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Lin CC, Li CI, Yang CW, Liu CS, Lin CH, Yang SY, Li TC. Effect modification of glycemic control on association of lung function with all-cause and cardiovascular mortality in persons with type 2 diabetes - A retrospective cohort study. Respir Med 2024; 234:107804. [PMID: 39251096 DOI: 10.1016/j.rmed.2024.107804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/14/2024] [Accepted: 09/07/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Poor glucose control might deteriorate the impaired pulmonary function, which can ultimately lead to mortality. However, few studies have examined the effect modification of glucose control on the association between pulmonary function and mortality. This study aimed to examine the association of pulmonary function with mortality and determine the effect modification of glycemic level on the association of pulmonary function with mortality in persons with type 2 diabetes (T2DM). METHODS A retrospective cohort study included 3846 persons with T2DM with pulmonary function testing in Taiwan during 2002-2020. Expiratory volume in 1 s (FEV1) was measured as pulmonary function. Cox proportional hazards models were used and the effect modification of pulmonary function parameters and glucose control was assessed by their product terms. RESULTS There were 733 deaths during an average follow-up of 7.83 years. Significant associations of FEV1 and mortality were found (hazards ratio [HR] for FEV1 Z-scores of <0 to -1, <-1 to -2 and <-2: 1.47 [1.20, 1.80], 2.48 [1.95, 3.14] and 3.07 [1.74, 5.44] compared with participants with Z-score ≥0, respectively. All p for trend<0.001). Significant effect modifications were found and the association between FEV1 and mortality was stronger in persons with good glycemic control compared with poor glycemic control (FEV1-FPG effect modification, P = 0.01; FEV1-HbA1c effect modification, P = 0.03). CONCLUSION Pulmonary function, measured by FEV1, is significantly associated with mortality in persons with T2DM. Significant effect modification of glucose control on the association between pulmonary function parameters and mortality was found.
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Affiliation(s)
- Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chuan-Wei Yang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Audiology and Speech-Language Pathology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Gao SY, Deng K, Wang J, Jin FD, Huang YL, Chen ZH, Oliver BG, Xie M, Wan HJ, Qin L, Liu D, Luo FM, Chen-Yu Hsu A, Li WM, Wang G, Wood LG. Homeostatic Measure of Insulin Resistance Is Associated With Future Asthma Exacerbations: A 1-Year Prospective Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00671-8. [PMID: 38944198 DOI: 10.1016/j.jaip.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 05/28/2024] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Recent evidence suggests that insulin resistance affects asthma outcomes. However, the effect of the homeostatic measure of insulin resistance (HOMA-IR) on airway inflammation and asthma exacerbations (AEs) is poorly understood. OBJECTIVE To analyze the relationship between HOMA-IR and clinical and inflammatory characteristics in patients with asthma, and the association between HOMA-IR and AEs in the following year. METHODS A prospective cohort study recruited participants with asthma, who were classified into the HOMA-IRhigh group and HOMA-IRlow group based on the cutoff value of 3.80 for HOMA-IR and were observed within 12 months. We evaluated the clinical and inflammatory features and conducted a 1-year follow-up to study the exacerbations. We used negative binomial regression models to analyze the association between HOMA-IR and AEs. RESULTS Compared with patients in the HOMA-IRlow group (n = 564), those in the HOMA-IRhigh group (n = 61) had higher levels of body mass index, a higher waist circumference and waist-hip ratio, higher triglycerides, lower cholesterol high-density lipoproteins, more neutrophils in the peripheral blood, and elevated IL-5 levels in the induced sputum. Furthermore, patients in the HOMA-IRhigh group had a significantly increased risk for moderate to severe AEs (adjusted incidence rate ratio [aIRR] = 2.26; 95% CI, 1.38-3.70), severe AEs (aIRR = 2.42; 95% CI, 1.26-4.67), hospitalization (aIRR = 2.54; 95% CI, 1.20-5.38), and emergency visits (aIRR = 3.04; 95% CI, 1.80-8.53). CONCLUSIONS The homeostatic measure of insulin resistance was associated with asthma-related clinical features and airway inflammation, and was an independent risk factor for future AEs. Therefore, insulin resistance may have important implications for managing asthma as a potential treatable trait.
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Affiliation(s)
- Si Yang Gao
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China
| | - Ke Deng
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China
| | - Ji Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China
| | - Fan Ding Jin
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China
| | - Yan Li Huang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China
| | - Zhi Hong Chen
- Department of Respiratory, Zhongshan Hospital, Shanghai Institute of Respiratory Disease, Fudan University, Shanghai, China
| | - Brian G Oliver
- School of Life Sciences, University of Technology Sydney, Ultimo, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Min Xie
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Jing Wan
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China
| | - Ling Qin
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China
| | - Feng Ming Luo
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China
| | - Alan Chen-Yu Hsu
- Signature Research Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Wei Min Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Respiratory Microbiome Laboratory, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China.
| | - Gang Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China.
| | - Lisa G Wood
- Hunter Medical Research Institute and School of Biomedical Science and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
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Olejnik AE, Kuźnar-Kamińska B. Association of Obesity and Severe Asthma in Adults. J Clin Med 2024; 13:3474. [PMID: 38930006 PMCID: PMC11204497 DOI: 10.3390/jcm13123474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
The incidence of obesity and asthma continues to enhance, significantly impacting global public health. Adipose tissue is an organ that secretes hormones and cytokines, causes meta-inflammation, and contributes to the intensification of bronchial hyperreactivity, oxidative stress, and consequently affects the different phenotypes of asthma in obese people. As body weight increases, the risk of severe asthma increases, as well as more frequent exacerbations requiring the use of glucocorticoids and hospitalization, which consequently leads to a deterioration of the quality of life. This review discusses the relationship between obesity and severe asthma, the underlying molecular mechanisms, changes in respiratory function tests in obese people, its impact on the occurrence of comorbidities, and consequently, a different response to conventional asthma treatment. The article also reviews research on possible future therapies for severe asthma. The manuscript is a narrative review of clinical trials in severe asthma and comorbid obesity. The articles were found in the PubMed database using the keywords asthma and obesity. Studies on severe asthma were then selected for inclusion in the article. The sections: 'The classification connected with asthma and obesity', 'Obesity-related changes in pulmonary functional tests', and 'Obesity and inflammation', include studies on subjects without asthma or non-severe asthma, which, according to the authors, familiarize the reader with the pathophysiology of obesity-related asthma.
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Affiliation(s)
- Aneta Elżbieta Olejnik
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, Szamarzewskiego 84 Street, 60-569 Poznan, Poland;
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Bartziokas K, Papaioannou AI, Drakopanagiotakis F, Gouveri E, Papanas N, Steiropoulos P. Unraveling the Link between Ιnsulin Resistance and Bronchial Asthma. Biomedicines 2024; 12:437. [PMID: 38398039 PMCID: PMC10887139 DOI: 10.3390/biomedicines12020437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Evidence from large epidemiological studies has shown that obesity may predispose to increased Th2 inflammation and increase the odds of developing asthma. On the other hand, there is growing evidence suggesting that metabolic dysregulation that occurs with obesity, and more specifically hyperglycemia and insulin resistance, may modify immune cell function and in some degree systemic inflammation. Insulin resistance seldom occurs on its own, and in most cases constitutes a clinical component of metabolic syndrome, along with central obesity and dyslipidemia. Despite that, in some cases, hyperinsulinemia associated with insulin resistance has proven to be a stronger risk factor than body mass in developing asthma. This finding has been supported by recent experimental studies showing that insulin resistance may contribute to airway remodeling, promotion of airway smooth muscle (ASM) contractility and proliferation, increase of airway hyper-responsiveness and release of pro-inflammatory mediators from adipose tissue. All these effects indicate the potential impact of hyperinsulinemia on airway structure and function, suggesting the presence of a specific asthma phenotype with insulin resistance. Epidemiologic studies have found that individuals with severe and uncontrolled asthma have a higher prevalence of glycemic dysfunction, whereas longitudinal studies have linked glycemic dysfunction to an increased risk of asthma exacerbations. Since the components of metabolic syndrome interact with one another so much, it is challenging to identify each one's specific role in asthma. This is why, over the last decade, additional studies have been conducted to determine whether treatment of type 2 diabetes mellitus affects comorbid asthma as shown by the incidence of asthma, asthma control and asthma-related exacerbations. The purpose of this review is to present the mechanism of action, and existing preclinical and clinical data, regarding the effect of insulin resistance in asthma.
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Affiliation(s)
| | - Andriana I. Papaioannou
- 1st University Department of Respiratory Medicine, “Sotiria” Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Fotios Drakopanagiotakis
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Evanthia Gouveri
- Diabetes Centre, 2nd Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.G.); (N.P.)
| | - Nikolaos Papanas
- Diabetes Centre, 2nd Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.G.); (N.P.)
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Han H, Choi YJ, Hong H, Kim CY, Byun MK, Cho JH, Lee JH, Park JW, Doherty TA, Park HJ. Effects of chitinase-1 inhibitor in obesity-induced and -aggravated asthma in a murine model. Life Sci 2023; 334:122163. [PMID: 37890698 DOI: 10.1016/j.lfs.2023.122163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
AIMS Despite recent investigations on the role of chitinase in asthma, its role in obesity-induced asthma has not been evaluated. Therefore, we investigated the roles of chitin, chitinase-1, and a chitinase-1 inhibitor (compound X, CPX) in a murine model. MAIN METHODS We assigned C57BL/6 mice to the ovalbumin (OVA) model or obesity model group. In the OVA model, mice received intraperitoneal OVA twice within a 2-week interval and intranasal OVA for 3 consecutive days. Additionally, chitin was intranasally administered for 3 consecutive days, and CPX was intraperitoneally injected three times over 5 days. In the obesity model, a high-fat diet (HFD) was maintained for 13 weeks, and CPX was intraperitoneally injected eight times over 4 weeks. KEY FINDINGS In the OVA model, chitin aggravated OVA-induced airway hyper-responsiveness (AHR), increased bronchoalveolar lavage fluid (BALF) cell proliferation, increased fibrosis, and increased the levels of various inflammatory cytokines (including chitinase-1, TGF-β, TNF-α, IL-1 β, IL-6, IL-4, and IL-13). CPX treatment significantly ameliorated these effects. In the obesity model, HFD significantly increased AHR, BALF cell proliferation, fibrosis, and the levels of various inflammatory cytokines. Particularly, compared to the control group, the mRNA expression of chitinase, chitinase-like molecules, and other molecules associated with inflammation and the immune system was significantly upregulated in the HFD and HFD/OVA groups. Immunofluorescence analysis also showed increased chitinase-1 expression in these groups. CPX significantly ameliorated all these effects in this model. SIGNIFICANCE This study showed that CPX can be an effective therapeutic agent in asthma, especially, obesity-induced and -aggravated asthma to protect against the progression to airway remodeling and fibrosis.
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Affiliation(s)
- Heejae Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yong Jun Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Hyerim Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Chi Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Min Kwang Byun
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jae Hwa Cho
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jae-Hyun Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Won Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taylor A Doherty
- Section of Allergy and Immunology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Hye Jung Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Section of Allergy and Immunology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
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Han YY, Celedón JC, Forno E. Serum α-Klotho level, lung function, airflow obstruction and inflammatory markers in US adults. ERJ Open Res 2023; 9:00471-2023. [PMID: 37936898 PMCID: PMC10626412 DOI: 10.1183/23120541.00471-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/19/2023] [Indexed: 11/09/2023] Open
Abstract
Background α-Klotho is a pleiotropic protein that may have anti-oxidative and anti-inflammatory properties in the lung, but its role in airflow obstruction or lung function is largely unknown. Methods This was a cross-sectional study of 6046 adults aged 40-79 years in the US National Health and Nutrition Examination Survey (NHANES) 2007-2012. We used multivariable logistic or linear regression to examine the relation between serum α-Klotho level and airflow obstruction, defined as forced expiratory volume in 1 s (FEV1) <80% of predicted and FEV1/forced vital capacity (FVC) ratio <0.70; FEV1, FVC and FEV1/FVC as percentage of predicted; and inflammatory markers in blood (white blood cell count, eosinophils, neutrophils and C-reactive protein (CRP)). Results α-Klotho levels in the second to fourth quartiles (Q2-Q4) were associated with significantly decreased odds of airflow obstruction (adjusted OR for Q2-Q4 versus lowest quartile (Q1) 0.54 (95% CI 0.35-0.81)) in never-smokers and ex-smokers with <10 pack-years of smoking, but not in current smokers or ex-smokers with ≥10 pack-years of smoking. In all participants, each unit increment in log10-transformed α-Klotho level was significantly associated with 5.0% higher FEV1 % pred and 3.7% higher FVC % pred. Higher α-Klotho was also associated with lower eosinophils, neutrophils and CRP in participants both with and without airflow obstruction. Conclusions Higher serum α-Klotho is associated with lower inflammatory markers and higher lung function in adults with and without airflow obstruction, and with decreased odds of airflow obstruction in never-smokers and ex-smokers with <10 pack-years of smoking. Further studies are warranted to replicate our findings and evaluate underlying mechanisms.
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Affiliation(s)
- Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erick Forno
- Division of Pulmonary, Allergy and Sleep Medicine, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, IN, USA
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Molina-Luque R, Molina-Recio G, de-Pedro-Jiménez D, Álvarez Fernández C, García-Rodríguez M, Romero-Saldaña M. The Impact of Metabolic Syndrome Risk Factors on Lung Function Impairment: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e43737. [PMID: 37669095 PMCID: PMC10516148 DOI: 10.2196/43737] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/17/2023] [Accepted: 07/18/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a constellation of risk factors increasingly present in the world's population. People with this syndrome are at an increased risk of cardiovascular disease and type 2 diabetes mellitus. Moreover, evidence has shown that it affects different organs. MetS and its risk factors are independently associated with impaired lung function, which can be quantified through spirometric variables. OBJECTIVE This study aims to determine whether a high number of MetS criteria is associated with increased lung function decline. METHODS We conducted a descriptive cross-sectional study with a random sample of 1980 workers. Workers with acute respiratory pathology (eg, influenza), chronic respiratory pathology (eg, chronic bronchitis), or exposure to substances harmful to the lungs (eg, organic and inorganic dust) were not included. MetS was established based on harmonized criteria, and lung function was assessed according to spirometric variables. On the basis of these, classification into restrictive lung disease (RLD), obstructive lung disease, and mixed lung disease (MLD) was performed. In addition, the association between MetS and lung function was established based on analysis of covariance, linear trend analysis, and multiple linear regression. RESULTS MetS was associated with worse lung function according to all the spirometric parameters analyzed (percentage of predicted forced expiratory volume in 1 second: mean 83, SD 13.8 vs mean 89.2, SD 12.8; P<.001 and percentage of predicted forced vital capacity: mean 85.9, SD 11.6 vs mean 92, SD 11.3; P<.001). Moreover, those diagnosed with MetS had a higher prevalence of lung dysfunction (41% vs 21.9%; P<.001), RLD (23.4% vs 11.2%; P<.001), and MLD (7.3% vs 2.2%; P<.001). Furthermore, an increasing number of MetS criteria was associated with a greater impairment of pulmonary mechanics (P<.001). Similarly, with an increasing number of MetS criteria, there was a significant linear trend (P<.001) in the growth of the prevalence ratio of RLD (0 criteria: 1, 1: 1.46, 2: 1.52, 3: 2.53, 4: 2.97, and 5: 5.34) and MLD (0 criteria: 1, 1: 2.68, 2: 6.18, 3: 9.69, and 4: 11.37). Regression analysis showed that the alteration of all MetS risk factors, adjusted for various explanatory variables, was significantly associated with a worsening of spirometric parameters, except for forced expiratory volume in 1 second/forced vital capacity. CONCLUSIONS The findings have shown that an increase in cardiometabolic risk factors is associated with a more significant worsening of spirometric variables and a higher prevalence of RLD and MLD. As spirometry could be a crucial tool for monitoring patients at risk of developing chronic pathologies, we conclude that this inexpensive and easily accessible test could help detect changes in lung function in patients with cardiometabolic disorders. This highlights the need to consider the importance of cardiometabolic health in lung function when formulating public health policies.
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Affiliation(s)
- Rafael Molina-Luque
- Estilos de Vida, Innovación y Salud, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Departamento de Enfermería, Famarcología y Fisioterapia, Universidad de Córdoba, Córdoba, Spain
| | - Guillermo Molina-Recio
- Estilos de Vida, Innovación y Salud, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Departamento de Enfermería, Famarcología y Fisioterapia, Universidad de Córdoba, Córdoba, Spain
| | - Domingo de-Pedro-Jiménez
- Indorama Ventures Química, Sociedad Limitado Unipersonal, Polígono Industrial Guadarranque, San Roque, Cádiz, Spain
| | | | - María García-Rodríguez
- Departamento de Enfermería y Nutrición, Facultad de Ciencias Biomédicas y de la Salud, Villaviciosa de Odón, Madrid, Spain
| | - Manuel Romero-Saldaña
- Estilos de Vida, Innovación y Salud, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Departamento de Enfermería, Famarcología y Fisioterapia, Universidad de Córdoba, Córdoba, Spain
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Cazzola M, Rogliani P, Ora J, Calzetta L, Matera MG. Cardiovascular diseases or type 2 diabetes mellitus and chronic airway diseases: mutual pharmacological interferences. Ther Adv Chronic Dis 2023; 14:20406223231171556. [PMID: 37284143 PMCID: PMC10240559 DOI: 10.1177/20406223231171556] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/06/2023] [Indexed: 06/08/2023] Open
Abstract
Chronic airway diseases (CAD), mainly asthma and chronic obstructive pulmonary disease (COPD), are frequently associated with different comorbidities. Among them, cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) pose problems for the simultaneous treatment of CAD and comorbidity. Indeed, there is evidence that some drugs used to treat CAD negatively affect comorbidity, and, conversely, some drugs used to treat comorbidity may aggravate CAD. However, there is also growing evidence of some beneficial effects of CAD drugs on comorbidities and, conversely, of the ability of some of those used to treat comorbidity to reduce the severity of lung disease. In this narrative review, we first describe the potential cardiovascular risks and benefits for patients using drugs to treat CAD and the potential lung risks and benefits for patients using drugs to treat CVD. Then, we illustrate the possible negative and positive effects on T2DM of drugs used to treat CAD and the potential negative and positive impact on CAD of drugs used to treat T2DM. The frequency with which CAD and CVD or T2DM are associated requires not only considering the effect that drugs used for one disease condition may have on the other but also providing an opportunity to develop therapies that simultaneously favorably impact both diseases.
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Affiliation(s)
| | - Paola Rogliani
- Chair of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
- Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy
| | - Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria Gabriella Matera
- Chair of Pharmacology, Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Hidden Comorbidities in Asthma: A Perspective for a Personalized Approach. J Clin Med 2023; 12:jcm12062294. [PMID: 36983294 PMCID: PMC10059265 DOI: 10.3390/jcm12062294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Bronchial asthma is the most frequent inflammatory non-communicable condition affecting the airways worldwide. It is commonly associated with concomitant conditions, which substantially contribute to its burden, whether they involve the lung or other districts. The present review aims at providing an overview of the recent acquisitions in terms of asthma concomitant systemic conditions, besides the commonly known respiratory comorbidities. The most recent research has highlighted a number of pathobiological interactions between asthma and other organs in the view of a shared immunological background underling different diseases. A bi-univocal relationship between asthma and common conditions, including cardiovascular, metabolic or neurodegenerative diseases, as well as rare disorders such as sickle cell disease, α1-Antitrypsin deficiency and immunologic conditions with hyper-eosinophilia, should be considered and explored, in terms of diagnostic work-up and long-term assessment of asthma patients. The relevance of that acquisition is of utmost importance in the management of asthma patients and paves the way to a new approach in the light of a personalized medicine perspective, besides targeted therapies.
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10
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Uppal P, Mohammed SA, Rajashekar S, Giri Ravindran S, Kakarla M, Ausaja Gambo M, Yousri Salama M, Haidar Ismail N, Tavalla P, Hamid P. Type 2 Diabetes Mellitus and Asthma: Pathomechanisms of Their Association and Clinical Implications. Cureus 2023; 15:e36047. [PMID: 37056543 PMCID: PMC10089620 DOI: 10.7759/cureus.36047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/11/2023] [Indexed: 03/14/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) and asthma are chronic illnesses concomitantly present in a significant percentage of the population. Their comorbidity is associated with poor disease control and lower quality of life, thus imposing a substantial medical and economic burden worldwide. This review investigates the association between asthma and T2DM, in terms of pathogenesis, clinical outcomes, and therapeutic opportunities. Our review found an increased risk of asthma among diabetics, and vice versa. Having diabetes and poor glycemic control is associated with an increased rate of asthma exacerbations and increased mortality among those hospitalized for asthma exacerbations. The mechanisms postulated for the diabetes-asthma association include chronic low-grade inflammation, obesity, hyperinsulinemia, and possibly diabetic pneumopathy. Usage of metformin, which is the first-line drug for type 2 diabetes, was found to be associated with a decreased asthma occurrence, asthma exacerbations, and asthma-related hospitalizations. Glucagon-like peptide 1 receptor agonists were also found to be associated with a lower occurrence of asthma exacerbations. Thiazolidinediones are also associated with lower rates of asthma exacerbations, but their clinical efficacy for the same was suggested to be limited. This literature review supports a partly causative association between asthma and diabetes. This comorbidity leads to poor patient compliance, worse disease outcomes, and poor quality of life. Thus, further studies are warranted to explore the prognostic implications, therapeutic opportunities, and specific clinical practice algorithms for patients with concurrent asthma and type 2 diabetes mellitus.
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11
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Yu L, Chen Y, Xu M, Li R, Zhang J, Zhu S, He Z, Chen M, Wang G. Association of weight-adjusted-waist index with asthma prevalence and the age of first asthma onset in United States adults. Front Endocrinol (Lausanne) 2023; 14:1116621. [PMID: 36896186 PMCID: PMC9988541 DOI: 10.3389/fendo.2023.1116621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
Objective The objective of this study was to assess whether the weight-adjusted-waist index(WWI) is associated with the prevalence of asthma and age when first asthma onset appears in US adults. Methods For analysis we selected participants from the National Health and Nutrition Examination Survey(NHANES)database between 2001 and 2018. A dose-response curve was calculated using logistic regression,subgroup analysis,and a dose-response curve. Results The study included 44480 people over the age of 20,including 6061 reported with asthma, and the increase in asthma prevalence was 15% associated with each unit increase in the WWI, after adjusting for all confounders(odds ratio(OR)=1.15,95% CI:1.11,1.20). The sensitivity analysis was performed by trichotomizing the WWI, and compared to the lowest tertile, the highest tertile WWI group displayed a 29% increase in asthma prevalence(OR=1.29,95% CI:1.19,1.40). A nonlinear correlation was found between the WWI index and the risk of asthma onset, with a threshold saturation effect indicating an inflection point of 10.53 (log-likelihood ratio test, P<0.05), as well as a positive linear correlation with age at first asthma onset. Conclusions A higher WWI index was associated with an increased prevalence of asthma and an older age of first asthma onset.
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Affiliation(s)
- Longshan Yu
- Department of Emergency Medicine: The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yan Chen
- Department of General Practice, Wuhu City Second People`s Hospital, Wuhu, Anhu, China
| | - Ming Xu
- Department of Emergency Medicine: The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Rongfu Li
- Department of Emergency Medicine: The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Juan Zhang
- Department of Emergency Medicine: The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Shouwei Zhu
- Department of Emergency Medicine: The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Zongbao He
- Department of Emergency Medicine: The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Mingwei Chen
- Department of Endocrinology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Gaosheng Wang
- Department of Emergency Medicine: The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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12
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Utility of Hypoglycemic Agents to Treat Asthma with Comorbid Obesity. Pulm Ther 2022; 9:71-89. [PMID: 36575356 PMCID: PMC9931991 DOI: 10.1007/s41030-022-00211-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
Adults with obesity may develop asthma that is ineffectively controlled by inhaled corticosteroids and long-acting beta-adrenoceptor agonists. Mechanistic and translational studies suggest that metabolic dysregulation that occurs with obesity, particularly hyperglycemia and insulin resistance, contributes to altered immune cell function and low-grade systemic inflammation. Importantly, in these cases, the same proinflammatory cytokines believed to contribute to insulin resistance may also be responsible for airway remodeling and hyperresponsiveness. In the past decade, new research has emerged assessing whether hypoglycemic therapies impact comorbid asthma as reflected by the incidence of asthma, asthma-related emergency department visits, asthma-related hospitalizations, and asthma-related exacerbations. The purpose of this review article is to discuss the mechanism of action, preclinical data, and existing clinical studies regarding the efficacy and safety of hypoglycemic therapies for adults with obesity and comorbid asthma.
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13
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Weare-Regales N, Chiarella SE, Cardet JC, Prakash YS, Lockey RF. Hormonal Effects on Asthma, Rhinitis, and Eczema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2066-2073. [PMID: 35436605 PMCID: PMC9392967 DOI: 10.1016/j.jaip.2022.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/18/2022] [Accepted: 04/02/2022] [Indexed: 05/03/2023]
Abstract
Hormones significantly influence the pathogenesis of asthma, rhinitis, and eczema. This review aims to summarize relevant clinical considerations for practicing allergists and immunologists. The first section reviews the effects of sex hormones: estrogen, progesterone, and testosterone. The second concerns insulin production in the context of type 1 and type 2 diabetes. The third concludes with a discussion of thyroid and adrenal pathology in relationship to asthma, rhinitis, and eczema.
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Affiliation(s)
- Natalia Weare-Regales
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla; Division of Endocrinology, Department of Internal Medicine, James A. Haley Veterans Administration, Tampa, Fla.
| | - Sergio E Chiarella
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
| | - Y S Prakash
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minn; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minn
| | - Richard F Lockey
- Division of Endocrinology, Department of Internal Medicine, James A. Haley Veterans Administration, Tampa, Fla; Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
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14
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Carr TF, Granell R, Stern DA, Guerra S, Wright A, Halonen M, Henderson J, Martinez FD. High Insulin in Early Childhood Is Associated with Subsequent Asthma Risk Independent of Body Mass Index. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:785-792.e5. [PMID: 34656798 PMCID: PMC9059620 DOI: 10.1016/j.jaip.2021.09.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Asthma and obesity are major, interconnected public health challenges that usually have their origins in childhood, and for which the relationship is strengthened among those with insulin resistance. OBJECTIVE To determine whether high insulin in early life confers increased longitudinal risk for asthma independent of body mass index. METHODS The study used data from the Tucson Children's Respiratory Study (TCRS) and the Avon Longitudinal Study of Parents and Children (ALSPAC). Nonfasting insulin was measured in TCRS participants at age 6 years and fasting insulin in ALSPAC participants at age 8 years. Physician-diagnosed active asthma was determined at baseline and at subsequent assessments up to age 36 years in TCRS and 17 years in ALSPAC. RESULTS In TCRS, high insulin (upper quartile) at age 6 years was associated with increased odds of having active asthma from ages 8 to 36 years compared with low insulin (odds ratio,1.98; 95% CI, 1.28-3.05; P = .002). Similarly, in ALSPAC, high insulin was associated with a significantly higher risk of active asthma from ages 11 to 17 years compared with low insulin (odds ratio, 1.59; 95% CI, 1.12-2.27; P = .009). These findings were independent of baseline body mass index in both cohorts, and were not related to other demographic and asthma risk factors nor other tested markers of systemic inflammation and metabolic syndrome. CONCLUSIONS In 2 separate birth cohorts, higher blood insulin level in early childhood was associated with increased risk of active asthma through adolescence and adulthood, independent of body mass index. High insulin indicates a novel mechanism for asthma development, which may be a target for intervention.
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Affiliation(s)
- Tara F Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz.
| | | | - Debra A Stern
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Anne Wright
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Marilyn Halonen
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | | | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
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15
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Chen Y, Yang J, Han K, Wang Y, Zhuang C, Zhu L, Chen M. An Elevated METS-IR Index Is Associated With Higher Asthma Morbidity and Earlier Age of First Asthma in US Adults: Results Based on a Cross-Sectional Study. Front Endocrinol (Lausanne) 2022; 13:920322. [PMID: 35898458 PMCID: PMC9309520 DOI: 10.3389/fendo.2022.920322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate whether there is a correlation between the METS-IR index and asthma among Americans. METHODS In an attempt to establish the relationship between the METS-IR index and asthma prevalence and age at first onset of asthma, we conducted a logistic regression analysis, subgroup analysis, and dose-response curve analysis using the National Health and Nutrition Examination Survey (NHANES) database. RESULTS In model 3, each unit increase in METS-IR index led to 1.5% increase in asthma prevalence (OR= 1.015, 95% CI: 1.012, 1.018) and an earlier age of onset of asthma by 0.057years (β= -0.057, 95% CI: -0.112, -0.002).Stratified analysis determined that an increase in METS-IR index was associated with asthma prevalence in almost all subgroups, except in the group where it was not known whether a blood relative had asthma, and a positive linear relationship was found between METS-IR index and asthma prevalence, as well as a linear negative relationship with age at asthma onset. CONCLUSION Despite the fact that a direct causal relationship cannot be demonstrated, a higher METS-IR index is positively related to asthma prevalence and correspondingly may result in asthma onset at younger ages.
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Affiliation(s)
- Yan Chen
- Department of General Practice, Wuhu City Second People’s Hospital, Wuhu, China
| | - Junping Yang
- Department of General Practice, Wuhu City Second People’s Hospital, Wuhu, China
| | - Kexing Han
- Department of Infectious Diseases, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yan Wang
- Department of General Practice, Wuhu City Second People’s Hospital, Wuhu, China
| | - Cuixia Zhuang
- Department of General Practice, Wuhu City Second People’s Hospital, Wuhu, China
| | - Laxiang Zhu
- Department of General Practice, Wuhu City Second People’s Hospital, Wuhu, China
- *Correspondence: Laxiang Zhu, ; Mingwei Chen,
| | - Mingwei Chen
- Department of Endocrinology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Laxiang Zhu, ; Mingwei Chen,
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16
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Abstract
Asthma is chronic eosinophilic bronchitis with the dominancy of T helper 2 (Th2) inflammation. However, patients with asthma and metabolic dysfunction have pathogenic and pathological differences from those with Th2 inflammation. Metabolic dysfunction, typically presented as metabolic syndrome, has several important clinical components including central obesity, insulin resistance or glucose intolerance, dyslipidemia, and vitamin D deficiency. Data from large epidemiological studies support the significance of these components in the control of asthma and their contribution to airway remodeling, suggesting the presence of an asthma phenotype with metabolic dysfunction. These components are quite interactive with each other, so it is difficult to reveal the individual role of each. It is well known that asthma is difficult to treat in patients with obesity, due in part to inadequate response to inhaled corticosteroids. Additionally, vitamin D deficiency and insulin resistance have been regarded as aggravating factors of asthma control and airway remodeling. Recent clinical and in vivo studies have revealed the specific mechanisms of these components, which may aggravate asthma control and airway remodeling. In this review article, I summarize the recent studies and unmet needs for patients with asthma and metabolic dysfunction.
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Affiliation(s)
- Jung-Won Park
- Institute for Allergy & Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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17
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Therapeutic approaches targeting molecular signaling pathways common to diabetes, lung diseases and cancer. Adv Drug Deliv Rev 2021; 178:113918. [PMID: 34375681 DOI: 10.1016/j.addr.2021.113918] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/23/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
Diabetes mellitus (DM), is the most common metabolic disease and is characterized by sustained hyperglycemia. Accumulating evidences supports a strong association between DM and numerous lung diseases including chronic obstructive pulmonary disease (COPD), fibrosis, and lung cancer (LC). The global incidence of DM-associated lung disorders is rising and several ongoing studies, including clinical trials, aim to elucidate the molecular mechanisms linking DM with lung disorders, in particular LC. Several potential mechanisms, including hyperglycemia, hyperinsulinemia, glycation, inflammation, and hypoxia, are cited as plausible links between DM and LC. In addition, studies also propose a connection between the use of anti-diabetic medications and reduction in the incidence of LC. However, the exact cause for DM associated lung diseases especially LC is not clear and is an area under intense investigation. Herein, we review the biological links reported between DM and lung disorders with an emphasis on LC. Furthermore, we report common signaling pathways (eg: TGF-β, IL-6, HIF-1, PDGF) and miRNAs that are dysregulated in DM and LC and serve as molecular targets for therapy. Finally, we propose a nanomedicine based approach for delivering therapeutics (eg: IL-24 plasmid DNA, HuR siRNA) to disrupt signaling pathways common to DM and LC and thus potentially treat DM-associated LC. Finally, we conclude that the effective modulation of commonly regulated signaling pathways would help design novel therapeutic protocols for treating DM patients diagnosed with LC.
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18
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Lee WH, Wu DW, Chen YC, Liu YH, Liao WS, Chen SC, Hung CH, Kuo CH, Su HM. Association of Pulmonary Function Decline over Time with Longitudinal Change of Glycated Hemoglobin in Participants without Diabetes Mellitus. J Pers Med 2021; 11:jpm11100994. [PMID: 34683134 PMCID: PMC8537814 DOI: 10.3390/jpm11100994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 01/13/2023] Open
Abstract
Pulmonary damage and function impairment were frequently noted in patients with diabetes mellitus (DM). However, the relationship between lung function and glycemic status in non-DM subjects was not well-known. Here, we evaluated the association of longitudinal changes of lung function parameters with longitudinal changes of glycated hemoglobin (HbA1c) in non-DM participants. The study enrolled participants without prior type 2 DM, hypertension, and chronic obstructive pulmonary disease (COPD) from the Taiwan Biobank database. Laboratory profiles and pulmonary function parameters, including forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), were examined at baseline and follow-up. Finally, 7055 participants were selected in this study. During a mean 3.9-year follow-up, FVC and FEV1 were significantly decreased over time (both p < 0.001). In the multivariable analysis, the baseline (unstandardized coefficient β = −0.032, p < 0.001) and longitudinal change (unstandardized coefficient β = −0.025, p = 0.026) of FVC were negatively associated with the baseline and longitudinal change of HbA1c, respectively. Additionally, the longitudinal change of FVC was negatively associated with the risk of newly diagnosed type 2 DM (p = 0.018). During a mean 3.9-year follow-up, our present study, including participants without type 2 DM, hypertension, and COPD, demonstrated that the baseline and longitudinal change of FVC were negatively and respectively correlated with the baseline and longitudinal change of HbA1c. Furthermore, compared to those without new-onset DM, participants with new-onset DM had a more pronounced decline of FVC over time.
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Affiliation(s)
- Wen-Hsien Lee
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan; (W.-H.L.); (D.-W.W.); (Y.-C.C.); (Y.-H.L.); (W.-S.L.); (S.-C.C.); (C.-H.H.); (C.-H.K.)
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
| | - Da-Wei Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan; (W.-H.L.); (D.-W.W.); (Y.-C.C.); (Y.-H.L.); (W.-S.L.); (S.-C.C.); (C.-H.H.); (C.-H.K.)
- Research Center for Environmental Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
| | - Ying-Chih Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan; (W.-H.L.); (D.-W.W.); (Y.-C.C.); (Y.-H.L.); (W.-S.L.); (S.-C.C.); (C.-H.H.); (C.-H.K.)
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
| | - Yi-Hsueh Liu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan; (W.-H.L.); (D.-W.W.); (Y.-C.C.); (Y.-H.L.); (W.-S.L.); (S.-C.C.); (C.-H.H.); (C.-H.K.)
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
| | - Wei-Sheng Liao
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan; (W.-H.L.); (D.-W.W.); (Y.-C.C.); (Y.-H.L.); (W.-S.L.); (S.-C.C.); (C.-H.H.); (C.-H.K.)
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan; (W.-H.L.); (D.-W.W.); (Y.-C.C.); (Y.-H.L.); (W.-S.L.); (S.-C.C.); (C.-H.H.); (C.-H.K.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
| | - Chih-Hsing Hung
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan; (W.-H.L.); (D.-W.W.); (Y.-C.C.); (Y.-H.L.); (W.-S.L.); (S.-C.C.); (C.-H.H.); (C.-H.K.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan; (W.-H.L.); (D.-W.W.); (Y.-C.C.); (Y.-H.L.); (W.-S.L.); (S.-C.C.); (C.-H.H.); (C.-H.K.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
| | - Ho-Ming Su
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan; (W.-H.L.); (D.-W.W.); (Y.-C.C.); (Y.-H.L.); (W.-S.L.); (S.-C.C.); (C.-H.H.); (C.-H.K.)
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, 482 Shan-Ming Rd., Hsiao-Kang Dist., Kaohsiung 812, Taiwan
- Correspondence: ; Tel.: +886-7-8036783-3441; Fax: +886-7-8063346
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19
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Abstract
PURPOSE OF REVIEW Disorders of glucose metabolism, including insulin resistance, prediabetes, and diabetes, have been identified as risk factors for worsened asthma. This review summarizes emerging evidence for their role as modifiable risk factors in asthma, including the potential benefit of diabetes medications on asthma outcomes. RECENT FINDINGS Experimental studies show that hyperinsulinemia associated with insulin resistance is associated with airway smooth muscle proliferation and promotes contractility. Epidemiologic studies have identified a higher prevalence of glycemic dysfunction among those with severe and uncontrolled asthma, and longitudinal studies have associated prediabetes and diabetes with higher risk of asthma exacerbations. The potential benefits of thiazolidinediones (TZDs), glucagon-like peptide-1 agonists, and metformin being investigated in asthma, but thus far interventional studies of TZDs have reported null results. On the contrary, observational studies have inconsistently controlled for relevant confounders which leaves conclusions vulnerable to misattribution of relationships due to corelated metabolic disorders, including dyslipidemia. SUMMARY Developing evidence suggests that disorders of glucose metabolism may be associated with worsening asthma. However, these conditions arise within a network of obesity-related metabolic diseases that may themselves worsen asthma. Few interventional trials have not identified a benefit, but data have been limited. Additional research is needed to define the potential independent impact of disorders of glucose metabolism in asthma.
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20
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Wu TD, Fawzy A, Akenroye A, Keet C, Hansel NN, McCormack MC. Metformin Use and Risk of Asthma Exacerbation Among Asthma Patients with Glycemic Dysfunction. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4014-4020.e4. [PMID: 34293503 DOI: 10.1016/j.jaip.2021.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/12/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diabetes is associated with worse asthma morbidity. Metformin, which treats diabetes, may have a role among patients with asthma and glycemic dysfunction. OBJECTIVE To determine the association between metformin use and asthma exacerbations among patients with diabetes. METHODS We queried the Johns Hopkins electronic health record from April 1, 2013, to May 31, 2018. Adults with asthma and diabetes were followed from first hemoglobin A1c (HbA1c) test to an asthma-related systemic corticosteroid prescription, emergency department (ED) visit, or hospitalization. Multivariable Cox models estimated time to each outcome associated with metformin use, modeled as either time-invariant (status at HbA1c testing) or time-dependent (based on fill data). Mediation of results by HbA1c was assessed. Sensitivity analysis was performed by propensity score matching. RESULTS The cohort comprised 1749 adults with asthma and diabetes. Metformin use at entry was associated with a lower hazard of asthma-related ED visits (adjusted hazard ratio [aHR], 0.40; 95% CI, 0.22-0.75) but not steroid prescription (aHR, 0.89; 95% CI, 0.70-1.13) or hospitalization (aHR, 0.38; 95% CI, 0.13-1.12). HbA1c did not mediate the association with ED visits. With metformin exposure modeled as time-dependent, metformin use was additionally associated with lower hazard of asthma-related hospitalization (aHR, 0.30; 95% CI, 0.09-0.93). Results were consistent within a subcohort of 698 metformin users matched 1:1 to nonusers by propensity score. CONCLUSIONS Metformin use, independent of glycemic control and obesity, was associated with lower hazard of asthma-related ED visits and hospitalizations. Metformin may have benefit in patients with asthma and glycemic dysfunction.
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Affiliation(s)
- Tianshi David Wu
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ayobami Akenroye
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Corinne Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
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21
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Foer D, Beeler PE, Cui J, Karlson EW, Bates DW, Cahill KN. Reply to Watchorn et al.: Asthma Exacerbations in Individuals on Glucagon-like Peptide-1 Receptor Agonists for Type 2 Diabetes. Am J Respir Crit Care Med 2021; 203:924-925. [PMID: 33508207 PMCID: PMC8017586 DOI: 10.1164/rccm.202012-4511le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Dinah Foer
- Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts
| | - Patrick E Beeler
- Brigham and Women's Hospital Boston, Massachusetts.,University of Zurich Zurich, Switzerland and
| | - Jing Cui
- Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts
| | - Elizabeth W Karlson
- Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts
| | - David W Bates
- Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts
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22
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Prentice BJ, Jaffe A, Hameed S, Verge CF, Waters S, Widger J. Cystic fibrosis-related diabetes and lung disease: an update. Eur Respir Rev 2021; 30:30/159/200293. [PMID: 33597125 PMCID: PMC9488640 DOI: 10.1183/16000617.0293-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022] Open
Abstract
The development of cystic fibrosis-related diabetes (CFRD) often leads to poorer outcomes in patients with cystic fibrosis including increases in pulmonary exacerbations, poorer lung function and early mortality. This review highlights the many factors contributing to the clinical decline seen in patients diagnosed with CFRD, highlighting the important role of nutrition, the direct effect of hyperglycaemia on the lungs, the immunomodulatory effects of high glucose levels and the potential role of genetic modifiers in CFRD.
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Affiliation(s)
- Bernadette J Prentice
- Dept of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
| | - Adam Jaffe
- Dept of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
| | - Shihab Hameed
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
- Dept of Endocrinology, Sydney Children's Hospital, Randwick, Australia
| | - Charles F Verge
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
- Dept of Endocrinology, Sydney Children's Hospital, Randwick, Australia
| | - Shafagh Waters
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
- MiCF Research Centre, Sydney, Australia
| | - John Widger
- Dept of Respiratory Medicine, Sydney Children's Hospital, Randwick, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Randwick, Australia
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23
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Diabetes and Glycemic Dysfunction in Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:3416-3417. [PMID: 33161966 DOI: 10.1016/j.jaip.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022]
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