1
|
Abstract
PURPOSE Social determinants of health (SDoHs) influence how well a family manages children's asthma. The aim of this study was to examine the influence of SDoHs on family asthma management. DESIGN A cross-sectional exploratory study was conducted with 292 children in grades 2 to 5 who had current asthma and their parents to examine associations between SDoHs and the families' asthma management, quality of life, and healthcare utilization. METHODS Data were collected from both child and parent. Social determinants of health include the child's race/ethnic group, age, gender, and asthma severity and the family's socioeconomic status and language spoken in the home, and the school was the community-level variable. Parents and children completed asthma management and quality-of-life scales and parents reported on the children's emergency department visits and hospitalizations for asthma. RESULTS Worse quality of life was reported by families with lower socioeconomic status and African American children. Asthma severity was associated with parents' asthma management but not children's asthma self-management. Families who spoke Spanish at home had the lowest socioeconomic status yet performed significantly more asthma management than English-speaking families. CONCLUSIONS The findings highlight factors the clinical nurse specialist should address in educational interventions.
Collapse
|
2
|
Horner SD, Timmerman GM, McWilliams BC. Feasibility study of a combined lifestyle behaviors and asthma self-management intervention for school-aged children. J SPEC PEDIATR NURS 2018; 23:e12224. [PMID: 29972278 PMCID: PMC6202196 DOI: 10.1111/jspn.12224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/10/2018] [Accepted: 06/18/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study is to test the feasibility of delivering an intervention that combines healthy lifestyle behaviors related to weight management with asthma self-management, the Living Healthy with Asthma intervention, to children who have asthma. METHODS AND DESIGN Using a mixed design, the feasibility study of the 12-week Living Healthy with Asthma intervention was conducted with a single group of children diagnosed with asthma. Pretest and posttest data were collected on asthma-related (self-management, metered dose inhaler [MDI] skill, asthma severity, quality of life [QOL]), and healthy lifestyle variables (body mass index [BMI], dietary quality). A matched comparison sample was drawn from a separate study that tested the same asthma self-management component (single intervention) used in the feasibility study to determine if the Living Healthy with Asthma intervention worked as well as the single intervention for improving children's asthma self-management. RESULTS Thirteen school-aged children were enrolled in the feasibility study. There were significant reductions in BMI z-scores (P = 0.007), and improvements in vegetable servings (P = 0.03), MDI skill (P = 0.005), children's QOL (P < 0.001), and parents' QOL (P = 0.03). When comparing the feasibility group with the matched comparison group (n = 13), there were no significant differences in asthma self-management, MDI skill, or asthma severity after the interventions. PRACTICE IMPLICATIONS Findings supported the feasibility of implementing the combined intervention, and it was not inferior to the single intervention-which supports nurses' efforts to help families manage multiple health problems.
Collapse
Affiliation(s)
- Sharon D. Horner
- Associate Dean for Research, The University of Texas at Austin School of Nursing
| | - Gayle M. Timmerman
- Associate Dean for Academic Affairs, The University of Texas at Austin School of Nursing
| | - Bennie C. McWilliams
- Director, Pediatric Pulmonary, Dell Children’s Medical Center of Central Texas, Associate Professor, The University of Texas at Austin Dell Medical School
| |
Collapse
|
3
|
ANDO K, TANAKA A, MIKUNI H, KAWAHARA T, KUWAHARA N, MANABE R, JINNO M, MIYATA Y, HIRAI K, OHNISHI T, INOUE S, SAGARA H. Indirect Comparison of Dupilumab and Mepolizumab Treatments for Uncontrolled Eosinophilic Asthma. ACTA ACUST UNITED AC 2018. [DOI: 10.15369/sujms.30.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Koichi ANDO
- Department of Medicine, Division of Respiratory Medicine and Allergology
- Showa University Dental Hospital Medical Clinic
| | - Akihiko TANAKA
- Department of Medicine, Division of Respiratory Medicine and Allergology
| | - Hatsuko MIKUNI
- Department of Medicine, Division of Respiratory Medicine and Allergology
| | - Tomoko KAWAHARA
- Department of Medicine, Division of Respiratory Medicine and Allergology
| | - Naota KUWAHARA
- Department of Medicine, Division of Respiratory Medicine and Allergology
| | - Ryo MANABE
- Department of Medicine, Division of Respiratory Medicine and Allergology
| | - Megumi JINNO
- Department of Medicine, Division of Respiratory Medicine and Allergology
| | - Yoshito MIYATA
- Department of Medicine, Division of Respiratory Medicine and Allergology
| | - Kuniaki HIRAI
- Department of Medicine, Division of Respiratory Medicine and Allergology
| | - Tsukasa OHNISHI
- Department of Medicine, Division of Respiratory Medicine and Allergology
| | - Shin INOUE
- Showa University Dental Hospital Medical Clinic
| | - Hironori SAGARA
- Department of Medicine, Division of Respiratory Medicine and Allergology
| |
Collapse
|
4
|
Bao Z, Zhang P, Yao Y, Lu G, Tong Z, Yan B, Tu L, Yang G, Zhou J. Deguelin Attenuates Allergic Airway Inflammation via Inhibition of NF-κb Pathway in Mice. Int J Biol Sci 2017; 13:492-504. [PMID: 28529457 PMCID: PMC5436569 DOI: 10.7150/ijbs.17238] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/02/2017] [Indexed: 01/10/2023] Open
Abstract
Asthma is a chronic respiratory disease characterized by airway inflammation and remodeling, resulting in a substantial economic burden on both patients and society. Deguelin, a constituent of the Leguminosae family, exhibits anti-proliferative and anti-inflammatory activities in cancer mice models via inhibiting phosphatidylinositol 3-kinases and the NF-κB pathway. We demonstrated that deguelin effectively reduced OVA-induced inflammatory cell recruitment, decreased lung tissue inflammation and mucus production, suppressed airway hyperresponsiveness, and inhibited serum immunoglobulin and Th2 cytokine levels in a dose-dependent manner in asthmatic mice. In addition, we found that deguelin reduced inflammatory gene expressions both in vivo and in vitro, which were closely associated with activation of the NF-κB signaling pathway. Thus, we further explored the underlying mechanisms of deguelin in normal human bronchial epithelial cells (BEAS-2B). Our results suggested that deguelin inhibited NF-κB binding activity by enhancing the ability of IκBα to maintain NF-κB in an inactive form in the cytoplasm and preventing the TNF-α induced translocation of p65 to the nucleus. In conclusion, our research indicates that deguelin attenuates allergic airway inflammation via inhibition of NF-κB pathway in mice model and may act as a potential therapeutic agent for patients with allergic airway inflammation.
Collapse
Affiliation(s)
- Zhang Bao
- Department of Respiratory Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pei Zhang
- Department of Respiratory Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yinan Yao
- Department of Respiratory Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guohua Lu
- Department of Respiratory Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhongkai Tong
- Department of Respiratory Diseases, Ningbo No.2 hospital, Ningbo, China
| | - Bing Yan
- Department of Respiratory Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingfang Tu
- Department of Respiratory Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guangdie Yang
- Department of Respiratory Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
5
|
Plourde A, Lavoie KL, Raddatz C, Bacon SL. Effects of acute psychological stress induced in laboratory on physiological responses in asthma populations: A systematic review. Respir Med 2017; 127:21-32. [PMID: 28502415 DOI: 10.1016/j.rmed.2017.03.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psychological stress has long been suspected to have a deleterious effect on asthma, with acute psychological stress being associated with physiological responses in asthma patients. OBJECTIVES The purpose of this systematic review was to provide a narrative synthesis of the impact of acute laboratory psychological stress on physiological responses among asthma patients. METHODS An extensive search was conducted by two independent authors using Pubmed, PsycINFO, PsyArticles and the Cochrane Library electronic databases (up to September 2016). English and French articles which assessed physiological responses during or post-stress and compare them to baseline or pre-stress values were included. RESULTS Thirty-two studies met the inclusion criteria. Studies indicated that exposure to active stressors (e.g., arithmetic tasks) was associated with an increase in sympathetic nervous system (SNS) responses, cortisol, and inflammatory responses, but had little effect on the caliber of the bronchi. Exposure to passive stressors (e.g., watching stressful movies or pictures) was also associated with an increase in SNS responses and with mild bronchoconstriction. However, a paucity of data for passive stressors limited conclusions on other measures. CONCLUSIONS In patients with asthma, both active and passive stressors seem to be associated with an increased activation of the SNS. Passive stressors seem to have a more immediate, deleterious impact on the airways than active stressors, but the latter may be associated with delayed inflammatory driven an asthma exacerbation. Further studies are needed to understand the impact of acute stressors on the physiological mechanisms associated with asthma, particularly HPA and immune markers. Systematic review registration number: CRD42015026431.
Collapse
Affiliation(s)
- Annik Plourde
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Research Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Department of Psychology, Université du Québec à Montréal (UQAM), Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Research Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Department of Psychology, Université du Québec à Montréal (UQAM), Canada
| | - Candace Raddatz
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Research Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Department of Exercise Science, Concordia University, Montreal, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Research Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Department of Exercise Science, Concordia University, Montreal, Canada.
| |
Collapse
|
6
|
Charriot J, Vachier I, Halimi L, Gamez AS, Boissin C, Salama M, Cucu-Jarjour A, Ahmed E, Bourdin A. Future treatment for asthma. Eur Respir Rev 2016; 25:77-92. [PMID: 26929425 DOI: 10.1183/16000617.0069-2015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The landscape of asthma has considerably changed after 40 years of inhaled corticosteroid development and nearly 20 years since the first monoclonal antibodies (mAbs) were approved. New members of pharmacological families and more effective drug-delivery devices have been designed but the proportion of uncontrolled patients, unfortunately, remains stable. The most promising treatments now rely on targeted therapies that encourage the improvement of the characterisation of our patients. These clinical (phenotype) or new biological (endotype) tools lead to palpable personalised medicine. This review examines not only the future of mAbs and other new ways of treating asthma but also describes futuristic views based on the paradigm shifts that are ready to occur.
Collapse
Affiliation(s)
- Jeremy Charriot
- Dept of Respiratory Diseases, CHU Montpellier, Montpellier, France
| | - Isabelle Vachier
- Dept of Respiratory Diseases, CHU Montpellier, Montpellier, France
| | - Laurence Halimi
- Dept of Respiratory Diseases, CHU Montpellier, Montpellier, France
| | | | - Clement Boissin
- Dept of Respiratory Diseases, CHU Montpellier, Montpellier, France
| | - Marine Salama
- Dept of Respiratory Diseases, CHU Montpellier, Montpellier, France
| | | | - Engi Ahmed
- Dept of Respiratory Diseases, CHU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Dept of Respiratory Diseases, CHU Montpellier, Montpellier, France PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Hôpital Arnaud de Villeneuve, Montpellier, France
| |
Collapse
|
7
|
Abstract
Asthma is one of the most frequent chronic respiratory diseases worldwide, with an increase in its prevalence in the last decade. Ongoing studies continue to search for better diagnostic tools and advanced treatment options in an effort to decrease the morbidity and mortality associated with it. Unfortunately, many asthmatic patients still suffer from poorly controlled asthma, which may lead to life-threatening situations. This article reviews the basics of asthma and highlights the current guidelines in making accurate diagnosis and initiating therapeutic plan.
Collapse
|
8
|
Rosenkranz MA, Esnault S, Christian BT, Crisafi G, Gresham LK, Higgins AT, Moore MN, Moore SM, Weng HY, Salk RH, Busse WW, Davidson RJ. Mind-body interactions in the regulation of airway inflammation in asthma: A PET study of acute and chronic stress. Brain Behav Immun 2016; 58:18-30. [PMID: 27039241 PMCID: PMC5045317 DOI: 10.1016/j.bbi.2016.03.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/08/2016] [Accepted: 03/26/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Psychological stress has long been recognized as a contributing factor to asthma symptom expression and disease progression. Yet, the neural mechanisms that underlie this relationship have been largely unexplored in research addressing the pathophysiology and management of asthma. Studies that have examined the mechanisms of this relationship in the periphery suggest that it is the superimposition of acute stress on top of chronic stress that is of greatest concern for airway inflammation. METHODS We compared asthmatic individuals with high and low levels of chronic life stress in their neural and peripheral physiological responses to the Trier Social Stress Test and a matched control task. We used FDG-PET to measure neural activity during performance of the two tasks. We used both circulating and airway-specific markers of asthma-related inflammation to assess the impact of acute stress in these two groups. RESULTS Asthmatics under chronic stress had a larger HPA-axis response to an acute stressor, which failed to show the suppressive effects on inflammatory markers observed in those with low chronic stress. Moreover, our PET data suggest that greater activity in the anterior insula during acute stress may reflect regulation of the effect of stress on inflammation. In contrast, greater activity in the mid-insula and perigenual anterior cingulate seems to reflect greater reactivity and was associated with greater airway inflammation, a more robust alpha amylase response, and a greater stress-induced increase in proinflammatory cytokine mRNA expression in airway cells. CONCLUSIONS Acute stress is associated with increases in markers of airway inflammation in asthmatics under chronic stress. This relationship may be mediated by interactions between the insula and anterior cingulate cortex, that determine the salience of environmental cues, as well as descending regulatory influence of inflammatory pathways in the periphery.
Collapse
Affiliation(s)
- Melissa A. Rosenkranz
- Waisman Laboratory for Brain Imaging & Behavior and Center for Investigating Healthy Minds, University of Wisconsin-Madison, 1500 Highland Ave, Madison, Wisconsin 53705, USA
| | - Stephane Esnault
- Department of Medicine, University of Wisconsin-Madison, 600 Highland Ave, Madison, Wisconsin 53792, USA
| | - Bradley T. Christian
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
| | - Gina Crisafi
- Department of Medicine, University of Wisconsin-Madison, 600 Highland Ave, Madison, Wisconsin 53792, USA
| | - Lauren K. Gresham
- Waisman Laboratory for Brain Imaging & Behavior and Center for Investigating Healthy Minds, University of Wisconsin-Madison, 1500 Highland Ave, Madison, Wisconsin 53705, USA
| | - Andrew T. Higgins
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
| | - Mollie N. Moore
- Department of Psychology, University of Wisconsin-Madison, 1202 W. Johnson St. Madison, Wisconsin 53706, USA
| | - Sarah M. Moore
- Department of Counseling Psychology, University of Wisconsin-Madison, 1000 Bascom Mall, Madison, Wisconsin 53706, USA
| | - Helen Y. Weng
- Waisman Laboratory for Brain Imaging & Behavior and Center for Investigating Healthy Minds, University of Wisconsin-Madison, 1500 Highland Ave, Madison, Wisconsin 53705, USA,Osher Center for Integrative Medicine, University of California, San Francisco, 1701 Divisadero St #150, San Francisco, CA 94115, USA
| | - Rachel H. Salk
- Department of Psychology, University of Wisconsin-Madison, 1202 W. Johnson St. Madison, Wisconsin 53706, USA
| | - William W. Busse
- Department of Medicine, University of Wisconsin-Madison, 600 Highland Ave, Madison, Wisconsin 53792, USA
| | - Richard J. Davidson
- Waisman Laboratory for Brain Imaging & Behavior and Center for Investigating Healthy Minds, University of Wisconsin-Madison, 1500 Highland Ave, Madison, Wisconsin 53705, USA,Department of Psychology, University of Wisconsin-Madison, 1202 W. Johnson St. Madison, Wisconsin 53706, USA,Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Asthma is quite common and is better described as a syndrome with a heterogeneous presentation than as a single disease. Although most individuals can be effectively managed using a guideline-directed approach to care, those with the most severe illness may benefit from a more targeted therapy. The review describes our current understanding of how asthma phenotypes (observable characteristics) and endotypes (specific biologic mechanisms) can be employed to gain insight into asthma pathobiology and personalized therapy. RECENT FINDINGS Our understanding of the heterogeneity of asthma is increasing. The concept of asthma phenotype has become more complex, incorporating both clinical and biologic features. Several asthma endotypes (e.g., allergic bronchopulmonary mycosis, aspirin-exacerbated respiratory disease, severe late-onset hypereosinophilic asthma, etc.) have been proposed, but further research is needed to delineate specific mechanisms underlying asthma pathogenesis. Several biologic therapies targeting certain phenotypes are in development and are expected to broaden our armamentarium for treatment of severe asthma. SUMMARY Asthma is a heterogeneous condition with diverse characteristics and biologic mechanisms. Severe asthma is associated with significant morbidity and even mortality and represents a major unmet need. Stratification of asthma subtypes into phenotypes and endotypes should move the field forward in terms of more effective and personalized treatment.
Collapse
|
10
|
Siracusa CM, Brewington JJ, Brockbank JC, Guilbert TW. Update in Pediatric Lung Disease 2014. Am J Respir Crit Care Med 2016; 192:918-23. [PMID: 26469841 DOI: 10.1164/rccm.201504-0752up] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Christopher M Siracusa
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John J Brewington
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Justin C Brockbank
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Theresa W Guilbert
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|