1
|
Chen W, Puttock EJ, Schatz M, Crawford W, Vollmer WM, Xie F, Xu S, Lustigova E, Zeiger RS. Risk Factors for Acute Asthma Exacerbations in Adults With Mild Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00549-X. [PMID: 38821437 DOI: 10.1016/j.jaip.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/07/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Although individuals with mild asthma account for 30% to 40% of acute asthma exacerbations (AAEs), relatively little attention has been paid to risk factors for AAEs in this population. OBJECTIVE To identify risk factors associated with AAEs in patients with mild asthma. METHODS This was a retrospective cohort study. We used administrative data from a large managed care organization to identify 199,010 adults aged 18 to 85 years who met study criteria for mild asthma between 2013 and 2018. An asthma-coded qualifying visit (index visit) was identified for each patient. We then used information at the index visit or from the year before the index visit to measure potential risk factors for AAEs in the subsequent year. An AAE was defined as either an asthma-coded hospitalization or emergency department visit, or an asthma-related systemic corticosteroid administration (intramuscular or intravenous) or oral corticosteroid dispensing. Poisson regression models with robust SEs were used to estimate the adjusted risk ratios for future AAEs. RESULTS In the study cohort, mean age was 44 years and 64% were female; 6.5% had AAEs within 1 year after the index visit. In multivariate models, age, sex, race, ethnicity, smoking status, body mass index, prior acute asthma care, and a variety of comorbidities and other clinical characteristics were significant predictors for future AAE risk. CONCLUSION Population-based disease management strategies for asthma should be expanded to include people with mild asthma in addition to those with moderate to severe disease.
Collapse
Affiliation(s)
- Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
| | - Eric J Puttock
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | - William Crawford
- Department of Allergy, Kaiser Permanente Southern California, Harbor City, Calif
| | | | - Fagen Xie
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Stanley Xu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Eva Lustigova
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| |
Collapse
|
2
|
Tashiro H, Kurihara Y, Kuwahara Y, Takahashi K. Impact of obesity in asthma: Possible future therapies. Allergol Int 2024; 73:48-57. [PMID: 37659887 DOI: 10.1016/j.alit.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 09/04/2023] Open
Abstract
Obesity is one of the factors associated with the severity of asthma. Obesity is associated with aggravation of the pathophysiology of asthma, including exacerbations, airway inflammation, decreased pulmonary function, and airway hyperresponsiveness. The present review addresses the characteristics of asthma with obesity, focusing especially on the heterogeneity caused by the degree of type 2 inflammation, sex differences, the onset of asthma, and race differences. To understand the severity mechanisms in asthma and obesity, such as corticosteroid resistance, fatty acids, gut microbiome, and cytokines, several basic research studies are evaluated. Finally, possible future therapies, including weight reduction, microbiome-targeted therapies, and other molecular targeted therapies are addressed. We believe that the present review will contribute to better understanding of the severity mechanisms and the establishment of novel treatments for severe asthma patients with obesity.
Collapse
Affiliation(s)
- Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
| | - Yuki Kurihara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuki Kuwahara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| |
Collapse
|
3
|
Lam SSW, Chen J, Wu JT, Lee CF, Ragavendran N, Ong MEH, Tan NC, Loo CM, Matchar DB, Koh MS. Association of quality-of-care indicators with asthma outcomes: A retrospective observational study for asthma care in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:497-509. [PMID: 38920201 DOI: 10.47102/annals-acadmedsg.2023151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Asthma guidelines have advocated for the use of quality-of-care indicators (QCIs) in asthma management. To improve asthma care, it is important to identify effective QCIs that are actionable. This study aimed to evaluate the effect of the presence of 3 QCIs: asthma education, Asthma Control Test (ACT) and spirometry testing on the time to severe exacerbation (TTSE). Method Data collected from the SingHealth COPD and Asthma Data Mart (SCDM), including asthma patients managed in 9 SingHealth polyclinics and Singapore General Hospital from January 2015 to December 2020, were analysed. Patients receiving Global Initiative for Asthma (GINA) Steps 3-5 treatment, with at least 1 QCI recorded, and at least 1 severe exacerbation within 1 year before the first QCI record, were included. Data were analysed using multivariate Cox regression and quasi-Poisson regression models. Results A total of 3849 patients in the registry fulfilled the criteria. Patients with records of asthma education or ACT assessment have a lower adjusted hazard ratio (HR) for TTSE (adjusted HR=0.88, P=0.023; adjusted HR=0.83, P<0.001). Adjusted HR associated with spirometry is higher (adjusted HR=1.22, P=0.026). No QCI was significantly associated with emergency department (ED)/inpatient visits. Only asthma education and ACT showed a decrease in the number of exacerbations for multivariate analysis (asthma education estimate: -0.181, P<0.001; ACT estimate: -0.169, P<0.001). No QCI was significant for the number of exacerbations associated with ED/inpatient visits. Conclusion Our study suggests that the perfor-mance of asthma education and ACT was associated with increased TTSE and decreased number of exacerbations, underscoring the importance of ensuring quality care in clinical practice.
Collapse
Affiliation(s)
- Sean Shao Wei Lam
- Duke-NUS Medical School, National University of Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore
- Lee Kong Chian School of Business, Singapore Management University, Singapore
| | - Jingwei Chen
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Jun Tian Wu
- Duke-NUS Medical School, National University of Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Chun Fan Lee
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Narayanan Ragavendran
- Duke-NUS Medical School, National University of Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Ngiap Chuan Tan
- Duke-NUS Medical School, National University of Singapore, Singapore
- SingHealth Polyclinics, SingHealth, Singapore
| | - Chian Min Loo
- Duke-NUS Medical School, National University of Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - David Bruce Matchar
- Duke-NUS Medical School, National University of Singapore, Singapore
- Department of Internal Medicine (General Internal Medicine), Duke University Medical School, Durham, North Carolina, US
| | - Mariko Siyue Koh
- Duke-NUS Medical School, National University of Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| |
Collapse
|
4
|
Womble JT, Ihrie MD, McQuade VL, Hegde A, McCravy MS, Phatak S, Tighe RM, Que LG, D’Alessio D, Walker JKL, Ingram JL. Vertical sleeve gastrectomy associates with airway hyperresponsiveness in a murine model of allergic airway disease and obesity. Front Endocrinol (Lausanne) 2023; 14:1092277. [PMID: 36926031 PMCID: PMC10011633 DOI: 10.3389/fendo.2023.1092277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Asthma is a chronic airway inflammatory disease marked by airway inflammation, remodeling and hyperresponsiveness to allergens. Allergic asthma is normally well controlled through the use of beta-2-adrenergic agonists and inhaled corticosteroids; however, a subset of patients with comorbid obesity experience resistance to currently available therapeutics. Patients with asthma and comorbid obesity are also at a greater risk for severe disease, contributing to increased risk of hospitalization. Bariatric surgery improves asthma control and airway hyperresponsiveness in patients with asthma and comorbid obesity, however, the underlying mechanisms for these improvements remain to be elucidated. We hypothesized that vertical sleeve gastrectomy (VSG), a model of metabolic surgery in mice, would improve glucose tolerance and airway inflammation, resistance, and fibrosis induced by chronic allergen challenge and obesity. Methods Male C57BL/6J mice were fed a high fat diet (HFD) for 13 weeks with intermittent house dust mite (HDM) allergen administration to induce allergic asthma, or saline as control. At week 11, a subset of mice underwent VSG or Sham surgery with one week recovery. A separate group of mice did not undergo surgery. Mice were then challenged with HDM or saline along with concurrent HFD feeding for 1-1.5 weeks before measurement of lung mechanics and harvesting of tissues, both of which occurred 24 hours after the final HDM challenge. Systemic and pulmonary cytokine profiles, lung histology and gene expression were analyzed. Results High fat diet contributed to increased body weight, serum leptin levels and development of glucose intolerance for both HDM and saline treatment groups. When compared to saline-treated mice, HDM-challenged mice exhibited greater weight gain. VSG improved glucose tolerance in both saline and HDM-challenged mice. HDM-challenged VSG mice exhibited an increase in airway hyperresponsiveness to methacholine when compared to the non-surgery group. Discussion The data presented here indicate increased airway hyperresponsiveness in allergic mice undergoing bariatric surgery.
Collapse
Affiliation(s)
- Jack T. Womble
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Mark D. Ihrie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Victoria L. McQuade
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Akhil Hegde
- School of Nursing, Duke University, Durham, NC, United States
| | - Matthew S. McCravy
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Sanat Phatak
- Diabetes/Rheumatology Units, King Edward Memorial Hospital, Pune, India
| | - Robert M. Tighe
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Loretta G. Que
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - David D’Alessio
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | | | - Jennifer L. Ingram
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| |
Collapse
|
5
|
Rosenberg D, Palmon P. Approaches to Management of Asthma: Guidelines for Stepped Care and Self-Monitoring. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:355-375. [PMID: 37464128 DOI: 10.1007/978-3-031-32259-4_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
While the twentieth century brought rapid changes to the diagnosis and management of asthma, consensus guidelines did not exist until the mid-1980s. Over the subsequent four decades, guidelines evolved from expert-based recommendations to comprehensive, evidenced-based references. The main two guidelines to be discussed in this chapter are the expert panel reports (EPR) published by the United States National Heart, Lung, and Blood Institute (NHLBI) and the Global Strategy for Asthma Management and Prevention Report (GINA) published by the NHLBI and World Health Organization (WHO). While these guidelines both focus on evidence-based approaches to the diagnosis and management of asthma, there are significant differences in both organization and recommendations. Just as the introduction of evidence-based guidelines was revolutionary to asthma management over the last 20 years, we anticipate further development of recommendations specific to precision medicine based on ongoing cutting-edge clinical research.
Collapse
Affiliation(s)
- Daniel Rosenberg
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Madison, WI, USA.
| | - Philip Palmon
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
6
|
Wang W, Lin J, Zhou X, Wang C, Huang M, Cai S, Chen P, Lin Q, Zhou J, Gu Y, Yuan Y, Sun D, Yang X, Yang L, Huo J, Chen Z, Jiang P, Zhang J, Ye X, Liu H, Tang H, Liu R, Liu C, Zhang W, Hu C, Chen Y, Liu X, Dai L, Zhou W, Huang Y, Xu J. Associations between comorbidities and annual incidence plus frequency of asthma exacerbation hospitalisation during the past year: data from CARN study. BMC Pulm Med 2022; 22:261. [PMID: 35778740 PMCID: PMC9250194 DOI: 10.1186/s12890-022-02038-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/09/2022] [Indexed: 02/08/2023] Open
Abstract
Purpose While asthma comorbidities are associated with higher health care utilisation, lower quality of life and poorer asthma control, the impact of asthma comorbidities on hospitalisation for asthma exacerbation (H-AX) remains less recognised. We aim to analyse the impact of asthma comorbidities on H-AX. Methods Based on a national survey on asthma control and disease perception (CARN 2015 study), we analysed the impact of comorbidities on annual incidence and frequency of H-AX in China. Information on demographic characteristics, asthma comorbidities and annual incidence and frequency of H-AX were presented in this study. Results Among 3875 ambulatory asthma patients, 75.9% (2941/3875) had comorbidities, and 26.4% (1017/3858) experienced H-AX during past year. After adjusting for confounding factors such as demographic data, smoking status and asthma control, COPD [OR = 2.189, 95% CI (1.673, 2.863)] and coronary heart disease [OR = 1.387, 95% CI (1.032, 1.864)] were associated with higher annual incidence, while allergic rhinitis [OR = 0.692, 95% CI (0.588, 0.815)] was associated with lower annual incidence, of H-AX. In terms of frequency, allergic rhinitis [OR = 1.630, 95% CI (1.214, 2.187)], COPD [OR = 1.472, 95% CI (1.021, 2.122)] and anxiety [OR = 2.609, 95% CI (1.051, 6.477)] showed statistically significant correlation with frequent H-AX. Conclusions COPD and coronary heart disease were associated with higher annual incidence, while allergic rhinitis was associated with lower annual incidence of H-AX. Allergic rhinitis, COPD and anxiety were associated with frequent H-AX. Comorbidities may have an important role in the risk and frequency of annual hospitalisations due to asthma exacerbation. The goal of asthma control should rely on a multi-disciplinary treatment protocol.
Collapse
Affiliation(s)
- Wenqiao Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, China.
| | - Xin Zhou
- Department of Respiration, Shanghai Central Hospital, Shanghai, China
| | - Changzheng Wang
- Department of Respiration, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Mao Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shaoxi Cai
- Department of Respiration, Nanfang Hospital, Guangzhou, China
| | - Ping Chen
- Department of Respiratory Diseases, General Hospital of Shenyang Military Command, Shenyang, China
| | - Qichang Lin
- Department of Respiration, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jianying Zhou
- Department of Respiration, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhai Gu
- Department of Respiration, Qinghai People's Hospital, Xining, China
| | - Yadong Yuan
- Department of Respiration, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dejun Sun
- Department of Pulmonary and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot, China
| | - Xiaohong Yang
- Department of Pulmonary and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Lan Yang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianmin Huo
- Department of Respiration, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhuochang Chen
- Department of Respiration, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ping Jiang
- Department of Respiration, Tianjin First Central Hospital, Tianjin, China
| | - Jie Zhang
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Xianwei Ye
- Department of Respiration, Guizhou Provincial People's Hospital, Guiyang, China
| | - Huiguo Liu
- Department of Respiration, Tongji Hospital, Wuhan, China
| | - Huaping Tang
- Department of Respiration, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Rongyu Liu
- Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chuntao Liu
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- Department of Respiration, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chengping Hu
- Department of Respiration, Xiangya Hospital, Changsha, China
| | - Yiqiang Chen
- Department of Respiration, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaoju Liu
- Department of Respiration, The First Affiliated Hospital of Lanzhou University, Lanzhou, China
| | - Luming Dai
- Department of Respiration, Kunming General Hospital of the People's Liberation Army, Kunming, China
| | - Wei Zhou
- Department of Respiration, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yijiang Huang
- Department of Respiration, Hainan General Hospital, Haikou, China
| | - Jianying Xu
- Department of Respiration, Shanxi Bethune Hospital, Taiyuan, China
| |
Collapse
|
7
|
Hossain N, Arhi C, Borg CM. Is Bariatric Surgery Better than Nonsurgical Weight Loss for Improving Asthma Control? A Systematic Review. Obes Surg 2021; 31:1810-1832. [PMID: 33590422 DOI: 10.1007/s11695-021-05255-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 01/01/2023]
Abstract
Obesity is associated with increased severity of asthma. Bariatric surgery can be effective in weight loss and improvement in asthma. Two reviewers conducted a systematic review using search terms: 'weight loss', 'bariatric surgery', and 'asthma'. Adult studies including all bariatric procedures and nonsurgical weight loss regimes were included. Thirty-nine studies, including twenty-six bariatric studies and thirteen nonsurgical studies, were found. No study directly compared bariatric surgery to nonsurgical techniques. Bariatric surgery offered greater weight loss (22-36%) than nonsurgical programmes (4.1-14.2%) and more consistently improved medication use, airway hyperresponsiveness, hospitalisation rate or ED attendance and lung function, while change in inflammatory markers were variable. Bariatric surgery appears to be superior in treating asthma; however, further study on surgery for both mild and severe asthma is required.
Collapse
Affiliation(s)
- Naveed Hossain
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK. .,Department of General Surgery, Whittington Hospital, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK.
| | - Chanpreet Arhi
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
| | - Cynthia-Michelle Borg
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
| |
Collapse
|
8
|
Altaii HA, Al-Tae FMD. Investigation of Serum Total IgE and Eosinophil Levels in Different Allergic Diseases Together with the Study of Their Correlations with Various Possible Allergens in Mosul City. Immunol Invest 2020; 51:567-587. [PMID: 33283561 DOI: 10.1080/08820139.2020.1853154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Serum total IgE (tIgE) is frequently used in the diagnosis of allergic diseases in Mosul city and Iraq. However, neither normal nor elevated levels can exclude or confirm the diagnosis of these diseases. Here, we tried to evaluate the validity of tIgE in the diagnosis of allergic asthma(AS), allergic rhinitis(AR) and atopic dermatitis(AD) in a sample of Mosul population, to set up an optimum cut-off value for diagnosis of these diseases and to study its correlation with different parameters that might affect its level. 38 patients with AS, 27 with AR, 46 with AD and 45 healthy controls were included in this study. tIgE were determined by ELISA and compared between allergic diseases and controls. Blood eosinophilia was ascertained and correlated with tIgE levels. The geometric means of tIgE were 316.87 IU/ml (95% CI: 234.69 to 427.82) in AS, 262.07 IU/ml (95% CI:174.24 to 394.18) in AR and 270.48 IU/ml (95% CI:202.57 to 361.16) in AD compared to 16.90 IU/ml (95% CI:12.32 to 23.18) in healthy controls. tIgE in allergic diseases was significantly increased in comparison to healthy controls (P <.0001). Female gender influenced tIgE in AS, but not in AR or AD. tIgE predominated in younger age groups; however, no significant difference was found between younger and older groups. Optimum values for tIgE with best discriminative accuracy were 77 IU/ml for AS and 81 IU/ml for AR and AD. Eosinophils count appeared to be a useful adjunct, and correlate well with tIgE in the diagnosis of allergic diseases.
Collapse
Affiliation(s)
- Hiyam A Altaii
- Department of Biology, College of Science, University of Mosul, Mosul, Iraq
| | - Firas M D Al-Tae
- Department of Microbiology and Immunology, College of Medicine, University of Mosul, Mosul, Iraq
| |
Collapse
|
9
|
Skevaki C, Karsonova A, Karaulov A, Xie M, Renz H. Asthma-associated risk for COVID-19 development. J Allergy Clin Immunol 2020; 146:1295-1301. [PMID: 33002516 PMCID: PMC7834224 DOI: 10.1016/j.jaci.2020.09.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
The newly described severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for a pandemic (coronavirus disease 2019 [COVID-19]). It is now well established that certain comorbidities define high-risk patients. They include hypertension, diabetes, and coronary artery disease. In contrast, the context with bronchial asthma is controversial and shows marked regional differences. Because asthma is the most prevalent chronic inflammatory lung disease worldwide and SARS-CoV-2 primarily affects the upper and lower airways leading to marked inflammation, the question arises about the possible clinical and pathophysiological association between asthma and SARS-CoV-2/COVID-19. Here, we analyze the global epidemiology of asthma among patients with COVID-19 and propose the concept that patients suffering from different asthma endotypes (type 2 asthma vs non-type 2 asthma) present with a different risk profile in terms of SARS-CoV-2 infection, development of COVID-19, and progression to severe COVID-19 outcomes. This concept may have important implications for future COVID-19 diagnostics and immune-based therapy developments.
Collapse
Affiliation(s)
- Chrysanthi Skevaki
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany; German Center for Lung Research (DZL), Marburg, Germany
| | - Antonina Karsonova
- Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia
| | - Alexander Karaulov
- Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia
| | - Min Xie
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Harald Renz
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany; German Center for Lung Research (DZL), Marburg, Germany; Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia.
| |
Collapse
|
10
|
Martin MJ, Beasley R, Harrison TW. Towards a personalised treatment approach for asthma attacks. Thorax 2020; 75:1119-1129. [PMID: 32839286 DOI: 10.1136/thoraxjnl-2020-214692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 12/16/2022]
Abstract
Asthma attacks (exacerbations) are common, accounting for over 90 000 UK hospital admissions per annum. They kill nearly 1500 people per year in the UK, have significant associated direct and indirect costs and lead to accelerated and permanent loss of lung function. The recognition of asthma as a heterogeneous condition with multiple phenotypes has revolutionised the approach to the long-term management of the condition, with greater emphasis on personalised treatment and the introduction of the treatable traits concept. In contrast asthma attacks are poorly defined and understood and our treatment approach consists of bronchodilators and systemic corticosteroids. This review aims to explore the current limitations in the description, assessment and management of asthma attacks. We will outline the risk factors for attacks, strategies to modify this risk and describe the recognised characteristics of attacks as a first step towards the development of an approach for phenotyping and personalising the treatment of these critically important events. By doing this, we hope to gradually improve asthma attack treatment and reduce the adverse effects associated with recurrent courses of corticosteroids.
Collapse
Affiliation(s)
- Matthew J Martin
- Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, UK
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Tim W Harrison
- Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, UK
| |
Collapse
|
11
|
Vatrella A, Maglio A, Pelaia C, Pelaia G, Vitale C. Pharmacotherapeutic strategies for critical asthma syndrome: a look at the state of the art. Expert Opin Pharmacother 2020; 21:1505-1515. [PMID: 32456498 DOI: 10.1080/14656566.2020.1766023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION 'Critical Asthma Syndrome' (CAS) is an umbrella term proposed to include several forms of asthma, responsible for acute and life-threatening exacerbations. CAS requires urgent and adequate supportive and pharmacological treatments to prevent serious outcomes. AREAS COVERED The purpose of this review is to discuss current knowledge on the pharmacotherapeutic strategies for treatment of CAS. EXPERT OPINION Airflow limitation, airway wall edema, and mucus plugs are the pathophysiological targets of pharmacological therapies. Strategies to achieve these goals are based on the use of various classes of drugs. Inhaled beta2-agonists are the mainstay of the initial therapy of CAS. Inhaled anticholinergic agents may be considered in the treatment of CAS in addition to beta 2 agonists. Systemic corticosteroids should be administered as soon as possible in order to counteract airway inflammation and restore normal airway sensitivity. The effectiveness of pharmacological therapies in CAS is linked not only to the timely use of drugsbut also to the dosage and route of administration. Early recognition and aggressive treatment are essential for the management of CAS; however, prevention is the best cure. Although significant progress has been made, further efforts are needed to implement an optimal exacerbation prevention strategy.
Collapse
Affiliation(s)
- Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno , Salerno, Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno , Salerno, Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, "Magna Græcia" University of Catanzaro , Catanzaro, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, "Magna Græcia" University of Catanzaro , Catanzaro, Italy
| | - Carolina Vitale
- Department of Medicine, Surgery and Dentistry, University of Salerno , Salerno, Italy
| |
Collapse
|
12
|
Guguen C, Launois C, Dormoy V, Dewolf M, Dumazet A, Dury S, Lebargy F, Deslee G, Perotin JM. [Obesity and asthma: Mechanisms and therapeutic options]. Rev Mal Respir 2019; 37:134-143. [PMID: 31864881 DOI: 10.1016/j.rmr.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/22/2022]
Abstract
Asthma and obesity are both common conditions, which lead to a substantial public health burden. The obese-asthma phenotype is characterized by poor asthma control, impaired lung function and decreased efficacy of inhaled treatment. However, this phenotype is highly heterogeneous and involves numerous mechanisms, including systemic inflammation and adipokines. A role for microbiota modifications and genetics has been suggested. Obese-asthma patient management currently consists in weight loss and usual anti-asthmatic treatment. New therapeutic options are being evaluated.
Collapse
Affiliation(s)
- C Guguen
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - C Launois
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - V Dormoy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - M Dewolf
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - A Dumazet
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - S Dury
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - F Lebargy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - G Deslee
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - J-M Perotin
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France.
| |
Collapse
|
13
|
Esteves de Oliveira E, de Castro E Silva FM, Caçador Ayupe M, Gomes Evangelista Ambrósio M, Passos de Souza V, Costa Macedo G, Ferreira AP. Obesity affects peripheral lymphoid organs immune response in murine asthma model. Immunology 2019; 157:268-279. [PMID: 31112301 DOI: 10.1111/imm.13081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 01/12/2023] Open
Abstract
Asthma and obesity present rising incidence, and their concomitance is a reason for concern, as obese individuals are usually resistant to conventional asthma treatments and have more exacerbation episodes. Obesity affects several features in the lungs during asthma onset, shifting the T helper type 2 (Th2)/eosinophilic response towards a Th17/neutrophilic profile. Moreover, those individuals can present reduced atopy and delayed cytokine production. However, the impact of obesity on follicular helper T (Tfh) cells and B cells that could potentially result in antibody production disturbances are still unclear. Therefore, we aimed to assess the peripheral response to ovalbumin (OVA) in a concomitant model of obesity and asthma. Pulmonary allergy was induced, in both lean and obese female BALB/c mice, through OVA sensitizations and challenges. Mediastinal lymph nodes (MLNs) and spleen were processed for immunophenotyping. Lung was used for standard allergy analysis. Obese-allergic mice produced less anti-OVA IgE and more IgG2a than lean-allergic mice. Dendritic cells (CD11c+ MHCIIhigh ) expressed less CD86 and more PDL1 in obese-allergic mice compared with lean-allergic mice, in the MLNs. Meanwhile, B cells (CD19+ CD40+ ) were more frequent and the amount of PDL1/PD1+ cells was diminished by obesity, with the opposite effects in the spleen. Tfh cells (CD3+ CD4+ CXCR5+ PD1+ ) expressing FoxP3 were more frequent in obese mice, associated with the predominance of Th (CD3+ CD4+ ) cells expressing interleukin-4/GATA3 in the MLNs and interleukin-17A/RORγT in the spleen. Those modifications to the main components of the germinal centers could be resulting in the increased IgG2a production, which - associated with the Th17/neutrophilic profile - contributes to asthma worsening and represents an important target for future treatment strategies.
Collapse
Affiliation(s)
- Erick Esteves de Oliveira
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Flávia Márcia de Castro E Silva
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Marina Caçador Ayupe
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Marcilene Gomes Evangelista Ambrósio
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Viviane Passos de Souza
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Gilson Costa Macedo
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Ana Paula Ferreira
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| |
Collapse
|
14
|
Hiranrattana A, Stern DA, Guerra S, Halonen M, Wright AL, Daines M, Martinez FD, Morgan WJ. Alternaria sensitisation at age 6 years is associated with subsequent airway hyper-responsiveness in non-asthmatics. Thorax 2018; 73:1170-1173. [PMID: 29563159 DOI: 10.1136/thoraxjnl-2017-210325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 11/04/2022]
Abstract
In the non-selected birth cohort Tucson Children's Respiratory Study, early sensitisation to Alternaria was associated with increased airway hyper-responsiveness (AHR) into adult life among non-asthmatics. The increase in AHR was of a similar magnitude to that seen for Alternaria sensitised asthmatics and was primarily evident among those who were overweight or obese. In contrast, there was no significant association between early sensitisation to aeroallergens other than Alternaria and AHR among non-asthmatics. Why this group of Alternaria sensitised individuals without asthma demonstrated increased AHR of a magnitude similar to asthmatics is unknown and requires further investigation.
Collapse
Affiliation(s)
- Anunya Hiranrattana
- Pediatric Pulmonary Allergy Division, Department of Pediatrics, University of Arizona, Tucson, Arizona, USA
| | - Debra A Stern
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Marilyn Halonen
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Anne L Wright
- Pediatric Pulmonary Allergy Division, Department of Pediatrics, University of Arizona, Tucson, Arizona, USA.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Michael Daines
- Pediatric Pulmonary Allergy Division, Department of Pediatrics, University of Arizona, Tucson, Arizona, USA.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Wayne J Morgan
- Pediatric Pulmonary Allergy Division, Department of Pediatrics, University of Arizona, Tucson, Arizona, USA.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| |
Collapse
|
15
|
Rutting S, Xenaki D, Lau E, Horvat J, Wood LG, Hansbro PM, Oliver BG. Dietary omega-6, but not omega-3, polyunsaturated or saturated fatty acids increase inflammation in primary lung mesenchymal cells. Am J Physiol Lung Cell Mol Physiol 2018; 314:L922-L935. [PMID: 29368548 DOI: 10.1152/ajplung.00438.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Obesity is an important risk factor for developing severe asthma. Dietary fatty acids, which are increased in sera of obese individuals and after high-fat meals, activate the innate immune system and induce inflammation. This study investigated whether dietary fatty acids directly cause inflammation and/or synergize with obesity-induced cytokines in primary human pulmonary fibroblasts in vitro. Fibroblasts were challenged with BSA-conjugated fatty acids [ω-6 polyunsaturated fatty acids (PUFAs) and ω-3 PUFAs or saturated fatty acids (SFAs)], with or without TNF-α, and release of the proinflammatory cytokines, IL-6 and CXCL8, was measured. We found that the ω-6 PUFA arachidonic acid (AA), but not ω-3 PUFAs or SFAs, upregulates IL-6 and CXCL8 release. Combined AA and TNF-α challenge resulted in substantially greater cytokine release than either alone, demonstrating synergy. Synergistic upregulation of IL-6, but not CXCL8, was mainly mediated via cyclooxygenase (COX). Inhibition of p38 MAPK reduced CXCL8 release, induced by AA and TNF-α alone, but not in combination. Synergistic CXCL8 release, following AA and TNF-α challenge, was not medicated via a single signaling pathway (MEK1, JNK, phosphoinositide 3-kinase, and NF-κB) nor by hyperactivation of NF-κB or p38. To investigate if these findings occur in other airway cells, effects of AA in primary human airway smooth muscle (ASM) cells and human bronchial epithelial cells were also investigated. We found proinflammatory effects in ASM cells but not epithelial cells. This study suggests that diets rich in ω-6 PUFAs might promote airway inflammation via multiple pathways, including COX-dependent and -independent pathways, and in an obese person, may lead to more severe airway inflammation.
Collapse
Affiliation(s)
- Sandra Rutting
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Dia Xenaki
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia
| | - Edmund Lau
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Jay Horvat
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle , Newcastle , Australia
| | - Lisa G Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle , Newcastle , Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and University of Newcastle , Newcastle , Australia
| | - Brian G Oliver
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia.,School of Life Sciences, University of Technology Sydney , Sydney , Australia
| |
Collapse
|
16
|
Hong J, Bao Y, Chen A, Li C, Xiang L, Liu C, Chen Z, Zhao D, Fu Z, Shang Y. Chinese guidelines for childhood asthma 2016: Major updates, recommendations and key regional data. J Asthma 2017; 55:1138-1146. [PMID: 29227721 DOI: 10.1080/02770903.2017.1396474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE With increased industrialization and urbanization in China, pediatric asthma is becoming more prevalent. Despite a growing body of evidence, there remains a significant unmet need for adequate management of childhood asthma. The Subspecialty Group of Respiratory Diseases of the Society of Pediatrics, the Chinese Medical Association, and the editorial board of the Chinese Journal of Pediatrics have recently updated the "Guidelines for diagnosis and optimal management of asthma in children," first published in 2008. METHODS This article reviews the major updates to the guidelines and covers the main recommendations for diagnosis, assessment, and treatment of pediatric asthma in China. Key regional data on epidemiology, clinical features, disease burden, knowledge among children and parents, and risk factors including pollution are provided to contextualize the recommendations. RESULTS The major updates to the guidelines include: (1) A more practical definition of asthma; (2) assessment of asthma control that takes into account both current symptom control and future risk; (3) classification based on disease severity that corresponds with treatment step; (4) differentiation between difficult-to-treat and poorly controlled asthma; (5) an open-ended approach to pharmacological management; and (6) allergen immunotherapy (AIT) in mild- to moderate-persistent asthma. CONCLUSIONS The updated "Guidelines for the diagnosis and optimal management of asthma in children (2016)" combine the latest national and international clinical evidence and experience to provide practical and reliable recommendations to Chinese clinicians.
Collapse
Affiliation(s)
- Jianguo Hong
- a Department of Pediatrics , Shanghai General Hospital, Shanghai Jiaotong University , Shanghai , China
| | - Yixiao Bao
- b National Children's Medical Center, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China.,c Department of Pediatrics , Shanghai EverBetter Pubin Children's Hospital , Shanghai , China
| | - Aihuan Chen
- d Department of Pediatrics , The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease , Guangzhou , China
| | - Changchong Li
- e Department of Pediatrics , the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , China
| | - Li Xiang
- f Department of Allergy , Beijing Children's Hospital, Capital Medical University , Beijing , China
| | - Chuanhe Liu
- g Department of Pediatrics , Capital Institute of Pediatrics , Beijing , China
| | - Zhimin Chen
- h Department of Respiratory Diseases , the Children's Hospital, Zhejiang University School of Medicine , Hangzhou , China
| | - Deyu Zhao
- i Department of Respiratory Diseases , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Zhou Fu
- j Department of Respiratory Diseases , Children's Hospital of Chongqing Medical University , Chongqing , China
| | - Yunxiao Shang
- k Department of Pediatrics , Shengjing Hospital of China Medical University , Shenyang , China
| |
Collapse
|
17
|
Lugogo N, Green CL, Agada N, Zhang S, Meghdadpour S, Zhou R, Yang S, Anstrom KJ, Israel E, Martin R, Lemanske RF, Boushey H, Lazarus SC, Wasserman SI, Castro M, Calhoun W, Peters SP, DiMango E, Chinchilli V, Kunselman S, King TS, Icitovic N, Kraft M. Obesity's effect on asthma extends to diagnostic criteria. J Allergy Clin Immunol 2017. [PMID: 28624608 DOI: 10.1016/j.jaci.2017.04.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of inflammatory biomarkers to delineate the type of lung inflammation present in asthmatic subjects is increasingly common. However, the effect of obesity on these markers is unknown. OBJECTIVES We aimed to determine the effect of obesity on conventional markers of inflammation in asthmatic subjects. METHODS We performed secondary analysis of data from 652 subjects previously enrolled in 2 Asthma Clinical Research Network trials. We performed linear correlations between biomarkers and logistic regression analysis to determine the predictive value of IgE levels, blood eosinophil counts, and fraction of exhaled nitric oxide values in relationship to sputum eosinophil counts (>2%), as well as to determine whether cut points existed that would maximize the sensitivity and specificity for predicting sputum eosinophilia in the 3 weight groups. RESULTS Overall, statistically significant but relatively weak correlations were observed among all 4 markers of inflammation. Within obese subjects, the only significant correlation found was between IgE levels and blood eosinophil counts (r = 0.33, P < .001); furthermore, all other correlations between inflammatory markers were approximately 0, including correlations with sputum eosinophil counts. In addition, the predictive value of each biomarker alone or in combination was poor in obese subjects. In fact, in obese subjects none of the biomarkers of inflammation significantly predicted the presence of high sputum eosinophil counts. Obese asthmatic subjects have lower cut points for IgE levels (268 IU), fraction of exhaled nitric oxide values (14.5 ppb), and blood eosinophil counts (96 cells/μL) than all other groups. CONCLUSIONS In obese asthmatic subjects conventional biomarkers of inflammation are poorly predictive of eosinophilic airway inflammation. As such, biomarkers currently used to delineate eosinophilic inflammation in asthmatic subjects should be approached with caution in these subjects.
Collapse
Affiliation(s)
- Njira Lugogo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich.
| | - Cynthia L Green
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Noah Agada
- Division of Pediatric Allergy and Immunology, Department of Pediatric Pulmonology, Riley Children's Hospital, and Eli Lilly and Company, Indianapolis, Ind
| | - Siyi Zhang
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Susanne Meghdadpour
- Department of Pediatrics, Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Duke University, Durham, NC
| | - Run Zhou
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Siyun Yang
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Kevin J Anstrom
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Elliot Israel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Richard Martin
- Department of Medicine, National Jewish Health and University of Colorado Denver, Denver, Colo
| | - Robert F Lemanske
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Homer Boushey
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, Calif
| | - Stephen C Lazarus
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, Calif
| | - Stephen I Wasserman
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of California, San Diego, Calif
| | - Mario Castro
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, Saint Louis, Mo
| | - William Calhoun
- Division of Pulmonary, Critical Care, and Sleep and Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex
| | - Stephen P Peters
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, NC
| | - Emily DiMango
- Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, Columbia University, New York, NY
| | - Vernon Chinchilli
- Department of Public Health Services, Penn State College of Medicine, Division of Biostatistics, Hershey, Pa
| | - Susan Kunselman
- Department of Public Health Services, Penn State College of Medicine, Division of Biostatistics, Hershey, Pa
| | - Tonya S King
- Department of Public Health Services, Penn State College of Medicine, Division of Biostatistics, Hershey, Pa
| | - Nikolina Icitovic
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Monica Kraft
- Department of Medicine, University of Arizona, Tucson, Ariz
| |
Collapse
|
18
|
Just J, Bourgoin-Heck M, Amat F. Clinical phenotypes in asthma during childhood. Clin Exp Allergy 2017; 47:848-855. [PMID: 28422351 DOI: 10.1111/cea.12939] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Asthma is a heterogeneous disease characterized by numerous phenotypes relating to age of onset, triggers, comorbidities, severity (assessed by multiple exacerbations, lung function pattern) and finally the inflammatory cells involved in the pathophysiologic pathway. These phenotypes can vary over time in relation to changes in the principal triggers involved in the aetiology of the disease. Nevertheless, in a patient with multiple allergies and early-onset disease (defined as multiple sensitizations and allergic comorbidities), the prognosis of asthma is poor with a high risk of persistence and severity of the disease during childhood. Future research will focus on classifying phenotypes into groups based on pathophysiologic mechanisms (endotypes) and the biomarkers attached to these endotypes, which could predict prognosis and lead to targeted therapy. Currently, these biomarkers are related to inflammatory cells associated with the asthma endotype, essentially eosinophils and neutrophils (and related cytokines) attached to Th-2 and non Th-1 pathways, respectively. The most severe asthma (refractory asthma) is linked to neutrophil-derived inflammation (frequently associated with female sex, obesity and possibly disorganized airway microbiota) encountered in very young children or teenagers. Severe asthma is also linked to or a marked eosinophil inflammatory process (frequently associated with multiple atopy and, more rarely, with non-atopic hypereosinophilic asthma in children) and frequently encountered in teenagers. Severe phenotypes of asthma could also play a role in the origin of chronic obstructive pulmonary disease in adult life.
Collapse
Affiliation(s)
- J Just
- Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.,EPAR, UMR-S 1136 INSERM & UPMC Paris6, Université Paris Pierre et Marie Curie, Paris, France
| | - M Bourgoin-Heck
- Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.,EPAR, UMR-S 1136 INSERM & UPMC Paris6, Université Paris Pierre et Marie Curie, Paris, France
| | - F Amat
- Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.,EPAR, UMR-S 1136 INSERM & UPMC Paris6, Université Paris Pierre et Marie Curie, Paris, France
| |
Collapse
|
19
|
Heck S, Al-Shobash S, Rapp D, Le DD, Omlor A, Bekhit A, Flaig M, Al-Kadah B, Herian W, Bals R, Wagenpfeil S, Dinh QT. High probability of comorbidities in bronchial asthma in Germany. NPJ Prim Care Respir Med 2017; 27:28. [PMID: 28432297 PMCID: PMC5435094 DOI: 10.1038/s41533-017-0026-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 03/02/2017] [Accepted: 03/21/2017] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Clinical experience has shown that allergic and non-allergic respiratory, metabolic, mental, and cardiovascular disorders sometimes coexist with bronchial asthma. However, no study has been carried out that calculates the chance of manifestation of these disorders with bronchial asthma in Saarland and Rhineland-Palatinate, Germany. Using ICD10 diagnoses from health care institutions, the present study systematically analyzed the co-prevalence and odds ratios of comorbidities in the asthma population in Germany. The odds ratios were adjusted for age and sex for all comorbidities for patients with asthma vs. without asthma. Bronchial asthma was strongly associated with allergic and with a lesser extent to non-allergic comorbidities: OR 7.02 (95%CI:6.83-7.22) for allergic rhinitis; OR 4.98 (95%CI:4.67-5.32) allergic conjunctivitis; OR 2.41 (95%CI:2.33-2.52) atopic dermatitis; OR 2.47 (95%CI:2.16-2.82) food allergy, and OR 1.69 (95%CI:1.61-1.78) drug allergy. Interestingly, increased ORs were found for respiratory diseases: 2.06 (95%CI:1.64-2.58) vocal dysfunction; 1.83 (95%CI:1.74-1.92) pneumonia; 1.78 (95%CI:1.73-1.84) sinusitis; 1.71 (95%CI:1.65-1.78) rhinopharyngitis; 2.55 (95%CI:2.03-3.19) obstructive sleep apnea; 1.42 (95%CI:1.25-1.61) pulmonary embolism, and 3.75 (95%CI:1.64-8.53) bronchopulmonary aspergillosis. Asthmatics also suffer from psychiatric, metabolic, cardiac or other comorbidities. Myocardial infarction (OR 0.86, 95%CI:0.79-0.94) did not coexist with asthma. Based on the calculated chances of manifestation for these comorbidities, especially allergic and respiratory, to a lesser extent also metabolic, cardiovascular, and mental disorders should be taken into consideration in the diagnostic and treatment strategy of bronchial asthma. BRONCHIAL ASTHMA PREVALENCE OF CO-EXISTING DISEASES IN GERMANY: Patients in Germany with bronchial asthma are highly likely to suffer from co-existing diseases and their treatments should reflect this. Quoc Thai Dinh at Saarland University Hospital in Homburg, Germany, and co-workers conducted a large-scale study of patients presenting with bronchial asthma in the Saarland region between 2009 and 2012. Patients with asthma made up 5.4% of the region's total population, with a higher prevalence occurring in females. They found that bronchial asthma was strongly associated with allergic comorbidities such as rhinitis. Indeed, asthmatic patients had a seven times higher chance to suffer from allergic rhinitis than the rest of the population, and were at higher risk of respiratory diseases like pneumonia and obstructive sleep apnea syndrome. Further associations included cardiovascular, metabolic and mental disorders. Dinh's team call for asthma treatments to take such comorbidities into account.
Collapse
Affiliation(s)
- S Heck
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - S Al-Shobash
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - D Rapp
- Department of Biometry, Epidemiology and Clinical informatics, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - D D Le
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - A Omlor
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - A Bekhit
- Department of Biometry, Epidemiology and Clinical informatics, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - M Flaig
- Department of Internal Medicine V, Pneumology, Allergology and Respiratory Critical Care Medicine, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - B Al-Kadah
- Department of Otorhinolaryngology, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - W Herian
- Head of the Regulatory Management Division, Association of Statutory Health Insurance Physicians Saarland, Saarbrucken, Germany
| | - R Bals
- Department of Internal Medicine V, Pneumology, Allergology and Respiratory Critical Care Medicine, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - S Wagenpfeil
- Department of Biometry, Epidemiology and Clinical informatics, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Q T Dinh
- Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany.
- Department of Internal Medicine V, Pneumology, Allergology and Respiratory Critical Care Medicine, Saarland University Faculty of Medicine, Homburg/Saar, Germany.
| |
Collapse
|
20
|
Silva FMC, Oliveira EE, Gouveia ACC, Brugiolo ASS, Alves CC, Correa JOA, Gameiro J, Mattes J, Teixeira HC, Ferreira AP. Obesity promotes prolonged ovalbumin-induced airway inflammation modulating T helper type 1 (Th1), Th2 and Th17 immune responses in BALB/c mice. Clin Exp Immunol 2017; 189:47-59. [PMID: 28263381 DOI: 10.1111/cei.12958] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 12/29/2022] Open
Abstract
Clinical and epidemiological studies indicate that obesity affects the development and phenotype of asthma by inducing inflammatory mechanisms in addition to eosinophilic inflammation. The aim of this study was to assess the effect of obesity on allergic airway inflammation and T helper type 2 (Th2) immune responses using an experimental model of asthma in BALB/c mice. Mice fed a high-fat diet (HFD) for 10 weeks were sensitized and challenged with ovalbumin (OVA), and analyses were performed at 24 and 48 h after the last OVA challenge. Obesity induced an increase of inducible nitric oxide synthase (iNOS)-expressing macrophages and neutrophils which peaked at 48 h after the last OVA challenge, and was associated with higher levels of interleukin (IL)-4, IL-9, IL-17A, leptin and interferon (IFN)-γ in the lungs. Higher goblet cell hyperplasia was associated with elevated mast cell influx into the lungs and trachea in the obese allergic mice. In contrast, early eosinophil influx and lower levels of IL-25, thymic stromal lymphopoietin (TSLP), CCL11 and OVA-specific immunoglobulin (IgE) were observed in the obese allergic mice in comparison to non-obese allergic mice. Moreover, obese mice showed higher numbers of mast cells regardless of OVA challenge. These results indicate that obesity affects allergic airway inflammation through mechanisms involving mast cell influx and the release of TSLP and IL-25, which favoured a delayed immune response with an exacerbated Th1, Th2 and Th17 profile. In this scenario, an intense mixed inflammatory granulocyte influx, classically activated macrophage accumulation and intense mucus production may contribute to a refractory therapeutic response and exacerbate asthma severity.
Collapse
Affiliation(s)
- F M C Silva
- Department of Parasitology, Microbiology, and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - E E Oliveira
- Department of Parasitology, Microbiology, and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - A C C Gouveia
- Department of Parasitology, Microbiology, and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - A S S Brugiolo
- Department of Parasitology, Microbiology, and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - C C Alves
- Federal University of Vales do Jequitinhonha e Mucuri, Medicial School do Mucuri, FAMMUC, São Paulo, MG, Brazil
| | - J O A Correa
- Department of Pharmaceutics Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - J Gameiro
- Department of Parasitology, Microbiology, and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - J Mattes
- Centre for Asthma and Respiratory Diseases and Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - H C Teixeira
- Department of Parasitology, Microbiology, and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - A P Ferreira
- Department of Parasitology, Microbiology, and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| |
Collapse
|
21
|
Associations of obesity with newly diagnosed and previously known atopic diseases in Chinese adults: a case-control study. Sci Rep 2017; 7:43672. [PMID: 28252017 PMCID: PMC5333111 DOI: 10.1038/srep43672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/27/2017] [Indexed: 12/02/2022] Open
Abstract
To assess the associations of obesity with newly diagnosed and previously known atopic disorders in Chinese adults. 4,629 adults aged 18 years or older were recruited in Harbin, China. Among them, 1,114 were previously diagnosed atopic cases, 1,298 were newly diagnosed cases, and 2,217 non-atopic controls. Obesity and overweight are defined according to the criteria established by the Working Group on Obesity in China. The associations of obesity with known and newly diagnosed atopic disorders were assessed using logistic regressions. Obesity was significantly associated with known atopic disorders (adjusted OR = 2.41 (95% CI: 1.81, 3.22)). The association of obesity with newly diagnosed atopic cases was not as strong as that with known cases, and was not statistically significant (adjusted OR = 1.27 (95% CI: 0.94, 1.72)). The similar pattern was observed in different allergic diseases, gender and age stratifications. The association between overweight and atopic diseases were not significant. Obesity is strongly associated with previously diagnosed atopic cases but not so with newly diagnosed atopic cases in Chinese adults. It is likely that people with atopic disorders have a higher risk of developing obesity. Our findings are important for the management of atopic disorders and chronic disease prevention among atopic disease patients.
Collapse
|
22
|
Cabral ALB, Sousa AW, Mendes FAR, Carvalho CRFD. Phenotypes of asthma in low-income children and adolescents: cluster analysis. ACTA ACUST UNITED AC 2017; 43:44-50. [PMID: 28125150 PMCID: PMC5790664 DOI: 10.1590/s1806-37562016000000039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/07/2016] [Indexed: 11/21/2022]
Abstract
Objective Studies characterizing asthma phenotypes have predominantly included adults or have involved children and adolescents in developed countries. Therefore, their applicability in other populations, such as those of developing countries, remains indeterminate. Our objective was to determine how low-income children and adolescents with asthma in Brazil are distributed across a cluster analysis. Methods We included 306 children and adolescents (6-18 years of age) with a clinical diagnosis of asthma and under medical treatment for at least one year of follow-up. At enrollment, all the patients were clinically stable. For the cluster analysis, we selected 20 variables commonly measured in clinical practice and considered important in defining asthma phenotypes. Variables with high multicollinearity were excluded. A cluster analysis was applied using a twostep agglomerative test and log-likelihood distance measure. Results Three clusters were defined for our population. Cluster 1 (n = 94) included subjects with normal pulmonary function, mild eosinophil inflammation, few exacerbations, later age at asthma onset, and mild atopy. Cluster 2 (n = 87) included those with normal pulmonary function, a moderate number of exacerbations, early age at asthma onset, more severe eosinophil inflammation, and moderate atopy. Cluster 3 (n = 108) included those with poor pulmonary function, frequent exacerbations, severe eosinophil inflammation, and severe atopy. Conclusions Asthma was characterized by the presence of atopy, number of exacerbations, and lung function in low-income children and adolescents in Brazil. The many similarities with previous cluster analyses of phenotypes indicate that this approach shows good generalizability.
Collapse
Affiliation(s)
| | - Andrey Wirgues Sousa
- . Hospital Infantil Darcy Vargas, São Paulo (SP) Brasil.,. Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | |
Collapse
|
23
|
Hansen S, Hoffmann-Petersen B, Sverrild A, Bräuner EV, Lykkegaard J, Bodtger U, Agertoft L, Korshøj L, Backer V. The Danish National Database for Asthma: establishing clinical quality indicators. Eur Clin Respir J 2016; 3:33903. [PMID: 27834178 PMCID: PMC5103671 DOI: 10.3402/ecrj.v3.33903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 12/12/2022] Open
Abstract
Asthma is one of the most common chronic diseases worldwide affecting more than 300 million people. Symptoms are often non-specific and include coughing, wheezing, chest tightness, and shortness of breath. Asthma may be highly variable within the same individual over time. Although asthma results in death only in extreme cases, the disease is associated with significant morbidity, reduced quality of life, increased absenteeism, and large costs for society. Asthma can be diagnosed based on report of characteristic symptoms and/or the use of several different diagnostic tests. However, there is currently no gold standard for making a diagnosis, and some degree of misclassification and inter-observer variation can be expected. This may lead to local and regional differences in the treatment, monitoring, and follow-up of the patients. The Danish National Database for Asthma (DNDA) is slated to be established with the overall aim of collecting data on all patients treated for asthma in Denmark and systematically monitoring the treatment quality and disease management in both primary and secondary care facilities across the country. The DNDA links information from population-based disease registers in Denmark, including the National Patient Register, the National Prescription Registry, and the National Health Insurance Services register, and potentially includes all asthma patients in Denmark. The following quality indicators have been selected to monitor trends: first, conduction of annual asthma control visits, appropriate pharmacological treatment, measurement of lung function, and asthma challenge testing; second, tools used for diagnosis in new cases; and third, annual assessment of smoking status, height, and weight measurements, and the proportion of patients with acute hospital treatment. The DNDA will be launched in 2016 and will initially include patients treated in secondary care facilities in Denmark. In the nearby future, the database aims to include asthma diagnosis codes and clinical data registered by general practitioners and specialised practitioners as well.
Collapse
Affiliation(s)
- Susanne Hansen
- Research Centre for Prevention and Health, Rigshospitalet Glostrup Hospital, Glostrup, Denmark
| | | | - Asger Sverrild
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Elvira V Bräuner
- Research Centre for Prevention and Health, Rigshospitalet Glostrup Hospital, Glostrup, Denmark
- Department of Occupational and Environmental Medicine, Bispebjerg - Frederiksberg Hospital, Copenhagen, Denmark
| | - Jesper Lykkegaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Region Zealand, Denmark
- Department of Respiratory Medicine, Zealand University Hospital Roskilde, Region Zealand, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lone Agertoft
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Vibeke Backer
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark;
| |
Collapse
|
24
|
Scott HA, Gibson PG, Garg ML, Upham JW, Wood LG. Sex hormones and systemic inflammation are modulators of the obese-asthma phenotype. Allergy 2016; 71:1037-47. [PMID: 27007085 DOI: 10.1111/all.12891] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Both systemic inflammation and sex hormones have been proposed as potential mediators of the obese-asthma phenotype. The aim of this study was to examine the associations between sex hormones, oral contraceptive pill (OCP) use, systemic inflammation and airway inflammation in adults with asthma. METHODS Obese (n = 39) and nonobese (n = 42) females and obese (n = 24) and nonobese (n = 25) males with asthma were recruited. Females were further categorized as reproductive-aged (<50 years old; n = 36) or older (>50 years old; n = 45). Thirteen (36.1%) reproductive-aged females were using the OCP. Participants had induced sputum cell counts measured and blood analysed for sex hormones and inflammatory markers. RESULTS Obese reproductive-aged females had higher sputum %neutrophils than nonobese reproductive-aged females (45.4 ± 24.3% vs 27.5 ± 17.5%, P = 0.016); however, there was no difference in sputum neutrophils in obese compared with nonobese males (P = 0.620) or older females (P = 0.087). Multiple linear regression analysis found testosterone and OCP use to be negative predictors of sputum %neutrophils, while C-reactive protein and IL-6 were positive predictors of sputum %neutrophils. BMI and age were not significant predictors in the multivariate model. Reproductive-aged females using the OCP had significantly lower sputum %neutrophils than those not using the OCP (23.2 ± 12.6% vs 42.1 ± 23.8%, P = 0.015). CONCLUSIONS This study suggests that sex hormones and systemic inflammation may be mediating the obese-asthma phenotype. The observation that OCP use was associated with lower sputum %neutrophils in reproductive-aged females warrants further investigation.
Collapse
Affiliation(s)
- H. A. Scott
- Centre for Asthma and Respiratory Diseases; Hunter Medical Research Institute; John Hunter Hospital; Newcastle NSW Australia
- School of Biomedical Sciences and Pharmacy; The University of Newcastle; Callaghan NSW Australia
- Lung and Allergy Research Centre; School of Medicine; The University of Queensland; Brisbane Qld Australia
| | - P. G. Gibson
- Centre for Asthma and Respiratory Diseases; Hunter Medical Research Institute; John Hunter Hospital; Newcastle NSW Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan NSW Australia
| | - M. L. Garg
- School of Biomedical Sciences and Pharmacy; The University of Newcastle; Callaghan NSW Australia
| | - J. W. Upham
- Lung and Allergy Research Centre; School of Medicine; The University of Queensland; Brisbane Qld Australia
| | - L. G. Wood
- Centre for Asthma and Respiratory Diseases; Hunter Medical Research Institute; John Hunter Hospital; Newcastle NSW Australia
- School of Biomedical Sciences and Pharmacy; The University of Newcastle; Callaghan NSW Australia
| |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW Optimal asthma management includes both the control of asthma symptoms and reducing the risk of future asthma exacerbations. Traditionally, treatment has been adjusted largely on the basis of symptoms and lung function and for many patients, this approach delivers both excellent symptom control and reduced risk. However, the relationship between these two key components of the disease may vary between different asthmatic phenotypes and disease severities and there is increasing recognition of the need for more individualized treatment approaches. RECENT FINDINGS A number of factors which predict exacerbation risk have been identified including demographic and behavioural features and specific inflammatory biomarkers. Type-2 cytokine-driven eosinophilic airways inflammation predisposes to frequent exacerbations and predicts response to corticosteroids, and the usefulness of sputum eosinophilia as both a marker of exacerbation risk and biomarker for adjustment of corticosteroid treatment has been established for some time. However, attempts to develop surrogate markers, which would be more straightforward to deliver in the clinic, have been challenging. SUMMARY Some patients with asthma have persistent symptoms in the absence of type-2 cytokine driven-eosinophilic airways inflammation due to noncorticosteroid responsive mechanisms (T2-low disease). Composite biomarker strategies using easily measured surrogate indicators of type-2 inflammation (such as fractional exhaled nitric oxide, blood eosinophil count and serum periostin levels) may predict exacerbation risk better but it is unclear if they can be used to adjust corticosteroid treatment. Biomarkers will be used to target novel biologic treatments but additionally may be used to optimize corticosteroid treatment dose and act as prognostics for exacerbation risk and potentially other important longer term asthma outcomes.
Collapse
|
26
|
Lee YJ, Liu C, Liao M, Sukhova GK, Shirakawa J, Abdennour M, Iamarene K, Andre S, Inouye K, Clement K, Kulkarni RN, Banks AS, Libby P, Shi GP. Deficiency of FcϵR1 Increases Body Weight Gain but Improves Glucose Tolerance in Diet-Induced Obese Mice. Endocrinology 2015; 156:4047-58. [PMID: 26295369 PMCID: PMC4606759 DOI: 10.1210/en.2015-1184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Prior studies demonstrated increased plasma IgE in diabetic patients, but the direct participation of IgE in diabetes or obesity remains unknown. This study found that plasma IgE levels correlated inversely with body weight, body mass index, and body fat mass among a population of randomly selected obese women. IgE receptor FcϵR1-deficient (Fcer1a(-/-)) mice and diet-induced obesity (DIO) mice demonstrated that FcϵR1 deficiency in DIO mice increased food intake, reduced energy expenditure, and increased body weight gain but improved glucose tolerance and glucose-induced insulin secretion. White adipose tissue from Fcer1a(-/-) mice showed an increased expression of phospho-AKT, CCAAT/enhancer binding protein-α, peroxisome proliferator-activated receptor-γ, glucose transporter-4 (Glut4), and B-cell lymphoma 2 (Bcl2) but reduced uncoupling protein 1 (UCP1) and phosphorylated c-Jun N-terminal kinase (JNK) expression, tissue macrophage accumulation, and apoptosis, suggesting that IgE reduces adipogenesis and glucose uptake but induces energy expenditure, adipocyte apoptosis, and white adipose tissue inflammation. In 3T3-L1 cells, IgE inhibited the expression of CCAAT/enhancer binding protein-α and peroxisome proliferator-activated receptor-γ, and preadipocyte adipogenesis and induced adipocyte apoptosis. IgE reduced the 3T3-L1 cell expression of Glut4, phospho-AKT, and glucose uptake, which concurred with improved glucose tolerance in Fcer1a(-/-) mice. This study established two novel pathways of IgE in reducing body weight gain in DIO mice by suppressing adipogenesis and inducing adipocyte apoptosis while worsening glucose tolerance by reducing Glut4 expression, glucose uptake, and insulin secretion.
Collapse
Affiliation(s)
- Yun-Jung Lee
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Conglin Liu
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Mengyang Liao
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Galina K Sukhova
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Jun Shirakawa
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Meriem Abdennour
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Karine Iamarene
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Sebastien Andre
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Karen Inouye
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Karine Clement
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Rohit N Kulkarni
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Alexander S Banks
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Peter Libby
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| | - Guo-Ping Shi
- Department of Medicine (Y.-J.L., C.L., M.L., G.K.S., K.I., A.S.B., P.L., G.-P.S.), Brigham and Women's Hospital and Harvard Medical School, Department of Genetics and Complex Diseases (K.I.), School of Public Health, Harvard University, and Department of Cell Biology (J.S., R.N.K.), Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts 02115; Department of Cardiology (C.L.), Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, People's Republic of China; Institute of Cardiology (M.L.), Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430072, People's Republic of China; and NutriOmique team (M.A., S.A., K.C.), Institute of Cardiometabolism and Nutrition, INSERM, Unité Mixte de Recherche en Santé Unité 1166, and NutriOmique team (M.A., S.A., K.C.), Université Pierre et Marie Curie-Paris 6, Paris F-75013 France
| |
Collapse
|
27
|
Lee JH, Han KD, Jung HM, Youn YH, Lee JY, Park YG, Lee SH, Park YM. Association Between Obesity, Abdominal Obesity, and Adiposity and the Prevalence of Atopic Dermatitis in Young Korean Adults: the Korea National Health and Nutrition Examination Survey 2008-2010. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 8:107-14. [PMID: 26739403 PMCID: PMC4713873 DOI: 10.4168/aair.2016.8.2.107] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/06/2015] [Accepted: 07/15/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Whether obesity is a risk factor for atopic dermatitis (AD) remains unclear. The aim of the present study was to investigate the association between obesity and AD in Korean young adults. METHODS We included nationally representative data of 5,202 Korean adults aged 19-40 years, obtained from the cross-sectional Korea National Health and Nutrition Examination Survey 2008-2010. RESULTS Single (unmarried) status was more frequently observed in AD patients (male, [P=0.0002] and female, [P<0.0001]). AD prevalence exhibited a U-shape trend in relation to body mass index (BMI), waist circumference (WC), and total body fat (BF) percentage, especially in young adult women. Women with BMI ≥25 kg/m², WC ≥80 cm, and highest quartile (Q4) of total BF percentage had the highest prevalence of AD. The odds ratio (OR) for participants with both BMI ≥25 kg/m² and WC ≥80 cm was 3.29 (95% confidence interval [CI] 1.71-3.55); therefore, having both general and abdominal obesity was considered a prominent risk factor for AD in young women. After adjustment for confounding factors, including age, smoking, alcohol drinking, exercise, vitamin D, income level, and single status, high BMI (≥30 kg/m²) (OR=4.08, 95% CI: 1.53-10.93), high WC (≥80 cm) (OR=2.05, 95% CI: 1.07-3.94), and high BF percentage (Q4) (OR=2.10, 95% CI: 1.24-3.57) were shown to be significantly associated with AD in young adult women. CONCLUSIONS In this large-scale nation-wide study of Korean adults, obesity was positively related to the presence of AD in women. Our findings suggest that weight management may help prevent AD.
Collapse
Affiliation(s)
- Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Han Mi Jung
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hoon Youn
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
28
|
Hamid F, Wahyuni S, van Leeuwen A, van Ree R, Yazdanbakhsh M, Sartono E. Allergic disorders and socio-economic status: a study of schoolchildren in an urban area of Makassar, Indonesia. Clin Exp Allergy 2015; 45:1226-36. [DOI: 10.1111/cea.12517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/06/2015] [Accepted: 02/03/2015] [Indexed: 12/20/2022]
Affiliation(s)
- F. Hamid
- Department of Microbiology; Faculty of Medicine; Hasanuddin University; Makassar Indonesia
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | - S. Wahyuni
- Department of Parasitology; Faculty of Medicine; Hasanuddin University; Makassar Indonesia
| | - A. van Leeuwen
- Department of Immunopathology; Sanquin Research; Amsterdam The Netherlands
| | - R. van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center of the University of Amsterdam; Amsterdam The Netherlands
| | - M. Yazdanbakhsh
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| | - E. Sartono
- Department of Parasitology; Leiden University Medical Center; Leiden The Netherlands
| |
Collapse
|
29
|
Zhang A, Silverberg JI. Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis. J Am Acad Dermatol 2015; 72:606-16.e4. [PMID: 25773409 DOI: 10.1016/j.jaad.2014.12.013] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/30/2014] [Accepted: 12/06/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous studies found conflicting results about whether atopic dermatitis (AD) is associated with overweight/obesity. OBJECTIVE We sought to examine the relationship between AD and overweight/obesity by performing a systematic review and metaanalysis. METHODS Observational studies of the relationship between AD and overweight/obesity were selected from PubMed, Embase, and the Cochrane Library. The quality of evidence was assessed using the Newcastle-Ottawa Scale. Fixed and random effects metaanalyses were performed to estimate pooled odds ratios (ORs). Sensitivity analyses were performed that compared results by location of study, study quality, and between studies in children and adults. RESULTS In total, 30 studies were included for review. Patients who were overweight (Cochrane-Mantel-Haenszel [CMH] OR, 1.27 [95% confidence interval {CI}: 1.19-1.36]; random effects OR, 1.23 [95% CI: 1.11-1.41]), obese (CMH OR, 1.68 [95% CI: 1.54-1.84]; random effects OR, 1.47 [95% CI: 1.21-1.79]), or overweight/obese (CMH OR, 1.42 [95% CI: 1.34-1.50]; random effects OR, 1.31 [95% CI: 1.16-1.48]) had higher odds of AD than normal weight patients. In sensitivity analyses, children who were overweight (random effects OR, 1.24 [95% CI: 1.08-1.43]), obese (random effects OR, 1.44 [95% CI: 1.12-1.86]), or overweight/obese (random effects OR, 1.32 [95% CI: 1.15-1.51]) and adults who were obese (random effects OR, 1.56 [95% CI: 1.24-1.95]) or overweight/obese (random effects OR, 1.29 [95% CI: 1.05-1.59]) had higher odds of AD. The association remained significant in North America and Asia but not Europe. LIMITATIONS Most studies were cross-sectional. CONCLUSIONS Overweight/obesity in North America and Asia is associated with an increased prevalence of AD.
Collapse
Affiliation(s)
- April Zhang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
30
|
Schatz M, Zeiger RS, Yang SJ, Chen W, Sajjan S, Allen-Ramey F, Camargo CA. Prospective Study on the Relationship of Obesity to Asthma Impairment and Risk. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:560-5.e1. [PMID: 25975622 DOI: 10.1016/j.jaip.2015.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although studies consistently show an association between obesity and increased asthma incidence, the role of obesity in asthma control is less clear. OBJECTIVE The objective of this study was to evaluate the association between baseline body mass index (BMI) and measures of subsequent asthma control in a large real-world cohort of adults with persistent asthma. METHODS In Kaiser Permanente Southern California (KPSC), a large managed care organization, we identified adults with persistent asthma in 2006, continuous health plan enrollment in 2007 and 2008, and a BMI measurement in 2006 or 2007. Each patient's last BMI measure in 2006 or 2007 was categorized into a BMI group: normal (<25 kg/m(2)), overweight (25-29.9 kg/m(2)), or obese (≥30 kg/m(2)). Asthma control outcomes in 2008 included asthma hospitalizations or emergency department visits (EDHO), oral corticosteroid dispensings linked to an asthma encounter (OCS), and dispensing of ≥7 short-acting beta-agonist canisters (SABA7). Multivariable analyses were conducted to assess the relationships of BMI categories with the risk of the asthma control outcomes after controlling for potential confounders. RESULTS In the 10,233 eligible adults-after adjusting for potential demographic, comorbidity, and prior utilization confounders-we found an increased relative risk (RR) of EDHO in overweight and obese (RR 1.40, 95% CI 1.10-1.78) individuals. Only obesity was associated in adjusted analyses with a significant increased relative risk of SABA7 (RR 1.27, 95% CI 1.15-1.40). CONCLUSIONS Elevated BMI, particularly obesity, is associated with subsequent poor asthma control, especially in the risk domain (exacerbations). These findings further support the importance of facilitating weight loss in overweight and obese adults with asthma.
Collapse
Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif.
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif
| | - Su-Jau Yang
- Department of Research and Evaluation, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif
| | - Shiva Sajjan
- Department of Global Health Outcomes, Merck & Co., Inc., West Point, Pa
| | | | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Obstructive lung disease (OLD), including asthma and chronic obstructive pulmonary disease, has a more substantial prevalence and morbidity in urban populations. This review highlights recent publications examining the epidemiology, risk factors and interventions concerning OLD in urban populations. RECENT FINDINGS Using a variety of approaches, estimates of asthma prevalence in urban populations range from 5 to 25%. Early life exposures including in-utero cigarette smoke, postnatal bisphenol A, home and school particulates, and environmental air pollution contribute to increased OLD prevalence and symptom manifestations. Individuals with increased exposure to traffic-related pollution demonstrate abnormal inflammatory and lung function profiles. Obesity, more common in urban populations, is likely both a risk factor for asthma as well as contributor to poor control. Interventions targeted at home-based education and assessments are efficacious and cost-effective in improving outcomes of OLD in urban settings. SUMMARY The burden of OLD in urban populations is driven by maternal, environmental and acquired factors. There are few recent data regarding risk factors and interventions for urban cohorts with chronic obstructive pulmonary disease. The complex interplay of race, socioeconomic status, environmental exposures and healthcare access in the urban population requires continued research efforts.
Collapse
|
32
|
Silverberg JI, Durkin HG, Joks R. Association between birthplace, prevalence, and age of asthma onset in adults: a United States population-based study. Ann Allergy Asthma Immunol 2014; 113:410-7.e1. [PMID: 25163403 DOI: 10.1016/j.anai.2014.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Previous studies have found associations between region of birth and asthma prevalence. OBJECTIVE To study the association among birthplace, US prevalence, age of onset, and disease course of adult asthma. METHODS Data from 447,801 adults from the 1997 to 2011 National Health Interview Survey were reviewed. History of asthma was compared with birthplace using Rao-Scott χ(2) tests, survey logistic, propensity score, and Cox regression. Trends of asthma prevalence were analyzed using logistic regression. Multivariate models controlled for sociodemographics, health care access, smoking history, and body mass index. RESULTS Adults born outside the United States had lower odds of ever asthma (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.49-0.55) or current asthma (OR 0.50, 95% CI, 0.46-0.54). The inverse association between foreign birthplace and asthma prevalence was significant in all regions of birth (P < .0001). Adults born outside the United States who resided in the United States for longer than 10 years compared with only 0 to 4 years had higher odds of ever asthma (OR 1.28, 95% CI, 1.18-1.38) and current asthma (OR 1.70, 95% CI, .31-2.19). Foreign-born compared with US-born adults also had delayed onset of asthma (adjusted hazard ratio 0.27, 95% CI, 0.27-0.28). The US prevalence of asthma increased in a linear manner from 1997 (9.1%, 8.77%-9.37%) to 2011 (12.5%, 12.1%-12.8%, P < .0001), which paralleled the trend for US-born adults. However, the prevalence of asthma in foreign-born adults was consistently lower and increased to a lesser extent (P < .0001). CONCLUSION Foreign-born American adults from all regions of birth have a lower prevalence of asthma, which increases after prolonged US residency. Foreign-born Americans may have a higher risk of adult-onset asthma.
Collapse
Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University, Chicago, Illinois.
| | - Helen G Durkin
- Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York; Department of Pathology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Rauno Joks
- Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York; Departments of Medicine and Allergy and Immunology, State University of New York Downstate Medical Center, Brooklyn, New York
| |
Collapse
|
33
|
Mari A, Antonietta Ciardiello M, Passalacqua G, Vliagoftis H, Wardlaw AJ, Wickman M. Developments in the field of allergy in 2012 through the eyes of Clinical & Experimental Allergy. Clin Exp Allergy 2014; 43:1309-32. [PMID: 24118214 DOI: 10.1111/cea.12212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In 2012, we received 683 submissions and published 20 editorials, 38 reviews, 11 letters and 128 original articles. This represents an acceptance rate for original papers in the range of 20%. About 30% of original papers were triaged not to go out to review, either because the editors did not feel they had sufficient priority for publication or because the topic did not feel right for the readers of the journal. We place great emphasis on obtaining sufficient high-quality reviews to make our decisions on publication fair and consistent. Inevitably, however, there is a degree of luck about what gets published and which papers miss out, and we are always happy to receive an appeal on our decisions either at the triage stage or after review. This gives us the opportunity to revisit the decision and revise it or explain in more detail to the authors the basis for the decision. Once again in 2012, we were delighted by the quality of the papers submitted and the breadth and depth of research into allergic disease that it revealed. The pattern of papers submitted was similar in previous years with considerable emphasis on all aspects of asthma and rhinitis. We were particularly pleased with our special issue on severe asthma. Elucidating mechanisms using either animal models or patients has always been a major theme of the journal, and the excellent work in these areas has been summarized by Harissios Vliagoftis with a particularly interesting section on early-life events guiding the development of allergic disease, which understandably continue to be a major theme of research. Magnus Wickman summarized the papers looking at the epidemiology of allergic disease including work from birth cohorts, which are an increasingly rich source of data on risk factors for allergic disease, and two papers on the epidemiology of anaphylaxis. Giovanni Passalacqua discussed the papers in the clinical allergy section of the journal, and Adriano Mari who runs the excellent Allergome website discussed the papers looking at allergens including characterization and the relative usefulness of allergen arrays versus single extracts in diagnosis and management.
Collapse
Affiliation(s)
- A Mari
- Allergome, Allergy Data Laboratories s.c., Latina, Italy
| | | | | | | | | | | |
Collapse
|
34
|
Rinne ST, Feemster LC, Collins BF, Au DH, Perkins M, Bryson CL, O’Riordan TG, Liu CF. Thiazolidinediones and the risk of asthma exacerbation among patients with diabetes: a cohort study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2014; 10:34. [PMID: 25024717 PMCID: PMC4094895 DOI: 10.1186/1710-1492-10-34] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/19/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thiazolidinediones are oral diabetes medications that selectively activate peroxisome proliferator-activated receptor gamma and have potent anti-inflammatory properties. While a few studies have found improvements in pulmonary function with exposure to thiazolidinediones, there are no studies of their impact on asthma exacerbations. Our objective was to assess whether exposure to thiazolidinediones was associated with a decreased risk of asthma exacerbation. METHODS We performed a cohort study of diabetic Veterans who had a diagnosis of asthma and were taking oral diabetes medications during the period of 10/1/2005 - 9/30/2006. The risk of asthma exacerbations and oral steroid use during 10/1/2006 - 9/30/2007 was compared between patients who were prescribed thiazolidinediones and patients who were on alternative oral diabetes medications. Multivariable logistic regression and negative binomial regression analyses were used to characterize this risk. A sensitivity analysis was performed, restricting our evaluation to patients who were adherent to diabetes therapy. RESULTS We identified 2,178 patients who were on thiazolidinediones and 10,700 who were not. Exposure to thiazolidinediones was associated with significant reductions in the risk of asthma exacerbation (OR = 0.79, 95% CI, 0.62 - 0.99) and oral steroid prescription (OR = 0.73, 95% CI 0.63 - 0.84). Among patients who were adherent to diabetes medications, there were more substantial reductions in the risks for asthma exacerbation (OR = 0.64, 95% CI 0.47 - 0.85) and oral steroid prescription (OR = 0.68, 95% CI 0.57 - 0.81). CONCLUSIONS Thiazolidinediones may provide a novel anti-inflammatory approach to asthma management by preventing exacerbations and decreasing the use of oral steroids.
Collapse
Affiliation(s)
- Seppo T Rinne
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA
| | - Laura C Feemster
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA
| | - Bridget F Collins
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA
| | - David H Au
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA
| | - Mark Perkins
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
| | - Christopher L Bryson
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Chuan-Fen Liu
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| |
Collapse
|
35
|
Pecht T, Gutman-Tirosh A, Bashan N, Rudich A. Peripheral blood leucocyte subclasses as potential biomarkers of adipose tissue inflammation and obesity subphenotypes in humans. Obes Rev 2014; 15:322-37. [PMID: 24251825 DOI: 10.1111/obr.12133] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 10/01/2013] [Accepted: 10/18/2013] [Indexed: 12/14/2022]
Abstract
While obesity is clearly accepted as a major risk factor for cardio-metabolic morbidity, it is also apparent that some obese patients largely escape this association, forming a unique obese subphenotype(s). Current approaches to define such subphenotypes include clinical biomarkers that largely reflect already manifested comorbidities, such as markers of dyslipidaemia, hyperglycaemia and impaired regulation of vascular tone, and anthropometric or imaging-based assessment of adipose tissue distribution. Low-grade inflammation, evident both systemically and within adipose tissue (particularly intra-abdominal fat depots), seems to characterize the more cardio-metabolically morbid forms of obesity. Indeed, several systemic inflammatory markers (C-reactive protein), adipokines (retinol-binding protein 4, adiponectin) and cytokines have been shown to correlate in humans with adipose tissue inflammation and with obesity-associated health risks. Circulating leucocytes constitute a diverse group of cells that form a major arm of the immune system. They are both major sources of cytokines and likely also of infiltrating adipose tissue immune cells in obesity. In the present review, we summarize currently available literature on 'classical' blood white cell classes and on more specific leucocyte subclasses present in the circulation in human obesity. We critically raise the possibility that leucocytes may constitute clinically available markers for the more morbidity-associated obesity subphenotype(s), and when available, for intra-abdominal adipose tissue inflammation.
Collapse
Affiliation(s)
- T Pecht
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The National Institute of Biotechnology (NIBN) in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | |
Collapse
|
36
|
Wagner JG, Birmingham NP, Jackson-Humbles D, Jiang Q, Harkema JR, Peden DB. Supplementation with γ-tocopherol attenuates endotoxin-induced airway neutrophil and mucous cell responses in rats. Free Radic Biol Med 2014; 68:101-9. [PMID: 24333275 PMCID: PMC3961823 DOI: 10.1016/j.freeradbiomed.2013.11.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/13/2013] [Accepted: 11/25/2013] [Indexed: 12/31/2022]
Abstract
Neutrophil-mediated tissue injury is a shared pathogenesis of both chronic pulmonary diseases and acute responses to pathogens, allergens, and airborne pollutants. Interventions to minimize toxic effects of neutrophil-derived oxidants and proteases are usually limited to corticosteroids, which can have adverse side effects. We used a rodent model of endotoxin-induced lung injury to test the hypothesis that the dietary supplement γ-tocopherol (γT), a natural form of vitamin E with antioxidant and novel anti-inflammatory properties, will protect from adverse nasal and pulmonary inflammatory responses induced by endotoxin (lipopolysaccharide; LPS). Male Fisher F344 rats were intranasally (i.n.) instilled with LPS for 2 consecutive days. Beginning 2 days before i.n. LPS, the rats were gavaged daily with 30mg/kg γT. Twenty-four hours after the last i.n. LPS, bronchoalveolar lavage fluid (BALF) was collected, and pulmonary and nasal tissues were analyzed for gene expression and morphometric analyses of neutrophils and intraepithelial mucosubstances (IM). LPS caused increased BALF total cells (70% increase), neutrophils (300%), protein (35%), PGE2 (500%), and secreted mucins (75%). Robust increases in neutrophils and IM were detected in conducting airways. Pulmonary expression of MUC5AC, MIP-2, CINC-1, and MCP-1 was elevated three- to eightfold by LPS. Treatment with γT inhibited LPS-induced increases in BALF total cells, neutrophils, protein, PGE2, and secreted mucins, as well as IM and tissue neutrophil influx. Furthermore γT induced the expression of the regulatory cytokines IL-10 and IFN-γ while decreasing MUC5AC, MIP-2, CINC-1, and MCP-1. These data demonstrate novel therapeutic effects of the dietary vitamin E γT promoting anti-inflammatory pathways to protect from neutrophil-mediated lung injury.
Collapse
Affiliation(s)
- James G Wagner
- Center for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, USA; Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI 48824, USA.
| | - Neil P Birmingham
- Center for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, USA
| | - Daven Jackson-Humbles
- Center for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, USA; Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI 48824, USA
| | - Qing Jiang
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Jack R Harkema
- Center for Integrative Toxicology, Michigan State University, East Lansing, MI 48824, USA; Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI 48824, USA
| | - David B Peden
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, NC 27599, USA
| |
Collapse
|
37
|
Silverberg JI, Joks R, Durkin HG. Allergic disease is associated with epilepsy in childhood: a US population-based study. Allergy 2014; 69:95-103. [PMID: 24251558 DOI: 10.1111/all.12319] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous studies using animal models suggest an association between allergic disease and epilepsy. We sought to determine whether allergic disease is associated with epilepsy in children. METHODS We used the 2007-2008 National Survey of Children's Health, a US population-based study of 91 642 children aged 0-17 years to determine the association between the prevalence of epilepsy and allergic disease, including asthma, atopic dermatitis (AD)/eczema, hay fever, and food allergies. Multivariate logistic regression models were constructed that controlled for confounding variables. RESULTS The US lifetime prevalence of childhood epilepsy was 1.03% and was significantly associated with older age, male sex, lower household income, family structure and history of brain injury or concussion. Children with ≥1 allergic disease had more epilepsy in their lifetime than nonallergic children (logistic regression, adjusted odds ratio [95% confidence interval] = 1.79 [1.37-2.33]). Lifetime prevalence (2.30 [1.50-3.52]) and one-year prevalence of asthma (2.00 [1.41-2.84]), AD/eczema (1.73 [1.17-2.56]), hay fever (1.93 [1.41-2.65]) and food allergies (2.69 [1.38-4.01]) were associated with increased odds of ever being diagnosed with epilepsy. Similar results were found for current history of epilepsy. Severe AD/eczema (3.89 [1.34-11.32]) [corrected] and hay fever (2.46 [1.11-5.41]) were associated with even higher odds of epilepsy compared with mild/moderate disease. As the number of allergic diseases increased, so did the odds of lifetime history and current history of epilepsy. CONCLUSIONS The US prevalence of epilepsy is associated with allergic diseases in children. Further studies are needed to determine whether allergic inflammation contributes toward epileptogenesis.
Collapse
Affiliation(s)
- J. I. Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences; Northwestern University; Chicago IL USA
- Department of Dermatology; Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center; New York NY USA
| | - R. Joks
- Center for Allergy and Asthma Research; State University of New York Downstate Medical Center; Brooklyn NY USA
- Departments of Medicine; Allergy and Immunology; State University of New York Downstate Medical Center; Brooklyn NY USA
| | - H. G. Durkin
- Center for Allergy and Asthma Research; State University of New York Downstate Medical Center; Brooklyn NY USA
- Department of Pathology; State University of New York Downstate Medical Center; Brooklyn NY USA
| |
Collapse
|
38
|
Ek A, Middelveld RJM, Bertilsson H, Bjerg A, Ekerljung L, Malinovschi A, Stjärne P, Larsson K, Dahlén SE, Janson C. Chronic rhinosinusitis in asthma is a negative predictor of quality of life: results from the Swedish GA(2)LEN survey. Allergy 2013; 68:1314-21. [PMID: 24107218 DOI: 10.1111/all.12222] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Asthma and chronic rhinosinusitis (CRS) both impair quality of life, but the quality-of-life impact of comorbid asthma and CRS is poorly known. The aim of this study was to evaluate the impact of CRS and other relevant factors on quality of life in asthmatic subjects. METHODS This Swedish cohort (age 17-76 years) consists of 605 well-characterized asthmatics with and without CRS, 110 individuals with CRS only, and 226 controls and is part of the Global Allergy and Asthma European Network (GA(2) LEN) survey. The Mini Asthma Quality of Life Questionnaire (mAQLQ), the Euro Quality of Life (EQ-5D) health questionnaire, spirometry, skin prick test (SPT), exhaled nitric oxide (FeNO), smell test, and peak nasal inspiratory flow were used. RESULTS Subjects having both asthma and CRS have lower mAQLQ scores in all domains (P < 0.001) and a lower EQ-5D index value and EQ-5D VAS value (P < 0.001) compared to those with asthma only. Asthmatics with CRS have significantly lower FEV1%pred and FVC%pred (88.4 [85.1-91.7] and 99.9 [96.7-103.0], respectively) compared with asthma only (91.9 [90.3-93.4] and 104.0 [102.5-105.5], respectively P < 0.05). Multiple regression analysis shows that low asthma quality of life is associated with having CRS (P < 0.0001), lower lung function (P = 0.008), current smoking (P = 0.01), BMI > 30 kg/m2 (P = 0.04), high age (P = 0.03), and a negative SPT (P = 0.04). CONCLUSIONS Comorbid CRS was a significant and independent negative predictor of quality of life in asthmatics. Other negative factors were lower lung function, current smoking, obesity, advanced age, and having nonatopic asthma.
Collapse
Affiliation(s)
- A. Ek
- Experimental Asthma and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - R. J. M. Middelveld
- The Centre for Allergy Research and Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - H. Bertilsson
- Department of Public Health and Clinical Medicine: Occupational and Environmental Medicine; Umeå University; Umeå; Sweden
| | - A. Bjerg
- Krefting Research Centre; Department of Internal Medicine and Clinical Nutrition; Sahlgrenska Academy; University of Gothenburg; Göteborg; Sweden
| | - L. Ekerljung
- Krefting Research Centre; Department of Internal Medicine and Clinical Nutrition; Sahlgrenska Academy; University of Gothenburg; Göteborg; Sweden
| | - A. Malinovschi
- Department of Medical Sciences: Clinical Physiology; Uppsala University; Uppsala; Sweden
| | - P. Stjärne
- Department of Clinical Science; Intervention and Technology: Otorhinolaryngology; Karolinska Institutet; Stockholm; Sweden
| | - K. Larsson
- Lung and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - S.-E. Dahlén
- Experimental Asthma and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology; Uppsala University; Uppsala; Sweden
| |
Collapse
|
39
|
Park HW, Kwon HS, Kim TB, Kim SH, Chang YS, Jang AS, Cho YS, Nahm DH, Park JW, Yoon HJ, Cho YJ, Choi BW, Moon HB, Cho SH. Differences between asthma in young and elderly: results from the COREA study. Respir Med 2013; 107:1509-14. [PMID: 23927852 DOI: 10.1016/j.rmed.2013.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/16/2013] [Accepted: 07/18/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND There has been no large-scale and comprehensive study of the differences between asthma in elderly asthmatics (EA) and non-elderly (i.e. young) asthmatics (NEA). METHODS We performed principal component analysis (PCA) using 2067 asthmatics (434 EA and 1633 NEA) from the Korean Cohort for Reality and Evolution of adult Asthma (COREA). EA was defined as asthmatics with the chronological age of 65 or more and eleven clinical variables measured at enrollment were used for PCA; symptom score, symptom duration, number of exacerbation during previous one year, smoking pack year, number of controller medications, body mass index, predicted % of FEV1, predicted % FVC, post-bronchodilator FEV1/FVC ratio, atopy index and number of eosinophils in peripheral blood. RESULTS PCA of all asthmatics showed that EA and NEA were distinctly separated by the first and second principal component on the plot of individual asthmatics according to their scores. For further analysis, we divided all asthmatics into the EA and the NEA group and performed PCA again in each group. The first four principal components with eigenvalues ≥ 1.0 were identified in both groups and they explained 55.5% of the variance in the EA group and 52.4% in the NEA group respectively. Clinical variables showed distinctly different patterns of loading on the first four principal components between the EA and the NEA group. CONCLUSION EA and NEA have different compositional patterns underlying their clinical variables. These observations helped in understanding the differences between EA and NEA from the integrated view covering various clinical aspects.
Collapse
Affiliation(s)
- Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Scott HA, Gibson PG, Garg ML, Pretto JJ, Morgan PJ, Callister R, Wood LG. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial. Clin Exp Allergy 2013; 43:36-49. [PMID: 23278879 DOI: 10.1111/cea.12004] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/09/2012] [Accepted: 08/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity and asthma are associated conditions; however, the mechanisms linking the two remain unclear. Few studies have examined the effects of weight loss on inflammation and clinical outcomes in obese-asthma. OBJECTIVE To compare the effects of weight loss achieved by dietary restriction, exercise or combined dietary restriction and exercise on airway inflammation and clinical outcomes in overweight and obese adults with asthma. METHODS Participants (n = 46; 54.3% female, body mass index (mean ± SD) 33.7 ± 3.5 kg/m(2) ) were randomized to complete a 10-week dietary, exercise or combined dietary and exercise intervention. Dual-energy x-ray absorptiometry was performed, the Juniper Asthma Control Questionnaire and Juniper Asthma Quality of Life Questionnaire completed and inflammatory markers, dietary intake and physical activity measured. The trial was registered with the Australian Clinical Trials Registry: ACTRN12611000235909. RESULTS Retention was 82.6%. Mean ± SD weight loss was 8.5 ± 4.2%, 1.8 ± 2.6% and 8.3 ± 4.9% after the dietary, exercise and combined interventions respectively. Asthma control improved after the dietary (mean ± SD; -0.6 ± 0.5, P ≤ 0.001) and combined interventions (-0.5 ± 0.7, P = 0.040), whereas quality of life improved after the dietary [median (IQR); 0.9 (0.4, 1.3), P = 0.002], exercise [0.49 (0.03, 0.78), P = 0.037] and combined [0.5 (0.1, 1.0), P = 0.007] interventions. A 5-10% weight loss resulted in clinically important improvements to asthma control in 58%, and quality of life in 83%, of subjects. Gynoid adipose tissue reduction was associated with reduced neutrophilic airway inflammation in women [β-coefficient (95% CI); 1.75 (0.02, 3.48), P = 0.047], whereas a reduction in dietary saturated fat was associated with reduced neutrophilic airway inflammation in males (r = 0.775, P = 0.041). The exercise intervention resulted in a significant reduction to sputum eosinophils [median (IQR); -1.3 (-2.0, -1.0)%, P = 0.028]. CONCLUSION AND CLINICAL RELEVANCE This study suggests a weight-loss goal of 5-10% be recommended to assist in the clinical management of overweight and obese adults with asthma. The obese-asthma phenotype may involve both innate and allergic inflammatory pathways.
Collapse
Affiliation(s)
- H A Scott
- Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | | | | | | | | | | | | |
Collapse
|
41
|
Almeida VP, Guimarães FS, Moço VJR, Menezes SLS, Mafort TT, Lopes AJ. [Correlation between pulmonary function, posture, and body composition in patients with asthma]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2013; 19:204-10. [PMID: 23746425 DOI: 10.1016/j.rppneu.2013.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/09/2013] [Accepted: 03/11/2013] [Indexed: 12/17/2022] Open
Abstract
AIM Asthma may result in postural disorders due to increased activity of accessory respiratory muscles and hyperinflation. Our primary objective was to assess the correlation between pulmonary function and posture in adult patients with asthma. Secondarily, we aimed to study the correlation between body composition and body posture in this group of patients. METHOD This was a cross-sectional study including 34 patients with asthma who were subjected to postural assessment (photogrammetry), pulmonary function testing (spirometry, whole-body plethysmography, diffusing capacity for carbon monoxide, and respiratory muscle strength), and body composition estimation by means of bioelectrical impedance. RESULTS Most patients were female (70.6%) with a median age of 32.5 years (range: 23-42 years old). We found a significant correlation between horizontal alignment of head (anterior view) and the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC; ρ=-0,37; P=.03), total lung capacity (TLC; ρ=0,42; P=.01), and residual volume (RV; ρ=0,45; P<.001). Bronchial obstruction and respiratory muscle strength variables also correlated with postural assessment measures on the right and left lateral views. Both body mass index and the percentage of fat mass correlated with horizontal alignment of head, horizontal alignment of the pelvis, and the frontal angle of the lower limbs. CONCLUSION Adult patients with asthma exhibit specific postural disorders that correlate with pulmonary function and body composition. The assessment of postural variables may provide a better pulmonary rehabilitation approach for these patients.
Collapse
Affiliation(s)
- V P Almeida
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Augusto Motta, Rio de Janeiro, Brasil
| | | | | | | | | | | |
Collapse
|
42
|
Dorevitch S, Conroy L, Karadkhele A, Rosul L, Stacewicz-Sapuntzakis M, Fantuzzi G. Associations between obesity and asthma in a low-income, urban, minority population. Ann Allergy Asthma Immunol 2013; 110:340-6. [PMID: 23622004 DOI: 10.1016/j.anai.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/03/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Community-based studies of obesity, asthma, biomarkers of oxidative stress, and adipokines among low-income, urban, minority populations are lacking. Oxidative stress, perhaps modulated by adipokines, may increase airway inflammation in obese individuals. OBJECTIVES To characterize associations between obesity and asthma in a low-income, urban, minority community and evaluate adipokines, biomarkers of inflammation, and oxidant-antioxidant balance in association with asthma and obesity. METHODS A door-to-door evaluation of asthma and obesity prevalence was performed in a low-income housing development. Nonsmoking adults and children underwent additional evaluation, including allergy skin testing, and measures of serum adipokines, and indicators of oxidative stress in blood and exhaled breath. RESULTS The prevalences of current asthma and a body mass index in the 85th percentile or higher were 15.8% and 35.3%, respectively, among 350 nonsmokers older than 4 years. Asthma and obesity were not associated with one another (odds ratio, 1.0; 95% confidence interval, 0.55-1.84). Among 116 nonsmoking participants who underwent biomarker evaluation, obesity was not associated with exhaled nitric oxide. In multivariate logistic models that adjusted for age category, sex, and a body mass index in 85th percentile or higher, leptin concentrations in the highest quartile were associated with asthma (odds ratio, 8.34; 95% confidence interval, 1.29-50.2) but not with atopy. Adiponectin was associated with total antioxidant capacity in exhaled breath. CONCLUSION Asthma and obesity, although both common in a low-income, minority community, were not associated with one another. Nevertheless, adipokines were associated with asthma status and with markers of oxidative stress in the lungs, providing some support for an adipokine-inflammatory mechanistic link between the two conditions.
Collapse
Affiliation(s)
- Samuel Dorevitch
- Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA.
| | | | | | | | | | | |
Collapse
|
43
|
Luo X, Xiang J, Dong X, Cai F, Suo J, Wang Z, Liu M. Association between obesity and atopic disorders in Chinese adults: an individually matched case-control study. BMC Public Health 2013; 13:12. [PMID: 23297741 PMCID: PMC3605115 DOI: 10.1186/1471-2458-13-12] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is regarded as a potential risk factor for atopy. The aim of this study was to assess the associations of obesity with atopic dermatitis, rhinitis, asthma and food allergy in Chinese adults. METHODS Two hundred and sixty six (266) atopic cases in Harbin, China, were identified according to the current Chinese guidelines for the diagnosis of atopic diseases. All cases had a previous diagnosis of atopic disorders (atopic dermatitis, rhinitis, asthma or food allergy) and were positive in one or more allergen specific IgE tests to 16 common allergens in the region. Each case was individually matched to two healthy controls based on their age, sex, and residential regions. All 532 healthy controls were negative in allergen specific IgE tests. The associations of obesity with four atopic disorders were assessed using a conditional logistic regression method. RESULTS Obesity was significantly associated with the presence of atopic diseases (OR = 3.2, 95% CI: 1.8, 5.7). Males and females had a similar association (OR = 3.1 for males and 3.2 for females). The associations of obesity with atopic dermatitis (OR = 2.7, 95% CI: 1.2, 6.3) and atopic rhinitis (OR = 3.1, 95% CI: 1.1, 8.7) were statistically significant. Although obesity was positively associated with atopic asthma, this association was not statistically significant (OR = 3.4, 95% CI: 0.6, 19.9). The association between obesity and food allergy was weak and not significant (OR = 1.1, 95% CI: 0.4, 3.7). CONCLUSIONS Obesity is positively associated with the presence of atopic diseases in Chinese adults. Specifically, obesity is significantly associated with atopic dermatitis and rhinitis. Our findings warrant further investigation on the causal nature between obesity and atopic diseases and the effect of weight reduction on preventing atopic diseases.
Collapse
Affiliation(s)
- Xiao Luo
- Public Health College, Harbin Medical University, 157 Baojian Road, Haerbin City, Heilongjiang Province Postcode 150081, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
44
|
The Editor takes a closer look at some of this month's articles. Clin Exp Allergy 2013. [DOI: 10.1111/cea.12061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
45
|
Sismanopoulos N, Delivanis DA, Mavrommati D, Hatziagelaki E, Conti P, Theoharides TC. Do mast cells link obesity and asthma? Allergy 2013; 68:8-15. [PMID: 23066905 DOI: 10.1111/all.12043] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2012] [Indexed: 12/13/2022]
Abstract
Asthma is a chronic inflammatory disease of the lungs. Both the number of cases and severity of asthma have been increasing without a clear explanation. Recent evidence suggests that obesity, which has also been increasing alarmingly, may worsen or precipitate asthma, but there is little evidence of how obesity may contribute to lung inflammation. We propose that mast cells are involved in both asthma and obesity by being the target and source of adipocytokines, 'alarmins' such as interleukin-9 (IL-9) and interleukin-33 (IL-33), and stress molecules including corticotropin-releasing hormone (CRH) and neurotensin (NT), secreted in response to the metabolic burden. In particular, CRH and NT have synergistic effects on mast cell secretion of vascular endothelial growth factor (VEGF). IL-33 augments VEGF release induced by substance P (SP) and tumor necrosis factor (TNF) release induced by NT. Both IL-9 and IL-33 also promote lung mast cell infiltration and augment allergic inflammation. These molecules are also expressed in human mast cells leading to autocrine effects. Obese patients are also less sensitive to glucocorticoids and bronchodilators. Development of effective mast cell inhibitors may be a novel approach for the management of both asthma and obesity. Certain flavonoid combinations may be a promising new treatment approach.
Collapse
Affiliation(s)
- N. Sismanopoulos
- Laboratory of Molecular Immunopharmacology and Drug Discovery; Department of Molecular Physiology and Pharmacology; Tufts University School of Medicine; Boston; MA; USA
| | - D.-A. Delivanis
- Laboratory of Molecular Immunopharmacology and Drug Discovery; Department of Molecular Physiology and Pharmacology; Tufts University School of Medicine; Boston; MA; USA
| | - D. Mavrommati
- Laboratory of Molecular Immunopharmacology and Drug Discovery; Department of Molecular Physiology and Pharmacology; Tufts University School of Medicine; Boston; MA; USA
| | - E. Hatziagelaki
- Second Department of Internal Medicine; Athens University Medical School; ‘Attikon’ General Hospital; Athens; Greece
| | - P. Conti
- Department of Oncology and Experimental Medicine; University of Chieti-Pescara; Chieti; Italy
| | | |
Collapse
|
46
|
Tsaroucha A, Daniil Z, Malli F, Georgoulias P, Minas M, Kostikas K, Bargiota A, Zintzaras E, Gourgoulianis KI. Leptin, adiponectin, and ghrelin levels in female patients with asthma during stable and exacerbation periods. J Asthma 2012; 50:188-97. [PMID: 23259727 DOI: 10.3109/02770903.2012.747101] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The mechanisms underlying the relationship between obesity and asthma have not been fully established. Data in the literature suggest that adipose tissue-derived hormones may be implicated. However, no definite conclusions regarding the role of leptin and adiponectin with asthma are available. No studies have examined the role of ghrelin in asthma. METHODS We assessed the circulating concentrations of leptin, adiponectin, and ghrelin in 32 postmenopausal stable asthma patients, 37 female asthmatics during exacerbations and 8 weeks later, and 22 controls. We examined the relationship between the three peptides and indexes of pulmonary function, airway inflammation, and atopy. RESULTS Stable asthma patients exhibited higher leptin and lower ghrelin concentrations compared with controls. Patients with severe asthma had higher leptin and lower adiponectin levels versus patients with mild to moderate asthma. Both leptin concentrations and leptin/adiponectin ratio served as markers for discriminating asthma patients from controls on the one hand, and severe from mild to moderate asthmatics on the other. Leptin levels were inversely correlated with both FEV(1)/FVC and FEF(25-75) in patients with mild to moderate asthma. Atopic asthma patients had higher leptin concentrations than nonatopic asthma patients. There was a positive correlation between serum leptin and total IgE levels in atopic asthmatics. Finally, serum leptin levels and leptin/adiponectin ratio were significantly increased during asthma exacerbations, while adiponectin and ghrelin levels were significantly decreased. CONCLUSION Our findings suggest that leptin, adiponectin, and ghrelin may play a significant role in the pathogenesis of asthma during both stable state and asthma exacerbation, independent of obesity.
Collapse
Affiliation(s)
- Agori Tsaroucha
- Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa, Greece.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Silverberg JI, Silverberg NB. Atopic Dermatitis: Update on Pathogenesis and Comorbidities. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-012-0021-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
48
|
Holguin F. Obesity as a risk factor for increased asthma severity and allergic inflammation; cause or effect? Clin Exp Allergy 2012; 42:612-3. [PMID: 22515384 DOI: 10.1111/j.1365-2222.2011.03901.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
49
|
Song WJ, Kim SH, Lim S, Park YJ, Kim MH, Lee SM, Lee SB, Kim KW, Jang HC, Cho SH, Min KU, Chang YS. Association between obesity and asthma in the elderly population: potential roles of abdominal subcutaneous adiposity and sarcopenia. Ann Allergy Asthma Immunol 2012; 109:243-8. [PMID: 23010229 DOI: 10.1016/j.anai.2012.07.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/30/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity is a significant risk factor for asthma; however, the association of asthma with obesity has rarely been studied in the elderly population. The role of central obesity has been suggested as a link between the 2 entities but has not been comprehensively studied in elderly populations. OBJECTIVE To investigate the mechanisms of association between obesity and asthma in the elderly population. METHODS This cross-sectional analysis included 994 participants (aged ≥65 years) in the Korean Longitudinal Study on Health and Aging. Asthma was defined by using questionnaires. Spirometry and chest radiography were performed to exclude asthma-mimicking conditions. Measurements of abdominal subcutaneous and visceral fat were calculated by computed tomography of the abdomen, and regional body compositions were measured by dual energy X-ray absorptiometry. Biochemical parameters were also measured. RESULTS The prevalence of asthma was 5.4%. The study population had a mean body mass index (BMI) of 24.0. Multivariate logistic regression tests revealed that the risk of asthma increased in proportion to an increase in BMI or abdominal subcutaneous adiposity. However, no association was found with visceral adiposity, serum adiponectin levels, or serum vitamin D levels. The dual energy X-ray absorptiometry-measured appendicular fat-free mass index was inversely related to asthma among patients with a BMI of 25.0 or greater. CONCLUSION Our findings suggest that the relationships between obesity and asthma in the elderly population may be mediated by factors such as abdominal subcutaneous adiposity and sarcopenia. These associations warrant further investigations to identify their potential roles.
Collapse
Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
The Editor takes a closer look at some of this month's articles. Clin Exp Allergy 2012. [DOI: 10.1111/j.1365-2222.2012.04054.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|