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Jiang Y, An R, Cheng L, Yue Q, Zhang H, Zhang Y, Kong X, Ma H, Chen F, Guo Y. Classification of non-acute bronchial asthma according to allergy and eosinophil characteristics: a retrospective study. Allergy Asthma Clin Immunol 2021; 17:45. [PMID: 33941235 PMCID: PMC8091754 DOI: 10.1186/s13223-021-00546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Investigating the endotypes of the different asthma phenotypes would help disease monitoring, prognosis determination, and improving asthma management standardization. This study aimed to classify asthma into four endotypes according to the allergic and eosinophilic characteristics and explore the phenotypes (clinical characteristics, pulmonary functions, and fractional expired nitric oxide (FeNO)) of each endotype. METHODS This retrospective study included non-acute asthma patients treated at the First Hospital of Shanxi Medical University (05/2016-01/2018). The patients were classified into the eosinophilic allergic, eosinophilic non-allergic, non-eosinophilic allergic, and non-eosinophilic non-allergic asthma endotypes. Serum sIgE, lung function, FeNO, and induced sputum cytology were tested and compared among groups. RESULTS Of the 171 included patients, 22 had eosinophilic allergic asthma, 17 had eosinophilic non-allergic asthma, 66 had non-eosinophilic allergic asthma, and 66 had non-eosinophilic non-allergic asthma. Lung function measurements (FEV1%, FEF25%, FEF50%, FEF75%, and FEF25-75%) showed that airway dysfunction was worse in eosinophilic non-allergic asthma than in the other three endotypes (all P < 0.001). In allergic asthma patients, eosinophilic asthma had worse airway dysfunction than non-eosinophilic asthma (all P < 0.05). Similar results were found in non-allergic asthma (all P < 0.01). The FeNO levels in eosinophilic allergic asthma were higher than in eosinophilic non-allergic and non-eosinophilic non-allergic asthma (both P = 0.001). CONCLUSIONS FeNO can objectively reflect eosinophilic airway inflammation in asthma. Endotypic classification of asthma patients regarding the allergic and eosinophilic characteristics is conducive to the effective management of patients with asthma.
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Affiliation(s)
- Yi Jiang
- Department of Respiratory and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Ruoli An
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Li Cheng
- General Internal Medicine Department, People's Hospital of Wenshui County, Shanxi Province, Wenshui, Shanxi, China
| | - Qianru Yue
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hanwei Zhang
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yali Zhang
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaomei Kong
- Department of Respiratory and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongxia Ma
- Department of Respiratory and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Fang Chen
- Department of Respiratory and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yufeng Guo
- Department of Respiratory and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Zakaria NN, Malahubban M, Fakurazi S, And WSC, Rajaee AH. Anti-Inflammatory Potential of Hexane Extract of Mud Lobster ( Thalassina anomala) in Lipopolysaccharide-Stimulated RAW 264.7 Macrophages. Trop Life Sci Res 2021; 32:145-162. [PMID: 33936556 PMCID: PMC8054671 DOI: 10.21315/tlsr2021.32.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mud lobsters are crustaceans from the genus Thalassina which are lesser known and seldom seen but are nevertheless an important organism to the mangrove ecosystem. In Malaysia and Thailand, mud lobsters are eaten by locals as treatment for asthma. It is traditionally believed that they are effective in reducing the number of asthma attacks and severity of asthma symptoms. However, the therapeutic potential of mud lobster extract remains unclear and has not been fully elucidated or reported in any scientific study. The objectives of this study are to investigate the anti-inflammatory potential of mud lobster, Thalassina anomala extracts (hexane, chloroform and methanol) in lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophages, and to identify the potential bioactive compounds involved. An MTT assay was performed to determine the cytotoxicity of the T. anomala extracts on RAW 264.7 macrophages. Nitrite quantification assay and enzyme-linked immunosorbent assay (ELISA) were conducted to investigate the ability of the T. anomala extracts to suppress the secretion and expression of nitric oxide (NO), Prostaglandin E2 (PGE2) and proinflammatory cytokines (TNF-α, IL-6 and IL-1β) in LPS-stimulated macrophages. GC-MS analysis was done to identify putative metabolites. The hexane extract of T. anomala showed anti-inflammatory activity by significantly inhibiting the LPS-induced production of NO, PGE2, interleukin- (IL-) 6, IL-1β and tumour necrosis factor-alpha (TNF-α) in a concentration-dependent manner. Hexane extract treatment with 100 μg/mL has decreased the NO secretion into 37 μM. Meanwhile, hexane extract at concentration of 100 μg/mL able to significantly suppressed PGE2,TNF-α, IL-6 and IL-1β production into 2015 pg/mL, 2406 pg/mL, 460 pg/mL and 9.6 pg/mL, respectively. GC-MS analysis of the hexane extract revealed the presence of 19 putative compounds. The identified compounds were reported to have anti-inflammatory, antioxidant and antibacterial activities. These results suggest that the hexane extract of T. anomala potentially has anti-inflammatory properties and concentration dependently suppressed NO, PGE2 and proinflammatory cytokines’ production in LPS-stimulated macrophages. The findings provide a rational basis of the traditional use of mud lobster for inflammation-associated ailments.
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Affiliation(s)
- Nur Nadiah Zakaria
- Department of Animal Science and Fishery, Faculty of Agricultural Science and Forestry, Universiti Putra Malaysia Bintulu Sarawak Campus, 97000 Bintulu, Sarawak, Malaysia
| | - Masnindah Malahubban
- Department of Animal Science and Fishery, Faculty of Agricultural Science and Forestry, Universiti Putra Malaysia Bintulu Sarawak Campus, 97000 Bintulu, Sarawak, Malaysia
| | - Sharida Fakurazi
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Wong Sie Chuong And
- Department of Science and Technology, Faculty of Humanities, Management and Science, Universiti Putra Malaysia Bintulu Sarawak Campus, 97000 Bintulu, Sarawak, Malaysia
| | - Amy Halimah Rajaee
- Department of Animal Science and Fishery, Faculty of Agricultural Science and Forestry, Universiti Putra Malaysia Bintulu Sarawak Campus, 97000 Bintulu, Sarawak, Malaysia.,Halal Products Research Institute, Universiti Putra Malaysia, Putra Infoport, 43400 UPM Serdang, Selangor, Malaysia
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Ibrahim W, Wilde M, Cordell R, Salman D, Ruszkiewicz D, Bryant L, Richardson M, Free RC, Zhao B, Yousuf A, White C, Russell R, Jones S, Patel B, Awal A, Phillips R, Fowkes G, McNally T, Foxon C, Bhatt H, Peltrini R, Singapuri A, Hargadon B, Suzuki T, Ng LL, Gaillard E, Beardsmore C, Ryanna K, Pandya H, Coates T, Monks PS, Greening N, Brightling CE, Thomas P, Siddiqui S. Assessment of breath volatile organic compounds in acute cardiorespiratory breathlessness: a protocol describing a prospective real-world observational study. BMJ Open 2019; 9:e025486. [PMID: 30852546 PMCID: PMC6429860 DOI: 10.1136/bmjopen-2018-025486] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/23/2018] [Accepted: 01/08/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Patients presenting with acute undifferentiated breathlessness are commonly encountered in admissions units across the UK. Existing blood biomarkers have clinical utility in distinguishing patients with single organ pathologies but have poor discriminatory power in multifactorial presentations. Evaluation of volatile organic compounds (VOCs) in exhaled breath offers the potential to develop biomarkers of disease states that underpin acute cardiorespiratory breathlessness, owing to their proximity to the cardiorespiratory system. To date, there has been no systematic evaluation of VOC in acute cardiorespiratory breathlessness. The proposed study will seek to use both offline and online VOC technologies to evaluate the predictive value of VOC in identifying common conditions that present with acute cardiorespiratory breathlessness. METHODS AND ANALYSIS A prospective real-world observational study carried out across three acute admissions units within Leicestershire. Participants with self-reported acute breathlessness, with a confirmed primary diagnosis of either acute heart failure, community-acquired pneumonia and acute exacerbation of asthma or chronic obstructive pulmonary disease will be recruited within 24 hours of admission. Additionally, school-age children admitted with severe asthma will be evaluated. All participants will undergo breath sampling on admission and on recovery following discharge. A range of online technologies including: proton transfer reaction mass spectrometry, gas chromatography ion mobility spectrometry, atmospheric pressure chemical ionisation-mass spectrometry and offline technologies including gas chromatography mass spectroscopy and comprehensive two-dimensional gas chromatography-mass spectrometry will be used for VOC discovery and replication. For offline technologies, a standardised CE-marked breath sampling device (ReCIVA) will be used. All recruited participants will be characterised using existing blood biomarkers including C reactive protein, brain-derived natriuretic peptide, troponin-I and blood eosinophil levels and further evaluated using a range of standardised questionnaires, lung function testing, sputum cell counts and other diagnostic tests pertinent to acute disease. ETHICS AND DISSEMINATION The National Research Ethics Service Committee East Midlands has approved the study protocol (REC number: 16/LO/1747). Integrated Research Approval System (IRAS) 198921. Findings will be presented at academic conferences and published in peer-reviewed scientific journals. Dissemination will be facilitated via a partnership with the East Midlands Academic Health Sciences Network and via interaction with all UK-funded Medical Research Council and Engineering and Physical Sciences Research Council molecular pathology nodes. TRIAL REGISTRATION NUMBER NCT03672994.
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Affiliation(s)
- Wadah Ibrahim
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Michael Wilde
- Department of Chemistry, University of Leicester, Leicester, UK
| | - Rebecca Cordell
- Department of Chemistry, University of Leicester, Leicester, UK
| | - Dahlia Salman
- Department of Chemistry, Loughborough University, Loughborough, UK
| | | | - Luke Bryant
- Department of Chemistry, University of Leicester, Leicester, UK
| | - Matthew Richardson
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Robert C Free
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Bo Zhao
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Ahmed Yousuf
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Christobelle White
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Richard Russell
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sheila Jones
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Bharti Patel
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Asia Awal
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Graham Fowkes
- NIHR Leicester Clinical Research Facility, Leicester, UK
| | | | - Clare Foxon
- Paediatric Clinical Investigation Centre, Leicester, UK
| | - Hetan Bhatt
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rosa Peltrini
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Beverley Hargadon
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Toru Suzuki
- Department of Cardiovascular Sciences, Cardiovascular Research Centre, University of Leicester, Leicester, UK
- Leicester NIHR Biomedical Research Centre (Cardiovascular Theme), Leicester, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, Cardiovascular Research Centre, University of Leicester, Leicester, UK
- Leicester NIHR Biomedical Research Centre (Cardiovascular Theme), Leicester, UK
| | - Erol Gaillard
- Paediatric Clinical Investigation Centre, Leicester, UK
| | | | - Kimuli Ryanna
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hitesh Pandya
- Discovery Medicine, Respiratory Therapeutic Area, GlaxoSmithKline PLC, Stevenage, UK
| | - Tim Coates
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Paul S Monks
- Department of Chemistry, University of Leicester, Leicester, UK
| | - Neil Greening
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Christopher E Brightling
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Paul Thomas
- Department of Chemistry, Loughborough University, Loughborough, UK
| | - Salman Siddiqui
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Abstract
The lung is often overlooked as a metabolically active organ, yet biochemical studies have long demonstrated that glucose utilization surpasses that of many other organs, including the heart, kidney, and brain. For most cells in the lung, energy consumption is relegated to performing common cellular tasks, like mRNA transcription and protein translation. However, certain lung cell populations engage in more specialized types of energy-consuming behaviors, such as the beating of cilia or the production of surfactant. While many extrapulmonary diseases are now linked to abnormalities in cellular metabolism, the pulmonary community has only recently embraced the concept of metabolic dysfunction as a driver of respiratory pathology. Herein, we provide an overview of the major metabolic pathways in the lung and discuss how cells sense and adapt to low-energy states. Moreover, we review some of the emerging evidence that links alterations in cellular metabolism to the pathobiology of several common respiratory diseases.
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Affiliation(s)
- Gang Liu
- Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
| | - Ross Summer
- Center for Translational Medicine and Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA;
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Corrêa MFP, Ventura TLB, Muzitano MF, Dos Anjos da Cruz E, Bergonzi MC, Bilia AR, Rossi-Bergmann B, Soares Costa S. Suppressive effects of Vochysia divergens aqueous leaf extract and its 5-methoxyflavone on murine macrophages and lymphocytes. JOURNAL OF ETHNOPHARMACOLOGY 2018; 221:77-85. [PMID: 29626672 DOI: 10.1016/j.jep.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/25/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Vochysia divergens Pohl (Vochysiaceae), popularly known as "Cambará", is a tree that is resistant to the seasonal floods in the Pantanal, and usually found in monodominant stands called "Cambarazal". The inhabitants of the Pantanal exploit this tree for medicinal uses. Infusions and decoctions of its leaves are taken as teas, particularly for the treatment of asthma, flu and diarrhea, according to the local tradition transmitted empirically through the generations. AIM OF THE STUDY To evaluate the beneficial health effects related to the ethnomedicinal uses of V. divergens (Vd) by using biomonitored fractionation of an aqueous leaf extract. MATERIALS AND METHODS The aqueous leaf extract was obtained by decoction, and then the extract was fractionated by a combination of separation techniques including precipitation, organic partition and chromatography. Chromatographic analyses of the active samples were carried out using HPLC-DAD-MS. Flavonoid 1 was isolated from the n-BuOH fraction through classic chromatographic techniques. The inhibitory effects and cytotoxicity of the Vd extract, fractions and flavonoid 1 on NO and TNF-α production were assessed in LPS-stimulated RAW 264.7 macrophage cultures. Additionally, suppression on the proliferation of BALB/c lymphocytes was estimated by [3H] thymidine incorporation. The antioxidant activity of the samples was verified by SNP and DPPH assays and the suppression of the iNOS protein expression was evaluated through Western blotting. RESULTS The HPLC-DAD-MS analysis of the Vd extract led to the identification of 5-methoxyluteolin-7-O-β-glucopyranoside (2), rutin (4) and the tannin galloyl-HHDP-glucopyranoside (3), besides the main flavonoid 3',5-dimethoxyluteolin-7-O-β-glucopyranoside (1), which was biologically evaluated in comparison with luteolin aglycone. The Vd extract, n-BuOH fraction and flavonoid 1 inhibited NO and TNF-α production by LPS-stimulated macrophages. The reduction of NO levels was mediated mainly by suppression of the iNOS expression. In addition, both the Vd extract (IC50 13.6 µg/mL) and flavonoid 1 (IC50 19.8 µg/mL; 41.6 µM) strongly inhibited stimulated lymphocyte proliferation when compared to the immunosuppressive agent cyclosporin A (IC50 43.8 µg/mL; 36.4 µM). The Vd extract also showed a scavenging activity toward DPPH and NO free radicals. This is the first report describing the immunomodulatory potential of V. divergens and its major flavonoid (1). CONCLUSION Our findings showed that the aqueous leaf extract of V. divergens and its flavonoid reduced the production of excessive pro-inflammatory markers, collaborating with the Pantanal folk medicinal tradition that recommends the tea of cambará leaves for both asthma and flu. In addition, this study contributes to the knowledge of the pharmacological properties of 5-methoxy flavones, a poorly investigated subclass of flavonoids.
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Affiliation(s)
- Maria Fernanda Paresqui Corrêa
- Instituto de Pesquisas de Produtos Naturais, Universidade Federal do Rio de Janeiro - UFRJ, 21941-902 Rio de Janeiro, RJ, Brazil.
| | - Thatiana Lopes Biá Ventura
- Laboratório de Biologia do Reconhecer, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense - UENF, 28013-602, Campos dos Goytacazes, RJ, Brazil; Laboratório de Produtos Bioativos, Curso de Farmácia, Universidade Federal do Rio de Janeiro - UFRJ, 27933-378 Macaé, RJ, Brazil.
| | - Michelle Frazão Muzitano
- Instituto de Pesquisas de Produtos Naturais, Universidade Federal do Rio de Janeiro - UFRJ, 21941-902 Rio de Janeiro, RJ, Brazil; Laboratório de Biologia do Reconhecer, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense - UENF, 28013-602, Campos dos Goytacazes, RJ, Brazil; Laboratório de Produtos Bioativos, Curso de Farmácia, Universidade Federal do Rio de Janeiro - UFRJ, 27933-378 Macaé, RJ, Brazil.
| | - Elaine Dos Anjos da Cruz
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro - UFRJ, 21941-902 Rio de Janeiro, RJ, Brazil.
| | - Maria Camilla Bergonzi
- Department of Chemistry, University of Florence, 50019 Sesto Fiorentino, Florence, Italy.
| | - Anna Rita Bilia
- Department of Chemistry, University of Florence, 50019 Sesto Fiorentino, Florence, Italy.
| | - Bartira Rossi-Bergmann
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro - UFRJ, 21941-902 Rio de Janeiro, RJ, Brazil.
| | - Sônia Soares Costa
- Instituto de Pesquisas de Produtos Naturais, Universidade Federal do Rio de Janeiro - UFRJ, 21941-902 Rio de Janeiro, RJ, Brazil.
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Yucel M, Akin O, Cayoren M, Akduman I, Palaniappan A, Liedberg B, Hizal G, Inci F, Yildiz UH. Hand-Held Volatilome Analyzer Based on Elastically Deformable Nanofibers. Anal Chem 2018; 90:5122-5129. [DOI: 10.1021/acs.analchem.7b05187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Muge Yucel
- Department of Biotechnology and Bioengineering, Izmir Institute of Technology, Izmir 35430, Turkey
| | - Osman Akin
- Department of Mechatronic Engineering, Izmir Katip Çelebi University, Izmir 35640, Turkey
| | - Mehmet Cayoren
- Department of Electronic and Communication, Istanbul Technical University, Istanbul 34398, Turkey
| | - Ibrahim Akduman
- Department of Electronic and Communication, Istanbul Technical University, Istanbul 34398, Turkey
| | - Alagappan Palaniappan
- Center for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 637553 Singapore
| | - Bo Liedberg
- Center for Biomimetic Sensor Science, School of Materials Science and Engineering, Nanyang Technological University, 637553 Singapore
| | - Gurkan Hizal
- Department of Chemistry, Istanbul Technical University, Istanbul 34398, Turkey
| | - Fatih Inci
- Department of Radiology, Stanford University, School of Medicine, Canary Center at Stanford for Cancer Early Detection, Palo Alto, California 94304, United States
| | - Umit Hakan Yildiz
- Department of Chemistry, Izmir Institute of Technology, Izmir 35430, Turkey
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Ricciardolo F, Sorbello V, Bellezza Fontana R, Schiavetti I, Ciprandi G. Exhaled nitric oxide in relation to asthma control: A real-life survey. Allergol Immunopathol (Madr) 2016; 44:197-205. [PMID: 26589339 DOI: 10.1016/j.aller.2015.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/16/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asthma is characterised by chronic airway inflammation, a complex cascade of events, mostly sustained by eosinophil recruitment and activation. Fractional exhaled nitric oxide (FeNO) is a surrogate marker of airway inflammation closely associated with bronchial eosinophilia. FeNO is used to define asthma phenotype, to assess eosinophilic inflammatory severity and to predict corticosteroid responsiveness. OBJECTIVE The aim of this study was to investigate whether FeNO may be associated with some clinical and functional factors in asthmatics evaluated in a real life setting. METHODS Globally 363 patients (150 males, mean age 46.3 years) with asthma were consecutively evaluated. The following parameters were assessed: history, including comorbidities, physical examination, body mass index (BMI), lung function, asthma control grade, asthma control test (ACT), and FeNO. RESULTS FeNO values were significantly higher in patients with poorly controlled asthma (p<0.01), asthma symptoms (p=0.015), wheezing (p<0.001), rhinitis diagnosis, (p=0.049) and rhinitis symptoms (p=0.019), but lower in patients with GERD (p=0.024) and pneumonia history (p=0.048). FeNO values increased in patients with the lowest corticosteroid dose (p=0.031). FeNO values>25ppb were associated with poorly controlled asthma (OR 3.71), asthma signs (OR 3.5) and symptoms (OR 1.79). A FeNO value cut-off of 29.9ppb was fairly predictive of (AUC 0.7) poorly controlled asthma. CONCLUSIONS FeNO assessment in clinical practice may be a useful tool for monitoring asthmatics as it is associated with several clinical factors, including asthma control.
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8
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Ricciardolo FL, Sorbello V, Ciprandi G. A pathophysiological approach for FeNO: A biomarker for asthma. Allergol Immunopathol (Madr) 2015; 43:609-16. [PMID: 25796309 DOI: 10.1016/j.aller.2014.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/19/2014] [Accepted: 11/25/2014] [Indexed: 10/23/2022]
Abstract
The present review is focused on literature concerning the relevance of fractional exhaled nitric oxide (FeNO) in clinical practice from a pathophysiological point of view. There is increasing evidence that asthma is a heterogeneous pathological condition characterised by different phenotypes/endotypes related to specific biomarkers, including FeNO, helpful to predict therapeutic response in selected asthmatic populations. Nowadays FeNO, a non-invasive biomarker, appears to be useful to foresee asthma developing, to recognise specific asthma phenotypes, like the eosinophilic, to ameliorate asthma diagnosis and management in selected populations and to predict standard corticosteroid and biologic therapy efficacy. In addition, FeNO assessment may also be useful in patients with allergic rhinitis in order to detect the potential involvement of eosinophilic bronchial inflammation in "case finding" subjects at risk of asthma diagnosis. Therefore, it is possible to hypothesise a future with an appropriate use of FeNO by physicians dealing with worrisome clinical issues in specific asthma phenotypes.
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9
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Metabolomic profiling of asthma and chronic obstructive pulmonary disease: A pilot study differentiating diseases. J Allergy Clin Immunol 2015; 136:571-580.e3. [PMID: 26152317 DOI: 10.1016/j.jaci.2015.05.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 05/01/2015] [Accepted: 05/07/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Differentiating asthma from other causes of chronic airflow limitation, such as chronic obstructive pulmonary disease (COPD), can be difficult in a typical outpatient setting. The inflammation of asthma typically is different than that of COPD, and the degree of inflammation and cellular damage varies with asthma severity. Metabolomics is the study of molecules created by cellular metabolic pathways. OBJECTIVES We hypothesized that the metabolic activity of adults with asthma would differ from that of adults with COPD. Furthermore, we hypothesized that nuclear magnetic resonance spectroscopy (NMR) would measure such differences in urine samples. METHODS Clinical and urine-based NMR data were collected on adults meeting the criteria of asthma and COPD before and after an exacerbation (n = 133 and 38, respectively) and from patients with stable asthma or COPD (n = 54 and 23, respectively). Partial least-squares discriminant analysis was performed on the NMR data to create models of separation (86 metabolites were measured per urine sample). Some subjects' metabolomic data were withheld from modeling to be run blindly to determine diagnostic accuracy. RESULTS Partial least-squares discriminant analysis of the urine NMR data found unique differences in select metabolites between patients with asthma and those with COPD seen in the emergency department and even in follow-up after exacerbation. By using these select metabolomic profiles, the model could correctly diagnose blinded asthma and COPD with greater than 90% accuracy. CONCLUSION This is the first report showing that metabolomic analysis of human urine samples could become a useful clinical tool to differentiate asthma from COPD.
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George BJ, Reif DM, Gallagher JE, Williams-DeVane CR, Heidenfelder BL, Hudgens EE, Jones W, Neas L, Hubal EAC, Edwards SW. Data-driven asthma endotypes defined from blood biomarker and gene expression data. PLoS One 2015; 10:e0117445. [PMID: 25643280 PMCID: PMC4314082 DOI: 10.1371/journal.pone.0117445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 12/25/2014] [Indexed: 11/19/2022] Open
Abstract
The diagnosis and treatment of childhood asthma is complicated by its mechanistically distinct subtypes (endotypes) driven by genetic susceptibility and modulating environmental factors. Clinical biomarkers and blood gene expression were collected from a stratified, cross-sectional study of asthmatic and non-asthmatic children from Detroit, MI. This study describes four distinct asthma endotypes identified via a purely data-driven method. Our method was specifically designed to integrate blood gene expression and clinical biomarkers in a way that provides new mechanistic insights regarding the different asthma endotypes. For example, we describe metabolic syndrome-induced systemic inflammation as an associated factor in three of the four asthma endotypes. Context provided by the clinical biomarker data was essential in interpreting gene expression patterns and identifying putative endotypes, which emphasizes the importance of integrated approaches when studying complex disease etiologies. These synthesized patterns of gene expression and clinical markers from our research may lead to development of novel serum-based biomarker panels.
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Affiliation(s)
- Barbara Jane George
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - David M. Reif
- National Center for Computational Toxicology, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Jane E. Gallagher
- National Health and Environmental Effects Research Laboratory—Environmental Public Health Division, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - ClarLynda R. Williams-DeVane
- National Health and Environmental Effects Research Laboratory—Integrated Systems Toxicology Division, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Brooke L. Heidenfelder
- National Health and Environmental Effects Research Laboratory—Environmental Public Health Division, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Edward E. Hudgens
- National Health and Environmental Effects Research Laboratory—Environmental Public Health Division, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Wendell Jones
- Department of Bioinformatics, Expression Analysis, a Quintiles company, Durham, North Carolina, United States of America
| | - Lucas Neas
- National Health and Environmental Effects Research Laboratory—Environmental Public Health Division, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Elaine A. Cohen Hubal
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Stephen W. Edwards
- National Health and Environmental Effects Research Laboratory—Integrated Systems Toxicology Division, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
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Wan KS, Chiu WH, Yang W. Asthma diagnosis and severity monitoring in primary school children: essential role of sequential testing of exhaled nitric oxide. Allergol Immunopathol (Madr) 2014; 42:439-43. [PMID: 23830305 DOI: 10.1016/j.aller.2013.04.007] [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: 02/13/2013] [Revised: 03/29/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chronic eosinophilic airway inflammation, airflow limitation, and airway hyper-responsiveness are the mainstays of asthma diagnosis. The increased levels of exhaled nitric oxide (FeNO) in asthma are closely related to the extent of airway inflammation. Sequential measurement of FeNO concentrations may accurately predict asthma severity and guide therapeutic decisions. METHODS A total of 22,083 grade 1 students in Taipei city primary schools were screened for wheezing episodes using the International Study of Asthma and Allergies in Childhood questionnaire (ISAAC) questionnaires while their sero-atopic conditions were confirmed by Fluorescent Enzyme Immune Assay (FEIA). All students with allergies were tested by FeNO electrochemical test. 100 age-matched healthy students were used as control group (FeNO levels<25ppb). RESULTS From the 2650 students (12%) initially included via the wheezing criteria, 2065 (78.0%) were confirmed to have allergy by FEIA (sensitisation to at least two common aero-allergens in Taiwan) and diagnosed by a paediatric allergologist. Among them, 1852 (89.6%) had elevated FeNO values (>25ppb) and 266 (10%) had FeNO values<25ppb. Using the GINA guidelines, 140 mild-to-moderate asthma students who had received inhaled corticosteroids (ICS) with or without Singulair treatment completed serial FeNO testing every three months for one year. The FeNO levels decreased in 121 students (86.4%) and increased in 19 students (13.6%), which was compatible to changing childhood asthma control score and response to step-down treatment, respectively. CONCLUSION FeNO is an easy, used non-invasive tool for the diagnosis of allergic asthma. Sequential FeNO testing can accurately reflect asthma severity and provide for successful stepwise therapy for asthmatic children.
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12
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Targeted therapy of bronchitis in obstructive airway diseases. Pharmacol Ther 2013; 140:213-22. [PMID: 23845862 DOI: 10.1016/j.pharmthera.2013.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 06/17/2013] [Indexed: 12/21/2022]
Abstract
Guidelines for the management of obstructive airway diseases do not emphasize the measurement of bronchitis to indicate appropriate treatments or monitor response to treatment. Bronchitis is the central component of airway diseases and contributes to symptoms, physiological and structural abnormalities. It can be measured directly and reliably by quantitative assay of spontaneous or induced sputum. The measurement is reproducible, valid, and responsive to treatment and to changes in disease status. Bronchitis may be eosinophilic, neutrophilic, mixed, or paucigranulocytic (eosinophils and neutrophils not elevated). Eosinophilic bronchitis is usually a Th2 driven process and therefore a sputum eosinophilia of greater than 3% usually indicates a response to treatment with corticosteroids or novel therapies directed against Th2 cytokines such as IL-4, IL-5 and IL-13. Neutrophilic bronchitis which is a non-Th2 driven disease is generally a predictor of response to antibiotics and may be a predictor to therapies targeted at pathways that lead to neutrophil recruitment such as IL-8 (eg anti-CXCR2), IL-17 (eg anti-IL17) etc. Paucigranulocytic disease may not warrant anti-inflammatory therapy. Several novel monoclonals and small molecule antagonists have been evaluated in clinical trials with variable results and several more are likely to be discovered in the near future. The success of these agents will depend on appropriate patient selection by accurate phenotyping or characterization of bronchitis.
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Ciprandi G, Tosca MA, Capasso M. High exhaled nitric oxide levels may predict bronchial reversibility in allergic children with asthma or rhinitis. J Asthma 2012; 50:33-8. [PMID: 23157515 DOI: 10.3109/02770903.2012.740119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Allergic asthma and rhinitis may be associated. Airway inflammation is shared by both disorders. The measure of the fractional concentration of exhaled nitric oxide (FeNO) may be considered as a surrogate marker for airway inflammation, mainly in allergic patients. Reversibility to bronchodilation (BD) testing is a functional characteristic of asthma. OBJECTIVE The aim of this study was to evaluate whether FeNO may predict reversibility to BD in a pediatric cohort of allergic subjects with asthma (180) or rhinitis (150). METHODS Lung function (including forced expiratory volume at the first second (FEV(1)), forced volume capacity (FVC), forced expiratory flow at 25-75% of volume capacity (FEF (25-75))), FeNO measurement, and BD testing were performed in all children. RESULTS Lung function, FeNO, and sensitization type were significantly different in the two groups. A strong correlation was found between FeNO and ΔFEV(1) after BD. Two main predictors of reversibility were FeNO values >34 ppb [Odds RatioAdj (ORAdj) = 1.9] and sensitization to perennial allergens (ORAdj = 1.7). CONCLUSIONS This study provided evidence that FeNO was strongly related with the response to BD testing and could predict bronchial reversibility in children with allergic rhinitis or asthma. Therefore, a simple FeNO measurement could suggest relevant information about bronchial reversibility.
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Affiliation(s)
- Giorgio Ciprandi
- IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
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14
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Cirillo I, Ricciardolo FLM, Medusei G, Signori A, Ciprandi G. Exhaled nitric oxide may predict bronchial hyperreactivity in patients with allergic rhinitis. Int Arch Allergy Immunol 2012; 160:322-8. [PMID: 23052027 DOI: 10.1159/000341675] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/06/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nowadays it is possible to assess airway inflammation by measuring the fractional concentration of exhaled nitric oxide (FeNO) during an office visit and there is international consensus on the testing methodology. The aim of this study was to evaluate whether FeNO measurement may be a predictor of bronchial hyperreactivity (BHR) in patients with allergic rhinitis (AR). METHODS Two hundred eleven patients (196 males, median age 28.5 years) suffering from persistent AR were evaluated. Values for bronchial function (FVC, FEV(1), and FEF(25-75)), bronchial provocation tests (methacholine), exhaled nitric oxide (FeNO), a visual analogue scale for nasal and bronchial symptoms, and sensitization were assessed. RESULTS A strong and inverse correlation between FeNO levels and BHR severity was found (r = -0.58). FeNO was a predictive factor for BHR, and 37 ppb was found to be the best cutoff (area under the curve 0.90) to define the presence of BHR in patients with AR. CONCLUSIONS This study highlights the relevance of FeNO as a possible predictive marker for BHR in AR patients and underlines the close link between upper and lower airways. Thus, FeNO measurement could be a useful screening tool in identifying subjects with rhinitis at risk of developing asthma.
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Nair P, Dasgupta A, Brightling CE, Chung KF. How to diagnose and phenotype asthma. Clin Chest Med 2012; 33:445-57. [PMID: 22929094 DOI: 10.1016/j.ccm.2012.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma has been described as a chronic disease of the airways characterized by variable airflow obstruction, airway hyperresponsiveness, and airway inflammation. This review discusses the diagnosis and phenotyping of asthma, with a special emphasis on phenotyping based on the nature of cellular inflammation and radiological imaging and how this could be used to direct the treatment of asthma and, in the future, to apply specifically directed therapies to specific phenotypes.
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Affiliation(s)
- Parameswaran Nair
- Department of Medicine, St Joseph's Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario L8N4A6, Canada.
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Karaman M, Arıkan Ayyıldız Z, Fırıncı F, Kiray M, Bağrıyanık A, Yilmaz O, Uzuner N, Karaman O. Effects of curcumin on lung histopathology and fungal burden in a mouse model of chronic asthma and oropharyngeal candidiasis. Arch Med Res 2011; 42:79-87. [PMID: 21565619 DOI: 10.1016/j.arcmed.2011.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 01/18/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Oropharyngeal candidiasis (OPC) is one of the most common local side effects of current therapy in chronic asthma. New therapeutic options with fewer side effects and reverse chronic changes are needed. Curcumin, as a promising antiinflammatory and antifungal agent, could be a candidate of alternative therapy in asthma. This study aimed to determine the efficacy of orally administrated curcumin on lung histopathology, serum nitric oxide levels and fungal burden in a murine model of asthma and OPC. METHODS Thirty five BALB/c mice were divided into five groups: I, II, III, IV (placebo) and V (control). All groups except the control were sensitized and challenged with ovalbumin. OPC model was established after the model of chronic asthma. Lung histology, serum nitric oxide levels and fungal burden were evaluated after 5 days of treatment with curcumin, dexamethasone, curcumin-dexamethasone combination and placebo. Evaluation of lung histology included subepithelial smooth muscle and epithelial thickness and number of goblet and mast cells by using light microscopy. RESULTS All histological parameters improved in curcumin group similar to dexamethasone group. Curcumin and dexamethasone-curcumin combination were also as effective as dexamethasone on decreasing nitric oxide levels. Oral fungal burden was significantly lower in curcumin-treated group than dexamethasone. CONCLUSIONS In our study we demonstrated that curcumin administration alleviates the pathological changes in asthma and decreases the fungal burden. Curcumin may have a potential effect on treating chronic asthma and decreasing the frequency of the OPC.
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Affiliation(s)
- Meral Karaman
- Department of Multidisciplinary Laboratory, Dokuz Eylul University Hospital, Izmir, Turkey
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Ciprandi G, Tosca MA, Capasso M. Exhaled nitric oxide in children with allergic rhinitis and/or asthma: a relationship with bronchial hyperreactivity. J Asthma 2010; 47:1142-7. [PMID: 20950134 DOI: 10.3109/02770903.2010.527026] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nowadays, the measure of the fractional concentration of exhaled nitric oxide (FeNO) enables to assess airway inflammation during an office visit and there is international consensus on this testing methodology. The aim of this study was to evaluate whether FeNO measurement is predictable for bronchial hyperreactivity (BHR) in children with allergic rhinitis, asthma, or both. METHODS Two hundred and eighty children with allergic rhinitis, allergic asthma, or both were evaluated. Bronchial function (FEV₁ and FEF(25-75)), BHR (assessed by methacholine challenge), FeNO, and sensitizations were assessed. RESULTS Bronchial function, BHR, and FeNO were significantly different in the three groups (p < .001). A strong inverse correlation between FeNO and BHR was found in patients with asthma and with asthma and rhinitis (r = -0.63 and r = -0.61, respectively). A cutoff of 32 ppb of FeNO was a predictive factor for BHR. CONCLUSIONS This study highlights the relevance of FeNO as possible marker for BHR in allergic children and underlines the close link between upper and lower airways.
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Affiliation(s)
- Giorgio Ciprandi
- Department of Internal Medicine, Azienda Ospedaliera Universitaria San Martino-University of Genoa, Genoa, Italy.
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Burioka N, Fukuoka Y, Koyanagi S, Miyata M, Takata M, Chikumi H, Takane H, Watanabe M, Endo M, Sako T, Suyama H, Ohdo S, Shimizu E. Asthma: Chronopharmacotherapy and the molecular clock. Adv Drug Deliv Rev 2010; 62:946-55. [PMID: 20359514 DOI: 10.1016/j.addr.2010.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 03/17/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
Bronchial asthma is characterized by chronic airways inflammation and reversible airflow limitation. In patients with asthma, symptoms generally worsen during the early hours of the morning, and pulmonary function often deteriorates at the same time, suggesting a role for chronopharmacotherapy. Several drugs for asthma have been developed based on chronopharmacology. Most medications employed for the chronotherapy of asthma are administered once at night with the goal of preventing chronic airway inflammation or development of airflow limitation. In addition to bronchodilators, the inhaled glucocorticosteroid ciclesonide is now available with once-daily dosing, which also improves patients' compliance. Numerous investigations have demonstrated the usefulness of chronotherapy for asthma, especially for patients with nocturnal asthma. This review focuses on chronotherapy of asthma, and also provides a molecular biological explanation for the influence of asthma medications on the clock genes.
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Jones AW, Andersson L. Determination of ethanol in breath for legal purposes using a five-filter infrared analyzer: studies on response to volatile interfering substances. J Breath Res 2008; 2:026006. [DOI: 10.1088/1752-7155/2/2/026006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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