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Triasih R, Setyowireni D, Nurani N, Setyati A. Prevalence, Management, and Risk Factors of Asthma Among School-Age Children in Yogyakarta, Indonesia. J Asthma Allergy 2023; 16:23-32. [PMID: 36636706 PMCID: PMC9830052 DOI: 10.2147/jaa.s392733] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Childhood asthma in developing countries has been increasing, but underdiagnosed and undertreated. We reported prevalence, management, and risk factors of asthma among school-age children in Yogyakarta, Indonesia. Patients and Methods We recruited children aged 6-7 years and 13-14 years attending schools in all districts in Yogyakarta, Indonesia. The schools were randomly selected via cluster random sampling. We used the Indonesian version of the Global Asthma Network (GAN) questionnaire, and the methodology employed by this study was in accordance with the GAN's protocol. Results A total of 2106 children aged 6-7 years and 3142 adolescents aged 13-14 years were eligible for analysis. The prevalence of current wheeze in children and adolescents was similar, which was 4.6%. Inhalation therapy was reported in <30% of those with asthma. Risk factors for current wheeze in children were wheezing in infancy period, ever had pneumonia, the house was passed by trucks every day, and fast-food consumption in the previous 12 months; whereas exclusive breastfeeding for more than 6 months decreased the risk of current wheeze. In adolescence, obesity, consumption of fast food once or twice a week, and paracetamol in the previous 12 months increased the risk of current wheeze. Conclusion The prevalence of current wheeze in children and adolescents in Indonesia was quite low. The use of inhalation therapy was limited. Respiratory problems during infancy, environmental, and nutritional factors play a role in the development of asthma.
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Affiliation(s)
- Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia,Correspondence: Rina Triasih, Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito Hospital, Jl. Kesehatan 1, Yogyakarta, 55284, Indonesia, Tel +62 81392764269, Fax +6274 583745, Email
| | - Dwikisworo Setyowireni
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Neti Nurani
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Amalia Setyati
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Magwenzi P, Rusakaniko S, Sibanda EN, Gumbo FZ. Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub Saharan Africa. Respir Res 2022; 23:254. [PMID: 36123720 PMCID: PMC9487077 DOI: 10.1186/s12931-022-02170-y] [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: 09/10/2021] [Accepted: 09/09/2022] [Indexed: 08/29/2023] Open
Abstract
Background Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of ‘asthma’ defined by symptoms is high compared to ‘doctor diagnosed asthma’. The questions answered by this review are (i) What challenges have been experienced in the diagnosis of asthma in children? (ii) What solutions will address these challenges? Methods The Arksey and O’Malley’s framework for scoping reviews was used for the study methodology, while the PRISMA-ScR checklist guided the reporting process. Electronic databases: PubMed Central, EMBASE and Google Scholar were searched. Primary quantitative and qualitative studies and reviews from 2010 to 2021, from Nigeria, South Africa and Uganda written in English or translated to English, which answered the study questions were included. The author, title, country, study type, methods, purpose, findings and references were captured onto a predefined data collection table. The ‘Preview, Question, Read, Summarise’ system was used and a narrative report was used to summarise the findings. Results A total of 28 studies were included. The causes of under-diagnosis of asthma include lack of community knowledge and perception of asthma, poor accessibility to health care, strained health systems, lack of diagnostic tests including spirometry, low levels of knowledge among health-care workers and lack of or non-implementation of asthma guidelines. Strategies to improve asthma diagnosis will include community and school based education programmes, revision of asthma diagnostic terms, guideline development and implementation and health systems strengthening. Conclusion This scoping review provides research evidence for policy makers and health-workers involved in the care of asthmatic children on challenges faced in asthma diagnosis and strategies to improve asthma diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02170-y.
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Affiliation(s)
- P Magwenzi
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe.
| | - S Rusakaniko
- Family Medicine, Global and Public Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
| | - E N Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, 113, Kwame Nkrumah Avenue, Harare, Zimbabwe
| | - F Z Gumbo
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
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3
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Asthma and COVID-19: Emphasis on Adequate Asthma Control. Can Respir J 2021; 2021:9621572. [PMID: 34457096 PMCID: PMC8397565 DOI: 10.1155/2021/9621572] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/18/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
Asthmatics are at an increased risk of developing exacerbations after being infected by respiratory viruses such as influenza virus, parainfluenza virus, and human and severe acute respiratory syndrome coronaviruses (SARS-CoV). Asthma, especially when poorly controlled, is an independent risk factor for developing pneumonia. A subset of asthmatics can have significant defects in their innate, humoral, and cell-mediated immunity arms, which may explain the increased susceptibility to infections. Adequate asthma control is associated with a significant decrease in episodes of exacerbation. Because of their wide availability and potency to promote adequate asthma control, glucocorticoids, especially inhaled ones, are the cornerstone of asthma management. The current COVID-19 pandemic affects millions of people worldwide and possesses mortality several times that of seasonal influenza; therefore, it is necessary to revisit this subject. The pathogenesis of SARS-CoV-2, the virus that causes COVID-19, can potentiate the development of acute asthmatic exacerbation with the potential to worsen the state of chronic airway inflammation. The relationship is evident from several studies that show asthmatics experiencing a more adverse clinical course of SARS-CoV-2 infection than nonasthmatics. Recent studies show that dexamethasone, a potent glucocorticoid, and other inhaled corticosteroids significantly reduce morbidity and mortality among hospitalized COVID-19 patients. Hence, while we are waiting for more studies with higher level of evidence that further narrate the association between COVID-19 and asthma, we advise clinicians to try to achieve adequate disease control in asthmatics as it may reduce incidences and severity of exacerbations especially from SARS-CoV-2 infection.
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Rahimian N, Aghajanpour M, Jouybari L, Ataee P, Fathollahpour A, Lamuch-Deli N, Kooti W, Kalmarzi RN. The Prevalence of Asthma among Iranian Children and Adolescent: A Systematic Review and Meta-Analysis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6671870. [PMID: 34471468 PMCID: PMC8405330 DOI: 10.1155/2021/6671870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/22/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asthma is an important reason for hospitalization in children aged under five years. Information about the current status of asthma in Iranian children can help the Iranian health sector plan carefully and prevent asthma incidence by educating the families. The present systematic review and meta-analysis is aimed at estimating asthma prevalence in Iranian children and adolescents. METHOD Data were found using keywords such as prevalence, epidemiology, asthma, adolescent, children, pediatrics, Iran in Web of Science, Scopus, PubMed, Cochrane, and Embase databases. Three national databases, including Magiran, Barakat Pharmed Co (Iran medex), and Scientific Information Databank (SID) were searched until 1 October 2020. Cross-sectional and original studies were included in the study, and then, quality assessment was done using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A pooled estimated prevalence of asthma was calculated using Der Simonian-Laird random model. Egger's test was used to evaluate publication bias. The data were analyzed using the STATA software version 16. RESULTS 30 studies were selected and investigated. The prevalence of asthma in children and adolescents was 6% and 8%, and the prevalence in boys and girls was 9% and 8%, respectively. Among the asthma symptoms, wheezing had the most prevalence (17% in children and 19% in adolescents) and sleep disturbance had the lowest prevalence (6% in children and 6% in adolescents). CONCLUSION The prevalence of asthma in Iranian children and adolescents is lower than in the world. Existing strategies should be pursued followed. Also, guidelines for asthma control and prevention should be considered in the future.
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Affiliation(s)
- Neda Rahimian
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammad Aghajanpour
- ENT & Head and Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Jouybari
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Pedram Ataee
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Asadollah Fathollahpour
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Nasrin Lamuch-Deli
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Wesam Kooti
- Lung Diseases & Allergy Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Rasoul Nasiri Kalmarzi
- Lung Diseases & Allergy Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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5
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Rodriguez-Martinez CE, Sossa-Briceño MP. Are we overcoming our inability to have pediatric patients properly use inhaled corticosteroids by inappropriately escalating their therapy? J Asthma 2021; 59:1360-1371. [PMID: 34044743 DOI: 10.1080/02770903.2021.1936016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To perform a narrative review to describe and discuss potential methods and strategies for effectively assessing and dealing with poor adherence and/or misuse of inhalers in difficult-to-treat pediatric asthmatic patients. DATA SOURCES Articles available in electronic databases, published from inception to April 2021. STUDY SELECTIONS Relevant articles in the literature that discuss and analyze potential methods and strategies for effectively assessing and dealing with poor adherence and/or misuse of inhalers in difficult-to-treat pediatric asthmatic patients. RESULTS Validated self-reported questionnaires, weighing inhaler canisters, and pharmacy records might be the most suitable methods for assessing adherence to inhaled controller therapy in clinical practice. Additionally, validated instruments could be used as an objective measurement of the adequacy of inhaler technique. Finally, empathy and a true and strong physician-parent/patient partnership have a more powerful influence on adherence than almost any other factor, and they are probably the most cost-effective methods not only for detecting poor adherence to controller therapy but also for dealing with and improving it. CONCLUSIONS Failure to detect or effectively handle nonadherence and/or inhaler misuse in a patient with uncontrolled asthma can mislead clinicians into thinking that the patient is nonresponsive to the original less-intensive therapy, resulting in unneeded dosage increases and/or escalation of controller therapy to more costly medications, in some cases reaching the level of biologic therapy.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
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Baard CB, Franckling-Smith Z, Munro J, Workman L, Zar HJ. Asthma in South African adolescents: a time trend and risk factor analysis over two decades. ERJ Open Res 2021; 7:00576-2020. [PMID: 33834055 PMCID: PMC8021807 DOI: 10.1183/23120541.00576-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/02/2020] [Indexed: 11/14/2022] Open
Abstract
Background South Africa has undergone major economic and health system changes, impacting the epidemiology of childhood asthma. This study aimed to investigate prevalence time trends of asthma in South African adolescents over two decades and to identify associated risk factors. Methods A cross-sectional survey was conducted in 2017, in a randomised sample of 13–14-year-old Cape Town adolescents, using the standardised Global Asthma Network written, video and environmental questionnaires. Using time-trend analysis, the prevalence and severity of asthma were compared with data from the 2002 ISAAC phase III study. Environmental and social risk factors were analysed. Results A total of 3979 adolescents were included. The prevalence of lifetime and current asthma were 34.5% and 21.3%, respectively, on the self-report written questionnaire, similar to 2002 results. The prevalence of severe asthma in the previous 12 months increased, measured by wheeze limiting speech (7.8% to 11.8%), four or more attacks of wheezing (5.0% to 5.8%) or woken by wheeze on one or more nights per week (5.0% to 6.9%). The video questionnaire revealed increases in lifetime (16.9% to 22.5%), current (11.2% to 18.7%) and severe asthma (12.1% to 14.8%). Multivariate analysis showed associations between current asthma and smoking, female sex, pet exposure and higher socioeconomic status. Severe asthma was associated with smoking, pet exposure, outdoor pollution exposure and informal housing; 33% of those with severe or current asthma had been diagnosed. Conclusion The prevalence of asthma is high, with increasing rates of severe asthma in adolescents. Underdiagnosis is a major concern and reduction in exposure to environmental factors, particularly smoking, and improved socioeconomic development are needed. Among South African adolescents, the prevalence of asthma is high, with increasing rates of severe asthma from 1995 to 2017. Smoking, poor living conditions and exposure to pets or air pollution are risk factors. Underdiagnosis is a major concern.https://bit.ly/3l71DKy
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Affiliation(s)
- Cynthia B Baard
- University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Zoe Franckling-Smith
- University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Jacinta Munro
- University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Lesley Workman
- University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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7
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Nicola M, Soliman YMA, Hussein R, Saeed H, Abdelrahim M. Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers. ERJ Open Res 2020; 6:00073-2020. [PMID: 33083443 PMCID: PMC7553115 DOI: 10.1183/23120541.00073-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022] Open
Abstract
Add-on devices that are attached to metered-dose inhalers (MDIs) were introduced to improve aerosol delivery. The objective of this study was to determine the efficacy of drug delivery from an MDI when attached to different add-on devices at different inhalation volumes. The total emitted dose (TED) of salbutamol was estimated for the MDI alone and the MDI connected to five different add-on devices (Able valved holding chamber, Tips-haler valved holding chamber, Aerochamber plus flow Vu valved holding chamber, Dolphin chamber, and a handmade water bottle spacer), at inhalation flow of 28.3 L·min−1 with flow volume of 1, 2 and 4 L, assuming young child (aged <6 years), old child (>6 years) and adult inhalation volumes, respectively. The TED% ranged between 84.1% and 87.2% at all inhalation volumes from the MDI alone, which was significantly greater than all MDI add-on device combinations (p<0.05). The TED% delivered to MDI sampling apparatus by a homemade water bottle spacer and Dolphin chamber, as non-antistatic add-on devices, ranged between 30.5% and 35.3%. However, washing these non-antistatic add-on devices with a light detergent before use improved their TED to range between 47.6% and 51.2%. Non-antistatic add-on devices had significantly lower TED (p<0.05) than that delivered by most antistatic add-on devices, which ranged from 51.3% to 71.6%. This study suggests that antistatic add-on devices delivered much more aerosol than non-antistatic add-on devices. However, it may be advised to still use a non-antistatic add-on device, for the sake of solving the coordination problem, and wash it with light detergent before use to improve TED. Antistatic add-on devices deliver much more aerosol from MDIs than non-antistatic add-on deviceshttps://bit.ly/3gSE5aR
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Affiliation(s)
- Mina Nicola
- Dept of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | | | - Raghda Hussein
- Dept of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Haitham Saeed
- Dept of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed Abdelrahim
- Dept of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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8
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Szefler SJ, Fitzgerald DA, Adachi Y, Doull IJ, Fischer GB, Fletcher M, Hong J, García-Marcos L, Pedersen S, Østrem A, Sly PD, Williams S, Winders T, Zar HJ, Bush A, Lenney W. A worldwide charter for all children with asthma. Pediatr Pulmonol 2020; 55:1282-1292. [PMID: 32142219 PMCID: PMC7187318 DOI: 10.1002/ppul.24713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and management vary depending on where children live in the world and how their community can care for them. Global improvement in diagnosis and management has been unsatisfactory, despite ever more evidence-based guidelines. Guidelines alone are insufficient and need supplementing by government support, changes in policy, access to diagnosis and effective therapy for all children, with research to improve implementation. We propose a worldwide charter for all children with asthma, a roadmap to better education and training which can be adapted for local use. It includes access to effective basic asthma medications. It is not about new expensive medications and biologics as much can be achieved without these. If implemented carefully, the overall cost of care is likely to fall and the global future health and life chance of children with asthma will greatly improve. The key to success will be community involvement together with the local and national development of asthma champions. We call on governments, institutions, and healthcare services to support its implementation.
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Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Pediatric Asthma Research Program, Anschutz Medical Campus, Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Dominic A Fitzgerald
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Yuichi Adachi
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | - Iolo J Doull
- Department of Paediatric Respiratory Medicine, Children's Hospital for Wales, Cardiff, UK
| | - Gilberto B Fischer
- Department of Paediatrics, Universidade Federal de Ciencias da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Monica Fletcher
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
| | - Jianguo Hong
- Department of Paediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Luis García-Marcos
- Department of Paediatrics, "Virgen de la Arrixaca" University Children's Hospital, University of Murcia, Murcia, Spain
| | - Søren Pedersen
- Paediatric Research Unit, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | | | - Peter D Sly
- Children's Health and Environment Program and World Health Organisation Collaborating Centre for Children's Health and Environment, Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
| | - Tonya Winders
- Allergy & Asthma Network, Vienna, Virginia.,Global Allergy & Asthma Patient Platform, Vienna, Virginia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andy Bush
- Department of Paediatrics, National Heart and Lung Institute and Royal Brompton & Harefield NHS Foundation Trust, Imperial College, London, UK
| | - Warren Lenney
- Department of Child Health, Institute of Applied Clinical Science, Keele University, Keele, UK
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Generational Patterns of Asthma Incidence among Immigrants to Canada over Two Decades. A Population-based Cohort Study. Ann Am Thorac Soc 2020; 16:248-257. [PMID: 30395726 DOI: 10.1513/annalsats.201803-187oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Canada, an industrialized country with high endemic asthma rates, is characterized by a large immigrant population. OBJECTIVES We sought to provide insight into the relative contribution of environmental exposure to asthma risk by comparing asthma rates among recent immigrants relative to long-term residents of Canada. METHODS This was a population-based, retrospective cohort study performed using provincial health administrative data for all residents of Ontario, Canada. Residents with and without a diagnosis of asthma from fiscal years 1996-2012 were included. Individuals were categorized as being immigrants (landed in Canada after 1985) or long-term residents of Ontario by linkage with the Immigration, Refugees, and Citizenship Canada's Permanent Resident Database. We calculated the age- and sex-standardized incidence of asthma among residents of Ontario, and compared the incidence of asthma among immigrants and long-term residents using incidence rate ratios (IRRs). RESULTS Analysis of approximately 11.7 million records showed that 2.2 immigrants arrived in Canada during the study period, with over 50% from East and South Asia and the Pacific. We found that asthma incidence was lower among immigrants compared with long-term residents (IRR = 0.30; 95% confidence interval = 0.30-0.30; P < 0.001). However, Ontario-born children of immigrants from most world regions had significantly higher asthma incidence compared with children of long-term residents (IRR = 1.44; 95% confidence interval = 1.43-1.45; P < 0.001). The overall incidence of asthma in Ontario decreased between 1996 and 2012 (Ptrend < 0.001). Immigrants contributed to only a small proportion of the asthma incidence in Ontario, and changes within this group did not significantly affect trends in the overall Ontario population asthma incidence. CONCLUSIONS The higher asthma incidence seen among children of immigrants, but not in their parents, suggests that being born in Canada was critical for determining asthma risk. These findings support the importance of in utero and/or early life exposures on asthma development.
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Kjærgaard J, Anastasaki M, Stubbe Østergaard M, Isaeva E, Akylbekov A, Nguyen NQ, Reventlow S, Lionis C, Sooronbaev T, Pham LA, Nantanda R, Stout JW, Poulsen A. Diagnosis and treatment of acute respiratory illness in children under five in primary care in low-, middle-, and high-income countries: A descriptive FRESH AIR study. PLoS One 2019; 14:e0221389. [PMID: 31693667 PMCID: PMC6834279 DOI: 10.1371/journal.pone.0221389] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 08/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Respiratory disease and, specifically, pneumonia, is the major cause of mortality and morbidity in young children. Diagnosis of both pneumonia and asthma in primary care rests principally on clinical signs, history taking, and bronchodilator responsiveness. This study aimed to describe clinical practices in diverse global primary care settings concerning differential diagnosis of respiratory disease in young children, especially between pneumonia and asthma. METHODS Health professionals in Greece, Kyrgyzstan, Vietnam, and Uganda were observed during consultations with children aged 2-59 months, presenting with cough and/or difficult breathing. Data were analyzed descriptively and included consultation duration, practices, diagnoses and availability/use of medications and equipment. The study is part of the European Horizon 2020 FRESH AIR project. RESULTS In total, 771 consultations by 127 health professionals at 74 facilities in the four countries were observed. Consultations were shorter in Vietnam and Uganda (3 to 4 minutes) compared to Greece and Kyrgyzstan (15 to 20 minutes). History taking was most comprehensive in Greece. Clinical examination was more comprehensive in Vietnam and Kyrgyzstan and less in Uganda. Viral upper respiratory tract infections were the most common diagnoses (41.7% to 67%). Pneumonia was diagnosed frequently in Uganda (16.3% of children), and rarely in other countries (0.8% to 2.9%). Asthma diagnosis was rare (0% to 2.8%). Antibiotics were prescribed frequently in all countries (32% to 69%). Short acting β-agonist trials were seldom available and used during consultations in Kyrgyzstan (0%) and Uganda (1.8%), and often in Greece (38.9%) and Vietnam (12.6%). CONCLUSIONS Duration and comprehensiveness of clinical consultations observed in this study seemed insufficient to guide respiratory diagnosis in young children. Appropriate treatment options may further not be available in certain studied settings. Actions aiming at educating and raising professional awareness, along with developing easy-to-use tools to support diagnosis and a general strengthening of health systems are important goals.
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Affiliation(s)
- Jesper Kjærgaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital “Rigshospitalet”, Copenhagen, Denmark
- * E-mail:
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Marianne Stubbe Østergaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Elvira Isaeva
- National Center of Maternity and Childhood Care, Bishkek, Kyrgyzstan
| | - Azamat Akylbekov
- National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Nhat Quynh Nguyen
- Family Medicine Department, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Talant Sooronbaev
- Kyrgyz Thoracic Society, Respiratory, Critical Care and Sleep Medicine Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Le An Pham
- Vietnamese Association Family Medicine, Center for training Family Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Rebecca Nantanda
- Department of Paediatrics, Mulago Hospital and Makere University, Kampala, Uganda
| | - James W. Stout
- University of Washington, Seattle, Washington, United States of America
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital “Rigshospitalet”, Copenhagen, Denmark
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Bissell K, Ellwood P, Ellwood E, Chiang CY, Marks GB, El Sony A, Asher I, Billo N, Perrin C. Essential Medicines at the National Level: The Global Asthma Network's Essential Asthma Medicines Survey 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E605. [PMID: 30791442 PMCID: PMC6406388 DOI: 10.3390/ijerph16040605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022]
Abstract
Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013⁻2020 sets an 80% target for essential NCD medicines' availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013⁻2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses-41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system's capacity to address NCDs.
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Affiliation(s)
- Karen Bissell
- School of Population Health, University of Auckland, Auckland 1023, New Zealand.
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Eamon Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Chen-Yuan Chiang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney 2085, Australia.
| | - Asma El Sony
- The Epidemiological Laboratory (Epi-Lab), for Public Health and Research, Khartoum, Sudan.
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Nils Billo
- Independent Consultant, 80220 Joensuu, Finland.
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Yao Y, Fan XL, Jiang D, Zhang Y, Li X, Xu ZB, Fang SB, Chiu S, Tse HF, Lian Q, Fu QL. Connexin 43-Mediated Mitochondrial Transfer of iPSC-MSCs Alleviates Asthma Inflammation. Stem Cell Reports 2018; 11:1120-1135. [PMID: 30344008 PMCID: PMC6234920 DOI: 10.1016/j.stemcr.2018.09.012] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 01/20/2023] Open
Abstract
We previously identified an immunomodulatory role of human induced pluripotent stem cell (iPSC)-derived mesenchymal stem cells (MSCs) in asthmatic inflammation. Mitochondrial transfer from bone marrow MSCs to epithelial cells can result in the attenuation of acute lung injury in mice. However, the effects of mitochondrial transfer from iPSC-MSCs to epithelial cells in asthma and the mechanisms underlying these effects are unclear. We found that iPSC-MSC transplantation significantly reduced T helper 2 cytokines, attenuated the mitochondrial dysfunction of epithelial cells, and alleviated asthma inflammation in mice. Tunneling nanotubes (TNTs) were formed between iPSC-MSCs and epithelial cells, and mitochondrial transfer from iPSC-MSCs to epithelial cells via TNTs was observed both in vitro and in mice. Overexpression or silencing of connexin 43 (CX43) in iPSC-MSCs demonstrated that CX43 plays a critical role in the regulation of TNT formation by mediating mitochondrial transfer between iPSC-MSCs and epithelial cells. This study provides a therapeutic strategy for targeting asthma inflammation.
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Affiliation(s)
- Yin Yao
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, P. R. China
| | - Xing-Liang Fan
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, P. R. China
| | - Dan Jiang
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, P. R. China; Stem Cell and Regenerative Medicine Consortium, The University of Hong Kong, Hong Kong SAR, P. R. China
| | - Yuelin Zhang
- Department of Emergency, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Road II, Guangzhou 510080, P. R. China
| | - Xin Li
- Department of Emergency, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Road II, Guangzhou 510080, P. R. China
| | - Zhi-Bin Xu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, P. R. China
| | - Shu-Bin Fang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, P. R. China
| | - Sinming Chiu
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, P. R. China; Stem Cell and Regenerative Medicine Consortium, The University of Hong Kong, Hong Kong SAR, P. R. China
| | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, P. R. China
| | - Qizhou Lian
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, P. R. China; Stem Cell and Regenerative Medicine Consortium, The University of Hong Kong, Hong Kong SAR, P. R. China.
| | - Qing-Ling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, P. R. China.
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13
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McCallum GB, Morris PS, Brown N, Chang AB. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev 2017; 8:CD006580. [PMID: 28828760 PMCID: PMC6483708 DOI: 10.1002/14651858.cd006580.pub5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND People with asthma who come from minority groups often have poorer asthma outcomes, including more acute asthma-related doctor visits for flare-ups. Various programmes used to educate and empower people with asthma have previously been shown to improve certain asthma outcomes (e.g. adherence outcomes, asthma knowledge scores in children and parents, and cost-effectiveness). Models of care for chronic diseases in minority groups usually include a focus of the cultural context of the individual, and not just the symptoms of the disease. Therefore, questions about whether tailoring asthma education programmes that are culturally specific for people from minority groups are effective at improving asthma-related outcomes, that are feasible and cost-effective need to be answered. OBJECTIVES To determine whether culture-specific asthma education programmes, in comparison to generic asthma education programmes or usual care, improve asthma-related outcomes in children and adults with asthma who belong to minority groups. SEARCH METHODS We searched the Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE, Embase, review articles and reference lists of relevant articles. The latest search fully incorporated into the review was performed in June 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the use of culture-specific asthma education programmes with generic asthma education programmes, or usual care, in adults or children from minority groups with asthma. DATA COLLECTION AND ANALYSIS Two review authors independently selected, extracted and assessed the data for inclusion. We contacted study authors for further information if required. MAIN RESULTS In this review update, an additional three studies and 220 participants were added. A total of seven RCTs (two in adults, four in children, one in both children and adults) with 837 participants (aged from one to 63 years) with asthma from ethnic minority groups were eligible for inclusion in this review. The methodological quality of studies ranged from very low to low. For our primary outcome (asthma exacerbations during follow-up), the quality of evidence was low for all outcomes. In adults, use of a culture-specific programme, compared to generic programmes or usual care did not significantly reduce the number of participants from two studies with 294 participants for: exacerbations with one or more exacerbations during follow-up (odds ratio (OR) 0.80, 95% confidence interval (CI) 0.50 to 1.26), hospitalisations over 12 months (OR 0.83, 95% CI 0.31 to 2.22) and exacerbations requiring oral corticosteroids (OR 0.97, 95% CI 0.55 to 1.73). However, use of a culture-specific programme, improved asthma quality of life scores in 280 adults from two studies (mean difference (MD) 0.26, 95% CI 0.17 to 0.36) (although the MD was less then the minimal important difference for the score). In children, use of a culture-specific programme was superior to generic programmes or usual care in reducing severe asthma exacerbations requiring hospitalisation in two studies with 305 children (rate ratio 0.48, 95% CI 0.24 to 0.95), asthma control in one study with 62 children and QoL in three studies with 213 children, but not for the number of exacerbations during follow-up (OR 1.55, 95% CI 0.66 to 3.66) or the number of exacerbations (MD 0.18, 95% CI -0.25 to 0.62) among 100 children from two studies. AUTHORS' CONCLUSIONS The available evidence showed that culture-specific education programmes for adults and children from minority groups are likely effective in improving asthma-related outcomes. This review was limited by few studies and evidence of very low to low quality. Not all asthma-related outcomes improved with culture-specific programs for both adults and children. Nevertheless, while modified culture-specific education programs are usually more time intensive, the findings of this review suggest using culture-specific asthma education programmes for children and adults from minority groups. However, more robust RCTs are needed to further strengthen the quality of evidence and determine the cost-effectiveness of culture-specific programs.
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Affiliation(s)
- Gabrielle B McCallum
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionDarwinNorthern TerritoryAustralia0810
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionDarwinNorthern TerritoryAustralia0810
| | - Ngiare Brown
- Ngaoara ‐ Child and Adolescent WellbeingAustinmerAustralia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionDarwinNorthern TerritoryAustralia0810
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneAustralia
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Claassen-Weitz S, Wiysonge CS, Machingaidze S, Thabane L, Horsnell WGC, Zar HJ, Nicol MP, Kaba M. Current Knowledge and Future Research Directions on Fecal Bacterial Patterns and Their Association with Asthma. Front Microbiol 2016; 7:838. [PMID: 27445990 PMCID: PMC4925717 DOI: 10.3389/fmicb.2016.00838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/18/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Shantelle Claassen-Weitz
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town Cape Town, South Africa
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch UniversityCape Town, South Africa; Cochrane South Africa, South African Medical Research CouncilCape Town, South Africa
| | - Shingai Machingaidze
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town Cape Town, South Africa
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster UniversityOntario, Canada; Biostatistics Unit, Father Sean O'SulliVan Research CentreOntario, Canada
| | - William G C Horsnell
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, University of Cape TownCape Town, South Africa; International Centre for Genetic Engineering and Biotechnology, University of Cape TownCape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape TownCape Town, South Africa; Red Cross War Memorial Children's HospitalCape Town, South Africa; Medical Research Council Unit on Child and Adolescent Health, University of Cape TownCape Town, South Africa
| | - Mark P Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, University of Cape TownCape Town, South Africa; National Health Laboratory Service, Groote Schuur HospitalCape Town, South Africa
| | - Mamadou Kaba
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, University of Cape TownCape Town, South Africa
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15
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Everard ML, Wahn U, Dorsano S, Hossny E, Le Souef P. Asthma education material for children and their families; a global survey of current resources. World Allergy Organ J 2015; 8:35. [PMID: 26681996 PMCID: PMC4677448 DOI: 10.1186/s40413-015-0084-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/18/2015] [Indexed: 12/05/2022] Open
Abstract
One of the keys to high quality paediatric asthma management is the provision of age appropriate information regarding the disease and its management. In order to determine whether the generation of a minimum dataset of information which can be translated into a wide range of languages might be used to assist children and their parents around the world, we undertook a survey of national Member Societies of the World Allergy Organization (WAO) to determine what educational material on asthma for children and their families already exists. A questionnaire was developed using Survey Monkey and distributed in 2014 to 263 representatives of the WAO member Societies from 95 countries. Thirty-three replies were received from thirty-one countries. The survey highlighted a considerable disparity in availability of material among the responding countries, with some countries reporting that information was freely available in hard copy and online and others reporting a lack of suitable material locally. The results highlight the need to develop a core set of simple, clear and consistent age appropriate information that can be easily translated and delivered in a cultural and educationally effective format.
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Affiliation(s)
- Mark L. Everard
- />School of Paediatrics and Child Health, University of Western Australia, TelethonKids Institute, Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western, Australia
| | - Ulrich Wahn
- />Department of Pediatric Pneumology and Immunology, Charité Humbolt University, Berlin, Germany
| | - Sofia Dorsano
- />World Allergy Organization, International Headquarters, Milwaukee, Wisconsin United States
| | - Elham Hossny
- />Pediatric Allergy and Immunology (PAI) Unit, Children’s Hospital of Ain Shams University, Cairo, Egypt
| | - Peter Le Souef
- />School of Paediatrics and Child Health, University of Western Australia, TelethonKids Institute, Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western, Australia
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Oliveira TT, Campos KM, Cerqueira-Lima AT, Cana Brasil Carneiro T, da Silva Velozo E, Ribeiro Melo ICA, Figueiredo EA, de Jesus Oliveira E, de Vasconcelos DFSA, Pontes-de-Carvalho LC, Alcântara-Neves NM, Figueiredo CA. Potential therapeutic effect of Allium cepa L. and quercetin in a murine model of Blomia tropicalis induced asthma. ACTA ACUST UNITED AC 2015; 23:18. [PMID: 25890178 PMCID: PMC4344790 DOI: 10.1186/s40199-015-0098-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/23/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Asthma is an inflammatory condition characterized by airway hyperresponsiveness and chronic inflammation. The resolution of inflammation is an essential process to treat this condition. In this study we investigated the effect of Allium cepa L. extract (AcE) and quercetin (Qt) on cytokine and on smooth muscle contraction in vitro and its therapeutic potential in a murine model of asthma. METHODS AcE was obtained by maceration of Allium cepa L. and it was standardized in terms of quercetin concentration using high performance liquid chromatography (HPLC). In vitro, using AcE 10, 100 or 1000 μg/ml or Qt 3.5, 7.5, 15 μg/ml, we measured the concentration of cytokines in spleen cell culture supernatants, and the ability to relax tracheal smooth muscle from A/J mice. In vivo, Blomia tropicalis (BT)-sensitized A/J mice were treated with AcE 100, 1000 mg/kg or 30 mg/kg Qt. We measured cell influx in bronchoalveolar lavage (BAL), eosinophil peroxidase (EPO) in lungs, serum levels of Bt-specific IgE, cytokines levels in BAL, and lung histology. RESULTS We observed a reduction in the production of inflammatory cytokines, a relaxation of tracheal rings, and a reduction in total number of cells in BAL and EPO in lungs by treatment with AcE or Qt. CONCLUSION AcE and Qt have potential as antiasthmatic drugs, as they possess both immunomodulatory and bronchodilatory properties.
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Affiliation(s)
| | - Keina Maciele Campos
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
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Affiliation(s)
- Antonio Francesco Corno
- King Fahad Medical City, Cardiovascular Surgery/Pediatric Cardiac Surgery Riyadh, Saudi Arabia
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