1
|
Oosterholt S, Pavord ID, Brusselle G, Yorgancıoğlu A, Pitrez PM, Pg A, Teli C, Della Pasqua O. Modelling ASthma TrEatment Responses (MASTER): Effect of individual patient characteristics on the risk of exacerbation in moderate or severe asthma: A time-to-event analysis of randomized clinical trials. Br J Clin Pharmacol 2023; 89:3273-3290. [PMID: 37221636 DOI: 10.1111/bcp.15801] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
AIMS There is limited understanding of how clinical and demographic characteristics are associated with exacerbation risk in patients with moderate-to-severe asthma, and how these factors correlate with symptom control and treatment response. Here we assess the relationship between baseline characteristics and exacerbation risk during regular dosing with inhaled corticosteroids (ICS) monotherapy or in combination with long-acting beta2-agonists (ICS/LABA) in clinical trial patients with varying levels of symptom control, as assessed by the asthma control questionnaire (ACQ-5). METHODS A time-to-event model was developed using pooled patient data (N = 16 282) from nine clinical studies [Correction added on 26 July 2023, after first online publication: The N value in the preceding sentence has been corrected in this version.]. A parametric hazard function was used to describe the time-to-first exacerbation. Covariate analysis included the assessment of the effect of seasonal variation, clinical and demographic baseline characteristics on baseline hazard. Predictive performance was evaluated by standard graphical and statistical methods. RESULTS An exponential hazard model best described the time-to-first exacerbation in moderate-to-severe asthma patients. Body mass index, smoking status, sex, ACQ-5, % predicted forced expiratory volume over 1 s (FEV1 p) and season were identified as statistically significant covariates affecting baseline hazard irrespective of ICS or ICS/LABA use. Fluticasone propionate/salmeterol (FP/SAL) combination therapy resulted in a significant reduction in the baseline hazard (30.8%) relative to FP monotherapy. CONCLUSIONS Interindividual differences at baseline and seasonal variation affect the exacerbation risk independently from drug treatment. Moreover, it appears that even when a comparable level of symptom control is achieved in a group of patients, each individual may have a different exacerbation risk, depending on their baseline characteristics and time of the year. These findings highlight the importance of personalized interventions in moderate-to-severe asthma patients.
Collapse
Affiliation(s)
- Sean Oosterholt
- Clinical Pharmacology Modelling and Simulation, GSK, London, UK
| | - Ian D Pavord
- Respiratory Medicine Unit and NIHR Respiratory BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | | | - Abhijith Pg
- Global Classic and Established Medicines, GSK, Singapore, Singapore
| | - Chirag Teli
- Global Classic and Established Medicines, GSK, Mumbai, India
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling and Simulation, GSK, London, UK
- Clinical Pharmacology & Therapeutics Group, University College London, London, UK
| |
Collapse
|
2
|
Pacheco-Quito EM, Jaramillo J, Sarmiento-Ordoñez J, Cuenca-León K. Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health. Dent J (Basel) 2023; 11:dj11050113. [PMID: 37232764 DOI: 10.3390/dj11050113] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
Asthma is a chronic, heterogeneous respiratory pathology characterized by reversible airway inflammation. Therapeutics focus on symptom reduction and control, aimed at preserving normal pulmonary function and inducing bronchodilatation. The objective of this review is to describe the adverse effects produced by anti-asthmatic drugs on dental health, according to the reported scientific evidence. A bibliographic review was carried out on databases, such as Web of science, Scopus, and ScienceDirect. Most anti-asthmatic medications are administered using inhalers or nebulizers, making it impossible to avoid contact of the drug with hard dental tissues and oral mucosa, and thus promoting a greater risk of oral alterations, mainly due to decreases in the salivary flow and pH. Such changes can cause diseases, such as dental caries, dental erosion, tooth loss, periodontal disease, bone resorption, as well as fungal infections, such as oral candidiasis.
Collapse
Affiliation(s)
- Edisson-Mauricio Pacheco-Quito
- Academic Unit of Health and Wellness, Faculty of Dentistry, Catholic University of Cuenca, Cuenca 010105, Ecuador
- Innovation and Pharmaceutical Development in Dentistry Research Group, Faculty of Dentistry, Head of Research and Innovation, Catholic University of Cuenca, Cuenca 010105, Ecuador
| | | | - Jéssica Sarmiento-Ordoñez
- Academic Unit of Health and Wellness, Faculty of Dentistry, Catholic University of Cuenca, Cuenca 010105, Ecuador
- Innovation and Pharmaceutical Development in Dentistry Research Group, Faculty of Dentistry, Head of Research and Innovation, Catholic University of Cuenca, Cuenca 010105, Ecuador
| | - Katherine Cuenca-León
- Academic Unit of Health and Wellness, Faculty of Dentistry, Catholic University of Cuenca, Cuenca 010105, Ecuador
- Innovation and Pharmaceutical Development in Dentistry Research Group, Faculty of Dentistry, Head of Research and Innovation, Catholic University of Cuenca, Cuenca 010105, Ecuador
| |
Collapse
|
3
|
MDSCs Aggravate the Asthmatic Progression in Children and OVA-Allergic Mice by Regulating the Th1/Th2/Th17 Responses. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6157385. [PMID: 36045657 PMCID: PMC9423955 DOI: 10.1155/2022/6157385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/12/2022] [Accepted: 07/30/2022] [Indexed: 11/28/2022]
Abstract
Background Asthma is a chronic inflammatory disease of respiratory with serious risks for children. This study explored myeloid-derived suppressor cells (MDSCs) on the pathogenesis of asthmatic children and mice. Methods The clinical study enrolled 30 asthma, 20 pneumonia, and 20 control participants. The MDSCs, Th17 and Th1 cells percentage, and IL-4, IL-12, IL-10, and IFN-γ levels were detected by flow cytometry and ELISA. In experimental asthma, mice were divided into control, ovalbumin (OVA), and OVA + MDSCs groups. The changes in inflammatory cell count and the levels of IL-5, IL-12, and IL-10 in mice BALF and the levels of inflammatory factors, IgE, and IFN-γ in mice were detected by ELISA. The amount of ROS generation and pathological changes and the levels of caspase 1 and caspase 3 were tested by flow cytometry, HE and PAS staining, and immunohistochemistry. The expression of cleaved caspase 1/caspase 1 and cleaved caspase 3/caspase 3 was detected by western blot. Results In clinical trials, the levels of IL-12, IFN-γ, and Th1 percentage decreased in pneumonia and asthma children's peripheral blood, while the levels of IL-4 and IL-10 and the percentages MDSCs and Th17 increased. In asthma mice, pathological staining showed that asthma caused lung inflammation and damage, while the OVA + MDSC group was severer. Moreover, the percentages of eosinophils, neutrophils, lymphocytes, and the levels of inflammatory factors, IgE, ROS production, caspase 1, caspase 3, cleaved caspase 1/caspase 1, and cleaved caspase 3/caspase 3 increased in OVA + MDSC group, while the percentage of macrophages, IL-12, and IFN-γ levels reduced, illustrating that MDSCs exacerbated asthma. Conclusion Our study indicated that MDSCs could aggravate asthma by regulating the Th1/Th2/Th17 response.
Collapse
|
4
|
Kim J, Im YN, Chung Y, Youm J, Im SY, Han MK, Lee HK. Glutamine deficiency shifts the asthmatic state toward neutrophilic airway inflammation. Allergy 2022; 77:1180-1191. [PMID: 34601745 PMCID: PMC9293426 DOI: 10.1111/all.15121] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/27/2021] [Indexed: 12/04/2022]
Abstract
Background The administration of L‐glutamine (Gln) suppresses allergic airway inflammation via the rapid upregulation of MAPK phosphatase (MKP)‐1, which functions as a negative regulator of inflammation by deactivating p38 and JNK mitogen‐activated protein kinases (MAPKs). However, the role of endogenous Gln remains to be elucidated. Therefore, we investigated the mechanism by which endogenous Gln regulates MKP‐1 induction and allergic airway inflammation in an ovalbumin‐based murine asthma model. Methods We depleted endogenous Gln levels using L‐γ‐glutamyl‐p‐nitroanilide (GPNA), an inhibitor of the Gln transporter ASCT2 and glutamine synthetase small interfering siRNA. Lentivirus expressing MKP‐1 was injected to achieve overexpression of MKP‐1. Asthmatic phenotypes were assessed using our previously developed ovalbumin‐based murine model, which is suitable for examining sequential asthmatic events, including neutrophil infiltration. Gln levels were analyzed using a Gln assay kit. Results GPNA or glutamine synthetase siRNA successfully depleted endogenous Gln levels. Importantly, homeostatic MKP‐1 induction did not occur at all, which resulted in prolonged p38 MAPK and cytosolic phospholipase A2 (cPLA2) phosphorylation in Gln‐deficient mice. Gln deficiency augmented all examined asthmatic reactions, but it exhibited a strong bias toward increasing the neutrophil count, which was not observed in MKP‐1‐overexpressing lungs. This neutrophilia was inhibited by a cPLA2 inhibitor and a leukotriene B4 inhibitor but not by dexamethasone. Conclusion Gln deficiency leads to the impairment of MKP‐1 induction and activation of p38 MAPK and cPLA2, resulting in the augmentation of neutrophilic, more so than eosinophilic, airway inflammation.
Collapse
Affiliation(s)
- June‐Mo Kim
- Department of Immunology and Institute for Medical Science Jeonbuk National University Medical School Jeonju South Korea
| | - Yoo Na Im
- Department of Immunology and Institute for Medical Science Jeonbuk National University Medical School Jeonju South Korea
| | - Yun‐Jo Chung
- Center for University‐wide Research Facilities Jeonbuk National University Medical School Jeonju South Korea
| | - Jung‐ho Youm
- Department of Preventive Medicine Jeonbuk National University Medical School Jeonju South Korea
| | - Suhn Young Im
- Department of Biological Sciences College of Natural Sciences Chonnam National University Gwangju South Korea
| | - Myung Kwan Han
- Department of Microbiology and Institute for Medical Science Jeonbuk National University Medical School Jeonju South Korea
| | - Hern Ku Lee
- Department of Immunology and Institute for Medical Science Jeonbuk National University Medical School Jeonju South Korea
| |
Collapse
|
5
|
Ayakannu R, Abdullah NA, Raj VL, Radhakrishnan AK, Liam CK. Clinical characteristics, cytokine profiles and plasma IgE in adults with asthma. Mol Immunol 2022; 143:50-57. [PMID: 35038659 DOI: 10.1016/j.molimm.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/06/2021] [Accepted: 01/10/2022] [Indexed: 12/29/2022]
Abstract
Asthma is a disease with complicated network of inflammatory responses of cytokines and ImmunoglobulinE (IgE). The aim of this study was to explore the clinical characteristics, cytokine profile and plasma IgE in the Malaysian population. This is a cross-sectional study involving physician-diagnosed asthma patients (n = 287) recruited from the Chest Clinic, University of Malaya Medical Centre (UMMC). Blood (8 mL) was taken after consent was obtained. The peripheral blood leucocytes (PBL) were cultured in presence of a mitogen for 72 h to quantify cytokines [Interleukin-5(IL-5), Interleukin-9 (IL-9), Interleukin-12 Beta (IL-12ꞵ) and granulocyte-macrophage colony-stimulating factor (GM-CSF)] and plasma was used to quantify IgE levels with commercial ELISA kits. Results were compared against the same biomarkers in healthy subjects (n = 203). In addition, the amount of the biomarkers in the asthma patients were compared with their disease severity and clinical characteristics. Statistical tests in the SPSS software (Mann-Whitney U test and the Kruskal Wallis) were used to compare cytokine production and plasma IgE levels. The mean plasma IgE level was markedly higher (p < 0.0001) in asthmatics compared to controls. There were higher levels of IL-5, IL-9, IL-12ꞵ and GM-CSF (p < 0.0001) produced by cultured PBL from asthma patients compared to controls. However, our results did not expose a significant association between these cytokine levels and severity and clinical symptoms of asthma. However, there was a marked association between asthma severity and blood lymphocyte count [ꭓ2(2) = 6.745, p < 0.05]. These findings support the roles played by cytokines and IgE in the airway inflammation in asthma. The findings of this study provide new information about inflammatory cytokines in Malaysian asthma patients.
Collapse
Affiliation(s)
- Rathimalar Ayakannu
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Department of Pharmacology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Nor Azizan Abdullah
- Department of Pharmacology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
| | - Vijaya Lechimi Raj
- Faculty of Medicine, Bioscience & Nursing, MAHSA University, Jalan SP 2, Bandar Saujana Putra, 42610, Jenjarom, Selangor, Malaysia
| | - Ammu K Radhakrishnan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
6
|
A Phenotypic Approach for Personalised Management of Obstructive Sleep Apnoea. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
Busse WW, Fang J, Marvel J, Tian H, Altman P, Cao H. Uncontrolled asthma across GINA treatment steps 2 - 5 in a large US patient cohort. J Asthma 2021; 59:1051-1062. [PMID: 33709871 DOI: 10.1080/02770903.2021.1897834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Despite advances in treatment, asthma remains uncontrolled in many patients, with increased risk of exacerbation and associated healthcare resource utilization (HCRU). We describe patient characteristics, exacerbations, asthma control, and HCRU using GINA treatment step (GS) as a proxy for asthma severity. . METHODS Using a large, US, health-claims database, 4 longitudinal cohorts of 517,738 patients in GS2-5, including a subgroup of patients with baseline eosinophil (EOS) counts, were analyzed retrospectively (study period 2010 - 2016). Index for each cohort was patients' first time entering the GS, determined by first claim of first regimen. Uncontrolled asthma was defined according to published criteria as a multi-dimensional measure that includes number of exacerbations. Key variables including, baseline characteristics, post-index exacerbations, and HCRU (all-cause and asthma-specific events) are summarized by descriptive statistics. RESULTS Uncontrolled asthma was reported in 19.8% patients in GS2, 44.8% in GS3, 49.3% in GS4, and 58.6% in GS5. Annualized mean (SD) rates of exacerbation 12 months post-index generally increased across GS2-5 (0.26 [0.86], 0.32 [0.79], 0.36 [0.83], 0.29 [0.86], respectively). HCRU also increased with increasing GS, with higher HCRU among the uncontrolled cohort within each GS. In patients with EOS ≥300 cells/µL, uncontrolled asthma also increased with increasing GS (21.8%, 43.9%, 50.5%, 67.2% for GS2-5, respectively). CONCLUSIONS This large database study provides real-world evidence of the substantial degree of uncontrolled asthma in US clinical practice across GS, supporting calls for better asthma management. Healthcare burden tends to increase with lack of control in all groups, highlighting the need for improved patient education, adherence, access, and treatment optimization. Supplemental data for this article can be accessed at publisher's website.
Collapse
Affiliation(s)
- William W Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Juanzhi Fang
- Novartis Pharmaceuticals Corporation, Global Medical Affairs, East Hanover, NJ, USA
| | - Jessica Marvel
- Novartis Pharmaceuticals Corporation, Department of Health Economics and Outcomes Research, East Hanover, NJ, USA
| | - Hengfeng Tian
- Novartis Services Inc, Medical and Knowledge Solutions, East Hanover, NJ, USA
| | - Pablo Altman
- Novartis Pharmaceuticals Corporation, Global Drug Development, East Hanover, NJ, USA
| | - Hui Cao
- Novartis Pharmaceuticals Corporation, Global Medical Affairs, East Hanover, NJ, USA
| |
Collapse
|
8
|
Almeshari MA, Stockley J, Sapey E. The diagnosis of asthma. Can physiological tests of small airways function help? Chron Respir Dis 2021; 18:14799731211053332. [PMID: 34693751 PMCID: PMC8543738 DOI: 10.1177/14799731211053332] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Asthma is a common, chronic, and heterogeneous disease with a global impact and substantial economic costs. It is also associated with significant mortality and morbidity and the burden of undiagnosed asthma is significant. Asthma can be difficult to diagnose as there is no gold standard test and, while spirometry is central in diagnosing asthma, it may not be sufficient to confirm or exclude the diagnosis. The most commonly reported spirometric measures (forced expiratory volume in one second (FEV1) and forced vital capacity assess function in the larger airways. However, small airway dysfunction is highly prevalent in asthma and some studies suggest small airway involvement is one of the earliest disease manifestations. Moreover, there are new inhaled therapies with ultrafine particles that are specifically designed to target the small airways. Potentially, tests of small airways may more accurately diagnose early or mild asthma and assess the response to treatment than spirometry. Furthermore, some assessment techniques do not rely on forced ventilatory manoeuvres and may, therefore, be easier for certain groups to perform. This review discusses the current evidence of small airways tests in asthma and future research that may be needed to further assess their utility.
Collapse
Affiliation(s)
- Mohammed A Almeshari
- Rehabilitation Health Sciences
Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Institute of Inflammation and
Ageing, University of
Birmingham, Birmingham, UK
- Mohammed A. Almeshari, Institute of
Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B152TT,
UK.
| | - James Stockley
- Department of Lung Function and
Sleep, University Hospitals Birmingham NHS
Foundation Trust, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and
Ageing, University of
Birmingham, Birmingham, UK
| |
Collapse
|
9
|
Yang Q, Kong L, Huang W, Mohammadtursun N, Li X, Wang G, Wang L. Osthole attenuates ovalbumin‑induced lung inflammation via the inhibition of IL‑33/ST2 signaling in asthmatic mice. Int J Mol Med 2020; 46:1389-1398. [PMID: 32700747 PMCID: PMC7447319 DOI: 10.3892/ijmm.2020.4682] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/03/2020] [Indexed: 01/12/2023] Open
Abstract
Asthma is a common chronic inflammatory airway disease. Recent studies have reported that interleukin (IL)-33 is a potential link between the airway epithelium and Th2-type inflammatory responses, which are closely related to the progression of asthma. The IL-33 receptor, ST2, is highly expressed in group 2 innate lymphoid cells (ILC2s), Th2 cells, mast cells, eosinophils and natural killer (NK) cells. Cnidii Fructus is a Chinese herb with a long history of use in the treatment of asthma in China. Osthole is one of the major components of Cnidii Fructus. The present study examined the anti-asthmatic effects of osthole in mice and aimed to elucidate the underlying mechanisms involving the IL-33/ST2 pathway. BALB/c mice were sensitized and challenged with ovalbumin and then treated with an intraperitoneal injection of osthole (25 and 50 mg/kg). Subsequently, the airway hyper-responsiveness (AHR) and inflammation of the lungs were evaluated. The amounts of IL-4, IL-5, IL-13, interferon (IFN)-γ and IL-33 in the bronchoalveolar lavage fluid (BALF) were measured by Luminex assay and their mRNA levels in the lungs were measured by reverse transcription-quantitative PCR. The histopathology of the lungs was performed with H&E, PAS and Masson's staining. The expression of ST2 in the lungs was evaluated by immunohistochemistry. The data demonstrated that osthole markedly reduced AHR and decreased the number of eosinophils and lymphocytes in BALF. It was also observed that osthole significantly inhibited the release of Th2-type cytokines (IL-4, IL-5 and IL-13) and upregulated the IFN-γ level in BALF. Moreover, osthole significantly attenuated the IL-33 and ST2 expression in the lungs of asthmatic mice. On the whole, osthole attenuated ovalbumin-induced lung inflammation through the inhibition of IL-33/ST2 signaling in an asthmatic mouse model. These results suggest that osthole is a promising target for the development of an asthma medication.
Collapse
Affiliation(s)
- Qingqing Yang
- Department of Respiratory Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Lingwen Kong
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Weiling Huang
- Department of Respiratory Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Nabijan Mohammadtursun
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Xiumin Li
- Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Guifang Wang
- Department of Respiratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Lixin Wang
- Department of Integrated Traditional Chinese and Western Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, P.R. China
| |
Collapse
|
10
|
Abstract
Asthma, a chronic respiratory disease characterized by chronic airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction, poses a substantial economic burden on patients and caregivers alike. Moreover, the heterogeneous nature of the disease and the presence of various phenotypes make the treatment of asthma challenging and nuanced. Despite the availability of several approved pharmacological treatments, approximately half of patients with asthma in the United States experienced exacerbations in 2016, highlighting the need for effective add-on treatments. Furthermore, asthma control remains suboptimal due to low adherence to medications, poor inhaler technique, and several patient-related factors. Importantly, the primary care setting, in which pharmacists play an integral role, represents a critical environment for providing long-term follow-up care for the effective management of chronic diseases, such as asthma. Pharmacists are uniquely positioned to ensure optimal clinical outcomes in patients with asthma since they have the clinical expertise to educate patients on their disease state and the role of asthma medications, provide training on inhalation technique, address patients’ concerns about potential side effects of medications, and improve adherence to therapy. Therefore, in this review article, we discuss the overall role of pharmacists in effective asthma care and management.
Collapse
Affiliation(s)
- Mary B Bridgeman
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, 5751Rutgers, The State University of New Jersey, NJ, USA
| | - Lori A Wilken
- Pharmacy Practice, 14681University of Illinois at Chicago College of Pharmacy, IL, USA
| |
Collapse
|
11
|
Li X, Chen Q, Zheng X, Li Y, Han M, Liu T, Xiao J, Guo L, Zeng W, Zhang J, Ma W. Effects of ambient ozone concentrations with different averaging times on asthma exacerbations: A meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 691:549-561. [PMID: 31325855 DOI: 10.1016/j.scitotenv.2019.06.382] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/10/2019] [Accepted: 06/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mounting evidence suggests that short-term exposure to ozone increases the risk of asthma exacerbations. However, ozone exposures have been assessed using ambient ozone concentrations averaged over different time periods in different studies. OBJECTIVE To evaluate the risks for asthma exacerbations related to ambient ozone measured as 1-hour or 8-hour daily maximum and 24-hour average concentrations. METHODS Based on a literature search in PubMed, EMBASE and Web of Science, we identified all time-series studies as of December 4th, 2018 and included 47 eligible studies in our analyses. Asthma exacerbation is defined as the risk for emergency room visits or hospital admissions. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) for a 10 μg/m3 increase in daily ozone concentration were estimated using random effect models. Subgroup analyses and sensitivity analyses were also performed to examine the risks for different seasons, regions and age groups and for the robustness of our main findings. RESULTS Significant and similar associations were found for O3-1 h max (RR,1.012; 95%CI, 1.005-1.019) and O3-8 h max (RR, 1.011; 95%CI, 1.007-1.014), while marginal effect was identified for O3-24 h average (RR, 1.005; 95%CI, 0.996-1.014). No significant publication bias but high heterogeneities were observed. During the warm season, ozone was significantly associated with asthma exacerbation. O3-1 h max had the highest RR of 1.014 (95%CI, 1.005-1.024), followed by O3-8 h max (RR, 1.012; 95%CI, 1.009-1.016), while marginal association was identified for O3-24 h avg (RR, 1.008; 95%CI, 0.998-1.017). During the cold season, null associations were identified for all the three averaging times. Variations were also observed in region and age. CONCLUSION Ozone exposure measured as 1-hour or 8-hour daily max were more consistently associated with asthma exacerbations than 24-hour average exposure during the warm season.
Collapse
Affiliation(s)
- Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China; Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Xueyan Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Yongzhi Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Min Han
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Junfeng Zhang
- Nicholas School of the Environment, Duke Global Health Institute, Duke University, Durham, NC 27705, USA; Duke Kunshan University, Kunshan, Jiangsu Province 215316, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China.
| |
Collapse
|
12
|
Cistulli PA, Sutherland K. Phenotyping obstructive sleep apnoea—Bringing precision to oral appliance therapy. J Oral Rehabil 2019; 46:1185-1191. [DOI: 10.1111/joor.12857] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Peter A. Cistulli
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
- Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine Royal North Shore Hospital Sydney New South Wales Australia
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
- Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine Royal North Shore Hospital Sydney New South Wales Australia
| |
Collapse
|
13
|
Peng J, Li XM, Zhang GR, Cheng Y, Chen X, Gu W, Guo XJ. TNF-TNFR2 Signaling Inhibits Th2 and Th17 Polarization and Alleviates Allergic Airway Inflammation. Int Arch Allergy Immunol 2019; 178:281-290. [PMID: 30763933 DOI: 10.1159/000493583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/07/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND TNF-TNFR2 signaling has been indicated to be involved in CD4+ T lymphocyte differentiation. However, its role in allergic airway inflammation is not well understood. OBJECTIVES The aim of this study was to investigate the role of TNF-TNFR2 signaling in allergic airway inflammation. METHODS AND RESULTS In this study, we used an allergen-induced asthma model to show that TNF-TNFR2 signaling alleviated allergic airway inflammation by reducing the airway infiltration of eosinophils and neutrophils. Activated TNF-TNFR2 signaling decreased the expression of Th2 and Th17 cytokines in serum and bronchoalveolar lavage fluid. Furthermore, TNF-TNFR2 signaling inhibited Th2 and Th17 polarization but promoted Th1 and CD4+CD25+ T cell differentiation in vivo. CONCLUSIONS Our study indicates that TNF-TNFR2 signaling alleviates allergic airway inflammation through inhibition of Th2 and Th17 cell differentiation.
Collapse
Affiliation(s)
- Juan Peng
- Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,
| | - Xiao-Ming Li
- Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guo-Rui Zhang
- Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Cheng
- Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xi Chen
- Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Gu
- Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xue-Jun Guo
- Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
14
|
Mésidor M, Benedetti A, El-Zein M, Menzies D, Parent MÉ, Rousseau MC. Asthma phenotypes based on health services use for allergic diseases in a province-wide birth cohort. Ann Allergy Asthma Immunol 2018; 122:50-57.e2. [PMID: 30223115 DOI: 10.1016/j.anai.2018.09.453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/23/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many previous studies on asthma phenotypes were conducted in selected clinical populations and overlooked changes throughout the life course. OBJECTIVE To identify asthma phenotypes based on use of health services for allergic diseases in 3 life periods and document transitions among phenotypes across life periods. METHODS In a population-based cohort of 78,211 individuals born in 1974 in the province of Québec, Canada, we documented medical visits and hospitalizations for asthma and other allergic diseases until 1994. Phenotypes based on clusters of health services use in childhood (8-12 years of age), adolescence (13-17 years of age), and young adulthood (18-20 years of age) were identified using a hierarchical method among 9,989 individuals (12.8%) who had at least one health encounter for asthma during follow-up. Population-level probabilities of transitioning among phenotypes were estimated in the full study population. RESULTS In the subset with asthma, 6 phenotypes were identified during both childhood and young adulthood and 7 during adolescence. The most common phenotype was no asthma or allergic diseases: 58% in childhood, 42% in adolescence, and 54% in adulthood. The second most common was the mild asthma and no allergic diseases phenotype, representing 36%, 31%, and 21%, respectively, in these 3 periods. In the study population, 87% of the individuals remained in the no asthma phenotype group during the follow-up. Most individuals in the asthma phenotypes transitioned over time. CONCLUSION Our study uniquely contributes to a better understanding, at the population level, of the manifestations and transitions in asthma phenotypes during the life course.
Collapse
Affiliation(s)
- Miceline Mésidor
- Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique, Institut Armand-Frappier, Université du Québec, Laval, Quebec, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mariam El-Zein
- Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique, Institut Armand-Frappier, Université du Québec, Laval, Quebec, Canada
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Marie-Élise Parent
- Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique, Institut Armand-Frappier, Université du Québec, Laval, Quebec, Canada
| | - Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, Institut national de la recherche scientifique, Institut Armand-Frappier, Université du Québec, Laval, Quebec, Canada.
| |
Collapse
|
15
|
Haikarainen J, Rytilä P, Roos S, Metsärinne S, Happonen A. Dose uniformity of budesonide Easyhaler® under simulated real-life conditions and with low inspiration flow rates. Chron Respir Dis 2018; 15:265-271. [PMID: 29216744 PMCID: PMC6100165 DOI: 10.1177/1479972317745733] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 10/18/2017] [Indexed: 12/01/2022] Open
Abstract
Budesonide Easyhaler® multidose dry powder inhaler is approved for the treatment of asthma. Objectives were to determine the delivered dose (DD) uniformity of budesonide Easyhaler® in simulated real-world conditions and with different inspiration flow rates (IFRs). Three dose delivery studies were performed using 100, 200, and 400 µg/dose strengths of budesonide. Dose uniformity was assessed during in-use periods of 4-6 months after exposure to high temperature (30°C) and humidity (60% relative humidity) and after dropping and vibration testing. The influence of various IFRs (31, 43, and 54 L/min) on the DD was also investigated. Acceptable dose uniformity was declared when mean DD were within 80-120% of expected dose; all data reported descriptively. DD was constant (range: 93-109% of expected dose) at all in-use periods and after exposure to high temperature and humidity for a duration of up to 6 months. DD post-dropping and -vibration were unaffected (range 98-105% of expected dose). Similarly, DD was constant and within 10% of expected dose across all IFRs. Results indicate that budesonide Easyhaler® delivers consistently accurate doses in various real-life conditions. Budesonide Easyhaler® can be expected to consistently deliver a uniform dose and improve asthma control regardless of high temperature and humidity or varying IFR.
Collapse
Affiliation(s)
| | | | - Sirkku Roos
- Orion Corporation, Orion Pharma, Espoo, Finland
| | | | | |
Collapse
|
16
|
Zeki AA, Elbadawi-Sidhu M. Innovations in asthma therapy: is there a role for inhaled statins? Expert Rev Respir Med 2018; 12:461-473. [PMID: 29575963 PMCID: PMC6018057 DOI: 10.1080/17476348.2018.1457437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/22/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Asthma manifests as chronic airflow obstruction with persistent inflammation and airway hyperresponsiveness. The immunomodulatory and anti-inflammatory properties of the HMG-CoA reductase (HMGCR) inhibitors (a.k.a. statins), suggest a therapeutic role in chronic inflammatory lung diseases. However, despite positive laboratory investigations and promising epidemiological data, clinical trials using statins for the treatment of asthma have yielded conflicting results. Inadequate statin levels in the airway compartment could explain these findings. Areas covered: HMGCR is in the mevalonate (MA) pathway and MA signaling is fundamental to lung biology and asthma. This article will discuss clinical trials of oral statins in asthma, review lab investigations relevant to the systemic versus inhaled administration of statins, address the advantages and disadvantages of inhaled statins, and answer the question: is there a role for inhaled statins in the treatment of asthma? Expert commentary: If ongoing investigations show that oral administration of statins has no clear clinical benefits, then repurposing statins for delivery via inhalation is a logical next step. Inhalation of statins bypasses first-pass metabolism by the liver, and therefore, allows for delivery of significantly lower doses to the airways at greater potency. Statins could become the next major class of novel inhalers for the treatment of asthma.
Collapse
Affiliation(s)
- Amir A. Zeki
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Davis, CA, USA
| | - Mona Elbadawi-Sidhu
- NIH West Coast Metabolomics Center, Genome and Biomedical Sciences Facility, University of California, Davis, CA, USA
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Asthma is a heterogeneous disease not only on a clinical but also on a mechanistic level. For a long time, the molecular mechanisms of asthma were considered to be driven by type 2 helper T cells (Th2) and eosinophilic airway inflammation; however, extensive research has revealed that T2-low subtypes that differ from the dominant T2 paradigm are also common. RECENT FINDINGS Research into asthma pathways has led to the recognition that some asthma phenotypes show absence of T2 inflammation or alternate between T2 and non-T2 responses. Moreover, numerous immune response modifiers that block key-molecules such as interleukin (IL)-5, IL-13, and immunoglobulin E (IgE) have been identified. Along the way, these studies pointed that T2-low inflammation may also be responsible for lack of responsiveness to current treatment regimes. SUMMARY Asthma pathogenesis is characterized by two major endotypes, a T2-high featuring increased eosinophilic airway inflammation, and a T2-low endotype presenting with either neutrophilic or paucigranulocytic airway inflammation and showing greater resistance to steroids. This clearly presents an unmet therapeutic challenge. A precise definition and characterization of the mechanisms that drive this T2-low inflammatory response in each patient phenotype is necessary to help identify novel drug targets and design more effective and targeted treatments.
Collapse
|
18
|
Villaseñor A, Rosace D, Obeso D, Pérez-Gordo M, Chivato T, Barbas C, Barber D, Escribese MM. Answer to: "Biomarkers in allergic asthma: Which matrix should we use?". Clin Exp Allergy 2017. [PMID: 28639292 DOI: 10.1111/cea.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A Villaseñor
- Faculty of Medicine, IMMA, Institute of Applied Molecular Medicine, CEU San Pablo University, Madrid, Spain
| | - D Rosace
- Faculty of Medicine, IMMA, Institute of Applied Molecular Medicine, CEU San Pablo University, Madrid, Spain
| | - D Obeso
- Faculty of Medicine, IMMA, Institute of Applied Molecular Medicine, CEU San Pablo University, Madrid, Spain.,Faculty of Pharmacy, CEMBIO, Centre for Metabolomics and Bioanalysis, CEU San Pablo University, Madrid, Spain
| | - M Pérez-Gordo
- Faculty of Pharmacy, CEMBIO, Centre for Metabolomics and Bioanalysis, CEU San Pablo University, Madrid, Spain.,Faculty of Medicine, Basic Medical Sciences Department, CEU San Pablo University, Madrid, Spain
| | - T Chivato
- Faculty of Medicine, Basic Medical Sciences Department, CEU San Pablo University, Madrid, Spain
| | - C Barbas
- Faculty of Pharmacy, CEMBIO, Centre for Metabolomics and Bioanalysis, CEU San Pablo University, Madrid, Spain
| | - D Barber
- Faculty of Medicine, IMMA, Institute of Applied Molecular Medicine, CEU San Pablo University, Madrid, Spain
| | - M M Escribese
- Faculty of Medicine, IMMA, Institute of Applied Molecular Medicine, CEU San Pablo University, Madrid, Spain.,Faculty of Medicine, Basic Medical Sciences Department, CEU San Pablo University, Madrid, Spain
| |
Collapse
|
19
|
Li XM, Chen X, Gu W, Guo YJ, Cheng Y, Peng J, Guo XJ. Impaired TNF/TNFR2 signaling enhances Th2 and Th17 polarization and aggravates allergic airway inflammation. Am J Physiol Lung Cell Mol Physiol 2017; 313:L592-L601. [PMID: 28619762 DOI: 10.1152/ajplung.00409.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 12/11/2022] Open
Abstract
CD4+ T-cell differentiation plays an important role in allergic airway diseases. Tumor necrosis factor receptor 2 (TNFR2) has been shown to regulate CD4+ T-lymphocyte differentiation, but its role in allergic airway inflammation is not clear. Here, we investigated the role of TNFR2 in allergic airway inflammation. The mouse model was generated by immunization with ovalbumin and intranasal administration of TNFR2 antibody. Airway inflammation and CD4+ T-cell differentiation were measured in vivo and in vitro. Inhibited TNFR2 signaling aggravated airway inflammation and increased the expression of inflammatory cytokines (IL-4, IL-5, IL-17, and TNF-α) in serum and bronchoalveolar lavage fluid. Impaired TNFR2 signaling promoted Th2 and Th17 polarization but inhibited Th1 and CD4+CD25+ T-cell differentiation in vivo. Furthermore, TNFR2 signaling inhibition promoted Th2 and Th17 polarization in vitro, which may occur through the activation of TNF receptor-associated factor 2 and NF-κB signaling. Therefore, our findings indicate that impaired TNF/TNFR2 signaling enhances Th2 and Th17 polarization and aggravates allergic airway inflammation.
Collapse
Affiliation(s)
- Xiao-Ming Li
- Department of Respiratory Medicine, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China; and
| | - Xi Chen
- Department of Respiratory Medicine, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China; and
| | - Wen Gu
- Department of Respiratory Medicine, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China; and
| | - Yi-Jia Guo
- Shanghai XiangMing High School, Shanghai, China
| | - Yi Cheng
- Department of Respiratory Medicine, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China; and
| | - Juan Peng
- Department of Respiratory Medicine, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China; and
| | - Xue-Jun Guo
- Department of Respiratory Medicine, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China; and
| |
Collapse
|
20
|
Sommer B, Flores-Soto E, Gonzalez-Avila G. Cellular Na+ handling mechanisms involved in airway smooth muscle contraction (Review). Int J Mol Med 2017; 40:3-9. [PMID: 28534960 PMCID: PMC5466399 DOI: 10.3892/ijmm.2017.2993] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/20/2017] [Indexed: 12/17/2022] Open
Abstract
A decrease in bronchial diameter is designated as bronchoconstriction (BC) and impedes the flow of air through the airway. Asthma is characterized by inflammation of the airways, reversible BC and nonspecific hyperreactivity. These last two symptoms are dependent on airway smooth muscle. Stimuli that trigger contraction can be characterized as chemical (neurotransmitters, cytokines and terpenoids) and physical (volume inspired, air pressure). Both stimuli activate signaling pathways by acting on membrane proteins and facilitating the passage of ions through the membrane, generating a voltage change and a subsequent depolarization. Na+ plays an important role in preserving the resting membrane potential; this ion is extracted from the cells by the Na+/K+ ATPase (NKA) or introduced into the cytoplasm by the Na+/Ca2+ exchanger (NCX). During depolarization, Na+ appears to accumulate in specific regions beneath the plasma membrane, generating local concentration gradients which determine the handling of Ca2+. At rest, the smooth muscle has a basal tone that is preserved by the continuous adjustment of intracytoplasmic concentrations of Ca2+ and Na+. At homeostasis, the Na+ concentration is primarily dependent on three structures: the NKA, the NCX and non-specific cation channels (NSCC). These three structures, their functions and the available evidence of the probable role of Na+ in asthma are described in the present review.
Collapse
Affiliation(s)
- Bettina Sommer
- Department of Bronchial Hyperreactivity, National Institute of Respiratory Diseases 'Ismael Cosio Villegas', CP 14080 Mexico City, Mexico
| | - Edgar Flores-Soto
- Department of Pharmacology, Faculty of Medicine, National Autonomous University of Mexico, CP 04510 Mexico City, Mexico
| | - Georgina Gonzalez-Avila
- Biomedical Oncology Laboratory, Department of Chronic‑Degenerative Diseases, National Institute of Respiratory Diseases 'Ismael Cosio Villegas', CP 14080 Mexico City, Mexico
| |
Collapse
|
21
|
Thiriou D, Morianos I, Xanthou G, Samitas K. Innate immunity as the orchestrator of allergic airway inflammation and resolution in asthma. Int Immunopharmacol 2017; 48:43-54. [PMID: 28463786 DOI: 10.1016/j.intimp.2017.04.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 04/15/2017] [Accepted: 04/24/2017] [Indexed: 12/31/2022]
Abstract
The respiratory system is constantly in direct contact with the environment and, has therefore, developed strong innate and adaptive immune responses to combat pathogens. Unlike adaptive immunity which is mounted later in the course of the immune response and is naive at the outset, innate immunity provides the first line of defense against microbial agents, while also promoting resolution of inflammation. In the airways, innate immune effector cells mainly consist of eosinophils, neutrophils, mast cells, basophils, macrophages/monocytes, dendritic cells and innate lymphoid cells, which attack pathogens directly or indirectly through the release of inflammatory cytokines and antimicrobial peptides, and coordinate T and B cell-mediated adaptive immunity. Airway epithelial cells are also critically involved in shaping both the innate and adaptive arms of the immune response. Chronic allergic airway inflammation and linked asthmatic disease is often considered a result of aberrant activation of type 2 T helper cells (Th2) towards innocuous environmental allergens; however, innate immune cells are increasingly recognized as key players responsible for the initiation and the perpetuation of allergic responses. Moreover, innate cells participate in immune response regulation through the release of anti-inflammatory mediators, and guide tissue repair and the maintenance of airway homeostasis. The scope of this review is to outline existing knowledge on innate immune responses involved in allergic airway inflammation, highlight current gaps in our understanding of the underlying molecular and cellular mechanisms and discuss the potential use of innate effector cells in new therapeutic avenues.
Collapse
Affiliation(s)
- Despoina Thiriou
- 2(nd) Respiratory Medicine Dept., Athens Chest Hospital "Sotiria", Athens, Greece
| | - Ioannis Morianos
- Cellular Immunology Laboratory, Division of Cell Biology, Center for Basic Research, Biomedical Research Foundation of the Academy of Athens, Greece
| | - Georgina Xanthou
- Cellular Immunology Laboratory, Division of Cell Biology, Center for Basic Research, Biomedical Research Foundation of the Academy of Athens, Greece
| | - Konstantinos Samitas
- Cellular Immunology Laboratory, Division of Cell Biology, Center for Basic Research, Biomedical Research Foundation of the Academy of Athens, Greece; 7(th) Respiratory Medicine Dept. and Asthma Center, Athens Chest Hospital "Sotiria", Athens, Greece.
| |
Collapse
|
22
|
Orellano P, Quaranta N, Reynoso J, Balbi B, Vasquez J. Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis. PLoS One 2017; 12:e0174050. [PMID: 28319180 PMCID: PMC5358780 DOI: 10.1371/journal.pone.0174050] [Citation(s) in RCA: 268] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 03/02/2017] [Indexed: 12/31/2022] Open
Abstract
Background Several observational studies have suggested that outdoor air pollution may induce or aggravate asthma. However, epidemiological results are inconclusive due to the presence of numerous moderators which influence this association. The goal of this study was to assess the relationship between outdoor air pollutants and moderate or severe asthma exacerbations in children and adults through a systematic review and multilevel meta-analysis. Material and methods We searched studies published in English on PubMed, Scopus, and Google Scholar between January 2000 and October 2016. Studies following a case-crossover design with records of emergency departments and/or hospital admissions as a surrogate of moderate or severe asthma exacerbations were selected. A multilevel meta-analysis was employed, taking into account the potential clustering effects within studies examining more than one lag. Odds ratios (ORs) and 95% confidence intervals were estimated. A subgroup analysis in children aged 0 to 18 years and a sensitivity analysis based on the quality of the included studies as defined in the Newcastle-Ottawa Scale were performed. Publication bias was evaluated through visual inspection of funnel plots and by a complementary search of grey literature. (Prospero Registration number CRD42015032323). Results Database searches retrieved 208 records, and finally 22 studies were selected for quantitative analysis. All pollutants except SO2 and PM10 showed a significant association with asthma exacerbations (NO2: 1.024; 95% CI: 1.005,1.043, SO2: 1.039; 95% CI: 0.988,1.094), PM10: 1.024; 95% CI: 0.995,1.053, PM2.5: 1.028; 95% CI: 1.009,1.047, CO: 1.045; 95% CI: 1.005,1.086, O3: 1.032; 95% CI: 1.005,1.060. In children, the association was significant for NO2, SO2 and PM2.5. Conclusion This meta-analysis provides evidence of the association between selected air pollutants and asthma exacerbations for different lags.
Collapse
Affiliation(s)
- Pablo Orellano
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Universidad Tecnológica Nacional, Facultad Regional San Nicolás, San Nicolás, Argentina
| | - Nancy Quaranta
- Universidad Tecnológica Nacional, Facultad Regional San Nicolás, San Nicolás, Argentina.,Comisión de Investigaciones Científicas (CIC), La Plata, Argentina
| | - Julieta Reynoso
- Hospital Interzonal General de Agudos "San Felipe", San Nicolás, Argentina
| | - Brenda Balbi
- Hospital Interzonal General de Agudos "San Felipe", San Nicolás, Argentina
| | - Julia Vasquez
- Hospital Interzonal General de Agudos "San Felipe", San Nicolás, Argentina
| |
Collapse
|
23
|
Lin CH, Cheng SL. A review of omalizumab for the management of severe asthma. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2369-78. [PMID: 27528798 PMCID: PMC4970638 DOI: 10.2147/dddt.s112208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite the expansion of the understanding in asthma pathophysiology and the continual advances in disease management, a small subgroup of patients remain partially controlled or refractory to standard treatments. Upon the identification of immunoglobulin E and other inflammatory mediators, investigations and developments of targeted agents have thrived. Omalizumab is a humanized monoclonal antibody that specifically targets the circulating immunoglobulin E, which in turn impedes and reduces subsequent releases of the proinflammatory mediators. In the past decade, omalizumab has been proven to be efficacious and well-tolerated in the treatment of moderate-to-severe asthma in both trials and real-life studies, most notably in reducing exacerbation rates and corticosteroid use. While growing evidence has demonstrated that omalizumab may be potentially beneficial in treating other allergic diseases, its indication remains confined to treating severe allergic asthma and chronic idiopathic urticaria. Future efforts may be focused on determining the optimal length of omalizumab treatment, seeking biomarkers that could better predict treatment response, as well as extending its indications.
Collapse
Affiliation(s)
- Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, Republic of China; Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan, Republic of China; School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, Republic of China; Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan County, Taiwan, Republic of China
| |
Collapse
|
24
|
Wang Y, Zhu H, Tong J, Li Z. Ligustrazine improves blood circulation by suppressing Platelet activation in a rat model of allergic asthma. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 45:334-339. [PMID: 27362664 DOI: 10.1016/j.etap.2016.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/12/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
Chuan-xiong (Ligusticum wallichii) is a traditional herbal medicine in Eastern Asia, but the effect of its active component ligustrazine remains unclear. We explored its effect and possible mechanism in a well-characterized rat model of allergic asthma. Ligustrazine suppressed bronchial hyper-responsiveness to methacholine, and suppressed lung inflammation in asthmatic rats. Ligustrazine exhibited potent immuno-modulatory and anti-inflammatory effects: it suppressed lymphocyte and eosinophil mobilization, and reduced cytokine IL-5 and IL-13 production significantly in lung tissues from asthmatic rats (P<0.05). Further histological examinations clearly demonstrated that ligustrazine improved blood circulation and ameliorated platelet activation, aggregation and adhesion, which induced sustained infiltration and activation of various inflammatory cells, including lymphocytes and eosinophils, followed by synthesis and release of a variety of pro-inflammatory mediators and cytokines. The present study suggests that ligustrazine is a potent agent for the treatment of allergic asthma due to its strong anti-inflammatory and immuno-modulatory properties.
Collapse
Affiliation(s)
- Yajuan Wang
- Anhui University of Chinese Medicine, No. 103 Meishan Road, Hefei 230012, Anhui, China
| | - Huizhi Zhu
- The First Affiliated Hospital of Anhui University of Chinese Medicine, No. 218 Jixi Road, Hefei 230022, Anhui, China
| | - Jiabing Tong
- The First Affiliated Hospital of Anhui University of Chinese Medicine, No. 218 Jixi Road, Hefei 230022, Anhui, China
| | - Zegeng Li
- Anhui University of Chinese Medicine, No. 103 Meishan Road, Hefei 230012, Anhui, China.
| |
Collapse
|