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Kaur S, Rosenstreich D, Cleven KL, Spivack S, Grizzanti J, Reznik M, Jariwala SP. Severe asthma in adult, inner-city predominantly African-American and latinx population: demographic, clinical and phenotypic characteristics. J Asthma 2021; 59:2341-2351. [PMID: 34822312 DOI: 10.1080/02770903.2021.2010748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The burden of asthma morbidity with co-existing atopy among the racial/ethnic minorities in the socio-economically disadvantaged NYC borough of the Bronx is unusually high. The multidisciplinary Montefiore Asthma Center (MAC) provides guideline-based treatment to this high-risk population through the joint efforts of Allergists/Immunologists, Pulmonologists, and on-site health educators. METHODS The objective of this prospective, observational study was to define the demographic and clinical characteristics of severe asthma, evaluate improvement in asthma severity and lung function through the course of treatment at the MAC, and describe the asthma phenotypes of the patients managed at the MAC. Adults with severe asthma receiving treatment at the MAC were followed from their first to their last visit at the MAC. Patient demographics, along with asthma severity and co-existing allergies, were assessed. Possible phenotypes were defined (based on presence or absence of atopy, age at asthma onset, and blood eosinophil counts). RESULTS 227 patients were included in the final analysis, of which 55.5% were Hispanic and 33.9% identified as non-Hispanic Black. Ninety-one percent (91%) of our cohort was found to be atopic and allergic rhinoconjunctivitis (ARC) was the most commonly identified co-existing allergic condition (86.3%). Mean Asthma Control Test (ACT) scores improved from 11.1 (± 4.9) at the initial visit to 14.8 (± 6.1) at the last visit. The spirometric values did not improve despite treatment at MAC. CONCLUSION A multidisciplinary severe asthma center is an ideal setting to phenotype patients and offer personalized guideline-based management and education to adults with severe asthma.
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Affiliation(s)
- Savneet Kaur
- Department of Medicine, Division of Allergy/Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Rosenstreich
- Department of Medicine, Division of Allergy/Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Krystal L Cleven
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simon Spivack
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joseph Grizzanti
- Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marina Reznik
- Department of Pediatrics, Division of Academic General Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sunit P Jariwala
- Department of Medicine, Division of Allergy/Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
INTRODUCTION Ustekinumab-induced eosinophilic pneumonia is rare and to our knowledge, this is the fifth reported case of such an entity. CASE STUDY A 60-year-old female was admitted with worsening shortness of breath and a nonproductive cough for 4 months. Her past medical history was significant for Crohn's disease and psoriatic arthritis that was previously managed with adalimumab and switched to ustekinumab 2 months before symptoms. Initial diagnostic workup showed 10% peripheral eosinophilia and a CT chest showed numerous 5 mm nodules scattered throughout the lungs along with some peripheral reticulations. Her BAL fluid analysis showed abnormally high eosinophil count (67%), greatly limiting her potential diagnoses to eosinophilic pneumonia, EGPA, and tropical pulmonary eosinophilia (TPE). AEP typically causes more severe disease with a rapid onset, and there was low suspicion for TPE based on history, leaving EGPA and CEP. Based on her negative autoimmune serology, a negative biopsy of the nasal mucosa (no vasculitis/granulomata or eosinophils), and negative infectious workup, the patient was diagnosed with CEP secondary to ustekinumab and the drug was stopped. She was started on high dose prednisone and after a prolonged taper over 5 months, her symptoms and nodules and reticulations on her CT scan resolved. DISCUSSION This case exemplifies the importance of identifying drug-induced lung diseases which in many cases might not have a strong temporal association with the symptom onset. It also highlights that some drugs owing to their long elimination half-time can remain in the system for a prolonged period and continues to cause symptoms despite their cessation and require prolonged treatment and reassurance. CONCLUSION The association of eosinophilic pneumonia with ustekinumab, a drug used in the treatment of psoriasis and other autoimmune diseases, is rare and there is a paucity of literature regarding this association.
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Affiliation(s)
- Saminder Singh Kalra
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Mwelwa Chizinga
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Cesar Trillo-Alvarez
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Eric S Papierniak
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
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Sterner T, Uldahl A, Svensson Å, Björk J, Svedman C, Nielsen C, Tunsäter A, Bruze M, Kiotseridis H. The Southern Sweden Adolescent Allergy-Cohort: Prevalence of allergic diseases and cross-sectional associations with individual and social factors. J Asthma 2018; 56:227-235. [PMID: 29621411 DOI: 10.1080/02770903.2018.1452033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Asthma and allergic diseases are the most frequent chronic diseases in childhood worldwide, and considered a burden for the affected children and their families. The diseases impose an economic burden on society if not diagnosed and treated properly and management of and these diseases are challenging for healthcare professionals. The aim of the present investigation was to assess the prevalence of allergic diseases in an unselected cohort of adolescents in southern Sweden. Additionally, associations with sociodemographic factors were investigated, as well as impact on daily life. METHODS This cross-sectional study was based on a cohort of n = 1 530 school children, aged 13 to 14, from 13 municipalities in southern Sweden. Data were collected through web-based questionnaires. RESULTS Of all children 32% reported at least one allergic disease. 67% reported one allergic disease and 33% reported more than one. No allergy-related disease were reported by 68%. Current asthma was reported by 9.8% and current rhino-conjunctivitis was reported by 13%. The prevalence of food hypersensitivity was 12% and the prevalence of eczema was 11%. One to three wheezing attacks were reported from 55% and 40% reported more than four attacks of wheezing in the preceding year. The self-reported allergic diseases were diagnosed by a doctor in; 36% (food hypersensitivity) to 69% (rhinoconjunctivitis) of the cases. CONCLUSIONS A high number of affected children were identified. Some children being undiagnosed and some not receiving satisfactory treatment. These results suggest that additional studies to evaluate treatment procedures in order to improve healthcare for allergic children are warranted.
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Affiliation(s)
- Therese Sterner
- a Department of Clinical Sciences , Lunds Universitet , Malmö , Lund , Sweden.,b Department of Dermatology , Skåne University Hospital , Malmö , Sweden.,c Skåne Regional Council , Competence Center of Allergy, Asthma and COPD , Lund , Sweden
| | - Ada Uldahl
- a Department of Clinical Sciences , Lunds Universitet , Malmö , Lund , Sweden.,b Department of Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Åke Svensson
- b Department of Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Jonas Björk
- d Department of Occupational and Environmental Medicine , Lunds Universitet , Lund , Sweden
| | - Cecilia Svedman
- e Department of Occupational and Environmental Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Christel Nielsen
- d Department of Occupational and Environmental Medicine , Lunds Universitet , Lund , Sweden
| | - Alf Tunsäter
- f Respiratory Medicine and Allergology , Medical Sciences, Lunds university , Sweden
| | - Magnus Bruze
- e Department of Occupational and Environmental Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Hampus Kiotseridis
- c Skåne Regional Council , Competence Center of Allergy, Asthma and COPD , Lund , Sweden
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Goedken AM, Brooks JM, Milavetz G, Rudzianski NJ, Chrischilles EA. Geographic variation in inhaled corticosteroid use for children with persistent asthma in Medicaid. J Asthma 2017; 55:851-858. [PMID: 28800267 DOI: 10.1080/02770903.2017.1362428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Geographic variation in the rates of inhaled corticosteroid (ICS) use for children with persistent asthma in Medicaid has been reported, but the source of this variation is unknown. The objective of this study was to quantify the geographic variation in ICS use for children with persistent asthma in Medicaid that remains after adjusting for the characteristics of children in an area. METHODS Data from the 2005-2007 Medicaid Analytic eXtract files were used. Frequent fills of short-acting beta2-agonist (SABA) were used to identify children 5-18 years of age with persistent asthma across the United States. A child was considered to have used an ICS if the child initially filled an ICS following frequent SABA use. Areas were determined using published methods, and the unadjusted ICS rate and the area treatment ratio for ICS, which adjusted for demographic and clinical characteristics, were calculated for each area. RESULTS Of 15,917 children, 13% used an ICS. The median unadjusted ICS rate for all areas was 10% but ranged from 0% to 64%. ICS use was less than expected for more than half of the areas based on the characteristics of the children in the area, but use was nearly five times what was expected in some areas. Areas with higher than expected ICS use were found contiguous to areas with lower than expected use. CONCLUSIONS Geographic variation in ICS not attributable to the demographic and clinical characteristics of the children in an area exists and could prove useful in the struggle to reduce asthma exacerbation rates.
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Affiliation(s)
- Amber M Goedken
- a Department of Pharmacy Practice and Science, College of Pharmacy , University of Iowa , Iowa City , Iowa , USA
| | - John M Brooks
- b Department of Health Services Policy and Management, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Gary Milavetz
- a Department of Pharmacy Practice and Science, College of Pharmacy , University of Iowa , Iowa City , Iowa , USA
| | - Nicholas J Rudzianski
- c Department of Epidemiology, College of Public Health , University of Iowa , Iowa City , Iowa , USA
| | - Elizabeth A Chrischilles
- c Department of Epidemiology, College of Public Health , University of Iowa , Iowa City , Iowa , USA
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Asano T, Takemura M, Kanemitsu Y, Yokota M, Fukumitsu K, Takeda N, Ichikawa H, Hijikata H, Uemura T, Takakuwa O, Ohkubo H, Maeno K, Ito Y, Oguri T, Nakamura A, Maki Y, Nakamura Y, Suzuki M, Niimi A. Combined measurements of fractional exhaled nitric oxide and nasal nitric oxide levels for assessing upper airway diseases in asthmatic patients. J Asthma 2017; 55:300-309. [PMID: 28513250 DOI: 10.1080/02770903.2017.1332203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the close linkage between rhinitis, chronic rhinosinusitis (CRS) and asthma, relevant biomarkers of both upper and lower airway inflammation are rare. METHODS Patients with asthma (without upper airway disease [UAD; n = 24], with rhinitis [n = 25], CRS [n = 24], and nasal polyps [n = 2]), isolated rhinitis (n = 13), isolated CRS (n = 13), and 10 healthy controls were prospectively recruited. Fractional exhaled nitric oxide (NO) levels at 50 mL/s (FeNO50), nasal NO levels, Lund-Macay-scores of sinus computed tomography and an asthma control questionnaire (ACQ) were evaluated. RESULTS Asthma was associated with higher FeNO50 levels irrespective of the UAD category. FeNO50 levels were higher in asthmatics with CRS (median: 54.0 ppb) than those with rhinitis (35.2 ppb, p = 0.02) and those without UAD (34.3 ppb, p = 0.002). Nasal NO levels were higher in rhinitis patients than other UAD categories, irrespective of the asthma concomitance. Nasal NO levels were higher in asthmatics with rhinitis (112.8 ppb) than those without UAD (67.2 ppb, p = 0.001) and those with CRS (57.6 ppb, p < 0.0001). A receiver-operating-characteristic curve analysis for detecting comorbid allergic rhinitis (AR) in asthmatics showed a high area under the curve (0.87). Nasal NO levels were positively correlated with FeNO50 levels (ρ = 0.56, p = 0.003) in asthmatics with rhinitis. In contrast, they were negatively correlated with the Lund-Macay (ρ = -0.46, p = 0.03) and ACQ scores (ρ = -0.52, p = 0.009) in asthmatics with CRS. CONCLUSIONS Higher nasal NO levels reflect the presence of AR, irrespective of asthma concomitance. Higher FeNO50 levels reflect the presence of CRS and asthma. These NO measurements are useful for assessing comorbid UAD in asthmatics.
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Affiliation(s)
- Takamitsu Asano
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Masaya Takemura
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Yoshihiro Kanemitsu
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Makoto Yokota
- b Department of Otorhinolaryngology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Kensuke Fukumitsu
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Norihisa Takeda
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Hiroya Ichikawa
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Hisatoshi Hijikata
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Takehiro Uemura
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Osamu Takakuwa
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Hirotsugu Ohkubo
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Ken Maeno
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Yutaka Ito
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Tetsuya Oguri
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Atsushi Nakamura
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Yumi Maki
- c Department of Radiology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Yoshihisa Nakamura
- b Department of Otorhinolaryngology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Motohiko Suzuki
- b Department of Otorhinolaryngology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
| | - Akio Niimi
- a Department of Respiratory Medicine, Allergy and Clinical Immunology , Nagoya City University Graduate School of Medical Sciences , Nagoya-City , Japan
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Abstract
OBJECTIVE Asthma is one of the most common chronic diseases globally. Atopy, and especially allergic rhinitis (AR), was found as an important risk factor for asthma. The purpose of this study was to examine the association between different atopic parameters and military professions to the incidence of asthma. METHODS In a retrospective study, we included 128 591 Israel Defense Forces soldiers drafted between the mid-nineties to the early-2000s. We examined the incidence rates of asthma in relation to atopic background and to military profession. RESULTS The relative risk (RR) for the development of asthma in persons with a history of AR and the RR for asthma in atopics vs. nonatopics was 1.86 (95% CI: 1.57-2.21) and 1.73 (95% CI: 1.47-2.04), respectively. The RR for the development of asthma in persons with a history of AR was higher in Combat Units (CU) and Administrative and Driving units (ADU) (RR = 2.80; 95% CI: 2.09-3.76 and RR = 1.58; 95% CI: 1.19-2.12, respectively) than in Maintenance Units (MU) (RR = 1.27; 95% CI: 0.93-1.74). When comparing the risk for asthma amongst persons with AR, we found it lower in MU compared to ADU (RR = 0.65; 95% CI: 0.43-0.97). In atopics vs. non-atopics, the risk for asthma was higher in ADU as compared to other occupations. CONCLUSIONS Atopy, particularly AR, is a risk factor for the development of new-onset asthma in young adults. Atopy has the highest significant effect in CU where the physical demands are higher.
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Affiliation(s)
- Shlomo Moshe
- Department of Environmental and Occupational Medicine, Tel Aviv University , Tel Aviv , Israel
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Bezerra GFDB, de Almeida FC, Neto da Silva MAC, Nascimento ACB, Meireles Guerra RN, Viana GMDC, Muniz Filho WE, Costa MDRDSR, Zaror L, Brandão Nascimento MDDS. Respiratory allergy to airborne fungi in São Luís--MA: clinical aspects and levels of IgE in a structured asthma program. J Asthma 2014; 51:1028-34. [PMID: 24986250 DOI: 10.3109/02770903.2014.936451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Respiratory allergies are becoming increasingly frequent, especially based on studies of asthma and rhinitis. It is estimated that 20-30% of the world's population is affected. Allergic reactions are caused by the production of IgE antibodies specific to inhaled allergens, such as fungi in the air. This study aimed to analyze the level of specific IgE against airborne fungi in patients with a clinical diagnosis of asthma and rhinitis/sinusitis. METHODS In total, 158 patients enrolled in the Program of Support for Asthmatic Patient, and 20 controls were studied. Clinical data from the period of 2007-2008 were surveyed using a protocol form. ELISAs were performed to quantify the levels of total and specific IgE. RESULTS Of the 158 patients diagnosed with asthma, 71 had rhinitis and 32 had sinusitis. There was a predominance of females and residents of urban areas. The main symptoms reported were dyspnea, cough, wheezing and nasal obstruction. There was a statistically significant relationship between dyspnea and seropositivity for Fusarium (p = 0.01) and Penicillium (p = 0.005) and between cough and seropositivity for Aspergillus (p = 0.007). CONCLUSIONS Anti-Penicillium (79.7%) and anti-Fusarium IgE (77.8%) were found to have the highest prevalence of seropositivity in individuals with asthma and rhinitis/sinusitis. Sensitivity to fungi was higher in symptomatic individuals. The identification of environmental fungi is essential for the diagnosis of respiratory allergy.
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