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Mortimer K, Reddel HK, Pitrez PM, Bateman ED. Asthma management in low- and middle-income countries: case for change. Eur Respir J 2022; 60:13993003.03179-2021. [PMID: 35210321 PMCID: PMC9474897 DOI: 10.1183/13993003.03179-2021] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
Asthma is the most common non-communicable disease in children, and among the most common in adults. The great majority of people with asthma live in low- and middle-income countries (LMICs), where they suffer disproportionately high asthma-related morbidity and mortality. Essential inhaled medications, particularly those containing inhaled corticosteroids (ICS), are often unavailable or unaffordable, and this explains much of the global burden of preventable asthma morbidity and mortality.Guidelines developed for LMICs are generally based on the outdated assumption that patients with asthma symptoms <1-3 times/week do not need (or benefit from) ICS. Even when ICS is prescribed, many patients manage their asthma with oral or inhaled short-acting beta2 agonist (SABA) alone, due to issues of availability and affordability. A single ICS-formoterol inhaler-based approach to asthma management for all severities of asthma, from mild to severe, starting at diagnosis, might overcome SABA overuse/over-reliance and reduce the burden of symptoms and severe exacerbations. However, ICS-formoterol inhalers are currently very poorly available or unaffordable in LMICs. There is a pressing need for pragmatic clinical trial evidence of the feasibility and cost-effectiveness of this and other strategies to improve asthma care in these countries.The global health inequality in asthma care that deprives so many children, adolescents and adults of healthy lives and puts them at increased risk of death - despite the availability of highly effective therapeutic approaches - is unacceptable. A World Health Assembly Resolution on universal access to affordable effective asthma care is needed to focus attention and investment on addressing this need.
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Affiliation(s)
- K Mortimer
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, United Kingdom (2) Department of Medicine, University of Cambridge, Cambridge, UK
| | - H K Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
| | - P M Pitrez
- Pediatric Respiratory Division, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - E D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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2
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Papadopoulos NG, Mathioudakis AG, Custovic A, Deschildre A, Phipatanakul W, Wong G, Xepapadaki P, Abou‐Taam R, Agache I, Castro‐Rodriguez JA, Chen Z, Cros P, Dubus J, El‐Sayed ZA, El‐Owaidy R, Feleszko W, Fierro V, Fiocchi A, Garcia‐Marcos L, Goh A, Hossny EM, Huerta Villalobos YR, Jartti T, Le Roux P, Levina J, López García AI, Ramos ÁM, Morais‐Almeida M, Murray C, Nagaraju K, Nagaraju MK, Navarrete Rodriguez EM, Namazova‐Baranova L, Nieto Garcia A, Pozo Beltrán CF, Ratchataswan T, Rivero Yeverino D, Rodríguez Zagal E, Schweitzer CE, Tulkki M, Wasilczuk K, Xu D, Alekseeva A, Almeida B, Andre M, Arimova P, Blonde A, Cunningham A, Da Mota S, Efendieva K, Kalugina V, Kiefer S, Klein A, López CGC, López JJR, Moratellti C, Fuentes Pérez M, Simermann M, Tapia JSP, Tatopoulos A, Vishneva E, Volkov Κ, Bacharier L, Bonini M, Craig T, Diamant Z, Ducharme FM, Gern JE, Grigg J, Hamelmann EH, Hedlin G, Jartti T, Kalayci O, Kaplan A, Konradsen J, Kuna P, Lau S, Le Souef P, Lemanske RF, Makela MJ, Matricardi PM, Gómez R, Miligkos M, Pitrez PMC, Price D, Pohunek P, Roberts GC, Sheikh A, Tsiligianni I, Turner S, Valiulis A, Winders T, Yusuf OM, Zar H. Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort. Allergy 2021; 76:1765-1775. [PMID: 33608919 PMCID: PMC8013557 DOI: 10.1111/all.14787] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Background The interplay between COVID‐19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID‐19 pandemic on childhood asthma outcomes. Methods The PeARL multinational cohort included 1,054 children with asthma and 505 non‐asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID‐19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control. Results During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty‐six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre‐bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non‐asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. Conclusion Childhood asthma outcomes, including control, were improved during the first wave of the COVID‐19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID‐19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.
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Mori V, Oliveira MA, Vargas MHM, da Cunha AA, de Souza RG, Pitrez PM, Moriya HT. Input respiratory impedance in mice: comparison between the flow-based and the wavetube method to perform the forced oscillation technique. Physiol Meas 2017; 38:992-1005. [PMID: 28378711 DOI: 10.1088/1361-6579/aa6b75] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective and approach: In this study, we estimated the constant phase model (CPM) parameters from the respiratory impedance of male BALB/c mice by performing the forced oscillation technique (FOT) in a control group (n = 8) and in a murine model of asthma (OVA) (n = 10). Then, we compared the results obtained by two different methods, using a commercial equipment (flexiVent-flexiWare 7.X; SCIREQ, Montreal, Canada) (FXV) and a wavetube method equipment (Sly et al 2003 J. Appl. Physiol. 94 1460-6) (WVT). We believe that the results from different methods may not be comparable. First, we compared the results performing a two-way analysis of variance (ANOVA) for the resistance, elastance and tissue damping. MAIN RESULTS We found statistically significant differences in all CPM parameters, except for resistance, when comparing Control and OVA groups. When comparing devices, we found statistically significant differences in resistance, while differences in elastance were not observed. For tissue damping, the results from WVT were observed to be higher than those from FXV. Finally, when comparing the relative variation between the CPM parameters of the Control and OVA groups in both devices, no significant differences were observed for all parameters. SIGNIFICANCE We then conclude that this assessment can compensate the effect of using different cannulas. Furthermore, tissue damping differences between groups can be compensated, since bronchoconstrictors were not used. Therefore, we believe that relative variations in the results between groups can be a comparing parameter when using different equipment without bronchoconstrictor administration.
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Affiliation(s)
- V Mori
- Biomedical Engineering Laboratory, Escola Politécnica, University of Sao Paulo, Av. Prof. Luciano Gualberto, travessa 3, nº 158, Predio Engenharia Elétrica, Room D2-01, ZIP 05508-900, Sao Paulo-SP, Brazil
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Rodrigues A, Gualdi LP, de Souza RG, Vargas MHM, Nuñez NK, da Cunha AA, Jones MH, Pinto LA, Stein RT, Pitrez PM. Bacterial extract (OM-85) with human-equivalent doses does not inhibit the development of asthma in a murine model. Allergol Immunopathol (Madr) 2016; 44:504-511. [PMID: 27707587 DOI: 10.1016/j.aller.2016.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 03/29/2016] [Accepted: 04/27/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND OM-85 is an immunostimulant bacterial lysate, which has been proven effective in reducing the number of lower airways infections. We investigated the efficacy of the bacterial lysate OM-85 in the primary prevention of a murine model of asthma. METHODS In the first phase of our study the animals received doses of 0.5μg, 5μg and 50μg of OM-85 through gavage for five days (days -10 to -6 of the protocol), 10 days prior to starting the sensitisation with ovalbumin (OVA), in order to evaluate the results of dose-response protocols. A single dose (5μg) was then chosen in order to verify in detail the effect of OM-85 on the pulmonary allergic response. Total/differential cells count and cytokine levels (IL-4, IL-5, IL-13 and IFN-γ) from bronchoalveolar lavage fluid (BALF), OVA-specific IgE levels from serum, lung function and lung histopathological analysis were evaluated. RESULTS OM-85 did not reduce pulmonary eosinophilic response, regardless of the dose used. In the phase protocol using 5μg/animal of OM-85, no difference was shown among the groups studied, including total cell and eosinophil counts in BALF, serum OVA-specific IgE, lung histopathologic findings and lung resistance. However, OM-85 decreased IL-5 and IL-13 levels in BALF. CONCLUSIONS OM-85, administered in early life in mice in human-equivalent doses, does not inhibit the development of allergic pulmonary response in mice.
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Affiliation(s)
- A Rodrigues
- Laboratory of Pediatric Respirology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - L P Gualdi
- Laboratory of Pediatric Respirology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - R G de Souza
- Laboratory of Pediatric Respirology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - M H M Vargas
- Laboratory of Pediatric Respirology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - N K Nuñez
- Laboratory of Pediatric Respirology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - A A da Cunha
- Laboratory of Pediatric Respirology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
| | - M H Jones
- Laboratory of Respiratory Physiology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - L A Pinto
- Laboratory of Pediatric Respirology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - R T Stein
- Laboratory of Pediatric Respirology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - P M Pitrez
- Laboratory of Pediatric Respirology, Infant Center, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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de Souza APD, de Freitas DN, Antuntes Fernandes KE, D'Avila da Cunha M, Antunes Fernandes JL, Benetti Gassen R, Fazolo T, Pinto LA, Scotta M, Mattiello R, Pitrez PM, Bonorino C, Stein RT. Respiratory syncytial virus induces phosphorylation of mTOR at ser2448 in CD8 T cells from nasal washes of infected infants. Clin Exp Immunol 2015; 183:248-57. [PMID: 26437614 DOI: 10.1111/cei.12720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 12/12/2022] Open
Abstract
Respiratory syncytial virus (RSV)-specific CD8(+) T cell responses do not protect against reinfection. Activation of mammalian target of rapamycin (mTOR) impairs memory CD8(+) T cell differentiation. Our hypothesis was that RSV inhibits the formation of CD8(+) T cells memory responses through mTOR activation. To explore this, human and mouse T cells were used. RSV induced mTOR phosphorylation at Ser2448 in CD8 T cells. mTOR activation by RSV was completely inhibited using rapamycin. RSV-infected children presented higher mTOR gene expression on nasal washes comparing to children infected with metapneumovirus and rhinovirus. In addition, RSV-infected infants presented a higher frequency of CD8(+) pmTORser2448(+) T cells in nasal washes compared to RSV-negative infants. Rapamycin treatment increased the frequency of mouse CD8 RSV-M282-90 pentamer-positive T cells and the frequency of RSV-specific memory T cells precursors. These data demonstrate that RSV is activating mTOR directly in CD8 T cells, indicating a role for mTOR during the course of RSV infection.
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Affiliation(s)
- A P Duarte de Souza
- Laboratório De Imunologia Clínica E Experimental, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - D Nascimento de Freitas
- Laboratório De Imunologia Clínica E Experimental, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - K E Antuntes Fernandes
- Laboratório De Imunologia Clínica E Experimental, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - M D'Avila da Cunha
- Laboratório De Imunologia Clínica E Experimental, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - J L Antunes Fernandes
- Laboratório De Imunologia Clínica E Experimental, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - R Benetti Gassen
- Laboratório De Imunologia Clínica E Experimental, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - T Fazolo
- Laboratório De Imunologia Clínica E Experimental, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - L A Pinto
- Laboratório De Respirologia Pediátrica, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - M Scotta
- Laboratório De Respirologia Pediátrica, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - R Mattiello
- Laboratório De Respirologia Pediátrica, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - P M Pitrez
- Laboratório De Respirologia Pediátrica, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - C Bonorino
- Laboratorio De Imunologia Celular E Molecular, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - R T Stein
- Laboratório De Respirologia Pediátrica, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Centro Infant, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Instituto De Pesquisas Biomédicas, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
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Pitrez PM, Gualdi LP, Barbosa GL, Sudbrack S, Ponzi D, Cao RG, Silva ACA, Machado DC, Jones MH, Stein RT, Graeff-Teixeira C. Effect of different helminth extracts on the development of asthma in mice: The influence of early-life exposure and the role of IL-10 response. Exp Parasitol 2015; 156:95-103. [PMID: 26093162 DOI: 10.1016/j.exppara.2015.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 04/07/2015] [Accepted: 06/12/2015] [Indexed: 11/19/2022]
Abstract
It is not currently clear whether different parasites have distinct effects on the airway inflammatory response in asthma and whether exposure in early life to helminths have a stronger impact in a potential inhibitory effect on asthma. The aim of this study is to evaluate the effect of exposure to different helminth extracts on the development of allergic pulmonary response in mice, including early-life exposure. Different helminth extracts (Angiostrongylus costaricensis, Angiostrongylus cantonensis and Ascaris lumbricoides) were studied in female adult BALB/c and C57BL/6 IL-10-deficient mice in a protocol of murine asthma, injected intraperitoneally in different periods of exposure (early, pre-sensitization and post-sensitization). Cell counts in bronchoalveolar lavage (BAL), eosinophil peroxidase (EPO) from lung tissue, cytokine levels from BAL/spleen cell cultures, and lung histology were analyzed. Airway cellular influx induced by OVA was significantly inhibited by extracts of A. cantonensis and A. lumbricoides. Extracts of A. lumbricoides and A. costaricensis led to a significant reduction of IL-5 in BAL (p < 0.001). Only the exposure to A. lumbricoides led to an increased production of IL-10 in the lungs (p < 0.001). In IL-10-deficient mice exposed to A. costaricensis pre-sensitization, eosinophil counts and IL-5 levels in BAL and EPO in lung tissue were significantly reduced. In the early exposure to A. cantonensis, lung inflammation was clearly inhibited. In conclusion, different helminth extracts inhibit allergic lung inflammation in mice. IL-10 may not play a central role in some helminth-host interactions. Early exposure to helminth extracts could be a potential strategy to explore primary prevention in asthma.
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Affiliation(s)
- P M Pitrez
- Institute of Biomedical Research, Infant Center, Laboratory of Pediatric Respirology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil.
| | - L P Gualdi
- Institute of Biomedical Research, Infant Center, Laboratory of Pediatric Respirology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - G L Barbosa
- Institute of Biomedical Research, Infant Center, Laboratory of Pediatric Respirology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - S Sudbrack
- Institute of Biomedical Research, Infant Center, Laboratory of Pediatric Respirology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - D Ponzi
- Institute of Biomedical Research, Infant Center, Laboratory of Pediatric Respirology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - R G Cao
- Institute of Biomedical Research, Infant Center, Laboratory of Pediatric Respirology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - A C A Silva
- Institute of Biomedical Research, Laboratory of Molecular Parasitology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - D C Machado
- Institute of Biomedical Research, Laboratory of Cell Biology and Respiratory Diseases, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - M H Jones
- Institute of Biomedical Research, Infant Center, Laboratory of Pediatric Respirology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - R T Stein
- Institute of Biomedical Research, Infant Center, Laboratory of Pediatric Respirology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - C Graeff-Teixeira
- Institute of Biomedical Research, Laboratory of Molecular Parasitology, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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Müller GC, Pitrez PM, Teixeira AL, Pires PS, Jones MH, Stein RT, Bauer ME. Plasma brain-derived neurotrophic factor levels are associated with clinical severity in school age children with asthma. Clin Exp Allergy 2010; 40:1755-9. [PMID: 20874832 DOI: 10.1111/j.1365-2222.2010.03618.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Asthma is characterized by chronic inflammation of the airways with significant changes in leucocyte trafficking, cellular activation and tissue remodelling. Brain-derived neurotrophic factor (BDNF) has been involved with asthma and allergic diseases but its role as a severity marker in paediatric asthma has not been clinically assessed. OBJECTIVES To evaluate plasma BDNF and inflammatory markers in order to address their relationships with disease severity in children (6-15 years) with controlled persistent asthma. METHODS Children with persistent asthma were selected and lung function and skin prick tests were performed in all patients. Plasma BDNF levels and various inflammatory markers (CCL3, CCL11, CCL22, CCL24, CXCL8, CXCL9, CXCL10, soluble TNF receptors) were assessed by ELISAs. RESULTS Subjects with moderate and severe asthma had higher BDNF levels than mild asthma and controls (P<0.001). The chemokines studied and soluble TNF receptors did not differ between the studied groups. CONCLUSION AND CLINICAL RELEVANCE Our results indicate BDNF as a potential biomarker for clinical severity in children with asthma.
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Affiliation(s)
- G C Müller
- Laboratory of Cellular and Molecular Immunology, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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8
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Drews AC, Pizzichini MMM, Pizzichini E, Pereira MU, Pitrez PM, Jones MH, Sly PD, Stein RT. Neutrophilic airway inflammation is a main feature of induced sputum in nonatopic asthmatic children. Allergy 2009; 64:1597-601. [PMID: 19392986 DOI: 10.1111/j.1398-9995.2009.02057.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asthma phenotypes are well described among children. However, there are few studies comparing airway inflammation in different clinical presentations of pediatric asthma. We tested the hypothesis that nonatopic asthma is associated with a predominant noneosinophilic inflammation in the airways, as assessed by induced sputum. The objective of this study was to evaluate the cytological characteristics of induced sputum (IS) in atopic (AA), nonatopic asthmatics (NAA) and nonatopic nonasthmatic children (NANA). METHODS Of 90 selected children, 77 met eligibility criteria for performing IS and were classified as: AA, n = 28, NAA, n = 29 and NANA, n = 19. Subjects answered to a set of ISAAC-based questions and were skin-tested for common aeroallergens. A defined series of exclusion criteria was applied. RESULTS Induced sputum was obtained from 54 (70.1%) subjects (21 AA, 20 NAA and 13 NANA). Demographic data and mean FEV(1) were similar in the three groups. The proportion of eosinophils [median, inter quartile range (IQR)] was significantly higher in the sputum of AA [(6.0.)12)] compared with NAAs [0 (2)] and NANAs [0 (1)], P < 0.001. The proportion of children with sputum eosinophilia (eos > 3%) was also significantly higher in AA (71.4%) when compared with NAA (28.6%); none of the NANA had sputum eosinophilia. Nonatopic asthmatic children had significantly higher proportions and absolute number of neutrophils than AA and controls. CONCLUSIONS The results suggest that nonatopic children present IS with a cell pattern that is predominantly neutrophilic while eosinophilia is the hallmark of airway inflammation in the majority of atopic wheezing children not treated with inhaled steroids.
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Affiliation(s)
- A C Drews
- Pediatric Respirology Unit, Department of Pediatrics, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Pereira MU, Sly PD, Pitrez PM, Jones MH, Escouto D, Dias ACO, Weiland SK, Stein RT. Nonatopic asthma is associated with helminth infections and bronchiolitis in poor children. Eur Respir J 2007; 29:1154-60. [PMID: 17331964 DOI: 10.1183/09031936.00127606] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Asthma is common in urban centres in Latin America, but atopic asthma may not be the main phenotype among children. Helminth infections are highly prevalent in poor populations, and it was hypothesised that they attenuate allergic asthma, whereas other factors are related to the expression of a nonatopic wheeze/asthma phenotype. A total of 1,982 children from Southern Brazil with a mean+/-sd age of 10.1+/-0.76 yrs completed asthma questionnaires, and 1,011 were evaluated for intestinal parasites and atopy using skin-prick tests (SPTs). Wheeze in the previous 12 months was reported by 25.6%, and 9.3% showed current asthma; 13% were SPT-positive and 19.1% were positive for any helminths. Most children with either wheeze or asthma were SPT-negative; however, severe wheeze was more prevalent among the atopic minority. Helminth infections were inversely associated with positive SPT results. Bronchiolitis before the age of 2 yrs was the major independent risk factor for asthma at age 10 yrs; high-load Ascaris infection, a family history of asthma and positive SPT results were also asthma risk factors. Most asthma and wheeze are of the nonatopic phenotype, suggesting that some helminths may exert an attenuating effect on the expression of the atopic portion of the disease, whereas viral bronchiolitis predisposes more specifically to recurrent airway symptoms.
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Affiliation(s)
- M U Pereira
- Paediatric Pulmonary Research Laboratory, Biomedical Research Institute, Pontifical Catholic University of Rio Grande de Sul, Porto Alegre, Brazil
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Abstract
OBJECTIVE: To present a current review about diagnosis and treatment of severe acute asthma, based on the reviewed publications and the authorś personal experience. METHODS: We reviewed the most relevant articles about diagnosis and management of severe acute asthma. RESULTS: Severe acute asthma is an important cause of morbidity in children and it can usually lead to respiratory failure. The diagnostic (clinical manifestations and lung function tests) and treatment (oxygen, bronchodilators and steroids) are now well determined by the literature, and are very important for a good prognosis of every patient. CONCLUSIONS: Considering severe acute asthma a prevalent condition in pediatric emergency room and intensive care unit, the ability to make an early diagnosis of this condition, associated with a prompt treatment, are essential for an effective reduction in morbimortality rates.
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Affiliation(s)
- J P Piva
- Pontifícia Universidade Católica (PUCRS), Porto Alegre, RS, Brazil
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