Guidance on the diagnosis and management of asthma among adults in resource limited settings

Is sibship composition a risk factor for childhood asthma? Systematic review and meta-analysis

BACKGROUND

Following the "hygiene hypothesis", the role of sibship composition in asthma and wheezing has been extensively studied, but the findings are inconsistent. For the first time, this systematic review and meta-analysis synthesized evidences from studies investigating the association of sibship size and birth order with risk of asthma and wheezing.

METHODS

Fifteen databases were searched to identify eligible studies. Study selection and data extraction were performed independently by pairs of reviewers. Meta-analysis with robust variance estimation (RVE) was used to produce pooled risk ratio (RR) effect estimates from comparable numerical data.

RESULTS

From 17,466 identified records, 158 reports of 134 studies (> 3 million subjects) were included. Any wheezing in the last ≤ 1.5 years occurred more frequently in infants with ≥ 1 sibling [pooled RR 1.10, 95% confidence interval (CI) 1.02-1.19] and ≥ 1 older sibling (pooled RR 1.16, 95% CI 1.04-1.29). The pooled effect sizes for asthma were overall statistically nonsignificant, although having ≥ 1 older sibling was marginally protective for subjects aged ≥ 6 years (pooled RR 0.93, 95% CI 0.88-0.99). The effect estimates weakened in studies published after 2000 compared with earlier studies.

CONCLUSIONS

Being second-born or later and having at least one sibling is associated with a slightly increased risk of temporary wheezing in infancy. In contrast, being second-born or later is associated with marginal protection against asthma. These associations appear to have weakened since the turn of the millennium, possibly due to lifestyle changes and socioeconomic development. Video Abstract.

Impact of the COVID-19 on asthma control among children: A systematic review

In December 2019, the current outbreak of coronavirus disease 2019 (COVID-19) was reported in Wuhan, China. Asthmatic patients are thought to be more vulnerable to the more severe form of SARS-CoV-2 infection due to their weakened immune systems and increased risk of respiratory exacerbation when infected with respiratory viruses; however, there is little evidence to support this theory. The objective of this systematic review is to assess the impact of the COVID-19 lockdown during the pandemic on asthma management outcome measures among children and adolescents. To conduct the search, we used five bibliographic databases. The results were limited to those articles published between December 2019 and February 2022, selecting only articles published in English that included the study population (children aged 0-18 years). All study designs were considered. Independent assessments of the included studies' quality were made and reported. Among the 945 results of the bibliographic search, only 21 articles were found to fit our eligibility criteria We organized the results from the studies according to the effect of the lockdown at the start of the COVID-19 pandemic on common outcomes, including the Pediatric Emergency Department Visits, hospitalization rates of pediatric asthmatic patients during the pandemic, asthma control, asthma exacerbations, psychological effects on patients, and caregivers' concerns. The management of pediatric asthma improved more during the 2020 COVID-19 pandemic lockdown than in previous years.

Acquisition and Classification of Lung Sounds for Improving the Efficacy of Auscultation Diagnosis of Pulmonary Diseases

Purpose

Lung diseases are the third leading cause of death worldwide. Stethoscope-based auscultation is the most commonly used, non-invasive, inexpensive, and primary diagnostic approach for assessing lung conditions. However, the manual auscultation-based diagnosis procedure is prone to error, and its accuracy is dependent on the physician’s experience and hearing capacity. Moreover, the stethoscope recording is vulnerable to different noises that can mask the important features of lung sounds which may lead to misdiagnosis. In this paper, a method for the acquisition of lung sound signals and classification of the top 7 lung diseases has been proposed for improving the efficacy of auscultation diagnosis of pulmonary disease.

Methods

An electronic stethoscope has been constructed for signal acquisition. Lung sound signals were then collected from people with COPD, upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), pneumonia, bronchiectasis, bronchiolitis, asthma, and healthy people. Lung sounds were analyzed using a wavelet multiresolution analysis. To choose the most relevant features, feature selection using one-way ANOVA was performed. The classification accuracy of various machine learning classifiers was compared, and the Fine Gaussian SVM was chosen for final classification due to its superior performance. Model optimization was accomplished through the application of Bayesian optimization techniques.

Results

A test classification accuracy of 99%, specificity of 99.2%, and sensitivity of 99.04%, have been achieved for the 7 lung diseases using the optimized Fine Gaussian SVM classifier.

Conclusion

Our experimental results demonstrate that the proposed method has the potential to be used as a decision support system for the classification of lung diseases, especially in those areas where the expertise and the means are limited.

Add-on probiotics in patients with persistent allergic rhinitis: A randomized crossover clinical trial

OBJECTIVES

Current medications for allergic rhinitis (AR) may have undesirable side effects that could affect quality of life (QoL). Probiotics could be an alternative in these patients. The aim of this study was to assess the impact of add-on probiotics on symptoms and QoL of patients.

METHODS

In this randomized crossover clinical trial, patients with persistent AR were included. Each subject received budesonide with probiotic supplements (BP) or budesonide with placebo for 8 weeks (B), then vice versa for a further 8 weeks. There was an 8-week washout. The primary outcome was the change of the Short Form 36-Item Health Survey (SF-36) score. The secondary outcomes were assessed by the Sinonasal Outcome Test-22 (SNOT-22) and the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaires.

RESULTS

A total of 152 subjects (30.1 ± 7.6 years) completed the study. The SF-36 score in both groups showed improvement compared with baseline values. Treatment BP was more effective than that of B. The Cohen's d and the number needed to treat for Physical Component Scales of SF-36 were 0.40 and 10.77, respectively. These values for Mental Component Scales were 0.33 and 12.61, respectively. Also, treatment BP showed more reduction in the score of SNOT-22 and CARAT.

CONCLUSION

This study showed that the addition of probiotics to budesonide significantly improved QoL in persistent AR patients. However, the clinical situation of these patients may be not very representative of AR patients in general population. Further studies are recommended.

LEVEL OF EVIDENCE

1b Laryngoscope, 129:1744-1750, 2019.

MMP12 -82 A>G Promoter Polymorphism in Bronchial Asthma in a Population of Central Bulgaria

A characteristic feature of inflamed lungs in bronchial asthma (BA) is airway remodeling. Due to limited information on this topic in the literature, we aimed to explore the possible role of polymorphisms in the promoter region of the macrophage elastase gene MMP12 82A>G (rs2276109) as a predisposing factor for BA in an ethnic Bulgarian population. Using restriction fragment length polymorphism analysis of polymerase chain reaction-amplified fragments (PCR-RFLP), we performed genotype analysis of 58 patients and 119 control individuals. We found statistically significant differences in the distribution of genotypes (P = .008) and alleles (P = .004) between patients and nonaffected controls. In the dominant model, carriers of the G allele genotypes had 3.6-fold lower risk for BA, compared with those with the AA genotype, after adjustment for age and sex (odds ratio [OR], -0.277; 95% confidence interval [CI], .12-.65; P = .003). The results of our study suggest that the variant G allele of the MMP12 -82 A>G promoter polymorphism might be considered protective for development of BA in ethnic Bulgarian adults residing in central Bulgaria.