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Aydin O, Akbay NO, Buyukatalay ZC, Arslan F, Dumlupinar E, Sozener ZC, Gokcan MK, Yildiz O, Demirel YS, Mungan D. Evaluation of sinonasal involvement in patients with asthma and chronic obstructive pulmonary disease. Allergy Asthma Proc 2024; 45:166-172. [PMID: 38755778 DOI: 10.2500/aap.2024.45.240014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background: Asthma and chronic obstructive pulmonary disease (COPD) are the most common obstructive diseases. Based on the similarities, we aimed to evaluate sinonasal symptoms in patients with asthma or COPD, and compare the two diseases with regard to upper-airway involvement. Methods: Patients with asthma or with COPD who were followed up at Ankara University Immunology and Allergy or Chest Diseases Departments were included in the study. The participants went through pulmonary function tests, skin-prick tests, and disease severity assessment of either disease. Nasal endoscopic evaluations of all the patients were performed in the Department of Otorhinolaryngology. Lund-Mackay scoring was performed on the computed tomography of the paranasal sinus. Chronic rinosinusitis (CRS) diagnosis was made as recent guidelines. Results: A total of 112 subjects (number of women/men: n = 67/45; median age, 49 years [The range for IQR was 22 years]) were included in the study. Fifty-five patients had asthma, 33 had COPD, and 24 were healthy controls. Nasal symptoms were more frequent in the patients with asthma (patients with asthma, n = 52 [98%]; patients with COPD, n = 17 [52%]; controls, n = 9 [38%]) (p < 0.001). The median (IQR) 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire score was higher in the patients with asthma (33 [20-50]) than in the patients with COPD (8 [1.5-18.7]) and the control group (3.5 [0-18.7]) (p < 0.01). Patients with asthma had significantly higher prevalence rates of rhinosinusitis than did those in the COPD and the control groups (36%, 15.6%, 8.3%, respectively; p < 0.01). The SNOT-22 optimal cutoff score was calculated as ≥11 to detect the score limit for CRS prediction with the best sensitivity and specificity. Conclusion: As a result, patients with both asthma and COPD may have upper-airway symptoms. CRS, was primarily seen in the patients with asthma. Accordingly, SNOT-22 scores were higher in the patients with asthma than in those in the COPD and the control groups. A referral to the Ear Nose Throat department for further evaluation with nasal endoscopy and computed tomography of the paranasal may be required in a subgroup of patients.
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Affiliation(s)
- Omur Aydin
- From the Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Nilay Orak Akbay
- From the Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | | | - Fatma Arslan
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey, and
| | - Ebru Dumlupinar
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Celebi Sozener
- From the Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Kursat Gokcan
- Department of Ear, Nose, Throat, Ankara University School of Medicine, Ankara, Turkey
| | - Oznur Yildiz
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey, and
| | - Yavuz Selim Demirel
- From the Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Dilsad Mungan
- From the Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
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Zihlif M, Abusara OH, Al-Qerem W, Al-Ibadah M, Mahafza TM, Al-Akhras FM, Mahafza NT. CRHR1 polymorphism at rs242941, rs242940, and rs72834580: association of symptoms improvement with intranasal corticosteroids in allergic rhinitis Jordanian patients. Drug Metab Pers Ther 2023; 38:331-338. [PMID: 37216433 DOI: 10.1515/dmpt-2023-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/04/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Rhinitis is classified into several types with allergic rhinitis (AR) being the most common. AR is among the inflammatory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), in which corticosteroids are administered to overcome the decrease in cortisol production. The treatment options available for AR vary with 1st line treatment being intranasal corticosteroids (INCS). The responsiveness to corticosteroids is due to their binding to corticotropin-releasing hormone receptor-1 (CRHR1). Various studies have studied the responsiveness to corticosteroids treatment in patients with asthma and COPD in association with CRHR1 gene single nucleotide polymorphisms (SNPs). METHODS In our study, we investigated the association of three SNPs of CRHR1 gene (rs242941, rs242940, and rs72834580) with symptoms improvement post-treatment in AR patients. Blood samples were collected from 103 patients for DNA extraction and gene sequencing. Those patients started to receive INCS for 8 weeks and their symptoms were assessed, through a questionnaire, before treatment and post-treatment to check for symptoms improvement. RESULTS Our data showed that improvement of eye redness is significantly less following INCS treatment in patients with allele (C) (AOR=0.289, p-value-0.028, 95 % CI=0.096-0.873) and genotype (CC) (AOR=0.048, p-value-0.037, 95 % CI=0.003-0.832) of rs242941 SNP. There was no correlation with other genotypes, alleles, or haplotypes of the investigated SNPs. CONCLUSIONS Our findings show that there is no correlation between CRHR1 gene polymorphism and symptoms improvement following INCS treatment. Further studies are required to evaluate the association of INCS and symptoms improvement post-treatment with larger sample size.
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Affiliation(s)
- Malek Zihlif
- Department of Pharmacology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Osama H Abusara
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Mahmood Al-Ibadah
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Tareq M Mahafza
- Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan
| | - Fatima M Al-Akhras
- Molecular Biology Research Laboratory, School of Medicine, The University of Jordan, Amman, Jordan
| | - Naseem T Mahafza
- Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan
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Conti DM, Hellings PW, Diamant Z, Bjermer L, Jesenak M, Backer V, Fokkens W, Lau S, Van Staeyen E, Scadding GK. A EUFOREA comment on a lost comorbidity of asthma. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:56. [PMID: 37391838 DOI: 10.1186/s13223-023-00816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
"Epidemiology of comorbidities and their association with asthma control" (Tomisa, G., Horváth, A., Sánta, B. et al. Epidemiology of comorbidities and their association with asthma control. Allergy Asthma Clin Immunol 17, 95 (2021). https://doi.org/10.1186/s13223-021-00598-3 ) is an interesting paper reflecting data collection from more than 12,000 asthmatic patients in Hungary regarding their condition and associated comorbidities. We found it valuable that the paper provides an overview of asthma comorbidities not usually considered in similar reports. Nevertheless, we believe that chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP or CRSsNP) should have been listed due to its high incidence and prevalence, its association with asthma which is also endorsed in both GINA and EPOS, as well as in several peer-reviewed scientific papers, and to reflect the role of this comorbidity in poor control and a most severe presentation of asthma for the patient. Consequently, several targeted therapies (especially monoclonal antibodies) used for several years in severe forms of asthma are now indicated also for the effective treatment of nasal polyps.
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Affiliation(s)
- Diego M Conti
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium.
| | - Peter W Hellings
- KU Leuven Department of Microbiology and Immunology, Allergy and Clinical Immunology Research Unit, Leuven, Belgium
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Otorhinolaryngology, Laboratory of Upper Airways Research, University of Ghent, Ghent, Belgium
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Zuzana Diamant
- KU Leuven Department of Microbiology and Immunology, Allergy and Clinical Immunology Research Unit, Leuven, Belgium
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
- Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Leif Bjermer
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
| | - Milos Jesenak
- Department of Pulmonology and Phthisiology, Department of Pediatrics, Department of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
| | - Vibeke Backer
- Department of Otorhinolaryngology, Head & Neck surgery, and Audiology. Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Wytske Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Susanne Lau
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Elizabeth Van Staeyen
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium
| | - Glenis K Scadding
- Department of Allergy & Rhinology, Royal National ENT Hospital, London, UK
- Division of Immunity and Infection, University College, London, UK
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De Marchi S, Cecchin E, De Marchi SU, Iuri F, Sechi LA. Subendotyping of Dermatophagoides pteronyssinus-Induced Rhinitis and Its Impact on Respiratory Comorbidities. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:922-929.e2. [PMID: 36535525 DOI: 10.1016/j.jaip.2022.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The impact of delayed hypersensitivity to Dermatophagoides pteronyssinus (DP) on comorbidities of allergic rhinitis (AR) is unknown. OBJECTIVE The primary end point was to test the hypothesis that DP-induced AR could be divided into 2 subendotypes on the basis of presence or absence of a delayed-type mite sensitization detected by the positive result of atopy patch test for DP (DP-APT). The second end point was to evaluate differences in the long-term risk of respiratory comorbidities and nasal airway response to mite exposure. METHODS In a prospective observational study, we included 472 patients with DP-induced AR. A total of 343 patients had positive results of skin prick test/serum specific IgE and DP-APT and were assigned to a subendotype with both IgE- and T-cell-mediated mite sensitization (BMSS). The remaining 129 patients without delayed-type mite sensitization were included in the subendotype with only IgE-mediated mite sensitization. Nasal allergen provocation test with active anterior rhinomanometry, paranasal sinuses computed tomography scan, nasal endoscopy, and spirometry were performed. RESULTS At baseline, BMSS showed a larger increase in nasal airway resistance, total nasal score, and visual analogue scale score to mite exposure. During a 15-year follow-up, 56 patients developed chronic rhinosinusitis with nasal polyps, with higher incidence in BMSS than in the subendotype with only IgE-mediated mite sensitization (50 patients, 14.6% vs 6 patients, 12.4%; P < .001). BMSS also showed a higher incidence of conjunctivitis (25.7% vs 12.4%; P < .01). The rate of adult-onset asthma did not differ between groups, but patients with BMSS showed a more frequent link to chronic rhinosinusitis with nasal polyps (6 of 29 patients, 20.7% vs 0 of 10 patients, 0%). DP-APT independently predicted chronic rhinosinusitis with nasal polyps and conjunctivitis. CONCLUSIONS Two subendotypes with significantly different clinical outcome can be identified among patients with DP-induced AR according to the presence of delayed-type mite sensitization detected by positive DP-APT result.
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Affiliation(s)
- Sergio De Marchi
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy.
| | - Emanuela Cecchin
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy
| | | | - Federico Iuri
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy
| | - Leonardo A Sechi
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy
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Bergqvist J, Bove M, Andersson A, Schiöler L, Klepaker G, Abrahamsen R, Fell AKM, Hellgren J. Chronic rhinosinusitis associated with chronic bronchitis in a five-year follow-up: the Telemark study. BMC Pulm Med 2022; 22:406. [PMID: 36348489 PMCID: PMC9644625 DOI: 10.1186/s12890-022-02203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic rhinosinusitis (CRS) is associated with generalised airway inflammation. Few studies have addressed the relationship between CRS and chronic bronchitis (CB). Methods This prospective study over a five-year period aims to investigate the risk of developing CB in subjects reporting CRS at the beginning of the study. A random sample of 7393 adult subjects from Telemark County, Norway, answered a comprehensive respiratory questionnaire in 2013 and then 5 years later in 2018. Subjects reporting CB in 2013 were excluded from the analyses. New cases of CB in 2018 were analysed in relation to having CRS in 2013 or not. Results The prevalence of new-onset CB in 2018 in the group that reported CRS in 2013 was 11.8%. There was a significant increase in the odds of having CB in 2018 in subjects who reported CRS in 2013 (OR 3.8, 95% CI 2.65–5.40), adjusted for age, sex, BMI, smoking and asthma. Conclusion In this large population sample, CRS was associated with increased odds of developing CB during a five-year follow-up. Physicians should be aware of chronic bronchitis in patients with CRS.
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Øie MR, Helvik AS, Sue-Chu M, Steinsvåg SK, Thorstensen WM. Sinonasal Symptoms in COPD: Burden and Associations with Clinical Markers of Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:2137-2147. [PMID: 36101792 PMCID: PMC9464443 DOI: 10.2147/copd.s372991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Sinonasal symptoms are prevalent in COPD, and knowledge of the relationship between these symptoms and clinical markers of COPD is limited. This study explores the associations between the burden of sinonasal symptoms and clinical markers and thresholds recommended for guiding treatment decisions in the GOLD guidelines. Patients and Methods Sinonasal symptoms were quantified with the rhinological subscale of the Sino-Nasal-Outcome-Test (SNOT-22) in 93 COPD patients characterized by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 diagnostic criteria for rhinosinusitis without nasal polyps (RSsNP). Associations between a high burden, defined as a SNOT22_rhinological score of ≥11, and the following markers were assessed by adjusted multivariable linear regressions; severity of dyspnea [modified Medical Research Council (mMRC)] and cough [Visual Analogue Scale (VAS)], physical activity [6-minute walking distance (6MWD)], mortality risk (BODE index), and HRQoL [disease-specific COPD Assessment Test (CAT) and St. Georges Respiratory Questionnaire (SGRQ), and physical component summary, Short Form-36 version 2.0 (PCS SF-36v2)]. Odds ratios for the association of a high burden and threshold levels for regular treatment were estimated by adjusted binomial logistic regression models. Results A high burden was associated with greater severity of dyspnea and cough, lower 6MWD, higher BODE index and poorer HRQoL. The odds ratio of having CAT and SGRQ scores that are above the thresholds recommended for treatment was 5–7-fold greater in the high burden group. Conclusion A high burden of sinonasal symptoms is positively associated with the clinical markers of symptom severity and mortality risk and is inversely associated with physical activity and HRQoL in COPD. These findings add further support that the UAD concept also applies to COPD. Enquiry about sinonasal symptoms in COPD patients should be incorporated into the clinical routine.
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Affiliation(s)
- Marte Rystad Øie
- Department of Otolaryngology, Head and Neck Surgery, St. Olavs hospital, 7006 Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne-Sofie Helvik
- Department of Otolaryngology, Head and Neck Surgery, St. Olavs hospital, 7006 Trondheim University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Malcolm Sue-Chu
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sverre Karmhus Steinsvåg
- Department of Otolaryngology, Head and Neck Surgery, Sørlandet Hospital, Kristiansand, 4604, Norway.,Haukeland University Hospital, Bergen, Norway
| | - Wenche Moe Thorstensen
- Department of Otolaryngology, Head and Neck Surgery, St. Olavs hospital, 7006 Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Wang M, Tang S, Yang X, Xie X, Luo Y, He S, Li X, Feng X. Identification of key genes and pathways in chronic rhinosinusitis with nasal polyps and asthma comorbidity using bioinformatics approaches. Front Immunol 2022; 13:941547. [PMID: 36059464 PMCID: PMC9428751 DOI: 10.3389/fimmu.2022.941547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma comorbidity (ACRSwNP) present severe symptoms and are more likely to relapse. However, the pathogenesis of ACRSwNP is not fully understood. The aim of this study was to explore the underlying pathogenesis of ACRSwNP using bioinformatics approaches. ACRSwNP-related differentially expressed genes (DEGs) were identified by the analysis of the GSE23552 dataset. The clusterProfiler R package was used to carry out functional and pathway enrichment analysis. A protein–protein interaction (PPI) network was built using the STRING database to explore key genes in the pathogenesis of ACRSwNP. The bioinformatics analysis results were verified through qRT-PCR. The Connectivity Map (CMap) database was used to predict potential drugs for the treatment of ACRSwNP. A total of 36 DEGs were identified, which were mainly enriched in terms of regulation of immune response and detection sensory perception of taste. Thirteen hub genes including AZGP1, AQP9, GAPT, PIP, and PRR4 were identified as potential hub genes in ACRSwNP from the PPI network. Analysis of the GSE41861 dataset showed that upregulation of CST1 in nasal mucosa was associated with asthma. qRT-PCR detection confirmed the bioinformatics analysis results. Tacrolimus and spaglumic acid were identified as potential drugs for the treatment of ACRSwNP from the CMap database. The findings of this study provide insights into the pathogenesis of ACRSwNP and may provide a basis for the discovery of effective therapeutic modalities for ACRSwNP.
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Affiliation(s)
| | | | | | | | | | | | | | - Xin Feng
- *Correspondence: Xin Feng, ; Xuezhong Li,
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8
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Glucocorticoid Insensitivity in Asthma: The Unique Role for Airway Smooth Muscle Cells. Int J Mol Sci 2022; 23:ijms23168966. [PMID: 36012240 PMCID: PMC9408965 DOI: 10.3390/ijms23168966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
Although most patients with asthma symptoms are well controlled by inhaled glucocorticoids (GCs), a subgroup of patients suffering from severe asthma respond poorly to GC therapy. Such GC insensitivity (GCI) represents a profound challenge in managing patients with asthma. Even though GCI in patients with severe asthma has been investigated by several groups using immune cells (peripheral blood mononuclear cells and alveolar macrophages), uncertainty exists regarding the underlying molecular mechanisms in non-immune cells, such as airway smooth cells (ASM) cells. In asthma, ASM cells are among the targets of GC therapy and have emerged as key contributors not only to bronchoconstriction but also to airway inflammation and remodeling, as implied by experimental and clinical evidence. We here summarize the current understanding of the actions/signaling of GCs in asthma, and specifically, GC receptor (GR) “site-specific phosphorylation” and its role in regulating GC actions. We also review some common pitfalls associated with studies investigating GCI and the inflammatory mediators linked to asthma severity. Finally, we discuss and contrast potential molecular mechanisms underlying the impairment of GC actions in immune cells versus non-immune cells such as ASM cells.
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De Prins L, Raap U, Mueller T, Schmid-Grendelmeier P, Haase CH, Backer V, Fokkens W, Benoist LB, Prokopakis E, Doulaptsi M, Hopkins C, Claeys N, Teeling T, Cypers L, Cools L, Bjermer LH, Diamant Z, Wahn U, Scadding G, Bachert C, Walther P, Patel SR, Van Staeyen E, Hellings P. White Paper on European Patient Needs and Suggestions on Chronic Type 2 Inflammation of Airways and Skin by EUFOREA. FRONTIERS IN ALLERGY 2022; 3:889221. [PMID: 35769567 PMCID: PMC9234878 DOI: 10.3389/falgy.2022.889221] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundType 2 inflammation underlies the chronicity of disease in subgroups of patients with asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and atopic dermatitis (AD), that often co-exist. Although several studies have investigated the unmet needs of asthma, AD and CRSwNP as such, little is known about the similarities and differences in experiences and perspectives of the current management of patients with comorbid Type 2 inflammatory diseases.AimsTo improve insight into the common and organ-specific needs of patients with Type 2 inflammation and comorbidities, allowing the formulation of recommendations to better address these needs in the future.MethodologyThis qualitative study was conducted between July 2021 and December 2021 using semi-structured face-to-face or telephone interviews with patients suffering from year-long severe chronic Type 2 inflammation and at least one co-morbid inflammatory condition. Seven participating academic centers in Europe interviewed asthma (Copenhagen and Leuven), CRSwNP (London, Amsterdam and Crete) and/or AD (Oldenburg and Zurich) patients on patient characteristics, disease severity, shortcomings of current care pathways and suggestions for improvement of care. Transcripts were analyzed using an inductive thematic analysis approach.ResultsEighty-one patients with severe Type 2 inflammation and comorbidities were interviewed. Similar needs were recognized by patients with Type 2 inflammation, with both a lack of coordination in care and a lack of a real cure reported as being most frustrating. However, several needs are specific to asthma, CRSwNP and AD. Suggestions for improvement of care were generic across diseases, such as the implementation of a multidisciplinary approach, the improved facilitation of access to better treatments, the increase of general awareness on disease burden, and better educational programs for healthcare providers and patients. Of note, patients with CRSwNP also stated the need for alternatives to sinus surgery, whereas patients with asthma requested better medical care to prevent exacerbations and patients with AD would warmly welcome the reimbursement of emollients.ConclusionPatients with asthma, CRSwNP and AD have shared unmet needs that need to be addressed by physicians, the academic community and health policy makers. This survey provides unique recommendations made by patients for the implementation of better care.
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Affiliation(s)
- Louise De Prins
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Ulrike Raap
- Division of Experimental Allergology and Immunodermatology, University of Oldenburg, Oldenburg, Germany
- Department of Dermatology, Klinikum Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Tara Mueller
- Division of Experimental Allergology and Immunodermatology, University of Oldenburg, Oldenburg, Germany
- Department of Dermatology, Klinikum Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Peter Schmid-Grendelmeier
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Dermatology, Allergy Unit, University Hospital of Zurich, Zurich, Switzerland
| | - Christiane H. Haase
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Vibeke Backer
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Wytske Fokkens
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Head & Neck Surgery, Academic Medical Center (AMC), Amsterdam, Netherlands
| | - Linda B. Benoist
- Department of Otorhinolaryngology, Head & Neck Surgery, Academic Medical Center (AMC), Amsterdam, Netherlands
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Maria Doulaptsi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Claire Hopkins
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Guy's and St Thomas' Hospital, London Bridge Hospital, London, United Kingdom
| | - Nele Claeys
- EUFOREA Patient Advisory Board Chairs, Brussels, Belgium
| | - Thijs Teeling
- EUFOREA Patient Advisory Board Chairs, Brussels, Belgium
| | - Lindsay Cypers
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- *Correspondence: Lindsay Cypers
| | - Leen Cools
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Leif H. Bjermer
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Zuzana Diamant
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Ulrich Wahn
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Glenis Scadding
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, University of Ghent, Ghent, Belgium
| | - Peter Walther
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Sunni R. Patel
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Elizabeth Van Staeyen
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Peter Hellings
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
- Department of Otorhinolaryngology, Head & Neck Surgery, Academic Medical Center (AMC), Amsterdam, Netherlands
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, University of Ghent, Ghent, Belgium
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10
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Baiardini I, Paoletti G, Mariani A, Malvezzi L, Pirola F, Spriano G, Mercante G, Puggioni F, Racca F, Melone G, Malipiero G, Ferri S, Canonica GW, Heffler E. Nasal Polyposis Quality of Life (NPQ): Development and Validation of the First Specific Quality of Life Questionnaire for Chronic Rhinosinusitis with Nasal Polyps. Healthcare (Basel) 2022; 10:healthcare10020253. [PMID: 35206869 PMCID: PMC8871881 DOI: 10.3390/healthcare10020253] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
To date, no disease-specific tool has been available to assess the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on health-related quality of life (HRQoL). Therefore, the purpose of this study was to develop and validate a questionnaire specifically designed to this aim: the Nasal Polyposis Quality of Life (NPQ) questionnaire. As indicated in the current guidelines, the development and validation of the NPQ occurred in two separate steps involving different groups of patients. The questionnaire was validated by assessing internal structure, consistency, and validity. Responsiveness and sensitivity to changes were also evaluated. In the development process of NPQ an initial list of 40 items was given to 60 patients with CRSwNP; the 27 most significant items were selected and converted into questions. The validation procedure involved 107 patients (mean age 52.9 ± 12.4). NPQ revealed a five-dimensional structure and high levels of internal consistency (Cronbach’s alpha 0.95). Convergent validity (Spearman’ coefficient r = 0.75; p < 0.01), discriminant validity (sensitivity to VAS score), and reliability in a sample of patients with a stable health status (Interclass Coefficient 0.882) were satisfactory. Responsiveness to clinical changes was accomplished. The minimal important difference was 7. NPQ is the first questionnaire for the assessment of HRQoL in CRSwNP. Our results demonstrate that the new tool is valid, reliable, and sensitive to individual changes.
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Affiliation(s)
- Ilaria Baiardini
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Giovanni Paoletti
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
- Correspondence: ; Tel.: +39-02-2440-1821; Fax: +39-02-3440-6684
| | - Alessia Mariani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Luca Malvezzi
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (L.M.); (F.P.)
| | - Francesca Pirola
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (L.M.); (F.P.)
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (L.M.); (F.P.)
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (L.M.); (F.P.)
| | - Francesca Puggioni
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Francesca Racca
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
| | - Giulio Melone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Giacomo Malipiero
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
| | - Sebastian Ferri
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
| | - Enrico Heffler
- Personalized Medicine Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, 20089 Milan, Italy; (I.B.); (F.P.); (F.R.); (G.M.); (S.F.); (G.W.C.); (E.H.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy; (A.M.); (G.S.); (G.M.); (G.M.)
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11
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Lygeros S, Danielides G, Kyriakopoulos GC, Grafanaki K, Tsapardoni F, Stathopoulos C, Danielides V. Evaluation of MMP-12 expression in chronic rhinosinusitis with nasal polyposis. Rhinology 2021; 60:39-46. [PMID: 34812434 DOI: 10.4193/rhin21.320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the expression of MMP-12 in patients with chronic rhinosinusitis with polyps (CRSwNP). METHODOLOGY Tissue samples from 37 patients with CRSwNP undergoing functional endoscopic sinus surgery and healthy mucosa specimens from 12 healthy controls were obtained intraoperatively. The mRNA and protein expression levels of MMP-12 were quantified by real-time polymerase chain reaction and Western blotting, respectively. RESULTS mRNA levels of MMP-12 were significantly elevated in the CRSwNP tissue samples compared to those in control ones. The protein levels of MMP-12 showed a trend of increasing but with no statistical significance. CONCLUSIONS Elevation of MMP-12 in patients with CRSwNP suggests its potential implication in the pathogenesis of the disease. The difference in the expression profile observed between mRNA and protein levels could be due to post-translational gene expression regulation. Our findings provide evidence that MMP-12 along with other MMPs may serve as a biomarker and therapeutic target in the management of the disease.
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Affiliation(s)
- S Lygeros
- Department of Otorhinolaryngology, University Hospital of Patras, Patras, Greece
| | - G Danielides
- Department of Otorhinolaryngology, University Hospital of Patras, Patras, Greece
| | - G C Kyriakopoulos
- Department of Biochemistry, School of Medicine, University of Patras, Patras, Greece
| | - K Grafanaki
- Department of Biochemistry, School of Medicine, University of Patras, Patras, Greece.,Department of Dermatology, School of Medicine, University of Patras, Patras, Greece
| | - F Tsapardoni
- Department of Ophthalmology, University Hospital of Patras, Patras, Greece
| | - C Stathopoulos
- Department of Biochemistry, School of Medicine, University of Patras, Patras, Greece
| | - V Danielides
- Department of Otorhinolaryngology, University Hospital of Patras, Patras, Greece
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12
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Thorstensen WM, Øie MR, Dahlslett SB, Sue-Chu M, Steinsvåg SK, Helvik AS. Olfaction in COPD. Rhinology 2021; 60:47-55. [PMID: 34647543 DOI: 10.4193/rhin21.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfaction is poorly characterized in COPD. To test the hypothesis that olfaction is reduced in COPD, we assessed olfaction with the "Sniffin' Sticks" test and a questionnaire addressing olfaction in COPD and a corresponding control group in respect to age and sex. We also explored whether there is an association between COPD, chronic rhinosinusitis without nasal polyps (CRSsNP), and other predefined covariates with olfactory function. METHODOLOGY Olfactory function was assessed by the score for threshold (T), discrimination (D) and identification (I), and the composite TDI score in the "Sniffin' Sticks" test and by self-reported evaluation of impaired olfaction and of "decreased sense of smell and taste" in the 22-item Sino-Nasal Outcome Test (SNOT-22) in 90 COPD patients and 93 controls. A clinical interview and ENT-examination with nasal endoscopy, skin prick test and spirometry with reversibility were performed. RESULTS The TDI, D and I scores were significantly lower in the COPD group than in the control group. The T score was not significantly different between the two groups. Hyposmia and anosmia were present in up to 79% of patients with COPD. The prevalence of self-reported impaired olfactory function and for "decreased sense of smell and taste" - was more than two-fold greater in the COPD than in the control group. COPD, higher age, male sex and allergy were associated with a lower TDI score, while CRSsNP was not associated with the TDI score. CONCLUSIONS COPD is associated with olfactory dysfunction and the underlying mechanisms for this dysfunction should be elucidated.
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Affiliation(s)
- W M Thorstensen
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - M R Øie
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - S B Dahlslett
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - M Sue-Chu
- Dept of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Dept of Thoracic Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - S K Steinsvåg
- Dept of Otolaryngology, Head and Neck Surgery, Sørlandet Hospital, Kristiansand, Norway.,Haukeland University Hospital, Bergen, Norway
| | - A S Helvik
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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13
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Van Bulck P, Cools L, Soumya MS, Nyembue DT, Kabobo P, Zhang L, Scadding GK, Toskala E, Fokkens WJ, Steelant B, Hellings PW. A multicenter real-life study on the multiple reasons for uncontrolled allergic rhinitis. Int Forum Allergy Rhinol 2021; 11:1452-1460. [PMID: 34259380 DOI: 10.1002/alr.22808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent data show uncontrolled disease in 35% of allergic rhinitis (AR) patients on medical treatment. The reasons for uncontrolled disease can arbitrarily be divided into disease-related, diagnosis-related, treatment-related, and patient-related factors. However, the relative importance of these factors in uncontrolled disease remains speculative. This explorative study aimed at determining the factors causing uncontrolled AR on four different continents worldwide, identifying the most common reasons for uncontrolled disease in AR. METHODS Patients with uncontrolled AR (n = 430) were asked to fill out a questionnaire and underwent a clinical examination at the outpatient clinic in five university outpatient clinics (Leuven [Belgium], Beijing [China], Kinshasa [Congo], Bangalore [India], and Philadelphia [US]). Two independent physicians evaluated the reason or multiple reasons for uncontrolled disease. The study was coordinated from the University Hospital of Leuven. RESULTS In uncontrolled AR patients, 76% of patients showed two or more reasons for uncontrolled disease according to the physicians' evaluation. Disease-related factors (64%) were considered most often the reason for uncontrolled disease, followed by treatment- (56%), patient- (54%), and diagnosis-related (47%) factors. There is limited variability in observations across different centers worldwide. CONCLUSION We here define the multiple reasons for uncontrolled AR across different continents, with disease-related factors being most frequently associated with uncontrolled disease. A better understanding of uncontrolled disease will guide us in defining strategies to improve AR care.
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Affiliation(s)
- Pauline Van Bulck
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Leen Cools
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Mysore S Soumya
- Department of ENT, St John's Medical College Hospital, Bangalore, India
| | - Dieudonné T Nyembue
- Department of Otolaryngology, University Hospitals Kinshasa, Kinshasa, Congo
| | - Patricia Kabobo
- Department of Otolaryngology, University Hospitals Kinshasa, Kinshasa, Congo
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Glenis K Scadding
- ENT Department Royal National Ear Nose and Throat Hospital, London, UK
| | - Elina Toskala
- Department of Otolaryngology, Head and Neck Surgery, Temple University School of Medicine, Philadelphia, USA
| | - Wytske J Fokkens
- Department of Otolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Brecht Steelant
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research unit, Leuven, Belgium
| | - Peter W Hellings
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Otolaryngology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Otorhinolaryngology-Head and Neck Surgery, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
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14
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Decreased retinal nerve fiber and choroidal thickness in chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2021; 278:2863-2868. [PMID: 33704528 DOI: 10.1007/s00405-020-06552-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/04/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE The assessment of the retina and choroid of patients with chronic rhinosinusitis (CRS), via spectral domain-optical coherence tomography (SD-OCT), was aimed in this study. We proposed that chronic upper airway restriction caused by chronic sinusitis could deteriorate the retinal and choroid morphology. METHODS This prospective controlled study included a total of 90 eyes of 90 patients, 30 of whom were CRS with nasal polyposis (CRSwNP), 30 of whom were CRS without nasal polyposis (CRSsNP) and 30 of whom were healthy controls (HC). Only the right eye of the patients were evaluated. All patients underwent full otorhinolaryngologic and ophthalmologic examinations, including SD-OCT. RESULTS Average retinal nerve fiber layer (RNFL) and RNFL in superior and inferior quadrants were measured significantly lower in CRS patients compared to HC. Ganglion cell-inner plexiform layer (GCIPL) thickness in all sectors was thinner in patients with CRS than in HC with significantly lower values in all sectors except inferior. Mean average GCIPL thickness and GCIPL thickness in the inferior sector were significantly lower in CRSwNP than CRSsNP patients. CONCLUSION CRS may lead to thinning in the choroidal thickness, RNFL thickness, especially in the superior and inferior quadrants and GCIPL thickness, presumably related with hypoxia, endothelial dysfunction, inflammation and vascular dysregulation. Ocular manifestations of the CRS should be taken in the consideration during the management of this disease.
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15
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Romanova J, Chikina E, Rydlovskaya A, Pohl W, Renner A, Zeifman A, Chuchalin A, Nebolsin V. New Anti-Chemokine Oral Drug XC8 in the Treatment of Asthma Patients with Poor Response to Corticosteroids: Results of a Phase 2A Randomized Controlled Clinical Trial. Pulm Ther 2020; 6:351-369. [PMID: 33095411 PMCID: PMC7671956 DOI: 10.1007/s41030-020-00134-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction A significant number of patients with moderate asthma remain symptomatic despite treatment with inhaled corticosteroids (ICS). These patients do not yet meet the criteria for oral corticosteroids (OCS) and monoclonal antibodies. The new anti-chemokine oral drug XC8 could represent an alternative treatment option for these patients. The objective of this trial was to evaluate the effect of different doses of the XC8 in patients with partly controlled asthma in a phase 2a clinical trial. Methods A double-blind, parallel-group, randomized, multicenter, phase 2a trial was conducted at 12 sites in Russia. Patients with asthma were randomized into four groups (n = 30 each) to receive XC8 at 2 mg, 10 mg, 100 mg or placebo once-daily for 12 weeks in addition to low-dose ICS with or without LABA. Efficacy and safety parameters were evaluated at weeks 0, 2, 6, and 12. Results No statistically significant difference between the treatment arms in the number of patients with adverse events was observed. The primary endpoint, improvement of forced expiratory volume in 1 s (FEV1) % predicted over 12 weeks compared to placebo, was not statistically significant. The treatment of patients with XC8 (100 mg) resulted in statistically and clinically significant improvements in FEV1 compared to baseline (7.40% predicted, p < 0.001). Patients with elevated peripheral blood eosinophil count (PBEC, > 300 cells/μl) or serum interferon-γ (IFN-γ) level (> 100 pg/mL) treated with XC8 (100 mg) achieved a statistically significant improvement in FEV1 (11.33% predicted or 8.69% predicted, respectively, p < 0.05) as compared to the baseline versus the placebo. The strongest effect was observed in patients with both high PBEC and IFN-γ level. Pharmacodynamic engagement was demonstrated through the reduction of serum levels of C–C motif ligand 2 (CCL2) and C–X–C motif chemokine 10 (CXCL10). Treatment with XC8 (100 mg) alleviated resistance to maintenance ICS therapy in patients with elevated IFN-γ level. Conclusions Given the high safety, oral route of administration, and efficacy, XC8 may provide a promising treatment option for patients with mild-to-moderate asthma. Trial Registration 795–30/12/2015 (Ministry of Health Russian Federation), NCT03450434 (ClinicalTrials.gov). Electronic supplementary material The online version of this article (10.1007/s41030-020-00134-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Wolfgang Pohl
- Karl Landsteiner Institute for Clinical and Experimental Pneumology, Hietzing Hospital, Vienna, Austria
| | - Andreas Renner
- Karl Landsteiner Institute for Clinical and Experimental Pneumology, Hietzing Hospital, Vienna, Austria
| | | | - Alexander Chuchalin
- Institute of Pulmonology, Federal Medical and Biological Agency, Moscow, Russia
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16
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Epilepsy and chronic obstructive pulmonary disease among U.S. adults: National Health Interview Survey 2013, 2015, and 2017. Epilepsy Behav 2020; 110:107175. [PMID: 32532551 DOI: 10.1016/j.yebeh.2020.107175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Among U.S. adults, over 4 million report a history of epilepsy, and more than 15 million report a history of chronic obstructive pulmonary disease (COPD); Chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema, is a common somatic comorbidity of epilepsy. This study assessed the relationship between self-reported physician-diagnosed epilepsy and COPD in a large representative sample of the U.S. adult population and explored possible mechanisms. METHODS Cross-sectional National Health Interview Surveys for 2013, 2015, and 2017 were aggregated to compare the prevalence of COPD between U.S. respondents aged ≥18 years with a history of physician-diagnosed epilepsy (n = 1783) and without epilepsy (n = 93,126). We calculated prevalence of COPD by age-standardized adjustment and prevalence ratios of COPD overall adjusted for sociodemographic and risk factors, by using multivariable logistic regression analyses. A Z-test was conducted to compare the prevalence between people with and without epilepsy at the statistical significance level of 0.05. Prevalence ratios whose 95% confidence intervals did not overlap 1.00 were considered statistically significant. RESULTS The overall age-standardized prevalence was 5.7% for COPD and 1.8% for epilepsy. Age-standardized prevalence of COPD among respondents with epilepsy (15.4%) exceeded that among those without epilepsy (5.5%). The association remained significantly different among all sociodemographic and risk factor subgroups (p < .05). In the adjusted analyses, epilepsy was also significantly associated with COPD, overall (adjusted prevalence ratio = 1.8, 95% confidence interval = 1.6-2.1) and in nearly all subgroups defined by selected characteristics. CONCLUSIONS Epilepsy is associated with a higher prevalence of COPD in U.S. adults. Public health interventions targeting modifiable behavioral and socioeconomic risk factors among people with epilepsy may help prevent COPD and related premature death.
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17
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Chronic rhinosinusitis in COPD: A prevalent but unrecognized comorbidity impacting health related quality of life. Respir Med 2020; 171:106092. [PMID: 32846336 DOI: 10.1016/j.rmed.2020.106092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Unified airway disease where upper respiratory tract inflammation including chronic rhinosinusitis (CRS) affects lower airway disease is known from asthma, bronchiectasis, cystic fibrosis and primary ciliary dyskinesia but little is known about CRS and health related quality of life in COPD. We investigate firstly, the prevalence of CRS in COPD. Secondly the impact of CRS on HRQoL. Thirdly, risk factors for CRS in COPD. METHODS cross-sectional study of CRS in 222 COPD patients from 2017 to 2019 according to EPOS2012/2020 and GOLD2019 criteria. Patients completed the COPD assessment test (CAT), Medical Research Council dyspnea scale and Sinonasal outcome test 22 (SNOT22) and questions on CRS symptoms. They then had a physical examination including flexible nasal endoscopy, CT-sinus scan and HRCT-thorax. RESULTS 22.5% of COPD patients had CRS and 82% of these were undiagnosed prior to the study. HRQoL (CAT, SNOT22 and the SNOT22-nasal symptom subscore) was significantly worse in COPD patients with CRS compared with those without CRS and healthy controls. Multiple logistic regression analysis suggests that the most likely candidate for having CRS was a male COPD patient who actively smoked, took inhaled steroids, had a high CAT and SNOT22_nasal symptom subscore. DISCUSSION the largest clinical study of CRS in COPD and the only study diagnosing CRS according to EPOS and GOLD. This study supports unified airway disease in COPD. The SNOT22_nasal symptoms subscore is recommended as a standard questionnaire for COPD patients and patients at risk should be referred to an otorhinolaryngologist.
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18
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Øie MR, Dahlslett SB, Sue-Chu M, Helvik AS, Steinsvåg SK, Thorstensen WM. Rhinosinusitis without nasal polyps in COPD. ERJ Open Res 2020; 6:00015-2020. [PMID: 32665943 PMCID: PMC7335833 DOI: 10.1183/23120541.00015-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022] Open
Abstract
The validity of the united airway disease concept for rhinosinusitis (RS) and chronic obstructive pulmonary disease (COPD) has been questioned because of methodological limitations in previous studies. In this study we investigated the prevalence of RS without nasal polyps (RSsNP) and the severity of sinonasal symptoms in COPD and a corresponding control group. We also evaluated the diagnostic accuracy of these symptoms for RSsNP in COPD. 90 COPD patients and 93 controls were included in an observational cross-sectional study where globally accepted diagnostic criteria of RS and COPD (EPOS 2012 and GOLD) were incorporated; symptomatic and endoscopic criteria for the diagnosis of RS, and spirometry with reversibility for diagnosis of COPD. RS symptoms were identified by responses to the sinonasal outcome test (SNOT-22), nasal endoscopy identified signs of sinonasal disease and discriminated between RS with and without nasal polyps, and visual analogue scales (VAS) rated the severity of sinonasal symptoms. We found RSsNP in 51% of our COPD patients which is threefold greater than in the control group (p<0.001). Nasal discharge (72%) and nasal obstruction (62%) were the two most frequently reported symptoms in COPD. The diagnostic accuracy for RSsNP is better for the composite VAS for rhinological symptoms than for facial symptoms. We conclude that RSsNP is present in 51% of our COPD patients, which is significantly more prevalent compared to a corresponding control group. These results suggest that COPD is associated with RS. Rhinosinusitis is associated with COPD and is significantly more prevalent (51%) compared to controlshttps://bit.ly/2YrIsmm
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Affiliation(s)
- Marte Rystad Øie
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sarah Bettina Dahlslett
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Malcolm Sue-Chu
- Dept of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Dept of Thoracic Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Anne-S Helvik
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sverre Karmhus Steinsvåg
- Dept of Otolaryngology, Head and Neck Surgery, Sørlandet Hospital, Kristiansand, Norway.,Haukeland University Hospital, Bergen, Norway
| | - Wenche Moe Thorstensen
- Dept of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway.,Dept of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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19
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Stefani K, Baxter C, Crittenden T, Dean NR. Normative data for the Nasal Obstruction Symptom Evaluation Scale in the general Australian population. ANZ J Surg 2020; 90:2304-2309. [PMID: 32419225 DOI: 10.1111/ans.15990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recent changes to the Australian Medicare Benefits Scheme have introduced the NOSE Score as a criteria threshold for funding rhinoplasty. On review of the literature, however, there is minimal normative Nasal Obstruction Symptom Evaluation (NOSE) score data to provide context for these changes. METHODS Participants were recruited according to the general Australian population distribution of age (18-65 years), gender and geographical locations using the market research company Pureprofile. The data included demographic details, risk factors for nasal obstruction such as smoking, obstructive sleep apnoea, use of continuous positive airway pressure, history of nasal trauma, operations to the nose and a history of cleft lip/palate and each participant completed the NOSE Scale. Analysis of data included descriptive statistics, independent t-tests and one-way analysis of variances to assess differences in NOSE scores between risk factors. RESULTS The NOSE score was completed by 247 males and 255 females with a mean age of 41(±13.39) years. The cohort had a mean NOSE score of 16 (±18.89) with a range from 0 to 95. A total of 48 respondents had a NOSE score greater than the Medicare threshold of >45. Cleft lip/palate, obstructive sleep apnoea and continuous positive airway pressure use were shown to have a statistically significant impact on NOSE score while other variables including body mass index, gender, smoking, location and other surgery to the nose were not shown to significantly impact results. CONCLUSIONS This study found that 9.6% of the general Australian population would have a NOSE score >45 and qualify for the Medicare Benefits Scheme rhinoplasty benefit.
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Affiliation(s)
- Kristian Stefani
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Claire Baxter
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Tamara Crittenden
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicola R Dean
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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20
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Feleszko W, Rossi GA, Krenke R, Canonica GW, Van Gerven L, Kalyuzhin O. Immunoactive preparations and regulatory responses in the respiratory tract: potential for clinical application in chronic inflammatory airway diseases. Expert Rev Respir Med 2020; 14:603-619. [PMID: 32250709 DOI: 10.1080/17476348.2020.1744436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The prevalence of chronic inflammatory airway diseases is rising. Their treatment with corticosteroids increases infection risk, while overuse of antimicrobial agents may increase morbidity and antimicrobial resistance. Nonspecific immunomodulatory compounds alter immune responses to both infectious and atopic challenges. These compounds may offer an alternative approach for symptom reduction and prophylaxis against both infections and exacerbations in chronic inflammatory airway disease.Areas covered: We assessed the available data on the efficacy of nonspecific immunomodulators including bacterial lysates, synthetic compounds, and vaccines in chronic rhinosinusitis (CRS); allergic and non-allergic rhinitis; chronic obstructive pulmonary disease (COPD), and asthma. A search of PubMed was carried out using the 'Clinical Trials' filter for each condition and immunomodulatory product detailed below, where available, data from meta-analyses were reported.Expert opinion: Pre-clinical data has revealed a coherent mechanistic path of action for oral immunomodulators on the respiratory immune system, principally via the gut-lung immune axis. In patients with asthma, allergic rhinitis, CRS, and COPD immunomodulatory therapy reduces symptoms, exacerbations, hospitalizations, and drug consumption. However, data are heterogeneous, and study quality remains limited. A lack of high-quality recent trials remains the major unmet research need in the field.
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Affiliation(s)
- Wojciech Feleszko
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - Giovanni A Rossi
- Chief Emeritus, Pediatric Pulmonology and Allergy Units, Cystic Fibrosis Regional Centre, IRCCS G. Gaslini, Genoa, Italy
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases & Allergy, Medical University of Warsaw, Warsaw, Poland
| | - G Walter Canonica
- Personalized Medicine Asthma & Allergy, Clinic-Humanitas University & Research Hospital, Milan, Italy
| | - Laura Van Gerven
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Oleg Kalyuzhin
- Professor of Department of Clinical Immunology and Allergy, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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21
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Xu X, Ong YK, Wang DY. Novel findings in immunopathophysiology of chronic rhinosinusitis and their role in a model of precision medicine. Allergy 2020; 75:769-780. [PMID: 31512248 DOI: 10.1111/all.14044] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/26/2019] [Accepted: 09/01/2019] [Indexed: 02/06/2023]
Abstract
Our understanding of the pathophysiology of chronic rhinosinusitis (CRS) is continuously evolving. The traditional description of CRS in terms of two phenotypes based on the presence or absence of nasal polyps belies the underlying intricate immunopathophysiological processes responsible for this condition. CRS is being increasingly recognized as a disease spectrum encompassing a range of inflammatory states in the sinonasal cavity, with non-type 2 inflammatory disease on one end, type 2 inflammatory, eosinophil-heavy disease on the other and an overlap of both in different proportions in between. Abundance in research on the immune mechanisms of CRS has revealed various new endotypes that hold promise as biomarkers for the development of targeted therapies in severe, uncontrolled CRS. The introduction of precision medicine to manage this chronic, complex condition is a step forward in providing individualized care for all patients with CRS. In this review, the latest research on the pathophysiology of CRS with a focus on potential novel biomarkers and treatment options over the last 2 years are summarized and integrated into a suggested model of precision medicine in CRS.
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Affiliation(s)
- Xinni Xu
- Department of Otolaryngology‐Head and Neck Surgery National University Hospital System (NUHS) Singapore Singapore
| | - Yew Kwang Ong
- Department of Otolaryngology‐Head and Neck Surgery National University Hospital System (NUHS) Singapore Singapore
| | - De Yun Wang
- Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
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22
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Bergqvist J, Andersson A, Schiöler L, Olin AC, Murgia N, Bove M, Janson C, Abramson MJ, Leynaert B, Nowak D, Franklin KA, Pin I, Storaas T, Schlünssen V, Heinrich J, Hellgren J. Non-infectious rhinitis is more strongly associated with early-rather than late-onset of COPD: data from the European Community Respiratory Health Survey (ECRHS). Eur Arch Otorhinolaryngol 2020; 277:1353-1359. [PMID: 32048027 PMCID: PMC7160078 DOI: 10.1007/s00405-020-05837-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is associated with several co-morbidities and non-infectious rhinitis (NIR) has emerged as a new possible co-morbidity. The primary aim of this study is to confirm a previously reported association between NIR and COPD in a multicentre population over time. The secondary aim is to investigate the course over time of such an association through a comparison between early- and late-onset COPD. METHODS This study is part of the European Community Respiratory Health Survey (ECRHS). A random adult population from 25 centres in Europe and one in Australia was examined with spirometry and answered a respiratory questionnaire in 1998-2002 (ECRHS II) and in 2008-2013 (ECRHS III). Symptoms of non-infectious rhinitis, hay fever and asthma, and smoking habits were reported. Subjects reporting asthma were excluded. COPD was defined as a spirometry ratio of FEV1/FVC < 0.7. A total of 5901 subjects were included. RESULTS Non-infectious rhinitis was significantly more prevalent in subjects with COPD compared with no COPD (48.9% vs 37.1%, p < 0.001) in ECRHS II (mean age 43) but not in ECHRS III (mean age 54). In the multivariable regression model adjusted for COPD, smoking, age, BMI, and gender, non-infectious rhinitis was associated with COPD in both ECRHS II and III. CONCLUSION Non-infectious rhinitis was significantly more common in subjects with COPD at a mean age of 43. Ten years later, the association was weaker. The findings indicate that NIR could be associated with the early onset of COPD.
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Affiliation(s)
- Joel Bergqvist
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 9, 413 45, Gothenburg, Sweden.
| | - Anders Andersson
- COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Carin Olin
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicola Murgia
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Mogens Bove
- Department of ENT and Oral Maxillofacial Surgery, NU Hospital Group, Trollhättan, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bénédicte Leynaert
- Inserm UMR1152, Pathophysiology and Epidemiology of Respiratory Diseases, University of Paris, Paris, France
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Karl A Franklin
- Department of Surgery and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Isabelle Pin
- Pneumologie Pédiatrique, Antenne Pédiatrique du CIC, Grenoble, France
| | - Torgeir Storaas
- SKS/RAAO-Helse Vest, Haukeland universitetssjukehus, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus University and the National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center (CPC), University Hospital, LMU Munich, Munich, Germany
| | - Johan Hellgren
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 9, 413 45, Gothenburg, Sweden
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23
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Baschal EE, Larson ED, Bootpetch Roberts TC, Pathak S, Frank G, Handley E, Dinwiddie J, Moloney M, Yoon PJ, Gubbels SP, Scholes MA, Cass SP, Jenkins HA, Frank DN, Yang IV, Schwartz DA, Ramakrishnan VR, Santos-Cortez RLP. Identification of Novel Genes and Biological Pathways That Overlap in Infectious and Nonallergic Diseases of the Upper and Lower Airways Using Network Analyses. Front Genet 2020; 10:1352. [PMID: 32010199 PMCID: PMC6979043 DOI: 10.3389/fgene.2019.01352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022] Open
Abstract
Previous genetic studies on susceptibility to otitis media and airway infections have focused on immune pathways acting within the local mucosal epithelium, and outside of allergic rhinitis and asthma, limited studies exist on the overlaps at the gene, pathway or network level between the upper and lower airways. In this report, we compared [1] pathways identified from network analysis using genes derived from published genome-wide family-based and association studies for otitis media, sinusitis, and lung phenotypes, to [2] pathways identified using differentially expressed genes from RNA-sequence data from lower airway, sinus, and middle ear tissues, in particular cholesteatoma tissue compared to middle ear mucosa. For otitis media, a large number of genes (n = 1,806) were identified as differentially expressed between cholesteatoma and middle ear mucosa, which in turn led to the identification of 68 pathways that are enriched in cholesteatoma. Two differentially expressed genes CR1 and SAA1 overlap in middle ear, sinus, and lower airway samples and are potentially novel genes for otitis media susceptibility. In addition, 56 genes were differentially expressed in both tissues from the middle ear and either sinus or lower airways. Pathways that are common in upper and lower airway diseases, whether from published DNA studies or from our RNA-sequencing analyses, include chromatin organization/remodeling, endocytosis, immune system process, protein folding, and viral process. Taken together, our findings from genetic susceptibility and differential tissue expression studies support the hypothesis that the unified airway theory wherein the upper and lower respiratory tracts act as an integrated unit also applies to infectious and nonallergic airway epithelial disease. Our results may be used as reference for identification of genes or pathways that are relevant to upper and lower airways, whether common across sites, or unique to each disease.
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Affiliation(s)
- Erin E Baschal
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Eric D Larson
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Tori C Bootpetch Roberts
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Shivani Pathak
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gretchen Frank
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elyse Handley
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, United States
| | - Jordyn Dinwiddie
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, United States
| | - Molly Moloney
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Patricia J Yoon
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, United States
| | - Samuel P Gubbels
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Melissa A Scholes
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, United States
| | - Stephen P Cass
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Herman A Jenkins
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel N Frank
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ivana V Yang
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - David A Schwartz
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Vijay R Ramakrishnan
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Regie Lyn P Santos-Cortez
- Department of Otolaryngology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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24
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Paiva Ferreira LKD, Paiva Ferreira LAM, Monteiro TM, Bezerra GC, Bernardo LR, Piuvezam MR. Combined allergic rhinitis and asthma syndrome (CARAS). Int Immunopharmacol 2019; 74:105718. [PMID: 31255882 DOI: 10.1016/j.intimp.2019.105718] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/30/2019] [Accepted: 06/21/2019] [Indexed: 12/22/2022]
Abstract
Combined allergic rhinitis and asthma syndrome (CARAS) is a concept of "one airway - one disease" or "unified airway disease ". The upper and lower airway inflammation characterizes allergic rhinitis and asthma, respectively and both diseases have shown an intimate connection in their genesis, coexistence and similarities as triggered by the same etiological agents; the same inflammatory cell profile and share therapeutic treatment. This review highlights the concept of CARAS by its phenotype, endotype and biomarker classification. Indeed, rhinitis is divided into four major phenotypes: allergic rhinitis; infectious rhinitis; non-infective/non-allergic rhinitis and mixed rhinitis. On the other hand, asthma has no common consensus yet; however, the most accepted classification is based on the stage of life (early- or late- onset asthma) in which the clinical symptoms are presented. Experimental researches where animals develop a syndrome similar to CARAS have been contributed to better understand the pathogenesis of the syndrome. Therefore, the aim of this review is to clarify current terms related to CARAS as definition, phenotypes, endotypes/biomarkers, physiopathology and treatments.
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Affiliation(s)
- Laércia K D Paiva Ferreira
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Larissa A M Paiva Ferreira
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Talissa M Monteiro
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Grasiela Costa Bezerra
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Larissa Rodrigues Bernardo
- Department of Physiology and Pathology, Graduate Program in Development and Technological Innovation of Medicines, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Marcia Regina Piuvezam
- Department of Physiology and Pathology, Graduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba, João Pessoa, PB, Brazil; Department of Physiology and Pathology, Graduate Program in Development and Technological Innovation of Medicines, Federal University of Paraíba, João Pessoa, PB, Brazil.
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25
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Hosseini S, Golshahi L. An in vitro evaluation of importance of airway anatomy in sub-regional nasal and paranasal drug delivery with nebulizers using three different anatomical nasal airway replicas of 2-, 5- and 50-Year old human subjects. Int J Pharm 2019; 563:426-436. [DOI: 10.1016/j.ijpharm.2019.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 11/30/2022]
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26
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Yii ACA, Tay T, Choo XN, Koh MSY, Tee AKH, Wang D. Precision medicine in united airways disease: A "treatable traits" approach. Allergy 2018; 73:1964-1978. [PMID: 29869791 DOI: 10.1111/all.13496] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/21/2022]
Abstract
United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma-allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms). The UAD paradigm also extends to myriad sinonasal diseases (eg, chronic rhinosinusitis with or without nasal polyps) and lower airway diseases (eg, bronchiectasis, chronic obstructive pulmonary disease). Here, we review currently known phenoendotypes of UAD and propose a "treatable traits" approach for the classification and management of UAD, wherein pathophysiological mechanisms and factors contributing to disease are identified and targeted for treatment. Treatable traits in UAD can be analyzed according to a framework comprising airway inflammation (eosinophilic, neutrophilic), impaired airway mucosal defense (impaired mucociliary clearance, antibody deficiency), and exogenous cofactors (allergic sensitizers, tobacco smoke, microbes). Appreciation of treatable traits is necessary in advancing the effort to deliver precise treatments and achieve better outcomes in patients with UAD.
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Affiliation(s)
- A. C. A. Yii
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - T.‐R. Tay
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - X. N. Choo
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - M. S. Y. Koh
- Department of Respiratory and Critical Care Medicine Singapore General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - A. K. H. Tee
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - D.‐Y. Wang
- Department of Otolaryngology National University of Singapore Singapore
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27
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Price DB, Smith PK, Harvey RJ, Carney AS, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner D, Carter V, Durieux AM. Real-life treatment of rhinitis in Australia: a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease. Pragmat Obs Res 2018; 9:43-54. [PMID: 30147391 PMCID: PMC6101013 DOI: 10.2147/por.s153266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The aim of the study was to explore rhinitis therapy purchases in different Australian regions for patients with and without additional respiratory disease, using both doctor's prescriptions and over-the-counter (OTC) medications. PATIENTS AND METHODS It was a historical cohort study of pharmacy-related claims that included prescription or OTC rhinitis therapy, with or without asthma/COPD therapy, from January 2013 to December 2014. RESULTS Overall, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over a calendar year; the majority were single-therapy purchases for rhinitis only patients. More multiple-therapy was purchased for rhinitis and asthma/COPD patients (4.4%) than for rhinitis only patients (4.0%), with a greater proportion purchased in VIC, SA and TAS (4.7% of rhinitis only patients and 4.5% of rhinitis and asthma/COPD patients) than in other areas. Dual therapy of oral antihistamine (OAH) and intranasal corticosteroid (INS) were the most frequently purchased multiple-therapy, with higher purchasing rates for rhinitis and asthma/COPD patients (2.6%) than for rhinitis only patients (1.6%). The most frequently purchased single therapy was OAH (70.1% of rhinitis only patients and 57.3% of rhinitis and asthma/COPD patients). First-line INS therapy was more likely to be purchased for rhinitis and asthma/COPD patients (15.3% by prescription and 11.7% OTC) than for rhinitis only patients (5.0% by prescription and 9.2% OTC); however, geographical differences in the proportion of therapies purchased OTC were noted, with a lower proportion of OTC OAH and INS purchases in Queensland and the Northern Territory for patients with and without comorbid respiratory disease. CONCLUSION Purchases of first-line INS therapy are more likely for patients with comorbid respiratory disease if they have received prescriptions and information/advice from their general practitioner. The study results indicate a need for patient information/education at the point-of-sale of OTC OAHs to enable patients to assess their nasal symptoms and receive treatment support from pharmacists. Greater availability to INSs in pharmacies as well as guidance from current guidelines and instruction in correct intranasal technique may also lead to greater uptake of INSs.
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Affiliation(s)
- David B Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK,
- Observational and Pragmatic Research Institute, Singapore, Singapore,
- Optimum Patient Care, Cambridge, UK,
| | - Pete K Smith
- Clinical Medicine, Griffith University, Southport, QLD, Australia
| | - Richard John Harvey
- Rhinology and Skull Base, Applied Medical Research Centre, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - A Simon Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinders University, Adelaide, SA, Australia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
| | - Sinthia Z Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | | | | | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore,
- Optimum Patient Care, Cambridge, UK,
| | - Alice Ms Durieux
- Observational and Pragmatic Research Institute, Singapore, Singapore,
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28
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Calabrese C, Costigliola A, Maffei M, Simeon V, Perna F, Tremante E, Merola E, Leone CA, Bianco A. Clinical impact of nasal budesonide treatment on COPD patients with coexistent rhinitis. Int J Chron Obstruct Pulmon Dis 2018; 13:2025-2032. [PMID: 29988687 PMCID: PMC6029594 DOI: 10.2147/copd.s165857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background A high percentage of patients with COPD report chronic nasal symptoms. The study aims to evaluate the clinical impact of a 2-month treatment with inhaled nasal budesonide (100 µg per nostril twice daily) in patients affected by COPD with chronic rhinitis comorbidity. Patients and methods Fifty-three stable COPD patients in therapy according to the Global initiative for chronic Obstructive Lung Disease recommendations were enrolled; 49 completed the study. At enrollment (visit 0), patients underwent skin prick test and rhinoscopy. At visit 0 and after 1 month (visit 1) and 2 months (visit 2) of therapy with nasal budesonide, patients underwent spirometry, and COPD assessment test (CAT), Sinonasal Outcome Test (SNOT 22), and modified Medical Research Council dyspnea scale were administered. Differences in continuous variables, after 2 months of treatment with nasal budesonide, were evaluated using a paired t-test or Wilcoxon matched-pairs signed-ranks test. Results Two months of treatment with nasal budesonide showed a significant statistical improvement in the total scores of CAT, SNOT 22, and modified Medical Research Council (p<0.001). A significant relationship between CAT and SNOT 22 total scores at baseline and after treatment was observed. Conclusion The results of the present study indicate the importance of careful evaluation of the presence of chronic nasal symptoms in all COPD patients and suggest beneficial clinical effect from treatment with nasal budesonide in terms of COPD symptoms and quality of life.
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Affiliation(s)
- Cecilia Calabrese
- Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy,
| | - Adriano Costigliola
- Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy,
| | - Marianna Maffei
- Ear Nose and Throat Unit and Neck Surgery, Monaldi Hospital, Naples, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Perna
- Department of Clinical Medicine and Surgery, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Eugenio Tremante
- Ear Nose and Throat Unit and Neck Surgery, Monaldi Hospital, Naples, Italy
| | - Elena Merola
- Bronchoscopic Unit, Public Hospital, Eboli, Italy
| | | | - Andrea Bianco
- Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy,
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Callebaut I, Hox V, Bobic S, Bullens DM, Janssens W, Dupont L, Hellings PW. Effect of Nasal Anti-Inflammatory Treatment in Chronic Obstructive Pulmonary Disease. Am J Rhinol Allergy 2018; 27:273-7. [DOI: 10.2500/ajra.2013.27.3887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Sinonasal inflammation and symptoms are often underdiagnosed in chronic obstructive pulmonary disease (COPD) patients. So far, it is not known to what extent anti-inflammatory nasal treatment may reduce sinonasal symptoms in COPD patients. This study was designed to examine the effects of nasal anti-inflammatory treatment on sinonasal symptoms and cough in COPD patients. Methods Thirty-three COPD patients on stable bronchial therapy (salmeterol/fluticasone propionate 50/500 mg b.i.d. for >6 weeks) were randomized to receive fluticasone furoate (FF) or placebo nasal spray at 110 μg once daily for 12 weeks. Sinonasal symptoms and cough were monitored at baseline, at 6 and 12 weeks of treatment, and at 4 weeks after cessation of the treatment using a visual analog scale. Levels of cytokines were measured in nasal secretions. Results In contrast to the placebo group (n = 13), FF patients (n = 14) reported less nasal blockage (10.62 ± 4.21 mm versus 36.57 ± 8.01 mm; p = 0.0026), postnasal drip (1.46 ± 0.29 score versus 2.83 ± 0.38 score; p = 0.03), and nasal discharge (0.23 ± 0.12 score versus 1.77 ± 0.43 score; p = 0.01) after 6 weeks of treatment compared with baseline, which was still present at 12 weeks. FF patients reported less cough compared with baseline (25.54 ± 4.46 mm versus 36.79 ± 5.75 mm; p = 0.04), which was not the case in the placebo group (49.58 ± 10.44 mm versus 42.00 ± 8.05 mm; p = 0.38). Nine of 14 patients in the FF group (64%) reported slight to total relief of nasal symptoms, and this subgroup had a significant decrease in IL-8 levels in nasal secretions after 6 weeks of treatment (850.7 ± 207.2 pg/mL versus 1608 ± 696.5 pg/mL; p = 0.03) compared with baseline. Conclusion Nasal FF treatment in COPD patients significantly reduced sinonasal symptoms, in parallel with reduced IL-8 in nasal secretion levels and cough.
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Affiliation(s)
- Ina Callebaut
- Clinical Immunology, Department of Microbiology and Immunology, Catholic University of Leuven, Belgium
| | - Valérie Hox
- Clinical Immunology, Department of Microbiology and Immunology, Catholic University of Leuven, Belgium
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Belgium
| | - Sonja Bobic
- Clinical Immunology, Department of Microbiology and Immunology, Catholic University of Leuven, Belgium
| | - Dominique M.A. Bullens
- Clinical Immunology, Department of Microbiology and Immunology, Catholic University of Leuven, Belgium
| | - Wim Janssens
- Division of Pneumology, Department of Clinical and Experimental Medicine, Catholic University of Leuven, Belgium
| | - Lieven Dupont
- Division of Pneumology, Department of Clinical and Experimental Medicine, Catholic University of Leuven, Belgium
| | - Peter W. Hellings
- Clinical Immunology, Department of Microbiology and Immunology, Catholic University of Leuven, Belgium
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Belgium
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Chaker AM. [Biologics in Rhinology - Forthcoming Personalized Concepts: the Future Starts Today]. Laryngorhinootologie 2018; 97:S142-S184. [PMID: 29905356 PMCID: PMC6541111 DOI: 10.1055/s-0043-123484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sinunasale Erkrankungen zählen mit zu den häufigsten chronischen Erkrankungen und führen zu einer erheblichen Störung der Lebensqualität, ein komorbides Asthma ist häufig. Trotz leitliniengerechter Therapie ist anzunehmen, dass mind. 20% der Patienten ihre Erkrankungssymptome nicht adäquat kontrollieren können. Neben den etablierten chirurgischen und konservativen Therapieoptionen finden sich nun vielversprechende Therapieansätze, die bspw. mittels therapeutischer Antikörper mechanistisch gezielt in die Pathophysiologie der Erkrankungen eingreifen können. Die Auswahl der geeigneten Patienten durch geeignete Biomarker und die richtige Therapie zum richtigen Stadium der Erkrankung anbieten zu können, ist das Ziel stratifizierter Medizin und eine wichtige Perspektive für die HNO.Chronic diseases of the nose and the paranasal sinuses are most common, frequently associated with bronchial asthma, and result in substantial reduction of quality of life. Despite optimal treatment according to guidelines, approx. 20 % of the patients will report inadequate control of symptoms. Apart from well established surgical and conservative approaches in therapy new therapeutic antibodies are available that aim specifically pathophysiological targets. The optimal allocation of effective therapy for patients using appropriate biomarkers at the most suitable timepoint is the hallmark of stratified medicine and an important perspective in ENT.
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Affiliation(s)
- Adam M. Chaker
- Klinik für Hals-Nasen-Ohrenheilkunde und Zentrum für Allergie und Umwelt, Klinikum rechts der Isar, Technische Universität München
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MiR-3202 protects smokers from chronic obstructive pulmonary disease through inhibiting FAIM2: An in vivo and in vitro study. Exp Cell Res 2017; 362:370-377. [PMID: 29208459 DOI: 10.1016/j.yexcr.2017.11.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 12/14/2022]
Abstract
Previous study found the variable miR-3202 as a potential biomarker in smoker with or without chronic obstructive pulmonary disease (COPD). This study aims to identify the molecular involvement of miR-3202 in the pathophysiology of COPD. Level of miR-3202 in blood sample of non-smoker non-COPD(C), smoker without COPD(S), smoker with stable COPD(S-COPD) and smoker with acute exacerbation COPD(AE-COPD) was observed by quantitative real-time PCR. By bioinformatics prediction, Fas apoptotic inhibitory molecule 2 (FAIM2) was identified as a potential target of miR-3202. In vitro, human bronchial epithelial (HBE) cells and cigarette smoke extract (CSE) stimulated T lymphocytes were co-cultured. Cell proliferation and apoptosis of HBE cells were determinated. In vivo, rats were exposed in cigarette smoke for 30 days and expression of miR-3202 and FAIM2 in bronchia were detected. Results showed that The miR-3202 was down-regulated in S, S-COPD and AE-COPD group when compared with C group. Decreased level of miR-3202 was also observed in CSE treated T lymphocyte. Additionally, CSE stimulation increased INF-γ and TNF-α levels and FAIM2 expression whereas inhibited Fas and FasL expressions in T lymphocytes. However, these effects were significantly suppressed by miR-3202 overexpression and enhanced by miR-3202 inhibitor. Likely to exogenous miR-3202, FAIM2 knockdown significantly inhibited HBE cells apoptosis, as well as inhibited INF-γ and TNF-α levels. In COPD rats model, miR-3202 was reduced while FAIM2 was up-regulated accordingly. Here, results suggest that high level miR-3202 in T lymphocytes may protect epithelial cells through targeting FAIM2. MiR-3202 might be used as a notable biomarker of COPD.
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Kumar A, Kunal S, Shah A. Frequency and effect of type 1 hypersensitivity in patients from India with chronic obstructive pulmonary disease and associated upper airways symptoms. Asia Pac Allergy 2017; 7:199-205. [PMID: 29094017 PMCID: PMC5663747 DOI: 10.5415/apallergy.2017.7.4.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/19/2017] [Indexed: 01/04/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is now recognized as a systemic disorder with many comorbidities. Atopy in patients with COPD and upper airways symptoms has not been characterized. Objective We investigated the occurrence and impact of aeroallergen sensitisation in patients with COPD and upper airways symptoms. Methods All 41 subjects with COPD diagnosed as per Global Initiative for Chronic Obstructive Lung Disease guidelines, underwent spirometry with reversibility, computed tomography of the paranasal sinuses (CT-PNS), skin prick test (SPT) against common aeroallergens and responded to St. George's Respiratory Questionnaire (SGRQ) and Sino Nasal Outcome Test - 22 (SNOT-22) questionnaires. Upper airways symptoms were assessed as per the Allergic Rhinitis and its Impact on Asthma guidelines. Results As documented earlier, 27 of the 41 patients (65.9%) with COPD had upper airways symptoms. Of these 27 patients, 11 had SPT positivity against at least one aeroallergen (group 1). One patient had monosensitisation to pollens of grass Imperata while polysensitisation was seen in 10/11 patients commonly to weeds, trees, and insects. Fungal sensitisation to Aspergillus fumigatus was seen in 3 of 11 patients (27.2%). In group 1, all 11 patients (100%) had radiological sinusitis as compared to 8 of 16 (50%) in group 2. The mean CT-PNS scores were significantly higher in group 1 as compared to group 2. Similarly, the SNOT-22 scores were significantly higher in group 1 as compared to group 2. However, there was no difference in SGRQ scores between the 2 groups. In group 1, there was a significant correlation between CT-PNS and SNOT-22 scores. Conclusion Patients with COPD, associated upper airways symptoms and a positive SPT had a significantly higher frequency of radiological sinusitis on CT-PNS. They even had worse quality of life as compared to those with a negative SPT. The study suggested that atopic patients with COPD and upper airways involvement were more symptomatic. It is therefore possible that upper airways symptoms, if left untreated, would result in less than desirable control of the disease.
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Affiliation(s)
- Avi Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India
| | - Shekhar Kunal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India
| | - Ashok Shah
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India
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Berger M, Geng B, Cameron DW, Murphy LM, Schulman ES. Primary immune deficiency diseases as unrecognized causes of chronic respiratory disease. Respir Med 2017; 132:181-188. [PMID: 29229095 DOI: 10.1016/j.rmed.2017.10.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/13/2017] [Accepted: 10/20/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND More than half of all primary immune deficiency diseases (PIDD) affect antibody production and are well known as causes of recurrent sinusitis and lung infections. Chronic and recurrent infections of the upper and/or lower airways can contribute to inflammatory and obstructive processes in the lower airways which are initially reversible and considered "asthma", but can eventually cause irreversible remodeling and chronic obstructive pulmonary disease (COPD). Conversely, several lines of evidence suggest that many patients who present with a diagnosis of asthma have an increased incidence of infection, suggesting underlying host-defense defects. Asthma and respiratory infections in the first decades of life are recognized as risk factors for development of COPD, but when patients present with COPD as adults, underlying primary immune deficiency disease may be unrecognized. MAIN FINDINGS AND CONCLUSIONS Detection of PIDD as a potentially treatable underlying contributor to recurrent/acute exacerbations and morbidity of COPD, and provision of immunoglobulin (Ig) G replacement therapy, when appropriate, may decrease the progression of COPD. Decreasing the severity and rate of exacerbations and admissions should improve the quality of life and longevity of an important subset of patients with COPD, while decreasing costs. Major steps toward achieving these goals include developing a high index of suspicion, more frequent use and appropriate interpretation of screening tests such as quantitative immunoglobulins and vaccine responses, and prompt institution of IgG replacement therapy when antibody deficiency has been diagnosed.
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Affiliation(s)
- Melvin Berger
- CSL Behring, 1020 First Avenue, King of Prussia, PA 19406, USA.
| | - Bob Geng
- Department of Medicine, University of California at San Diego, 200W Arbor Dr Frnt, San Diego, CA 92103, USA.
| | - D William Cameron
- Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
| | | | - Edward S Schulman
- Department of Medicine, Drexel University College of Medicine, 219 N. Broad Street, The Arnold T. Berman MD Building, 9th Floor, Philadelphia 19107, USA.
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Hellings PW, Fokkens WJ, Bachert C, Akdis CA, Bieber T, Agache I, Bernal-Sprekelsen M, Canonica GW, Gevaert P, Joos G, Lund V, Muraro A, Onerci M, Zuberbier T, Pugin B, Seys SF, Bousquet J. Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement. Allergy 2017; 72:1297-1305. [PMID: 28306159 DOI: 10.1111/all.13162] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/20/2022]
Abstract
Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim of the current document was to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second-level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its implementation and the high cost of molecular diagnosis and biological treatment.
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Affiliation(s)
- P. W. Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery; UZ Leuven; Leuven Belgium
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
- Department of Otorhinolaryngology-Head and Neck Surgery; Upper Airways Research Laboratory; Ghent University; Ghent Belgium
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
| | - C. Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery; Upper Airways Research Laboratory; Ghent University; Ghent Belgium
- Department of Otorhinolaryngology; Karolinska Institute; Stockholm Sweden
| | - C. A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); Christine-Kühne Center for Allergy Research and Education; University of Zurich; Davos Switzerland
| | - T. Bieber
- Department of Dermatology and Allergy; Christine Kühne-Center for Allergy Research and Education; Friedrich-Wilhelms-University; Bonn Germany
| | - I. Agache
- Faculty of Medicine; Transylvania University; Brasov Romania
| | - M. Bernal-Sprekelsen
- Department of Otorhinolaryngology; Hospital Clínic Universitari; Barcelona Spain
| | - G. W. Canonica
- Department of Biomedical Science; Personalized Medicine Clinic Asthma & Allergy; Humanitas Clinical and Research Center; Humanitas University - Rozzano (Milano); Rozzano Italy
| | - P. Gevaert
- Department of Otorhinolaryngology-Head and Neck Surgery; Upper Airways Research Laboratory; Ghent University; Ghent Belgium
| | - G. Joos
- Department of Respiratory Medicine; Ghent University; Ghent Belgium
| | - V. Lund
- Royal National Throat, Nose and Ear Hospital; University College London Hospitals; London UK
| | - A. Muraro
- Department of Women and Child Health; Food Allergy Referral Centre Veneto Region; Padua General University Hospital; Padua Italy
| | - M. Onerci
- Department of Otorhinolaryngology Head and Neck Surgery; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - T. Zuberbier
- Department of Dermatology and Allergy; Comprehensive Allergy-Centre-Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - B. Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA); Brussels Belgium
| | - S. F. Seys
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA); Brussels Belgium
- Department of Immunology and Microbiology; Laboratory of Clinical Immunology; KU Leuven; Leuven Belgium
| | - J. Bousquet
- Department of Respiratory Disease; University Hospital Arnaud de Villeneuve; Montpellier France
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De Greve G, Hellings PW, Fokkens WJ, Pugin B, Steelant B, Seys SF. Endotype-driven treatment in chronic upper airway diseases. Clin Transl Allergy 2017; 7:22. [PMID: 28706720 PMCID: PMC5506670 DOI: 10.1186/s13601-017-0157-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/05/2017] [Indexed: 12/31/2022] Open
Abstract
Rhinitis and rhinosinusitis are the two major clinical entities of chronic upper airway disease. Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) affect respectively up to 10 and 30% of the total population, hence being associated with an important socio-economic burden. Different phenotypes of rhinitis and CRS have been described based on symptom severity and duration, atopy status, level of control, comorbidities and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different, and sometimes overlapping, endotypes being recognized. Type 2 inflammation is well characterized in both AR and CRS with nasal polyps (CRSwNP), whereas type 1 inflammation is found in infectious rhinitis and CRS without nasal polyps (CRSsNP). The neurogenic endotype has been demonstrated in some forms of non-allergic rhinitis. Epithelial barrier dysfunction is shown in AR and CRSwNP. Emerging therapies are targeting one specific pathophysiological pathway or endotype. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment. Personalized medicine is addressing the issue of providing targeted treatment for the right patient and should be seen as one aspect of the promising trend towards precision medicine. This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.
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Affiliation(s)
- Glynnis De Greve
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Louvain, Belgium
| | - Peter W Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Louvain, Belgium
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Ghent, Belgium
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Benoit Pugin
- Laboratory of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Herestraat 49/PB811, 3000 Louvain, Belgium
| | - Brecht Steelant
- Laboratory of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Herestraat 49/PB811, 3000 Louvain, Belgium
| | - Sven F Seys
- Laboratory of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Herestraat 49/PB811, 3000 Louvain, Belgium
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Kumar A, Kunal S, Shah A. Incidence and Impact of Upper Airway Symptoms in Patients With Chronic Obstructive Pulmonary Disease. Arch Bronconeumol 2017; 53:647-649. [PMID: 28676253 DOI: 10.1016/j.arbres.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/16/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Avi Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Shekhar Kunal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Ashok Shah
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Kämpe M, Vosough M, Malinovschi A, Alimohammadi M, Alving K, Forsberg B, Lötvall J, Middelveld R, Dahlén B, Janson C. Upper airway and skin symptoms in allergic and non-allergic asthma: Results from the Swedish GA 2LEN study. J Asthma 2017; 55:275-283. [PMID: 28463525 DOI: 10.1080/02770903.2017.1326132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Allergic and non-allergic asthma are viewed as separate entities, despite sharing similarities. The aims of this study were to determine differences in symptoms from the upper airways and the skin in allergic and non-allergic asthma. The secondary aims were to identify childhood risk factors and to compare quality of life in the two asthma groups. METHODS This cohort (age 17-76 years) consisted of 575 subjects with allergic or non-allergic asthma and 219 controls. The participants participated in an interview, spirometry, FeNO, skin prick test, and responded to the Mini Asthma Quality of Life Questionnaire. RESULTS Self-reported allergic rhinitis was significantly more common in both allergic and non-allergic asthma (82.3 and 40.7%) groups compared with the controls. The prevalence of chronic rhinosinusitis (CRS) was similar in both asthma groups. Eczema was significantly more common in both asthmatic groups (72.3 and 59.8%) than controls (47.0%) (p < 0.001 and p = 0.012). Severe respiratory infection in childhood and parental allergy were risk factors for both allergic and non-allergic asthma groups. Quality of life was significantly lower in non-allergic than allergic asthma groups (p = 0.01). CONCLUSION Concomitant symptoms from the upper airways and the skin were significantly more common in both allergic and non-allergic asthma. This indicates that non-allergic asthma has a systemic component with similarities to what is found in allergic asthma. There were similarities in the childhood risk factor pattern between the two types of asthma but asthma-related quality of life was lower in the non-allergic asthma group.
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Affiliation(s)
- Mary Kämpe
- a Department of Medical Sciences: Respiratory, Allergy and Sleep Research , Uppsala University , Uppsala , Sweden
| | - Maria Vosough
- a Department of Medical Sciences: Respiratory, Allergy and Sleep Research , Uppsala University , Uppsala , Sweden
| | - Andrei Malinovschi
- b Department of Medical Sciences: Clinical Physiology , Uppsala University , Uppsala , Sweden
| | - Mohammad Alimohammadi
- c Department of Medical Sciences: Dermatology , Uppsala University , Uppsala , Sweden
| | - Kjell Alving
- d Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Bertil Forsberg
- e Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Jan Lötvall
- f Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition , Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden
| | - Roelinde Middelveld
- g The Centre for Allergy Research , Karolinska Institutet , Stockholm , Sweden.,h The Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Barbro Dahlén
- i Department of Medicine, Unit for Heart and Lung disease , Karolinska institutet , Stockholm , Sweden
| | - Christer Janson
- a Department of Medical Sciences: Respiratory, Allergy and Sleep Research , Uppsala University , Uppsala , Sweden
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The Impact of Endonasal Endoscopic Sinus Surgery on Patients with Chronic Pulmonary Diseases. SINUSITIS 2017. [DOI: 10.3390/sinusitis2020004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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.
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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.
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Yang X, Xu Y, Jin J, Li R, Liu X, Sun Y. Chronic rhinosinusitis is associated with higher prevalence and severity of bronchiectasis in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:655-662. [PMID: 28260873 PMCID: PMC5325112 DOI: 10.2147/copd.s124248] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and purpose Bronchiectasis revealed by high-resolution computed tomography (HRCT) is common in chronic obstructive pulmonary disease (COPD), but the causes and risk factors remain to be determined. Chronic rhinosinusitis (CRS) is closely associated with bronchiectasis or COPD, but whether it is associated with comorbid bronchiectasis in COPD (COPD-Bx) is unknown. Patients and methods Patients with stable COPD were enrolled consecutively and evaluated for the presence of CRS by questionnaire and paranasal sinus computed tomography. The presence and severity of bronchiectasis on lung HRCT were evaluated by the Smith and severity scores. COPD symptoms were evaluated by COPD Assessment Test (CAT) and Modified British Medical Research Council Questionnaire. The sputum cell differentials and concentrations of interleukin (IL)-6, IL-8, IL-5, matrix metalloproteinases-9 (MMP-9), and tissue inhibitor of matrix metalloproteinases-1 were measured. Results We enrolled 136 patients with stable COPD, of which 66 (48.5%) were diagnosed with CRS according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) criteria. The prevalence of bronchiectasis was 57.6% in patients with CRS, but 37.1% in those without CRS (P=0.017). COPD-Bx patients with CRS showed a significantly higher severity score of bronchiectasis than those without CRS (P=0.034). COPD patients with CRS had a higher percentage of eosinophils, higher levels of IL-8, IL-6, and MMP-9 in sputum as compared to those without CRS. In COPD-Bx patients with CRS, the percentage of eosinophils and the levels of IL-6 and MMP-9 in sputum were increased as compared to those without CRS. In all the subjects, Sino-Nasal Outcome Test-20 correlated with CAT score (r=0.315, P<0.01) and in COPD patients with CRS, Lund–MacKay scores correlated with forced expiratory volume in 1 s (% pred) (r=−0.251, P<0.05). Conclusions CRS was associated with COPD-Bx and this was probably due to increased airway inflammation.
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Affiliation(s)
- Xia Yang
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University
| | - Yali Xu
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University
| | - Jianmin Jin
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University
| | - Ruimin Li
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University
| | - Xiaofang Liu
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University
| | - Yongchang Sun
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University; Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People's Republic of China
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Frendø M, Håkansson K, Schwer S, Rix I, Ravn AT, Backer V, von Buchwald C. Asthma in ear, nose, and throat primary care patients with chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy 2017; 30:67-71. [PMID: 27216338 DOI: 10.2500/ajra.2016.30.4304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder associated with asthma. This association is well described in patients with CRSwNP undergoing endoscopic sinus surgery (ESS); however, some patients are never referred for surgery, and the frequency of asthma in this group is largely unknown. OBJECTIVE To determine the frequency of asthma in patients with CRSwNP treated in a primary care (PC) setting who have never been referred for surgery and to compare this with ESS patients. METHODS Fifty-seven patients with CRSwNP who had never undergone ESS were prospectively recruited from nine PC ear, nose, and throat clinics in the Copenhagen area. CRSwNP was diagnosed according to the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps; severity was assessed by using a visual analog scale. Allergy, lung function, and asthma tests (reversibility to β2-agonist, peak expiratory flow variability, and mannitol challenge) were performed. Findings were compared with our previously published data from patients with CRSwNP referred for surgery. RESULTS Asthma was diagnosed in 25 patients (44%) based on respiratory symptoms and a positive asthma test; of these, 12 (48%) had undiagnosed asthma prior to study onset. Furthermore, when using the same methods, we found a lower frequency of asthma in PC patients compared with ESS patients (44% versus 65%, p = 0.04). CONCLUSION A high prevalence of asthma in PC patients with CRSwNP was found. Frequently, asthma was undiagnosed. However, asthma was significantly less prevalent in PC patients compared with patients referred for ESS. The frequent concomitance of asthma, i.e., united airways disease, in PC patients calls for closer collaboration between ear, nose, and throat specialists, and asthma specialists.
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Affiliation(s)
- Martin Frendø
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Białas AJ, Sitarek P, Miłkowska-Dymanowska J, Piotrowski WJ, Górski P. The Role of Mitochondria and Oxidative/Antioxidative Imbalance in Pathobiology of Chronic Obstructive Pulmonary Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:7808576. [PMID: 28105251 PMCID: PMC5220474 DOI: 10.1155/2016/7808576] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/23/2016] [Indexed: 12/12/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. The major risk factor of COPD, which has been proven in many studies, is the exposure to cigarette smoke. However, it is 15-20% of all smokers who develop COPD. This is why we should recognize the pathobiology of COPD as involving a complex interaction between several factors, including genetic vulnerability. Oxidant-antioxidant imbalance is recognized as one of the significant factors in COPD pathogenesis. Numerous exogenous and endogenous sources of ROS are present in pathobiology of COPD. One of endogenous sources of ROS is mitochondria. Although leakage of electrons from electron transport chain and forming of ROS are the effect of physiological functioning of mitochondria, there are various intra- and extracellular factors which may increase this amount and significantly contribute to oxidative-antioxidative imbalance. With the coexistence with impaired antioxidant defence, all these issues lead to oxidative and carbonyl stress. Both of these states play a significant role in pathobiology of COPD and may account for development of major comorbidities of this disease.
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Affiliation(s)
- Adam Jerzy Białas
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland
- Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Przemysław Sitarek
- Department of Biology and Pharmaceutical Botany, Medical University of Łódź, Łódź, Poland
| | - Joanna Miłkowska-Dymanowska
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland
- Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Wojciech Jerzy Piotrowski
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland
- Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Paweł Górski
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland
- Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
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Zoratti EM, Krouse RZ, Babineau DC, Pongracic JA, O'Connor GT, Wood RA, Khurana Hershey GK, Kercsmar CM, Gruchalla RS, Kattan M, Teach SJ, Sigelman SM, Gergen PJ, Togias A, Visness CM, Busse WW, Liu AH. Asthma phenotypes in inner-city children. J Allergy Clin Immunol 2016; 138:1016-1029. [PMID: 27720016 PMCID: PMC5104222 DOI: 10.1016/j.jaci.2016.06.061] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children with asthma in low-income urban areas have high morbidity. Phenotypic analysis in these children is lacking, but may identify characteristics to inform successful tailored management approaches. OBJECTIVE We sought to identify distinct asthma phenotypes among inner-city children receiving guidelines-based management. METHODS Nine inner-city asthma consortium centers enrolled 717 children aged 6 to 17 years. Data were collected at baseline and prospectively every 2 months for 1 year. Participants' asthma and rhinitis were optimally managed by study physicians on the basis of guidelines. Cluster analysis using 50 baseline and 12 longitudinal variables was performed in 616 participants completing 4 or more follow-up visits. RESULTS Five clusters (designated A through E) were distinguished by indicators of asthma and rhinitis severity, pulmonary physiology, allergy (sensitization and total serum IgE), and allergic inflammation. In comparison to other clusters, cluster A was distinguished by lower allergy/inflammation, minimally symptomatic asthma and rhinitis, and normal pulmonary physiology. Cluster B had highly symptomatic asthma despite high step-level treatment, lower allergy and inflammation, and mildly altered pulmonary physiology. Cluster C had minimally symptomatic asthma and rhinitis, intermediate allergy and inflammation, and mildly impaired pulmonary physiology. Clusters D and E exhibited progressively higher asthma and rhinitis symptoms and allergy/inflammation. Cluster E had the most symptomatic asthma while receiving high step-level treatment and had the highest total serum IgE level (median, 733 kU/L), blood eosinophil count (median, 400 cells/mm3), and allergen sensitizations (15 of 22 tested). CONCLUSIONS Allergy distinguishes asthma phenotypes in urban children. Severe asthma often coclusters with highly allergic children. However, a symptomatic phenotype with little allergy or allergic inflammation was identified.
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Affiliation(s)
- Edward M Zoratti
- Henry Ford Health System and Wayne State University School of Medicine, Detroit, Mich.
| | | | | | | | | | - Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | | | - Meyer Kattan
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Stephen J Teach
- Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Steven M Sigelman
- National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Peter J Gergen
- National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Alkis Togias
- National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | | | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Andrew H Liu
- National Jewish Health, Denver, Colo; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
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Upper respiratory symptoms worsen over time and relate to clinical phenotype in chronic obstructive pulmonary disease. Ann Am Thorac Soc 2016; 12:997-1004. [PMID: 25938279 DOI: 10.1513/annalsats.201408-359oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE How nasal symptoms in patients with chronic obstructive pulmonary disease (COPD) change over time and resolve during naturally occurring exacerbations has not been described previously. OBJECTIVES To evaluate the evolution and impact of upper airway symptoms in a well-defined COPD cohort when stable and at exacerbation. METHODS Patients in the London COPD cohort were asked about the presence of nasal symptoms (nasal discharge, sneezing, postnasal drip, blocked nose, and anosmia) over an 8-year period (2005-2013) every 3 months at routine clinic visits while in a stable state and daily during exacerbations with the use of diary cards. Data were prospectively collected, and, in a subgroup of patients, COPD Assessment Test scores and human rhinovirus identification by polymerase chain reaction were available. Patients were also defined as having infrequent or frequent exacerbations (<2 or ≥2 exacerbations/yr, respectively). MEASUREMENTS AND MAIN RESULTS At an aggregate of 4,368 visits, 209 patients with COPD were asked about their nasal symptoms. At 2,033 visits when the patients were stable, the odds ratio (OR) for nasal discharge increased by 1.32% per year (95% confidence interval [CI], 1.19-1.45; P < 0.001); the OR for sneezing increased by 1.16% (95% CI, 1.05-1.29; P = 0.005); the OR for postnasal drip increased by 1.18% (95% CI, 1.03-1.36; P = 0.016); and the OR for anosmia increased by 1.19% (95% CI, 1.03-1.37; P = 0.015). At visits when the patients were having exacerbations, nasal discharge was present for 7 days and blocked nose, sneezing, and postnasal drip increased for just 3 days. Anosmia did not change. Nasal discharge was more likely in patients with frequent exacerbations (OR, 1.96; 95% CI, 1.17-3.28; P = 0.011), and COPD Assessment Test scores were higher by 1.06 units (95% CI, 0.32-1.80; P = 0.005) when patients were stable and higher by 1.30 units (95% CI, 0.05-2.57; P = 0.042) during exacerbations. CONCLUSIONS Upper airway symptoms increase over time in patients with COPD and are related to the frequent exacerbation phenotype. These longitudinal changes may be due to increasing airway inflammation or to progression of COPD.
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Shapira Galitz Y, Halperin D, Bavnik Y, Warman M. Sino-Nasal Outcome Test-22: Translation, Cross-cultural Adaptation, and Validation in Hebrew-Speaking Patients. Otolaryngol Head Neck Surg 2016; 154:951-6. [PMID: 26908555 DOI: 10.1177/0194599816629378] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 01/07/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To perform the translation, cross-cultural adaptation, and validation of the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire to the Hebrew language. STUDY DESIGN AND SETTING A single-center prospective cross-sectional study. SUBJECTS AND METHODS Seventy-three chronic rhinosinusitis (CRS) patients and 73 patients without sinonasal disease filled the Hebrew version of the SNOT-22 questionnaire. Fifty-one CRS patients underwent endoscopic sinus surgery, out of which 28 filled a postoperative questionnaire. Seventy-three healthy volunteers without sinonasal disease also answered the questionnaire. Internal consistency, test-retest reproducibility, validity, and responsiveness of the questionnaire were evaluated. RESULTS Questionnaire reliability was excellent, with a high internal consistency (Cronbach's alpha coefficient, 0.91-0.936) and test-retest reproducibility (Spearman's coefficient, 0.962). Mean scores for the preoperative, postoperative, and control groups were 50.44, 29.64, and 13.15, respectively (P < .0001 for CRS vs controls, P < .001 for preoperative vs postoperative), showing validity and responsiveness of the questionnaire. CONCLUSION The Hebrew version of SNOT-22 questionnaire is a valid outcome measure for patients with CRS with or without nasal polyps.
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Affiliation(s)
- Yael Shapira Galitz
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; affiliated with the Hebrew University of Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; affiliated with the Hebrew University of Jerusalem, Israel
| | - Yosef Bavnik
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; affiliated with the Hebrew University of Jerusalem, Israel
| | - Meir Warman
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; affiliated with the Hebrew University of Jerusalem, Israel
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Celik H, Akpinar S, Karabulut H, Oktar P, Dursun B, Erguden HC, Gunay S, Sipit T. Evaluation of IL-8 nasal lavage levels and the effects of nasal involvement on disease severity in patients with stable chronic obstructive pulmonary disease. Inflammation 2015; 38:616-22. [PMID: 25028101 DOI: 10.1007/s10753-014-9968-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Interleukin 8 (IL-8) is used to evaluate the severity of inflammation in the airways. The aim of this study was to evaluate patients with chronic obstructive pulmonary disease (COPD) for the presence of upper respiratory tract involvement by questioning patients regarding nasal symptoms and by measuring levels of IL-8 in nasal lavage material. A total of 47 COPD patients and 23 healthy controls were enrolled in this study. Pulmonary function tests were performed for all participants who were asked to complete a Sinonasal Outcome Test-20 (SNOT-20) questionnaire on the same day, as a measure of quality of life. Median IL-8 level in nasal lavage specimens of COPD patients with stable disease was higher than that of healthy controls. An increase in cigarette pack-years was significantly associated with an increase in nasal IL-8 levels. Similarly, IL-8 levels correlated positively with stage of COPD. A significant link between number of visits to the emergency department and stage of disease was observed. Patients with COPD had a significantly higher mean SNOT-20 severity score compared to healthy controls. Proper management of sinonasal disease may help to decrease the number of COPD attacks and consequently improve quality of life.
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Affiliation(s)
- Hacer Celik
- Department of Pulmonary, Ataturk Chest Disease and Chest Surgery Training and Research Hospital, Ankara, Turkey,
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Rhinitis: A clinical marker of COPD-asthma overlap phenotype? Arch Bronconeumol 2015; 52:343. [PMID: 26548505 DOI: 10.1016/j.arbres.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/12/2015] [Accepted: 09/18/2015] [Indexed: 11/20/2022]
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Hansen AG, Helvik AS, Thorstensen WM, Nordgård S, Langhammer A, Bugten V, Stovner LJ, Eggesbø HB. Paranasal sinus opacification at MRI in lower airway disease (the HUNT study-MRI). Eur Arch Otorhinolaryngol 2015; 273:1761-8. [PMID: 26499376 DOI: 10.1007/s00405-015-3790-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/24/2015] [Indexed: 11/26/2022]
Abstract
The study builds on the concept of united airways, which describes the link between the upper and lower airways. Explorations of this concept have mainly related to asthma and less to chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate paranasal sinus opacification at magnetic resonance imaging (MRI) in COPD, self-reported asthma and respiratory symptoms. In this cross-sectional study, 880 randomly selected participants in the Nord-Trøndelag health survey (HUNT) (mean age 57.7 years, range 50-66 years, 463 women) were investigated using MRI of the paranasal sinuses. Participants were allocated to four mutually exclusive groups: (1) COPD (n = 20), (2) asthma (n = 89), (3) respiratory symptoms (n = 199), and (4) reference group (n = 572). Paranasal sinus opacifications were categorised as mucosal thickening, polyps and retention cysts, and fluid. In each participant, measurements ≥1 mm from all sinuses were summed to give a total for each category of opacities. The sums for these three categories were further added together, and referred to as the total sum. Using the 75th percentile cut-off values, the likelihood of having paranasal sinus opacifications was more than six times higher in participants with COPD and twice as high in participants with asthma than among the reference group. Respiratory symptoms were only associated with mucosal thickening. The present study shows that paranasal sinus opacification is associated not only with asthma, but also with COPD and respiratory symptoms. This is in accordance with the united airways hypothesis, and should be kept in mind when handling patients with these conditions.
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Affiliation(s)
- Aleksander Grande Hansen
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway.
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anne-Sofie Helvik
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche Moe Thorstensen
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ståle Nordgård
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnulf Langhammer
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Vegard Bugten
- Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Norwegian University of Science and Technology, 7006, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Beate Eggesbø
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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Ilmarinen P, Tuomisto LE, Kankaanranta H. Phenotypes, Risk Factors, and Mechanisms of Adult-Onset Asthma. Mediators Inflamm 2015; 2015:514868. [PMID: 26538828 PMCID: PMC4619972 DOI: 10.1155/2015/514868] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 12/11/2022] Open
Abstract
Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Genetic factors, atopy, and early respiratory tract infections are well-recognized factors predisposing to childhood-onset asthma. Adult-onset asthma is more often associated with obesity, smoking, depression, or other life-style or environmental factors, even though genetic factors and respiratory tract infections may also play a role in adult-onset disease. Adult-onset asthma is characterized by absence of atopy and is often severe requiring treatment with high dose of inhaled and/or oral steroids. Variety of risk factors and nonatopic nature of adult-onset disease suggest that variety of mechanisms is involved in the disease pathogenesis and that these mechanisms differ from the pathobiology of childhood-onset asthma with prevailing Th2 airway inflammation. Recognition of the mechanisms and mediators that drive the adult-onset disease helps to develop novel strategies for the treatment. The aim of this review was to summarize the current knowledge on the pathogenesis of adult-onset asthma and to concentrate on the mechanisms and mediators involved in establishing adult-onset asthma in response to specific risk factors. We also discuss the involvement of these mechanisms in the currently recognized phenotypes of adult-onset asthma.
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Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Leena E. Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
- Department of Respiratory Medicine, University of Tampere, 33014 Tampere, Finland
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Miłkowska-Dymanowska J, Białas AJ, Zalewska-Janowska A, Górski P, Piotrowski WJ. Underrecognized comorbidities of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015. [PMID: 26203239 PMCID: PMC4507790 DOI: 10.2147/copd.s82420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
COPD is associated with different comorbid diseases, and their frequency increases with age. Comorbidities severely impact costs of health care, intensity of symptoms, quality of life and, most importantly, may contribute to life span shortening. Some comorbidities are well acknowledged and established in doctors’ awareness. However, both everyday practice and literature searches provide evidence of other, less recognized diseases, which are frequently associated with COPD. We call them underrecognized comorbidities, and the reason why this is so may be related to their relatively low clinical significance, inefficient literature data, or data ambiguity. In this review, we describe rhinosinusitis, skin abnormalities, eye diseases, different endocrinological disorders, and gastroesophageal reflux disease. Possible links to COPD pathogenesis have been discussed, if the data were available.
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Affiliation(s)
- Joanna Miłkowska-Dymanowska
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland ; Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Adam J Białas
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland ; Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Anna Zalewska-Janowska
- Unit of Psychodermatology, Chair of Clinical Immunology and Microbiology, Medical University of Lodz, Łódź, Poland
| | - Paweł Górski
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland ; Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Wojciech J Piotrowski
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Łódź, Poland ; Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
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