels. Decreased serum iron level could predict the transition of COVID-19 from mild to severe and critical illness. Seven (53.8%) patients with a lower serum iron level after treatment in the critical group had died. There was a significant difference in posttreatment serum iron levels between COVID-19 survivors and nonsurvivors. Conclusions Serum iron deficiency was detected in the patients with COVID-19. The severity and mortality of the disease was closely correlated with serum iron levels. Low serum iron concentration was an independent risk factor for death in COVID-19 patients.
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Affiliation(s)
- Kang Zhao
- Department of Hepatology, Hubei No. 3 People's Hospital of Jianghan University, Wuhan, China
| | - Jucun Huang
- Department of Hepatology, Hubei No. 3 People's Hospital of Jianghan University, Wuhan, China
| | - Dan Dai
- Department of Hepatology, Hubei No. 3 People's Hospital of Jianghan University, Wuhan, China
| | - Yuwei Feng
- Department of Hepatology, Hubei No. 3 People's Hospital of Jianghan University, Wuhan, China
| | - Liming Liu
- Department of Hepatology, Hubei No. 3 People's Hospital of Jianghan University, Wuhan, China
| | - Shuke Nie
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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9
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Park YJ, Lim HS, Kim TH. Annual Prevalence, Health Expenditures, and Co-Morbidities Trend of Iron Deficiency Anemia in Korea: National Health Insurance Service Data from 2002 to 2013. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124433. [PMID: 32575693 PMCID: PMC7345556 DOI: 10.3390/ijerph17124433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022]
Abstract
Despite improvements in nutritional status, iron deficiency anemia (IDA) remains a debilitating nutritional problem worldwide. We estimate annual IDA prevalence rates by sex and age and the trends therein in Korea. We also calculate the health expenditures of IDA and its co-morbidities by analyzing claims data in the National Health Information Database from 2002 to 2013. All analyses were performed based on diagnosis codes of IDA (D50, D50.0, D50.8, and D50.9) regardless of whether IDA was the principal or a coexisting disease. Trends in IDA prevalence rates were evaluated by calculating annual percent changes (APCs) in prevalence. The health expenditures of IDA were calculated based on the direct medical costs (outpatient and hospitalization costs, pharmaceutical costs) and direct non-medical costs (travel costs). The overall IDA prevalence in both sexes increased approximately 2.3-fold from 2002 to 2013; the APC was +7.6%. In females, the prevalence of IDA was highest in aged 30–39 and 40–49 years. The APC was highest in those aged <10 years (+18.2%), followed by those aged ≥80 (+14.7%) and 70–79 (+9.8%) years. In males, the prevalence rates were highest in aged <10 years, followed by those aged ≥60 years. The APC was highest in those aged <10 years (+19.1%), followed by those aged ≥80 years (+10.5%). The total health expenditures increased 2.8-fold during 12 years. Diseases of the respiratory or gastrointestinal tract were the most prevalent co-morbidities in both males and females. The annual prevalence of IDA continues to rise in association with adverse health expenditures and co-morbidities in spite of improvements in nutritional status. Most importantly, infants and young children, the elderly, and females aged 30–49 years are at highest risk of IDA. A national, prospective, and well-organized effort to improve iron status and to manage IDA is required.
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Affiliation(s)
- Yoo-Jin Park
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University Graduate School, Asan 31538, Korea;
| | - Hee-Sook Lim
- Department of Food Sciences and Nutrition, Yeonsung University, Anyang 14011, Korea;
| | - Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, Korea
- Correspondence: ; Tel.: +82-32-621-5380; Fax: +82-22-6008-6874
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Sato K, Inoue S, Igarashi A, Tokairin Y, Yamauchi K, Kimura T, Nishiwaki M, Nemoto T, Nakano H, Sato M, Machida H, Yang S, Minegishi Y, Furuyama K, Watanabe M, Shibata Y. Effect of Iron Deficiency on a Murine Model of Smoke-induced Emphysema. Am J Respir Cell Mol Biol 2020; 62:588-597. [DOI: 10.1165/rcmb.2018-0239oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Yoshikane Tokairin
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Tomomi Kimura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Michiko Nishiwaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Takako Nemoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Hiroshi Nakano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Masamichi Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Hiroyoshi Machida
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Sujeong Yang
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Yukihiro Minegishi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Kodai Furuyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; and
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
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Th1- and Th17-Related Cytokines in Venous and Arterial Blood of Sclerodermic Patients with and without Digital Ulcers. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7908793. [PMID: 31687398 PMCID: PMC6800960 DOI: 10.1155/2019/7908793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/10/2019] [Accepted: 08/30/2019] [Indexed: 01/01/2023]
Abstract
The earliest clinical manifestation of SSc is usually Raynaud's phenomenon, a small-arteries vasospasm driven by vascular tone dysregulation and microcirculatory abnormalities, resulting in digital ulcers (DU) in up to 50% of patients. Many cytokines as well as growth factors have been shown to play a role in promoting vascular smooth muscle cell proliferation and fibroblast activation, leading to ischemic damage as well as skin fibrosis. We aim to investigate a possible difference in venous and arterial blood levels of many cytokines (Th1- and Th17-related), GM-CSF, and endothelin-1 (ET1) in patients with and without DU. In the same patients, the correlations between capillary damage, evaluated by nailfold videocapillaroscopy (NVC), extension of skin fibrosis, calculated by modified Rodnan skin score (mRSS), and cytokines, ET-1, and GM-CSF levels were also measured. Patients with DU showed venous levels of IL-1β (p=0.024), IL-6 (p=0.012), IL-22(p=0.006), and TGF-β (p=0.046) significantly higher compared to arterial levels and arterial levels of GM-CSF and TNF-alpha significantly higher compared to venous levels (p < 0.001). NVC abnormalities were correlated with arterial TNFa and venous IL22, IL23, and IL17 levels and negatively correlated with venous ET-1 levels, whereas mRSS showed a negative correlation with IL-21(ρ = -0.427, p=0.050). The increased Th17-cytokine levels in venous compared to arterial blood of patients with DU suggest local cytokine production on ulcer site. The higher TNFa and GM-CSF levels in arterial blood of DU patients support the attempt to mitigate the hypoxic damage, and the correlation between Th17-cytokines, mRSS, NVC, and ET1 agrees with the potent profibrotic stimulus at the onset of the disease, which decreases as the SSc progresses.
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Nicola S, Rolla G, Brussino L. Breakthroughs in hereditary angioedema management: a systematic review of approved drugs and those under research. Drugs Context 2019; 8:212605. [PMID: 31645881 PMCID: PMC6788388 DOI: 10.7573/dic.212605] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/16/2019] [Accepted: 08/27/2019] [Indexed: 01/01/2023] Open
Abstract
Hereditary angioedema (HAE) is a rare genetic disorder, characterized by recurrent and unexpected potentially life-threatening mucosal swelling. The impairment underlying HAE could be a defect in C1-inhibitor activity, or in its serum concentration. Patients affected by HAE should be treated with on-demand or prophylactic drugs. Lifelong C1-inhibitor supplementation is sometimes required. In this review, we review the currently approved drugs for HAE due to C1-inhibitor defect and to describe those under research. In particular, we focused on the mechanisms of action, routes of administration, and efficacy of these therapies. A systematic review of the literature was performed using the PubMed database for original articles and clinical trials of HAE treatments from 2005 to 2019. The approved HAE treatments can minimize the risk of death, but they are not effective in complete healing from the disease. The new gene therapies seem to provide promising opportunities for the treatment of hereditary angioedema. However, there are still many unmet needs, including efficacy, route, and timing of administration.
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Affiliation(s)
- Stefania Nicola
- Dipartimento di Scienze Mediche - SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I di Torino, Torino, Italy
| | - Giovanni Rolla
- Dipartimento di Scienze Mediche - SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I di Torino, Torino, Italy
| | - Luisa Brussino
- Dipartimento di Scienze Mediche - SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I di Torino, Torino, Italy
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13
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Asthma from immune pathogenesis to precision medicine. Semin Immunol 2019; 46:101294. [PMID: 31387788 DOI: 10.1016/j.smim.2019.101294] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022]
Abstract
Asthma is characterized by multiple immunological mechanisms (endotypes) determining variable clinical presentations (phenotypes). The identification of endotypic mechanisms is crucial to better characterize patients and to identify tailored therapeutic approaches with novel biological agents targeting specific immunological pathways. This review focused on summarizing the major immunological mechanisms involved in the pathogenesis of asthma, as well as on discussing the emergence of phenotypic features of the disease. Novel biological agents and other drugs targeting specific endotypes are discussed, as their use represent a precision medicine approach to the disease that is nowadays mandatory particularly for treating more severe patients.
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14
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Long L, Lai K. Characteristics of Chinese chronic cough patients. Pulm Pharmacol Ther 2019; 57:101811. [PMID: 31176802 DOI: 10.1016/j.pupt.2019.101811] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 02/07/2023]
Abstract
Chronic cough is one of the most common complains for patients seeking medical attention in both general practice and respiratory specialist clinics. Cough variant asthma, eosinophilic bronchitis, upper airway cough syndrome, as well as gastro-esophageal reflux disease are common conditions associated with chronic cough, and cough variant asthma, eosinophilic bronchitis account for a higher proportion of patients with chronic cough in China than in Western countries. An older female predominance has been reported in most Western countries, which may be attributed to a higher cough reflex sensitivity in females, especially those post-menopausal females. However, studies conducted in China showed that patients with chronic cough have a nearly similar gender distribution and most of them are in their late 30s or early 40s, despite the similar gender and age difference in cough reflex sensitivity as Western countries. Environmental and occupational exposures, cigarette smoking, unhealthy lifestyle might play a role in the distinct age and gender distribution of Chinese chronic cough patients, yet further study is needed to clarify it.
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Affiliation(s)
- Li Long
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China.
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15
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Heffler E, Crimi C, Brussino L, Nicola S, Sichili S, Dughera L, Rolla G, Crimi N. Exhaled breath condensate pH and cysteinyl leukotriens in patients with chronic cough secondary to acid gastroesophageal reflux. J Breath Res 2016; 11:016002. [DOI: 10.1088/1752-7163/11/1/016002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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16
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Jiang G, Huang X, Li T, Xu D. Chronic cough: clinical characteristics and etiologies of 510 cases. Turk J Med Sci 2016; 46:1734-1739. [PMID: 28081319 DOI: 10.3906/sag-1508-133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 03/09/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM To investigate the clinical features and underlying etiologies of chronic cough (CC). MATERIALS AND METHODS Five hundred and ten CC patients were enrolled. The phases, characteristics and associated clinical manifestations of CC among the gastroesophageal reflux cough (GERC), cough-variant asthma (CVA), and upper airway cough syndrome (UACS) groups were compared, and the diagnostic values of each group were evaluated by multiple regression analysis. RESULTS In the 510 patients, 404 had CC with single etiology-GERC (n = 175), CVA (n = 134), and UACS (n = 95). The characteristic features of GERC included gastric acid backflow symptoms such as sour-tasting regurgitation, heartburn, endoscopic esophagitis, poststimulation cough, frequent throat clearing, daytime mono-cough, and feelings of heaviness and pain in the chest. Patients with CVA typically exhibited sensitivity to smog and other irritants; the cough occurred mostly at night, and was associated with positive bronchodilator and provocation test results. The typical features of UACS included a history and/or symptoms of rhinitis, retropharyngeal postnasal drip, and wet cough occurring mostly during the daytime. The diagnostic specificities of above factors were >70%. CONCLUSION The most common causes of CC include GERC, CVA, and UACS, and their diagnosis is based on the characteristics of the underlying disease.
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Affiliation(s)
- Guiyuan Jiang
- Respiratory Department, Xiamen Chang Gung Hospital, Xiamen, P.R. China
| | - Xinying Huang
- Respiratory Department, Xiamen Chang Gung Hospital, Xiamen, P.R. China
| | - Tianlin Li
- Respiratory Department, Xiamen Chang Gung Hospital, Xiamen, P.R. China
| | - Dongping Xu
- Respiratory Department, Xiamen Chang Gung Hospital, Xiamen, P.R. China
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17
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Asthma as a disruption in iron homeostasis. Biometals 2016; 29:751-79. [PMID: 27595579 DOI: 10.1007/s10534-016-9948-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 12/28/2022]
Abstract
Over several decades, asthma has evolved from being recognized as a single disease to include a diverse group of phenotypes with dissimilar natural histories, pathophysiologies, responses to treatment, and distinctive molecular pathways. With the application of Occam's razor to asthma, it is proposed that there is one cause underlying the numerous phenotypes of this disease and that the responsible molecular pathway is a deficiency of iron in the lung tissues. This deficiency can be either absolute (e.g. asthma in the neonate and during both pregnancy and menstruation) or functional (e.g. asthma associated with infections, smoking, and obesity). Comparable associations between asthma co-morbidity (e.g. eczema, urticaria, restless leg syndrome, and pulmonary hypertension) with iron deficiency support such a shared mechanistic pathway. Therapies directed at asthma demonstrate a capacity to impact iron homeostasis, further strengthening the relationship. Finally, pathophysiologic events producing asthma, including inflammation, increases in Th2 cells, and muscle contraction, can correlate with iron availability. Recognition of a potential association between asthma and an absolute and/or functional iron deficiency suggests specific therapeutic interventions including inhaled iron.
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18
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Laryngeal hypersensitivity in chronic cough. Pulm Pharmacol Ther 2015; 35:111-6. [DOI: 10.1016/j.pupt.2015.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/22/2015] [Accepted: 08/25/2015] [Indexed: 11/18/2022]
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19
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Song WJ, Chang YS. Cough hypersensitivity as a neuro-immune interaction. Clin Transl Allergy 2015; 5:24. [PMID: 26180629 PMCID: PMC4503292 DOI: 10.1186/s13601-015-0069-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/09/2015] [Indexed: 12/31/2022] Open
Abstract
Cough is an intrinsic protective reflex. However, chronic cough affects a considerable proportion of general population and has a major impact on quality of life. A recent paradigm shift to ‘cough hypersensitivity syndrome’ suggests that chronic cough arises from hypersensitivity of the airway sensory nerves. As cough reflex is determined by interaction of the nervous system with immune system, persistent dysregulation of one or both of these systems may lead to chronic cough hypersensitivity. Here we review the current evidence for the neuro-immune interactions that underlie cough hypersensitivity and discuss future therapeutic strategies.
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Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744 South Korea ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744 South Korea ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do South Korea
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20
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Brigham EP, McCormack MC, Takemoto CM, Matsui EC. Iron status is associated with asthma and lung function in US women. PLoS One 2015; 10:e0117545. [PMID: 25689633 PMCID: PMC4331366 DOI: 10.1371/journal.pone.0117545] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/28/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Asthma and iron deficiency are common conditions. Whether iron status affects the risk of asthma is unclear. OBJECTIVE To determine the relationship between iron status and asthma, lung function, and pulmonary inflammation. METHODS Relationships between measures of iron status (serum ferritin, serum soluble transferrin receptor (sTfR), and sTfR/log10ferritin (sTfR-F Index)) and asthma, lung function, and pulmonary inflammation were examined in women 20-49 years in the National Health and Nutrition Examination Survey. Logistic, linear, and quadratic regression models accounting for the survey design of NHANES were used to evaluate associations between iron status and asthma-related outcomes and were adjusted for race/ethnicity, age, smoking status, income, and BMI. RESULTS Approximately 16% reported a lifetime history of asthma, 9% reported current asthma, and 5% reported a recent asthma episode/attack (n = 2906). Increased ferritin (iron stores) was associated with decreased odds of lifetime asthma, current asthma, and asthma attacks/episodes in the range of ferritin linearly correlated with iron stores (20-300ng/ml). The highest quintile of ferritin (>76 ng/ml) was also associated with a decreased odds of asthma. Ferritin levels were not associated with FEV1. Increased values of the sTfR-F Index and sTfR, indicating lower body iron and higher tissue iron need, respectively, were associated with decreased FEV1, but neither was associated with asthma. None of the iron indices were associated with FeNO. CONCLUSION In US women, higher iron stores were inversely associated with asthma and lower body iron and higher tissue iron need were associated with lower lung function. Together, these findings suggest that iron status may play a role in asthma and lung function in US women.
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Affiliation(s)
- Emily P. Brigham
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland, United States of America
| | - Meredith C. McCormack
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Clifford M. Takemoto
- Johns Hopkins University School of Medicine, Division of Pediatric Hematology, Baltimore, Maryland, United States of America
| | - Elizabeth C. Matsui
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins University School of Medicine, Division of Pediatric Allergy and Immunology, Baltimore, Maryland, United States of America
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