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Kholis FN, Pratama KG, Hadiyanto JN. Association between inhaled corticosteroid use and risk of hyperglycemia in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Tzu Chi Med J 2023; 35:355-361. [PMID: 38035057 PMCID: PMC10683519 DOI: 10.4103/tcmj.tcmj_131_23] [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: 05/25/2023] [Revised: 07/13/2023] [Accepted: 08/04/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Chronic obstructive pulmonary disease (COPD) patients have a higher risk of developing diabetes, and studies suggest that inhaled corticosteroids (ICSs) use may be associated with a higher risk of diabetes, particularly at higher doses. This study aims to investigate the effects of ICS use on the risk of diabetes and blood glucose levels in COPD patients. Materials and Methods A systematic search was carried out on the PubMed, EBSCOhost, and ProQuest databases using the terms "Inhaled Corticosteroids," "Diabetes," and "Chronic Obstructive Pulmonary Disease" for the period between 2013 and 2023. The systematic review adhered to the PRISMA 2020 guideline. A meta-analysis was conducted using a random-effects model using the RevMan 5 software. Results A total of 14 studies were included in the final analysis, with 10 randomized controlled trials (RCTs) and 4 observational studies. Two observational studies investigated the relationship between ICS dose and diabetes risk. A meta-analysis of the RCTs studies showed a nonstatistically significant tendency toward increased blood glucose (odds ratio [OR] 1.07 and 95% confidence interval [CI] 0.88-1.30) after a 52-week follow-up. Whereas the observational studies showed a tendency toward an increased risk of diabetes (OR 1.40 and 95% CI 0.96-2.03). Furthermore, a subgroup meta-analysis of high-dose ICS (>900 μg/day) showed a significant increase in the risk of diabetes (OR 1.20 and 95% CI 1.09-1.32). Conclusion Short-term use of ICS does not have a significant effect on blood glucose. However, long-term use, especially at higher doses, can increase the risk of developing diabetes.
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Affiliation(s)
- Fathur Nur Kholis
- Divison of Pulmonology, Department of Internal Medicine, Faculty of Medicine, Dr. Kariadi General Hospital, Diponegoro University, Semarang, Central Java, Indonesia
| | | | - Jessica Novia Hadiyanto
- Department of Internal Medicine, Faculty of Medicine, Dr. Kariadi General Hospital, Diponegoro University, Semarang, Central Java, Indonesia
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2
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Luan Y, Luan Y, He H, Jue B, Yang Y, Qin B, Ren K. Glucose metabolism disorder: a potential accomplice of SARS-CoV-2. Int J Obes (Lond) 2023; 47:893-902. [PMID: 37542197 DOI: 10.1038/s41366-023-01352-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
Globally, 265,713,467 confirmed cases of SARS-CoV-2 (CoV-2), including 5,260,888 deaths, have been reported by the WHO. It is important to study the mechanism of this infectious disease. A variety of evidences show the potential association between CoV-2 and glucose metabolism. Notably, people with type 2 diabetes mellitus (T2DM) and other metabolic complications were prone to have a higher risk of developing a more severe infection course than people who were metabolically normal. The correlations between glucose metabolism and CoV-2 progression have been widely revealed. This review will discuss the association between glucose metabolism disorders and CoV-2 progression, showing the promoting effect of diabetes and other diseases related to glucose metabolism disorders on the progression of CoV-2. We will further conclude the effects of key proteins and pathways in glucose metabolism regulation on CoV-2 progression and potential interventions by targeting glucose metabolism disorders for CoV-2 treatment. Therefore, this review will provide systematic insight into the treatment of CoV-2 from the perspective of glucose metabolism.
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Affiliation(s)
- Yi Luan
- Department of Translational Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Ying Luan
- State Key Laboratory for Artificial Microstructures and Mesoscopic Physics, School of Physics, Peking University, Beijing, 100000, China
| | - Hongbo He
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450001, China
| | - Bolin Jue
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, 453000, China
| | - Yang Yang
- Department of Translational Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Bo Qin
- Department of Translational Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Kaidi Ren
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
- Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, 450052, China.
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3
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Chiang YC, Ni W, Zhang G, Shi X, Patel MR. The Association Between Cost-Related Non-Adherence Behaviors and Diabetes Outcomes. J Am Board Fam Med 2023; 36:15-24. [PMID: 36759134 PMCID: PMC10626976 DOI: 10.3122/jabfm.2022.220272r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND We examined the impact of various comorbid conditions on diabetes and condition-specific cost-related nonadherence (CRN), and HbA1c in adults with diabetes. METHODS This was a cross-sectional analysis of participants with diabetes and poor glycemic control in an ongoing trial (n = 600). We computed prevalence of condition-specific CRN, prevalence of specific types of diabetes-related CRN by comorbid condition, prevalence of specific types of condition-specific CRN within each comorbidity, and the association between condition-specific and diabetes-related CRN and HbA1c for each comorbid condition. RESULTS Fifty-eight percent (n = 350) of participants reported diabetes-related CRN. Diabetes-related CRN rates were highest in those with liver problems (63%), anemia (61%), respiratory diseases (60%), and hyperlipidemia (60%). Condition-specific CRN rates were high in those with respiratory diseases (44%), back pain (41%), and depression (40%). Participants with cancer and kidney diseases reported the lowest rates of diabetes-related and condition-specific CRN. Delaying getting diabetes prescriptions filled was the most commonly reported form of diabetes-related CRN across all comorbid conditions and was the highest in those with liver problems (47%), anemia (46%), and respiratory diseases (45%). In adjusted models, those with back pain (beta-coefficient, 0.45; 95%CI 0.02-0.88; P = .04) and hyperlipidemia (beta-coefficient, 0.50; 95%CI 0.11-0.88; P = .01) who reported both diabetes-related and condition-specific CRN had higher HbA1c. CONCLUSIONS CRN in patients with diabetes is higher than in other comorbid conditions and is associated with poor diabetes control. These findings may be driven by higher out-of-pocket costs for medications to manage diabetes, lack of symptoms associated with poor diabetes control, or other factors, with implications for both clinicians and health insurance programs.
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Affiliation(s)
- Yu-Chyn Chiang
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP)
| | - William Ni
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP)
| | - Guanghao Zhang
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP)
| | - Xu Shi
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP)
| | - Minal R Patel
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP).
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Xu R, Zheng T, Ouyang C, Ding X, Ge C. Causal associations between site-specific cancer and diabetes risk: A two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1110523. [PMID: 36860363 PMCID: PMC9968794 DOI: 10.3389/fendo.2023.1110523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Both cancer and diabetes are complex chronic diseases that have high economic costs for society. The co-occurrence of these two diseases in people is already well known. The causal effects of diabetes on the development of several malignancies have been established, but the reverse causation of these two diseases (e.g., what type of cancer can cause T2D) has been less investigated. METHODS Multiple Mendelian randomization (MR) methods, such as the inverse-variance weighted (IVW) method, weighted median method, MR-Egger, and MR pleiotropy residual sum and outlier test, were performed to evaluate the causal association of overall and eight site-specific cancers with diabetes risk using genome-wide association study summary data from different consortia, such as Finngen and UK biobank. RESULTS A suggestive level of evidence was observed for the causal association between lymphoid leukaemia and diabetes by using the IVW method in MR analyses (P = 0.033), indicating that lymphoid leukaemia increased diabetes risk with an odds ratio of 1.008 (95% confidence interval, 1.001-1.014). Sensitivity analyses using MR-Egger and weighted median methods showed consistent direction of the association compared with the IVW method. Overall and seven other site-specific cancers under investigation (i.e., multiple myeloma, non-Hodgkin lymphoma, and cancer of bladder, brain, stomach, lung, and pancreas) were not causally associated with diabetes risk. CONCLUSIONS The causal relationship between lymphoid leukaemia and diabetes risk points to the necessity of diabetes prevention amongst leukaemia survivors as a strategy for ameliorating the associated disease burden.
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Affiliation(s)
- Rong Xu
- Department of Pharmacy, Quanzhou Medical College, Quanzhou, China
- *Correspondence: Rong Xu, ; Chenjin Ge,
| | - Tingjin Zheng
- Department of Clinical Laboratory, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Chaoqun Ouyang
- Department of Pharmacy, Quanzhou Medical College, Quanzhou, China
| | - Xiaoming Ding
- Department of Basic Medicine, Quanzhou Medical College, Quanzhou, China
| | - Chenjin Ge
- Department of Medical Imaging, Shanghai Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Rong Xu, ; Chenjin Ge,
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Liljendahl MS, Sevelsted A, Chawes BL, Stokholm J, Bønnelykke K, Andersen ZJ, Bisgaard H. Childhood asthma is associated with development of type 1 diabetes and inflammatory bowel diseases: a Danish nationwide registry study. Sci Rep 2022; 12:21728. [PMID: 36526660 PMCID: PMC9758130 DOI: 10.1038/s41598-022-26067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Asthma and autoimmune disorders might be affected by opposing immune mechanisms, T helper cells type 2 (Th2) and T helper cells type 1 (Th1) immunity, respectively. Knowledge on comorbidity can increase understanding of the underlying etiologies. We aim to examine the association between childhood asthma and subsequent risk of type 1 diabetes (T1D) and inflammatory bowel diseases (IBD) in Danish children. Children of Danish origin born during 1991-1996 were included and childhood asthma, defined as a minimum of two collected prescriptions of inhalation corticosteroids age 5-7 years, was linked to hospitalisations with either T1D or IBD after age 8. Associations between childhood asthma and incidence of T1D and IBD were analysed using sex- and year stratified Cox regression. A total of 366,200 children were included in the study, 4.9% had asthma, which increased the risk of both T1D and IBD, hazard ratios of 1.32 (1.08-1.61) and 1.27 (1.09-1.48). In this large nationwide Danish study, we found that children with asthma have increased risk of developing immune diseases T1D and IBD. This contradicts the Th1 vs Th2 paradigm and points towards shared disease mechanisms and risk factors.
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Affiliation(s)
- Mie Sylow Liljendahl
- grid.5254.60000 0001 0674 042XCOPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Sevelsted
- grid.5254.60000 0001 0674 042XCOPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo L. Chawes
- grid.5254.60000 0001 0674 042XCOPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- grid.5254.60000 0001 0674 042XCOPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- grid.5254.60000 0001 0674 042XCOPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zorana Jovanovic Andersen
- grid.5254.60000 0001 0674 042XSection of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- grid.5254.60000 0001 0674 042XCOPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Wang B, Glicksberg BS, Nadkarni GN, Vashishth D. Evaluation and management of COVID-19-related severity in people with type 2 diabetes. BMJ Open Diabetes Res Care 2021; 9:e002299. [PMID: 34493495 PMCID: PMC8424422 DOI: 10.1136/bmjdrc-2021-002299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/25/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION People with type 2 diabetes (T2D) have an increased rate of hospitalization and mortality related to COVID-19. To identify ahead of time those who are at risk of developing severe diseases and potentially in need of intensive care, we investigated the independent associations between longitudinal glycated hemoglobin (HbA1c), the impact of common medications (metformin, insulin, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and corticosteroids) and COVID-19 severity in people with T2D. RESEARCH DESIGN AND METHODS Retrospective cohort study was conducted using deidentified claims and electronic health record data from the OptumLabs Data Warehouse across the USA between January 2017 and November 2020, including 16 504 individuals with T2D and COVID-19. A univariate model and a multivariate model were applied to evaluate the association between 2 and 3-year HbA1c average, medication use between COVID-19 diagnosis and intensive care unit admission (if applicable), and risk of intensive care related to COVID-19. RESULTS With covariates adjusted, the HR of longitudinal HbA1c for risk of intensive care was 1.12 (per 1% increase, p<0.001) and 1.48 (comparing group with poor (HbA1c ≥9%) and adequate glycemic control (HbA1c 6%-9%), p<0.001). The use of corticosteroids and the combined use of insulin and metformin were associated with significant reduction of intensive care risk, while ACEIs and ARBs were not associated with reduced risk of intensive care. CONCLUSIONS Two to three-year longitudinal glycemic level is independently associated with COVID-19-related severity in people with T2D. Here, we present a potential method to use HbA1c history, which presented a stronger association with COVID-19 severity than single-point HbA1c, to identify in advance those more at risk of intensive care due to COVID-19 in the T2D population. The combined use of metformin and insulin and the use of corticosteroids might be significant to prevent patients with T2D from becoming critically ill from COVID-19.
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Affiliation(s)
- Bowen Wang
- Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
- OptumLabs Visiting Fellow, Optum Health, Eden Prairie, Minnesota, USA
| | - Benjamin S Glicksberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Girish N Nadkarni
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Deepak Vashishth
- Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
- OptumLabs Visiting Fellow, Optum Health, Eden Prairie, Minnesota, USA
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Impact of comorbid conditions on asthmatic adults and children. NPJ Prim Care Respir Med 2020; 30:36. [PMID: 32820164 PMCID: PMC7441401 DOI: 10.1038/s41533-020-00194-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
Comorbid conditions (comorbidities) can complicate the diagnosis and management of asthma. In different age groups, comorbid conditions can present varying challenges, including diagnostic confusion due to mimicking asthma symptoms, exacerbation of asthma symptoms, therapy for comorbid conditions affecting asthma or therapy for asthma affecting these conditions. This review aims to summarise some common comorbid conditions with asthma, such as rhinitis, vocal cord dysfunction, gastro-oesophageal reflux, psychiatric disorders, obesity and obstructive sleep apnoea, and discuss their prevalence, symptoms, diagnosis and treatment, highlighting any differences in how they impact children and adults. Overall, there is a lack of data on the impact of treating comorbid conditions on asthma outcomes and further studies are needed to guide age-appropriate asthma management in the presence of these conditions.
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Muchuweti D, Muguti E, Mungazi SG. Spontaneous closure of an extensive postdebridement perineal wound in a newly diagnosed diabetic patient presenting with necrotizing fasciitis. Clin Case Rep 2020; 8:1044-1047. [PMID: 32577261 PMCID: PMC7303866 DOI: 10.1002/ccr3.2805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/28/2020] [Accepted: 02/26/2020] [Indexed: 12/19/2022] Open
Abstract
Diabetes mellitus may present for the first time with necrotizing fasciitis. Early treatment of septic shock and immediate surgical debridement reduces mortality. A diverting loop colostomy prevents soiling of extensive postdebridement wound. Local wound care together with good glycemic and infection control leads to spontaneous wound closure.
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Affiliation(s)
- David Muchuweti
- Department of SurgeryCollege of Health SciencesUniversity of ZimbabweHarareZimbabwe
| | - Edwin Muguti
- Department of SurgeryCollege of SciencesUniversity of ZimbabweHarareZimbabwe
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Smew AI, Lundholm C, Sävendahl L, Lichtenstein P, Almqvist C. Familial Coaggregation of Asthma and Type 1 Diabetes in Children. JAMA Netw Open 2020; 3:e200834. [PMID: 32163166 PMCID: PMC7068230 DOI: 10.1001/jamanetworkopen.2020.0834] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE The association between atopic and autoimmune disease, particularly asthma and type 1 diabetes, has been debated. Further understanding of the underlying factors associated with the comorbidity in children is warranted. OBJECTIVES To assess the bidirectional association between asthma and type 1 diabetes and examine the possibility of a shared risk for the diseases by studying their pattern of familial coaggregation. DESIGN, SETTING, AND PARTICIPANTS A birth cohort study of children born from January 1, 2001, and followed up until December 31, 2015, was performed. Population data were obtained from multiple national Swedish registers. A total of 1 347 901 singleton children, live-born in Sweden between January 1, 2001, and December 31, 2013, were identified, and children with incomplete data were excluded. The remaining 1 284 748 children were linked to their biological full siblings, maternal and paternal half-siblings, cousins, and half-cousins. Data analysis was conducted from April 1, 2019, to January 17, 2020. MAIN OUTCOMES AND MEASURES Cases of asthma and type 1 diabetes were defined using a combination of diagnoses and medication prescriptions found in the registers. RESULTS In the cohort of 1 284 748 children, 660 738 children (51.4%) were boys; 121 809 children (9.5%) had asthma, 3812 children (0.3%) had type 1 diabetes, and 494 children had both asthma and type 1 diabetes, representing 0.4% of all asthma or 13% of all type 1 diabetes. Mean (SD) age at diagnosis was 3.0 (2.8) years for children with asthma, and 5.9 (3.3) years for those with type 1 diabetes. Asthma and type 1 diabetes were associated within individuals (odds ratio, 1.15; 95% CI, 1.05-1.27). Children with asthma had an increased risk of subsequent type 1 diabetes (hazard ratio, 1.16; 95% CI, 1.06-1.27); however, subsequent asthma risk did not differ substantially among children with type 1 diabetes (hazard ratio, 0.92; 95% CI, 0.75-1.12). Siblings of individuals with asthma were at an increased risk of type 1 diabetes (odds ratio, 1.27; 95% CI, 1.13-1.42) and vice versa. The results remained positive after controlling for the direct association of one disease with the other. CONCLUSIONS AND RELEVANCE This study appears to provide evidence for co-occurrence, importance of sequential appearance, and coaggregation of asthma and type 1 diabetes in children and their siblings. The findings may suggest shared familial factors contributing to the associations. Knowledge of the nature of the association could be of importance in future clinical practice.
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Affiliation(s)
- Awad I. Smew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Sävendahl
- Pediatric Endocrinology Unit at Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
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New cassane-type diterpenoids from kernels of Caesalpinia bonduc (Linn.) Roxb. and their inhibitory activities on phosphodiesterase (PDE) and nuclear factor-kappa B (NF-κB) expression. Bioorg Chem 2020; 96:103573. [PMID: 31962203 DOI: 10.1016/j.bioorg.2020.103573] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 12/16/2022]
Abstract
In this paper, chemical investigation on the chloroform soluble fraction of seed kernels of Caesalpinia bonduc resulted in the isolation of five new cassane diterpenoids: norcaesalpinin O (1), norcaesalpinin P (2), caesalpinin MQ (3), caesall O/P (4/5) and seven known compounds (6-12). Compounds structures were elucidated by 1H NMR, 13C NMR, 2D NMR, HR-MS and ECD (electronic circular dichroism) spectral analysis. The characters for new compounds with the presence of an aromatized C ring or demethyl group at C-17 position in the structures were found. By means of bioactive screenings, the inhibitory effect on type-4 phosphodiesterase (PDE4, the target protein of asthma disease) and nuclear factor-kappa B (NF-κB) expression were valued. Compound 1 was found to exhibit moderate inhibitory activity on PDE4 and much better binding affinity than other structures by docking studies for interaction analyzing. Compounds 6, 10 and 11 displayed considerable inhibitory strength against NF-κB expression with inhibitory ratio 48.6%, 42.9% and 37.1% at 10 µM, respectively. The isolation of cassane-type diterpenoids with anti-inflammation activity from C. bonduc implied that this plant might be a good source for anti-inflammation agents finding.
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Abstract
COPD and Type 2 diabetes are two highly prevalent global health conditions associated
with high mortality and morbidity. The connection between these two common diseases is complex,
and more research is required for further understanding of these conditions. COPD is being
increasingly recognized as a risk factor for the development of type2 diabetes through different
mechanisms including systemic inflammation, obesity, hypoxia and use of corticosteroids. Also,
hyperglycemia in diabetes patients is linked to the adverse impact on lung physiology, and a possible
increase in the risk of COPD. In this review article, we discuss the studies demonstrating the
associations between COPD and Type 2 Diabetes, underlying pathophysiology and recommended
therapeutic approach in the management of patients with coexisting COPD and diabetes.
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Affiliation(s)
- Chaitanya Mamillapalli
- Springfield Clinic, Endocrinology, 1025 South 6th Street, Springfield, IL, 62702, United States
| | - Ramesh Tentu
- St. Davids Health care, Team health Hospitalist Service, Georgetown, TX 78626, United States
| | - Nitesh Kumar Jain
- Mercy Medical Centre, Pulmonology and Critical Care, Sioux City, IA 51104, United States
| | - Ramanath Bhandari
- Springfield Clinic, Endocrinology, 1025 South 6th Street, Springfield, IL, 62702, United States
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12
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Abstract
Background: There is an ongoing discussion regarding the coexistence of bronchial asthma and diabetes. The objective of the study was to assess the relationship between asthma and the diabetes course and the influence of corticosteroid therapy in asthma on diabetes control.Methods: This was a cross-sectional study. There were 2431 adult patients who were selected from 40,015 patients and assigned to subgroups of patients with only asthma, with both asthma and diabetes and with only diabetes. The following parameters were measured: fasting blood glucose level, oral glucose tolerance and glycated hemoglobin (HbA1c).Results: The value of HbA1c in patients with asthma and diabetes was compared to the value of this parameter in patients suffering only from diabetes: 7.23 ± 1.73% versus 7.42 ± 2.09% (P > 0.05). The diabetes control criteria were met in 48.5% patients with asthma and concomitant diabetes and in 50.6% patients who suffered only from diabetes. There was a negative relationship between severe asthma and diabetes control. A daily dose of budesonide up to 825 mcg used by asthmatic and diabetic patients had no significant influence on fasting glucose.Conclusions: The effect of asthma on diabetes does not seem to be significant, except for in patients with severe asthma. Inhaled steroids administered in low or mild doses do not affect fasting glycemia.
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Affiliation(s)
- Barbara Rogala
- Clinical Department of Internal Disease, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Andrzej Bożek
- Clinical Department of Internal Disease, Dermatology and Allergology, Medical University of Silesia, Katowice, Poland
| | - Joanna Gluck
- Clinical Department of Internal Disease, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
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Lin SC, Shi LS, Ye YL. Advanced Molecular Knowledge of Therapeutic Drugs and Natural Products Focusing on Inflammatory Cytokines in Asthma. Cells 2019; 8:cells8070685. [PMID: 31284537 PMCID: PMC6678278 DOI: 10.3390/cells8070685] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 02/07/2023] Open
Abstract
Asthma is a common respiratory disease worldwide. Cytokines play a crucial role in the immune system and the inflammatory response to asthma. Abnormal cytokine expression may lead to the development of asthma, which may contribute to pathologies of this disease. As cytokines exhibit pleiotropy and redundancy characteristics, we summarized them according to their biologic activity in asthma development. We classified cytokines in three stages as follows: Group 1 cytokines for the epithelial environment stage, Group 2 cytokines for the Th2 polarization stage, and Group 3 cytokines for the tissue damage stage. The recent cytokine-targeting therapy for clinical use (anti-cytokine antibody/anti-cytokine receptor antibody) and traditional medicinal herbs (pure compounds, single herb, or natural formula) have been discussed in this review. Studies of the Group 2 anti-cytokine/anti-cytokine receptor therapies are more prominent than the studies of the other two groups. Anti-cytokine antibodies/anti-cytokine receptor antibodies for clinical use can be applied for patients who did not respond to standard treatments. For traditional medicinal herbs, anti-asthmatic bioactive compounds derived from medicinal herbs can be divided into five classes: alkaloids, flavonoids, glycosides, polyphenols, and terpenoids. However, the exact pathways targeted by these natural compounds need to be clarified. Using relevant knowledge to develop more comprehensive strategies may provide appropriate treatment for patients with asthma in the future.
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Affiliation(s)
- Sheng-Chieh Lin
- Division of Allergy, Asthma and Immunology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei 23561, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Li-Shian Shi
- Department of Biotechnology, National Formosa University, Yunlin 63201, Taiwan
| | - Yi-Ling Ye
- Department of Biotechnology, National Formosa University, Yunlin 63201, Taiwan.
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Metsälä J, Lundqvist A, Virta LJ, Kaila M, Gissler M, Virtanen SM, Nevalainen J. The association between asthma and type 1 diabetes: a paediatric case-cohort study in Finland, years 1981-2009. Int J Epidemiol 2019; 47:409-416. [PMID: 29211844 DOI: 10.1093/ije/dyx245] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 12/21/2022] Open
Abstract
Background The association between asthma and type 1 diabetes, two chronic, immune-mediated diseases, has been of longstanding interest, but the evidence is still conflicting. We examined this association in a large, nationwide case-cohort study among Finnish children, using a novel statistical approach. Methods Among the initial cohort of all children born between 1 January 1981 and 31 December 2008, those who were diagnosed with asthma (n = 81 473) or type 1 diabetes (n = 9541) up to age 16 years by the end of 2009 were identified from the Central Drug Register maintained by the Social Insurance Institution of Finland. A 10% random sample from each initial birth year cohort was selected as a reference cohort (n = 171 138). The association between asthma and type 1 diabetes was studied using a multistate modelling approach to estimate transition rates between healthy and disease states since birth. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to represent the change in the transition rate between the disease states. Results After adjusting for sex and birth decade, previous diagnosis of asthma increased the risk of subsequent type 1 diabetes by 41% (95% CI: 1.28, 1.54), whereas previous diagnosis of type 1 diabetes decreased the risk of subsequent asthma by 18% (95% CI: 0.69, 0.98). Conclusions The findings of the present study imply that the association between the diseases is more complex than previously thought, and its direction depends on the sequential appearance of the diseases.
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Affiliation(s)
- Johanna Metsälä
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Annamari Lundqvist
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Lauri J Virta
- Research Department, Social Insurance Institution, Turku, Finland
| | - Minna Kaila
- Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Department of Information Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Suvi M Virtanen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.,Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Jaakko Nevalainen
- Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Katsaounou P, Buhl R, Brusselle G, Pfister P, Martínez R, Wahn U, Bousquet J. Omalizumab as alternative to chronic use of oral corticosteroids in severe asthma. Respir Med 2019; 150:51-62. [PMID: 30961951 DOI: 10.1016/j.rmed.2019.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/21/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
Systemic/oral corticosteroids (OCS) have been used for decades in the management of acute asthma exacerbations and chronically in patients with uncontrolled severe asthma. However, while OCS are effective at treating acute exacerbations, there is only empirical evidence regarding the efficacy of OCS at reducing the rate of exacerbations. Evidence, although scarce, is suggestive of high exacerbation rates in severe asthma patients even when receiving maintenance treatment with OCS. In addition, use of OCS is associated with undesirable effects. Despite all this, physicians have continued to use OCS for managing severe asthma and acute exacerbation due to the lack of availability of effective alternatives. Fortunately, in the last decade several biologics have been proven safe and effective for patients with uncontrolled severe asthma. This has led to the Global Initiative for Asthma (GINA) recommending the use of biologics, instead of maintenance OCS, in patients with severe asthma (GINA Step 5). These include one biologic targeting immunoglobulin E (IgE) (omalizumab), and different biologics targeting interleukin-5 (IL-5), the IL-5 receptor (IL-5R) or IL-4 receptor α-unit (IL-4R α), including mepolizumab (subcutaneous), reslizumab (intravenous), benralizumab (subcutaneous) and dupilumab (subcutaneous). Omalizumab for the treatment of severe allergic asthma reduces exacerbations, irrespective of blood eosinophil levels. Anti-IL-5/IL-5R biologics are indicated in patients with severe eosinophilic asthma and repetitive exacerbations, irrespective of the presence or absence of allergy. Recently, an anti-IL4Rα biologic has been approved by the FDA for eosinophilic phenotype or oral corticosteroid-dependent asthma. Finally, physicians should consider using biologics as an alternative to chronic OCS therapy.
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Affiliation(s)
- Paraskevi Katsaounou
- School of Medicine, National and Kapodistrian University of Athens, 1st ICU Evangelismos Hospital, Athens, Greece.
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany.
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan, Ghent, Belgium; Department of Epidemiology and Respiratory Medicine, Erasmus MC Rotterdam, Rotterdam, the Netherlands.
| | - Pascal Pfister
- Global Medical Department, Novartis Pharma AG, Basel, Switzerland.
| | - Rafael Martínez
- Global Medical Department, Novartis Pharma AG, Basel, Switzerland
| | - Ulrich Wahn
- Department of Paediatric Pneumology & Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Jean Bousquet
- Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Rayner L, McGovern A, Creagh-Brown B, Woodmansey C, de Lusignan S. Type 2 Diabetes and Asthma: Systematic Review of the Bidirectional Relationship. Curr Diabetes Rev 2019; 15:118-126. [PMID: 29992891 DOI: 10.2174/1573399814666180711114859] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/10/2018] [Accepted: 07/04/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Obesity is an important contributor to the risk of both asthma and Type 2 Diabetes (T2DM). However, it has been suggested that T2DM and asthma are also independently associated. The aim of this systematic review was to synthesize the evidence for an independent relationship between T2DM and asthma. METHODS MEDLINE and EMBASE were searched for studies reporting the relationship between asthma and T2DM in adults. Given a potential bidirectional relationship, articles relating to T2DM as a risk factor for asthma, and asthma as a risk factor for T2DM were examined separately. RESULTS Eight studies were identified for inclusion in the review (n=2,934,399 participants). Four studies examined incident diabetes in those with asthma. The pooled (random effects model) adjusted hazard ratio for incident T2DM in asthma was 1.37 (95%CI 1.12-1.69; p <0.001) after controlling for BMI. Four studies reported prevalence or incidence rates of asthma in people with T2DM; higher rates of asthma in those with T2DM were reported in all four studies. Meta-analysis of results was not possible due to methodological heterogeneity. The quality of included studies was good, but due to small numbers, publication bias cannot be excluded. CONCLUSION The published literature suggests a bidirectional independent relationship between T2DM and asthma, although we cannot exclude publication bias.
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Affiliation(s)
- Louise Rayner
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7XH, United Kingdom
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom
| | - Andrew McGovern
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Ben Creagh-Brown
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7XH, United Kingdom
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom
| | - Chris Woodmansey
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7XH, United Kingdom
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7XH, United Kingdom
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Association of Metabolic Syndrome with the Severity of Airflow Obstruction in Patients with Chronic Obstructive Pulmonary Disease. J ASEAN Fed Endocr Soc 2018; 33:181-187. [PMID: 33442125 PMCID: PMC7784159 DOI: 10.15605/jafes.033.02.11] [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] [Received: 07/06/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022] Open
Abstract
Background Metabolic Syndrome (MetS) is common in Chronic Obstructive Pulmonary Disease (COPD) patients but their association is still an unsettled issue. The aim of this study was to determine the association of MetS with the severity of airflow obstruction. Methodology This was a cross-sectional analytic study of 157 patients with COPD. They were classified using the Global Initiative for Chronic Obstructive Lung Diseases (GOLD). MetS was assessed using two well-recognized criteria. Demographics, clinical data, lifestyle-related characteristics, fasting blood sugar (FBS) and lipid profile were obtained. Multiple logistic regression was used to determine the association of MetS with the severity of airflow obstruction. Results 40.13% and 17.20% of patients had MetS using the NCEP/ATP III-AHA/NHBLI and IDF criteria, respectively. MetS was not associated with severity of airflow obstruction. Of the MetS components, only elevated blood pressure (BP) was significantly associated with severity of airflow obstruction (GOLD II: OR=3.28, p<0.001; GOLD III: OR=4.04, p=0.2; GOLD IV: OR=6.21, p=0.04). Elevated FBS was also associated with GOLD IV (OR=16.09, p=0.02). Significant factors associated with MetS in COPD patients were body mass index, inhaled steroid, number of pack-years, and GOLD II. Conclusion MetS is not associated with severity of airflow obstruction. Only certain components of MetS showed significant associations such as elevated BP with GOLD II-IV and elevated FBS with GOLD IV.
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Heffler E, Madeira LNG, Ferrando M, Puggioni F, Racca F, Malvezzi L, Passalacqua G, Canonica GW. Inhaled Corticosteroids Safety and Adverse Effects in Patients with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:776-781. [DOI: 10.1016/j.jaip.2018.01.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 01/06/2023]
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Lin SC, Cheng FY, Liu JJ, Ye YL. Expression and Regulation of Thymic Stromal Lymphopoietin and Thymic Stromal Lymphopoietin Receptor Heterocomplex in the Innate-Adaptive Immunity of Pediatric Asthma. Int J Mol Sci 2018; 19:ijms19041231. [PMID: 29670037 PMCID: PMC5979588 DOI: 10.3390/ijms19041231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/12/2018] [Accepted: 04/14/2018] [Indexed: 12/18/2022] Open
Abstract
Asthma is a chronic inflammatory disease affecting the airway, and it is characterized by a wheezing breathing sound, variable airflow obstruction and the presence of inflammatory cells in the submucosa of the bronchi. Viral infection, pollutants and sensitivity to aeroallergens damage the epithelium from childhood, which causes asthma. The pathogenesis of asthma includes pathways of innate stimulation by environmental microbes and irritant pathogens. Damaged epithelial cells produce thymic stromal lymphopoietin (TSLP) and stimulate myeloid dendritic cell maturation through the thymic stromal lymphopoietin receptor (TSLPR) heterocomplex. TSLP-activated myeloid dendritic cells promote naive CD4+ T cells to differentiate into T helper type 2 (Th2) phenotype CD4+ T cells. Re-exposure to allergens or environmental stimuli causes an adaptive immune response. TSLP-activated dendritic cells expressing the OX40 ligand (OX40L; CD252) trigger naive CD4+ T cells to differentiate into inflammatory Th2 effector cells secreting the cytokines interleukin-4, 5, 9, and 13 (IL-4, IL-5, IL-9 and IL-13), and the dendritic cells (DCs) promote the proliferation of allergen-specific Th2 memory cells. Allergen presentation by Th2 cells through its interaction with their receptors in the presence of major histocompatibility complex (MHC) class II on B cells and through costimulation involving CD40 and CD40L interactions results in immunoglobulin class switching from IgM to IgE. DCs and other blood cell subsets express the TSLPR heterocomplex. The regulatory mechanism of the TSLPR heterocomplex on these different cell subsets remains unclear. The TSLPR heterocomplex is composed of the IL-7Rα chain and TSLPR chain. Moreover, two isoforms of TSLP, short isoform TSLP (sfTSLP) and long isoform TSLP (lfTSLP), have roles in atopic and allergic development. Identifying and clarifying the regulation of TSLPR and IL-7Rα in pediatric asthma are still difficult, because the type of blood cell and the expression for each blood cell in different stages of atopic diseases are poorly understood. We believe that further integrated assessments of the regulation mechanism of the TSLP–TSLPR heterocomplex axis in vitro and in vivo can provide a faster and earlier diagnosis of pediatric asthma and promote the development of more effective preventive strategies at the onset of allergies.
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Affiliation(s)
- Sheng-Chieh Lin
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei 23561, Taiwan.
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan.
| | - Fang-Yi Cheng
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan.
- School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei 11031, Taiwan.
| | - Jun-Jen Liu
- School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei 11031, Taiwan.
- Ph.D. Program in Biotechnology Research and Development, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan.
| | - Yi-Ling Ye
- Department of Biotechnology, National Formosa University, Yunlin County 63201, Taiwan.
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Price DB, Russell R, Mares R, Burden A, Skinner D, Mikkelsen H, Ding C, Brice R, Chavannes NH, Kocks JWH, Stephens JW, Haughney J. Metabolic Effects Associated with ICS in Patients with COPD and Comorbid Type 2 Diabetes: A Historical Matched Cohort Study. PLoS One 2016; 11:e0162903. [PMID: 27658209 PMCID: PMC5033451 DOI: 10.1371/journal.pone.0162903] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/30/2016] [Indexed: 12/24/2022] Open
Abstract
Background Management guidelines for chronic obstructive pulmonary disease (COPD) recommend that inhaled corticosteroids (ICS) are prescribed to patients with the most severe symptoms. However, these guidelines have not been widely implemented by physicians, leading to widespread use of ICS in patients with mild-to-moderate COPD. Of particular concern is the potential risk of worsening diabetic control associated with ICS use. Here we investigate whether ICS therapy in patients with COPD and comorbid type 2 diabetes mellitus (T2DM) has a negative impact on diabetic control, and whether these negative effects are dose-dependent. Methods and Findings This was a historical matched cohort study utilising primary care medical record data from two large UK databases. We selected patients aged ≥40 years with COPD and T2DM, prescribed ICS (n = 1360) or non-ICS therapy (n = 2642) between 2008 and 2012. The primary endpoint was change in HbA1c between the baseline and outcome periods. After 1:1 matching, each cohort consisted of 682 patients. Over the 12–18-month outcome period, patients prescribed ICS had significantly greater increases in HbA1c values compared with those prescribed non-ICS therapies; adjusted difference 0.16% (95% confidence interval [CI]: 0.05–0.27%) in all COPD patients, and 0.25% (95% CI: 0.10–0.40%) in mild-to-moderate COPD patients. Patients in the ICS cohort also had significantly more diabetes-related general practice visits per year and received more frequent glucose strip prescriptions, compared with those prescribed non-ICS therapies. Patients prescribed higher cumulative doses of ICS (>250 mg) had greater odds of increased HbA1c and/or receiving additional antidiabetic medication, and increased odds of being above the Quality and Outcomes Framework (QOF) target for HbA1c levels, compared with those prescribed lower cumulative doses (≤125 mg). Conclusion For patients with COPD and comorbid T2DM, ICS therapy may have a negative impact on diabetes control. Patients prescribed higher cumulative doses of ICS may be at greater risk of diabetes progression. Trial Registration ENCePP ENCEPP/SDPP/6804
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Affiliation(s)
- David B. Price
- Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
- Observational and Pragmatic Research Institute, Singapore, Singapore
- * E-mail:
| | - Richard Russell
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rafael Mares
- Research in Real Life Ltd, Cambridge, United Kingdom
| | - Anne Burden
- Cambridge Research Support, Cambridge, United Kingdom
| | | | | | - Cherlyn Ding
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Richard Brice
- Whitstable Medical Practice, Whitstable, Canterbury, United Kingdom
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Janwillem W. H. Kocks
- Department of General Practice and GRIAC Research Institute, University Medical Center Groningen, Groningen, the Netherlands
| | - Jeffrey W. Stephens
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea, United Kingdom
| | - John Haughney
- Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
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Hossny E, Rosario N, Lee BW, Singh M, El-Ghoneimy D, SOH JY, Le Souef P. The use of inhaled corticosteroids in pediatric asthma: update. World Allergy Organ J 2016; 9:26. [PMID: 27551328 PMCID: PMC4982274 DOI: 10.1186/s40413-016-0117-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023] Open
Abstract
Despite the availability of several formulations of inhaled corticosteroids (ICS) and delivery devices for treatment of childhood asthma and despite the development of evidence-based guidelines, childhood asthma control remains suboptimal. Improving uptake of asthma management plans, both by families and practitioners, is needed. Adherence to daily ICS therapy is a key determinant of asthma control and this mandates that asthma education follow a repetitive pattern and involve literal explanation and physical demonstration of the optimal use of inhaler devices. The potential adverse effects of ICS need to be weighed against the benefit of these drugs to control persistent asthma especially that its safety profile is markedly better than oral glucocorticoids. This article reviews the key mechanisms of inhaled corticosteroid action; recommendations on dosage and therapeutic regimens; potential optimization of effectiveness by addressing inhaler technique and adherence to therapy; and updated knowledge on the real magnitude of adverse events.
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Affiliation(s)
- Elham Hossny
- Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, 11566 Egypt
| | | | - Bee Wah Lee
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Meenu Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dalia El-Ghoneimy
- Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, 11566 Egypt
| | - Jian Yi SOH
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter Le Souef
- Winthrop Professor of Paediatrics & Child Health, School of Paediatrics & Child Health, University of Western Australia, Crawley, Australia
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Pappachan JM. Editorial inhaled corticosteroids: the endocrine and metabolic complications. Open Respir Med J 2014; 8:55-8. [PMID: 25674174 PMCID: PMC4319191 DOI: 10.2174/1874210601408010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Joseph M Pappachan
- Address correspondence to this author at the Department of Endocrinology, Walsall Manor Hospital, West Midlands, WS2 9PS, UK; Tel: +44-1922 721172; Fax: +44-1922 721172;
E-mail:
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