1
|
Martin A, Lupfer C, Amen R. Sodium Pyruvate Nasal Spray Reduces the Severity of Nasal Inflammation and Congestion in Patients with Allergic Rhinitis. J Aerosol Med Pulm Drug Deliv 2022; 35:291-295. [PMID: 35960504 PMCID: PMC9807276 DOI: 10.1089/jamp.2022.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: As an anti-inflammatory and antioxidant, sodium pyruvate significantly reduces inflammatory cytokines and oxygen radicals such as interleukin (IL) IL-6, IL-8, Monocyte Chemoattractant Protein-1, and hydrogen peroxide. Thus, sodium pyruvate holds promise as a treatment for many respiratory diseases, including allergic rhinitis (AR). Novel treatments for AR are needed as current medications, including steroids, often fail to treat severe symptoms. Methods: The data from five human clinical studies were analyzed to determine the effect of 20 mM sodium pyruvate nasal spray (N115) in patients with AR. Nasal inflammation scores were compared to a placebo control or a no-treatment baseline control. Three studies were open-labeled and two were appropriately blinded to both patients and clinicians using computer randomization of subjects. Results: The intranasal administration of sodium pyruvate significantly improved nasal inflammation scores in all five clinical trials of patients with AR (p < 0.0001 in all trials). Conclusions: These results give credence to the overall ability of sodium pyruvate, administered by nasal spray, to treat inflammation of the nasal airways.
Collapse
Affiliation(s)
- Alain Martin
- EmphyCorp/Cellular Sciences, Inc., Flemington, New Jersey, USA.,Address correspondence to: Alain Martin, PhD, Emphycorp/Cellular Sciences, Inc., 84 Park Avenue, Suite E-102, Flemington, NJ 08822, USA
| | - Christopher Lupfer
- Department of Biology, Missouri State University, Springfield, Missouri, USA
| | - Ronald Amen
- EmphyCorp/Cellular Sciences, Inc., Flemington, New Jersey, USA
| |
Collapse
|
2
|
Øie MR, Helvik AS, Sue-Chu M, Steinsvåg SK, Thorstensen WM. Sinonasal Symptoms in COPD: Burden and Associations with Clinical Markers of Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:2137-2147. [PMID: 36101792 PMCID: PMC9464443 DOI: 10.2147/copd.s372991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Sinonasal symptoms are prevalent in COPD, and knowledge of the relationship between these symptoms and clinical markers of COPD is limited. This study explores the associations between the burden of sinonasal symptoms and clinical markers and thresholds recommended for guiding treatment decisions in the GOLD guidelines. Patients and Methods Sinonasal symptoms were quantified with the rhinological subscale of the Sino-Nasal-Outcome-Test (SNOT-22) in 93 COPD patients characterized by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 diagnostic criteria for rhinosinusitis without nasal polyps (RSsNP). Associations between a high burden, defined as a SNOT22_rhinological score of ≥11, and the following markers were assessed by adjusted multivariable linear regressions; severity of dyspnea [modified Medical Research Council (mMRC)] and cough [Visual Analogue Scale (VAS)], physical activity [6-minute walking distance (6MWD)], mortality risk (BODE index), and HRQoL [disease-specific COPD Assessment Test (CAT) and St. Georges Respiratory Questionnaire (SGRQ), and physical component summary, Short Form-36 version 2.0 (PCS SF-36v2)]. Odds ratios for the association of a high burden and threshold levels for regular treatment were estimated by adjusted binomial logistic regression models. Results A high burden was associated with greater severity of dyspnea and cough, lower 6MWD, higher BODE index and poorer HRQoL. The odds ratio of having CAT and SGRQ scores that are above the thresholds recommended for treatment was 5–7-fold greater in the high burden group. Conclusion A high burden of sinonasal symptoms is positively associated with the clinical markers of symptom severity and mortality risk and is inversely associated with physical activity and HRQoL in COPD. These findings add further support that the UAD concept also applies to COPD. Enquiry about sinonasal symptoms in COPD patients should be incorporated into the clinical routine.
Collapse
Affiliation(s)
- Marte Rystad Øie
- Department of Otolaryngology, Head and Neck Surgery, St. Olavs hospital, 7006 Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne-Sofie Helvik
- Department of Otolaryngology, Head and Neck Surgery, St. Olavs hospital, 7006 Trondheim University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Malcolm Sue-Chu
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sverre Karmhus Steinsvåg
- Department of Otolaryngology, Head and Neck Surgery, Sørlandet Hospital, Kristiansand, 4604, Norway.,Haukeland University Hospital, Bergen, Norway
| | - Wenche Moe Thorstensen
- Department of Otolaryngology, Head and Neck Surgery, St. Olavs hospital, 7006 Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
3
|
Rhinitis Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1492-1503. [PMID: 32389274 DOI: 10.1016/j.jaip.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different "phenotypes," based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment.
Collapse
|
4
|
Tiotiu A, Novakova P, Baiardini I, Bikov A, Chong-Neto H, de-Sousa JC, Emelyanov A, Heffler E, Fogelbach GG, Kowal K, Labor M, Mihaicuta S, Nedeva D, Novakova S, Steiropoulos P, Ansotegui IJ, Bernstein JA, Boulet LP, Canonica GW, Dubuske L, Nunes C, Ivancevich JC, Santus P, Rosario N, Perazzo T, Braido F. Manifesto on united airways diseases (UAD): an Interasma (global asthma association - GAA) document. J Asthma 2021; 59:639-654. [PMID: 33492196 DOI: 10.1080/02770903.2021.1879130] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The large amount of evidence and the renewed interest in upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). METHODS Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members. RESULTS The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change. UAD refers to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient's health status and requiring an integrated diagnostic and therapeutic plan. The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient's quality of life. CONCLUSIONS Patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and home based continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD. Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.
Collapse
Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, Nancy, France.,EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andras Bikov
- Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Herberto Chong-Neto
- Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil
| | - Jaime Correia- de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University named after I.I.Mechnikov, St-Petersburg, Russia
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Guillermo Guidos Fogelbach
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria.,Instituto Politécnico Nacional, Escuela Nacional de Medicina y Homeopatía, Laboratorio de Bioquímica Estructural, Ciudad de México, México
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | | | - Stefan Mihaicuta
- Pulmonology Department, Cardio Prevent Foundation, University of Medicine and Pharmacy "Dr Victor Babes", Timisoara, Romania
| | - Denislava Nedeva
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Sylvia Novakova
- Allergy Unit of Internal Consulting Department, University Hospital "St. George", Plovdiv, Bulgaria
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section University of Cincinnati, Cincinnati, OH, USA
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Lawrence Dubuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Carlos Nunes
- Centro de ImmunoAlergologia de Algarve, Porto, Portugal
| | - Juan Carlos Ivancevich
- Immunology Department, Faculty of Medicine, del Salvador University, Buenos Aires, Argentina
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences, University of Milan, Division of Respiratory Diseases "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Tommaso Perazzo
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Fulvio Braido
- Department of Internal Medicine, University of Genoa, Genova, Italy.,Respiratory Unit for Continuity of Care IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| |
Collapse
|
5
|
Bergqvist J, Andersson A, Schiöler L, Olin AC, Murgia N, Bove M, Janson C, Abramson MJ, Leynaert B, Nowak D, Franklin KA, Pin I, Storaas T, Schlünssen V, Heinrich J, Hellgren J. Non-infectious rhinitis is more strongly associated with early-rather than late-onset of COPD: data from the European Community Respiratory Health Survey (ECRHS). Eur Arch Otorhinolaryngol 2020; 277:1353-1359. [PMID: 32048027 PMCID: PMC7160078 DOI: 10.1007/s00405-020-05837-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is associated with several co-morbidities and non-infectious rhinitis (NIR) has emerged as a new possible co-morbidity. The primary aim of this study is to confirm a previously reported association between NIR and COPD in a multicentre population over time. The secondary aim is to investigate the course over time of such an association through a comparison between early- and late-onset COPD. METHODS This study is part of the European Community Respiratory Health Survey (ECRHS). A random adult population from 25 centres in Europe and one in Australia was examined with spirometry and answered a respiratory questionnaire in 1998-2002 (ECRHS II) and in 2008-2013 (ECRHS III). Symptoms of non-infectious rhinitis, hay fever and asthma, and smoking habits were reported. Subjects reporting asthma were excluded. COPD was defined as a spirometry ratio of FEV1/FVC < 0.7. A total of 5901 subjects were included. RESULTS Non-infectious rhinitis was significantly more prevalent in subjects with COPD compared with no COPD (48.9% vs 37.1%, p < 0.001) in ECRHS II (mean age 43) but not in ECHRS III (mean age 54). In the multivariable regression model adjusted for COPD, smoking, age, BMI, and gender, non-infectious rhinitis was associated with COPD in both ECRHS II and III. CONCLUSION Non-infectious rhinitis was significantly more common in subjects with COPD at a mean age of 43. Ten years later, the association was weaker. The findings indicate that NIR could be associated with the early onset of COPD.
Collapse
Affiliation(s)
- Joel Bergqvist
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 9, 413 45, Gothenburg, Sweden.
| | - Anders Andersson
- COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Carin Olin
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicola Murgia
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Mogens Bove
- Department of ENT and Oral Maxillofacial Surgery, NU Hospital Group, Trollhättan, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bénédicte Leynaert
- Inserm UMR1152, Pathophysiology and Epidemiology of Respiratory Diseases, University of Paris, Paris, France
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Karl A Franklin
- Department of Surgery and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Isabelle Pin
- Pneumologie Pédiatrique, Antenne Pédiatrique du CIC, Grenoble, France
| | - Torgeir Storaas
- SKS/RAAO-Helse Vest, Haukeland universitetssjukehus, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus University and the National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center (CPC), University Hospital, LMU Munich, Munich, Germany
| | - Johan Hellgren
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 9, 413 45, Gothenburg, Sweden
| |
Collapse
|
6
|
Maio S, Baldacci S, Carrozzi L, Pistelli F, Simoni M, Angino A, La Grutta S, Muggeo V, Viegi G. 18-yr cumulative incidence of respiratory/allergic symptoms/diseases and risk factors in the Pisa epidemiological study. Respir Med 2019; 158:33-41. [PMID: 31585374 DOI: 10.1016/j.rmed.2019.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Few population-based studies on the effects of environmental exposure variation exist. AIM Assessing respiratory symptom/disease incidence related to risk factor exposure changes. METHODS A longitudinal general population sample from two surveys (PISA2:1991-1993; PISA3:2009-2011; no. = 970), aged ≥20 years at baseline, completed a questionnaire on respiratory symptoms/diseases, risk factor exposure and performed spirometry. 18-year follow-up cumulative incidence of respiratory symptoms/diseases and longitudinal changes (persistence, incidence, remittance) in risk factor exposure were computed. RESULTS Cumulative incidence values were: 3.2% (corresponding to a 1.8‰/year incidence rate), asthma; 6.6% (3.8‰/year), asthma attacks; 4.5% (2.6‰/year), wheeze; 31.7% (21.0‰/year), allergic rhinitis-AR; 7.6% (4.4‰/year), chronic obstructive pulmonary disease-COPD; 16.1% (9.7‰/year), usual cough; 18.5% (11.3‰/year), usual phlegm; 30.7% (20.1‰/year), dyspnoea 1+; 13.9% (8.3‰/year), airway obstruction. The following associations emerged among respiratory symptom/disease cumulative incidence and risk factor exposure changes: a two-to-five fold higher risk for COPD, phlegm, cough, dyspnoea, asthma attacks, airway obstruction in persistent smokers; a two-to-three fold higher risk for COPD in remittent smokers; a two-fold higher risk for AR, phlegm and a four-fold higher risk for asthma in subjects with persistent occupational exposure; a two-fold higher risk for cough, phlegm, dyspnoea, AR in subjects with incident occupational exposure; a two-fold higher risk for AR, asthma attacks, COPD in subjects with incident traffic exposure. CONCLUSIONS Our study showed noteworthy respiratory symptom/disease incidence values and indicated that life-style and environmental exposure changes can differently influence onset. This information could be useful for primary prevention strategies in order to reduce the chronic disease burden in the general population.
Collapse
Affiliation(s)
- Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy; University of Palermo, Department of Economics, Business and Statistic, Palermo, Italy.
| | - Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Italy
| | - Francesco Pistelli
- Unit of Pulmonology, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Marzia Simoni
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Anna Angino
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Stefania La Grutta
- CNR Institute for Research and Biomedical Innovation (IRIB), Palermo, Italy
| | - Vito Muggeo
- University of Palermo, Department of Economics, Business and Statistic, Palermo, Italy
| | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy; CNR Institute for Research and Biomedical Innovation (IRIB), Palermo, Italy
| |
Collapse
|
7
|
NİKSARLIOĞLU EY, IŞIK R, UYSAL MA, ÜNAL D, ÇAMSARI G. Prevalence of atopy and allergic rhinitis in patients with adult non-cystic fibrosis bronchiectasis. Turk J Med Sci 2019; 49:551-557. [PMID: 30997791 PMCID: PMC7018301 DOI: 10.3906/sag-1807-229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background/aim Non-cystic fibrosis bronchiectasis (non-CF BR) is common in developing countries.Limited data are available regarding the impact of atopy, and no data are available regarding allergic rhinitis in patients with adult bronchiectasis.The aim of this study was to evaluate the prevalence of atopy and allergic rhinitis in the clinical conditions of patients with BR. Materials and methods The study enrolled 101 patients who were diagnosed with non-CF BR using high-resolution computed chest tomography. Allergic rhinitis (AR) was defined by skin prick test (SPT) positivity and the presence of any nasal symptoms (watery runny nose, nasal obstruction, nasal itching, and sneezing). Results The mean age of patients was 48 ± 15 years (range 18–82); 55 (54.5%) patients were female. SPT positivity was detected in 37 (36.6%) cases. AR was detected in 32 (31.7%) patients with non-CF BR. AR was related to dyspnea (P = 0.04) and number of admissions to an emergency department in the previous year (P = 0.01). Forced expiratory volume in 1 s and forced vital capacity in patients with and without AR were different (P = 0.01 and P = 0.01, respectively). AR was correlated with number of admissions to an emergency department in the last year (r = 0.417, P = 0.005). Conclusion We concluded that atopy was detected in more than one-third of adult non-CF BR patients. This study demonstrated that non-CF BR patients might have AR; it might be important to be aware of nasal symptoms in non-CF BR patients.
Collapse
Affiliation(s)
- Elif Yelda NİKSARLIOĞLU
- Department of Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training andResearch Hospital, İstanbulTurkey
| | - Rana IŞIK
- Department of Adult Allergy Unit, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbulTurkey
| | - Mehmet Atilla UYSAL
- Department of Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training andResearch Hospital, İstanbulTurkey
| | - Derya ÜNAL
- Department of Adult Allergy Unit, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbulTurkey
| | - Güngör ÇAMSARI
- Department of Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training andResearch Hospital, İstanbulTurkey
| |
Collapse
|
8
|
Yii ACA, Tay T, Choo XN, Koh MSY, Tee AKH, Wang D. Precision medicine in united airways disease: A "treatable traits" approach. Allergy 2018; 73:1964-1978. [PMID: 29869791 DOI: 10.1111/all.13496] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/21/2022]
Abstract
United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma-allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms). The UAD paradigm also extends to myriad sinonasal diseases (eg, chronic rhinosinusitis with or without nasal polyps) and lower airway diseases (eg, bronchiectasis, chronic obstructive pulmonary disease). Here, we review currently known phenoendotypes of UAD and propose a "treatable traits" approach for the classification and management of UAD, wherein pathophysiological mechanisms and factors contributing to disease are identified and targeted for treatment. Treatable traits in UAD can be analyzed according to a framework comprising airway inflammation (eosinophilic, neutrophilic), impaired airway mucosal defense (impaired mucociliary clearance, antibody deficiency), and exogenous cofactors (allergic sensitizers, tobacco smoke, microbes). Appreciation of treatable traits is necessary in advancing the effort to deliver precise treatments and achieve better outcomes in patients with UAD.
Collapse
Affiliation(s)
- A. C. A. Yii
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - T.‐R. Tay
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - X. N. Choo
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - M. S. Y. Koh
- Department of Respiratory and Critical Care Medicine Singapore General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - A. K. H. Tee
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - D.‐Y. Wang
- Department of Otolaryngology National University of Singapore Singapore
| |
Collapse
|
9
|
|
10
|
Kumar A, Kunal S, Shah A. Frequency and effect of type 1 hypersensitivity in patients from India with chronic obstructive pulmonary disease and associated upper airways symptoms. Asia Pac Allergy 2017; 7:199-205. [PMID: 29094017 PMCID: PMC5663747 DOI: 10.5415/apallergy.2017.7.4.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/19/2017] [Indexed: 01/04/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is now recognized as a systemic disorder with many comorbidities. Atopy in patients with COPD and upper airways symptoms has not been characterized. Objective We investigated the occurrence and impact of aeroallergen sensitisation in patients with COPD and upper airways symptoms. Methods All 41 subjects with COPD diagnosed as per Global Initiative for Chronic Obstructive Lung Disease guidelines, underwent spirometry with reversibility, computed tomography of the paranasal sinuses (CT-PNS), skin prick test (SPT) against common aeroallergens and responded to St. George's Respiratory Questionnaire (SGRQ) and Sino Nasal Outcome Test - 22 (SNOT-22) questionnaires. Upper airways symptoms were assessed as per the Allergic Rhinitis and its Impact on Asthma guidelines. Results As documented earlier, 27 of the 41 patients (65.9%) with COPD had upper airways symptoms. Of these 27 patients, 11 had SPT positivity against at least one aeroallergen (group 1). One patient had monosensitisation to pollens of grass Imperata while polysensitisation was seen in 10/11 patients commonly to weeds, trees, and insects. Fungal sensitisation to Aspergillus fumigatus was seen in 3 of 11 patients (27.2%). In group 1, all 11 patients (100%) had radiological sinusitis as compared to 8 of 16 (50%) in group 2. The mean CT-PNS scores were significantly higher in group 1 as compared to group 2. Similarly, the SNOT-22 scores were significantly higher in group 1 as compared to group 2. However, there was no difference in SGRQ scores between the 2 groups. In group 1, there was a significant correlation between CT-PNS and SNOT-22 scores. Conclusion Patients with COPD, associated upper airways symptoms and a positive SPT had a significantly higher frequency of radiological sinusitis on CT-PNS. They even had worse quality of life as compared to those with a negative SPT. The study suggested that atopic patients with COPD and upper airways involvement were more symptomatic. It is therefore possible that upper airways symptoms, if left untreated, would result in less than desirable control of the disease.
Collapse
Affiliation(s)
- Avi Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India
| | - Shekhar Kunal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India
| | - Ashok Shah
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India
| |
Collapse
|