Asthma Management in Children

Exosomes derived from M2 macrophages regulate airway inflammation by modulating epithelial cell proliferation and apoptosis

BACKGROUND

Asthma is a chronic inflammatory disease characterized by airway remodeling and immune dysregulation. This study aimed to explore the mechanisms by which M2 macrophage-derived exosomes (M2Φ-Exos) regulate airway inflammation in asthma by modulating epithelial cell proliferation and apoptosis.

METHODS

M2Φ-Exos were extracted and characterized by morphology, size, and marker protein expression. In vitro, the effects of M2Φ-Exos on House Dust Mites (HDM)-stimulated mouse lung epithelial cells (MLE-12s) were evaluated using western blotting to analyze Proliferating Cell Nuclear Antigen (PCNA), B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax), and cleaved caspase-3 expression. In vivo, M2Φ-Exos were administered to HDM-induced asthmatic mice to assess their impact on airway inflammation, epithelial remodeling, and proliferation-apoptosis balance using immunohistochemistry, immunofluorescence, and western blotting. Cytokine levels in lung tissue and bronchoalveolar lavage fluid (BALF) were measured by qRT-PCR and ELISA.

RESULTS

M2Φ-Exos displayed typical cup-shaped morphology, an average diameter of 115.5 nm, and expressed marker proteins CD9, TSG101, and CD63. MLE-12 cells internalized M2Φ-Exos, leading to reduced abnormal proliferation and apoptosis in HDM-stimulated cells. In asthmatic mice, M2Φ-Exos alleviated airway inflammation and epithelial thickening while reducing PCNA, cleaved caspase-3, and Bax levels and increasing Bcl-2 expression. M2Φ-Exos suppressed pro-inflammatory cytokines (IL-4, IL-5, IL-13) and Transforming growth factor (TGF)-β, while enhancing anti-inflammatory cytokine IFN-γ and IL-10.

CONCLUSION

These findings demonstrate that M2Φ-Exos regulate the imbalance in epithelial proliferation and apoptosis in asthma, reducing inflammation and mitigating tissue remodeling, and provide new insights into potential therapeutic strategies for asthma management.

Geographic pattern of asthma prevalence in Brazilian adolescents: a systematic review with meta-analysis

OBJECTIVES

This study aimed to verify the prevalence of asthma in Brazilian adolescents and its geographic pattern carried through a systematic review and meta-analysis.

SOURCES

A survey of databases (Pubmed, Chocrane, LILACS, SCIELO and SCOPUS) was carried out, following the PRISMA statement, between the years 2013 and 2023 (PROSPERO-ID-CRD42023427988). Articles that presented a measure relative to the prevalence of asthma in adolescents were included. The methodological quality regarding risk of bias was assessed according to the approach proposed by the Joanna Brigg Institute.

SUMMARY OF THE FINDINGS

Ten of a total of 3140 studies were included. Six studies were collected before 2015. The prevalence of active asthma, severe asthma, and diagnosed asthma were 18 %, 6 %, and 14 %, respectively. The studies were presented in large urban centers and capitals, had a high methodological quality, and showed high heterogeneity. Subgroup analysis was carried out, separating the cities according to the different regions of Brazil (north, northeast, center-west, south, and southeast). The northeast was the region with the lowest prevalence of active asthma (14 %, 95 % CI = 12-17 %, p < 0.001). There was no difference between regions in terms of diagnosed asthma and severity.

CONCLUSION

A high proportion of Brazilian adolescents reported having active asthma, with the northeast region having the lowest prevalence. Most of the studies were collected more than eight years ago and regard capitals and large urban centers. The high heterogeneity found demonstrates uncertainty in asthma prevalence in Brazil and highlights the need for clearer protocols addressing the multifactorial nature of the disease.

Effects of probiotics, prebiotics, synbiotics and postbiotics on pediatric asthma: a systematic review

Background

Pediatric asthma, a prevalent chronic disease with rising global incidence, imposing substantial healthcare and socioeconomic burdens. Emerging evidence highlights the gut-lung axis as a pivotal therapeutic target, with microbiota dysbiosis implicated in immune dysregulation and airway hyperresponsiveness. This systematic review evaluated the efficacy and safety of probiotics, prebiotics, synbiotics, and postbiotics in pediatric asthma management.

Methods

A comprehensive search of PubMed, Cochrane library, Web of Science, and Embase was conducted up to 2nd January 2025. Inclusion criteria encompassed randomized controlled trials (RCTs) evaluating the therapeutic use of probiotics, prebiotics, synbiotics, or postbiotics in children and/or adolescents (<18 years) with asthma.

Results

Eighteen studies (13 RCTs, n = 2,419 participants) were analyzed, focusing on children aged < 18 years. Probiotic interventions, predominantly Lactobacillus (5 studies) and Bifidobacterium (5 studies), demonstrated significant reductions in asthma exacerbations and improved pulmonary function, with strain-specific effects linked to Th2 cytokine suppression and gut-lung axis modulation. Postbiotics, including bacterial lysates (OM-85 BV, PMBL®), attenuated airway hyperresponsiveness and systemic inflammation. Synbiotics reduced viral respiratory infections and healthcare utilization. However, there is still a lack of direct RCTs to explore the therapeutic effects of prebiotics on pediatric asthma. Key limitations include methodological heterogeneity (dosing: 108-1010 CFU/day; duration: 8 weeks-12 months) and risk of bias (3 low-risk, 12 with concerns).

Conclusion

Our findings underscored the potential of microbiota-targeted therapies but highlight the need for standardized protocols, strain-specific trials, and pediatric prebiotic research. Future studies should integrate multi-omics to elucidate mechanisms and optimize personalized interventions.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42025641318, identifier: CRD42025641318.

Controversies in Pediatric Asthma: A Bibliometric Evaluation

OBJECTIVE

Pediatric asthma is a common chronic inflammatory airway disease in children. This paper analyzes research literature on pediatric asthma and its treatment over the past decade using bibliometric methods, discussing research hotspots and trends to guide future studies.

METHOD

The Web of Science database was selected as the data source, with the retrieval period from January 1, 2014, to January 1, 2025. This study collected and analyzed literature on pediatric asthma and its treatment from the past decade, covering aspects such as publication volume, countries, institutions, journals, authors, and keywords.

RESULTS

The search yielded 640 documents involving 68 countries and 1208 institutions, authored by 3506 researchers and published across 259 journals. The global annual average publication volume of 56.8 articles indicates active research in this field. China ranks second globally in publication volume, yet there is a gap in research quality and international influence compared to Western countries. Pediatric asthma treatment remains a core challenge in the pediatric and respiratory fields, making it a central research focus for the future.

CONCLUSION

Asthma has become a major health issue among children. Over the past decade, substantial progress has been made globally in the research of pediatric asthma and its treatment. Despite surpassing many developed countries in publication volume, China needs to enhance the quality and impact of its research. There is a hope that China will increase investment in scientific research and publish more high-quality articles in both domestic and international prestigious journals, advancing the country's development in this field.

The Effect of Asthma Education Program on Disease Management in Children with Asthma: A Retrospective Analysis

Aims/Background As a common chronic respiratory disease, asthma may lead to airway inflammation and accelerated, progressive loss of lung function, if not well controlled, posing risks to patients' life and health. This study evaluates the impact of asthma education program on enhancing asthma control, quality of life, and pulmonary function in children, addressing gaps in existing management approaches. Methods In this retrospective study, 60 patients who had undergone routine nursing mode at Beijing Shijitan Hospital affiliated to Capital Medical University from May 2022 to May 2023 were enrolled for the reference group; after excluding 3 patients, this study finally included 57 patients. Separately, 55 patients who had attended the child-oriented asthma education program on the basis of routine nursing care at the same hospital from May 2023 to May 2024 were enrolled for the observation group; after excluding 2 patients, this study eventually included 53 patients. The Childhood Asthma Control Test (C-ACT) score, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) score, pulmonary function index levels measured in terms of percentage of predicted forced vital capacity (FVC%), peak expiratory flow (PEF), forced vital capacity in one second/forced vital capacity (FEV1/FVC), and the disappearance time of clinical symptoms (dyspnea, chest tightness, cough, wheezing) were compared between the two groups. Results Before the management, there were no differences in the C-ACT and PAQLQ scores between the two groups (p > 0.05). After management, the C-ACT and PAQLQ scores of the observation group were significantly higher than those of the reference group (p < 0.001). There were no differences in FVC%, PEF, and FEV1/FVC between the two groups before management (p > 0.05). After management, the FVC%, PEF, and FEV1/FVC levels of the observation group were higher than those of the reference group (p < 0.001). The disappearance time of clinical symptoms such as dyspnea, chest tightness, cough and lung wheezing in the observation group was shorter than that in the reference group (p < 0.001). Conclusion The child-oriented asthma education program is beneficial to the disease management in children with asthma, improving asthma control, quality of life, lung function indexes, and shortening the time of symptom disappearance.

Exploring the knowledge, attitude, and practice of community pharmacists regarding pediatric asthma management in Guangdong Province, China: a cross-sectional survey study

BACKGROUND

Pediatric asthma is a common respiratory disease that significantly affects children's physical and mental health. This study aims to investigate community pharmacists' self-reported knowledge of asthma and explore their attitude and practice in providing pharmaceutical services to address the needs of pediatric asthma patients.

METHODS

An online questionnaire informed by recent literature was distributed to community pharmacists in Guangdong Province, China via Qualtrics using convenience sampling and snowballing. Descriptive analysis and generalized multiple linear regression analysis were used for data analysis.

RESULTS

Out of 579 community pharmacists who attempted this questionnaire, 473 completed it, giving a completion rate of 81.7%. Among the participants, 217 (45.9%) were female, and 319 (67.5%) aged between 31 and 50. The mean score of self-reported knowledge was 60.29 ± 6.16 out of 95 (range: 19-76); the mean score of attitude was 87.62 ± 8.37 out of 130 (range: 77-130); the mean score of practice was 18.72 ± 2.32 out of 30 (range: 6-24). Age, years of employment, highest education level, the average number of patients serving per day, and the average number of asthma patients serving per week were factors significantly associated with participants' self-reported knowledge, attitude, or practice toward pediatric asthma management (p < 0.05).

CONCLUSIONS

Many community pharmacists felt they lacked sufficient knowledge about pediatric asthma and infrequently provided pharmaceutical services to children with asthma, despite having a positive attitude towards this professional role. To enhance the pharmaceutical care for pediatric asthma patients, it is essential to develop practice guidelines and care models, and provide education and training to community pharmacists accordingly.

Role of the Gut-Lung Microbiome Axis in Airway Inflammation in OVA-Challenged Mice and the Effect of Azithromycin

Objective

This study aimed to investigate the role of the gut-lung microbiome axis in airway inflammation in asthma and to evaluate the effect of azithromycin on this axis, with a focus on the potential mechanism by which azithromycin reduces allergic airway inflammation.

Methods

Haematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining were used to assess pathological changes in the lung tissues of asthmatic mice. Leukocyte cell types in bronchoalveolar lavage fluid (BALF) samples were quantified following Wright-Giemsa staining. Total IgE, OVA-specific IgE, IL-4, IL-6, and IL-17A levels in BALF and total IgE in serum were measured by ELISA. The respiratory and gut microbiota were analysed using 16S rRNA gene sequencing and subsequent taxonomic analysis.

Results

OVA-challenged asthmatic mice with gut microbiota dysbiosis exhibited alterations in the respiratory microbiota, resulting in further aggravation of airway inflammation. Following faecal microbiota transplantation (FMT) to restore gut microbiota, respiratory microbiota dysbiosis was partially improved, and airway inflammation was significantly alleviated. Furthermore, azithromycin reduced airway inflammation in asthmatic mice, particularly non-eosinophilic inflammation, for which low-dose azithromycin combined with budesonide proved more effective. Azithromycin significantly enhanced the diversity and microbial composition of the gut microbiota and also affected the respiratory microbiota. At the phylum level, azithromycin decreased the abundance of Proteobacteria in the gut microbiota. At the genus level, azithromycin reduced the abundance of Pseudomonas in the respiratory microbiota.

Conclusion

The gut-lung microbiome axis plays a crucial role in airway inflammation in asthma. Azithromycin may reduce airway inflammation in asthma through modulation of the gut-lung microbiome axis.

Global, regional, national burden of asthma from 1990 to 2021, with projections of incidence to 2050: a systematic analysis of the global burden of disease study 2021

Background

Asthma is the second leading cause of mortality among chronic respiratory illnesses. This study provided a comprehensive analysis of the burden of asthma.

Methods

Data on asthma were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We focused on the effects of age, sex, risk factors, and the socio-demographic index (SDI) on the burden of asthma and calculated the average annual percent change (AAPC) via joinpoint regression. Two-sample Mendelian randomization (MR) was adopted to estimate the causal relationships between risk factors and asthma. The Bayesian age-period-cohort (BAPC) model was used to predict incidence patterns of asthma from 2022 to 2050.

Findings

In 2021, there was an observed prevalence of asthma, with 3,340 cases per 100,000 people. Males who were below 20 years old had a greater prevalence of asthma. The incidence and prevalence correlated positively with the SDI, whereas mortality and disability-adjusted life years (DALYs) correlated negatively. The contribution of high body mass index (BMI) to asthma DALYs increased by 4.3% worldwide between 1990 and 2021. MR studies have confirmed that high BMI and smoking can increase the risk of asthma. The prediction results indicated that the global age-standardised incidence rate will remain high from 2022 to 2050.

Interpretation

The global mortality of patients with asthma is a significant concern. The analysis of the burden of asthma can help formulate public health policies, allocate resources, and prevent asthma.

Funding

This study was supported by the National Natural Science Foundation of China; Program for Young Talents of Basic Research in Universities of Heilongjiang Province; Marshal Initiative Funding; Mathematical Tianyuan Fund of the National Natural Science Foundation of China; XingLian Outstanding Talent Support Program 2024.

Analysis of allergen positivity rates in relation to gender, age, and cross-reactivity patterns

OBJECTIVE

This study aims to gain a deeper understanding of the patterns of allergen detection positivity rates among different age and gender groups, and to explore cross-reactivity patterns among allergens.

METHODS

We conducted a retrospective analysis of patients who underwent allergen testing at our hospital. The sample for this study included all patients who underwent allergen testing. We utilized immune blotting to detect specific IgE antibodies to 20 allergens in patient sera.

RESULTS

The study results showed a higher proportion of female samples (72.35%) compared to male samples (27.65%). Among all participants, the age distribution was primarily concentrated in the 25-35 age group, accounting for 37.43% of the total sample, followed by the 45 years and older age group, accounting for 27.00%. This indicates that allergic symptoms may occur not only in children and adolescents but also at any time after adulthood. We further observed significant influences of factors such as gender and age on individual sensitivity to specific allergens. For example, compared to males, females were found to be more sensitive to certain allergens such as cat hair, dust mites, and dog epithelium. Similarly, we also found variations in sensitivity to specific allergens among different age groups.

CONCLUSION

Close monitoring of allergen distribution in populations facilitates active engagement of allergic individuals in self-management, while gender and age may be important factors influencing individual sensitivity to specific allergens. These findings provide valuable insights for understanding the pathogenesis of allergic diseases and designing more effective prevention and treatment strategies.

Effectiveness of specialist nurse-led WeChat mini program management for disease control in asthma: A randomized controlled study

BACKGROUND

Asthma is a common chronic respiratory disease in childhood, requiring effective management strategies.

PURPOSE

This study aims to evaluate the effectiveness of a nurse-led WeChat Mini Program in managing asthma among children aged 6 to 11 years.

METHODS

This randomized controlled trial adhered to the CONSORT checklist and was conducted at a tertiary hospital in China from January 2023 to August 2023. One hundred and eight children with asthma were randomly assigned to two groups, and 81 children completed the 6-month follow-up. All participants received asthma management from specialist nurses, including routine treatments such as inhaled corticosteroids. The experimental group also utilized the WeChat Mini Program for asthma management. Both groups underwent follow-up assessments at 3 and 6 months post-enrollment, which included the Childhood Asthma Control Test (C-ACT), asthma control levels, frequency of exacerbations, and lung function.

RESULTS

At 3 and 6 months, the experimental group showed significantly higher C-ACT scores and a lower exacerbation frequency compared to the control group (p < 0.05). While Peak Expiratory Flow improved, Forced Expiratory Volume in 1 Second Percentage Predicted (FEV1%) and FEV1/FVC did not change significantly.

CONCLUSIONS

The WeChat Mini Program significantly improved asthma control and reduced exacerbations but did not substantially enhance all lung function parameters. Further research is required to confirm its long-term effects.

APPLICATION TO PRACTICE

Incorporating a specialist nurse-led digital management tool, such as the WeChat Mini Program, into standard pediatric asthma care may offer an effective management strategy.

Coke oven emissions exacerbate allergic asthma by promoting ferroptosis in airway epithelial cells

Epidemiological studies have shown that coke oven emissions (COEs) affect the deterioration of asthma, but has not been proven by experimental results. In this study, we found for the first time that COEs exacerbate allergen house dust mite (HDM)-induced allergic asthma in the mouse model. The findings reveal that airway inflammation, airway remodeling and allergic reaction were aggravated in the COE + HDM combined exposure group compared with the individual exposure group. Mechanism studies indicated higher levels of iron and MDA in the COE + HDM combined exposure group, along with increased expression of Ptgs2 and reduced GPX4 expression. Iron chelator deferoxamine (DFO) effectively inhibited ferroptosis induced by COE synergistically with HDM in vitro. Further studies highlighted the role of ferritinophagy in the COE + HDM-induced ferroptosis. 3-methyladenine (3-MA) could inhibit ferroptosis in the COE + HDM exposure group. Interestingly, we injected DFO intraperitoneally into mice in the combined exposure group and found DFO could significantly inhibit the COE-exacerbated ferroptosis and allergic asthma. Our findings link ferroptosis with COE-exacerbated allergic asthma, implying that ferroptosis may have important therapeutic potential for asthma in patients with occupational exposure of COE.

Prevalence of asthma triggers and control status among pediatric asthmatic patients in Saudi Arabia

AIM

This study aims to assess the prevalence of asthma triggers and control status among pediatric asthmatic patients in Saudi Arabia.

METHODS

From October 2015 to March 2016, an Arabic version of the Asthma Trigger Inventory questionnaire and asthma control test (ACT) were distributed to 200 parents of children diagnosed with asthma at the pulmonary clinic of King Fahad Medical City in Riyadh, Saudi Arabia. Data were collected and analyzed using the Statistical Package for Social Sciences (SPSS) software version 29. Descriptive statistics of the participants were presented in frequencies, percentages, means, and standard deviations for categorical variables.

RESULTS

The survey data revealed that the most prevalent asthma triggers among pediatric asthmatic children in Saudi Arabia were Arabic incense (Bakhour) with a mean score of 3.76 (±1.3), followed by being excited 3.70 (±1.5), and stress at home 3.58 (±1.4). Furthermore, the degree of asthma control among children with asthma in Saudi Arabia was 72.0% with a mean score of 17.7 (±4.7) for the ACT, indicating partial degree of asthma.

CONCLUSIONS

Arabic incense (Bakhour) and psychological stimuli emerged as significant determinants of asthma triggers in Saudi Arabian children diagnosed with asthma. Further studies are warranted to elucidate the physiological mechanisms underpinning the response to Arabic incense (Bakhour).

Urinary metabolomic profiles uncover metabolic pathways in children with asthma

OBJECTIVE

The prevalence of asthma has gradually increased worldwide in recent years, which has made asthma a global public health problem. However, due to its complexity and heterogeneity, there are a few academic debates on the pathogenic mechanism of asthma. The study of the pathogenesis of asthma through metabolomics has become a new research direction. We aim to uncover the metabolic pathway of children with asthma.

METHODS

Liquid chromatography (LC)-mass spectrometry (MS)-based metabolomic analysis was conducted to compare urine metabolic profiles between asthmatic children (n = 30) and healthy controls (n = 10).

RESULTS

Orthogonal projections to latent structures-discrimination analysis (OPLS-DA) showed that there were significant differences in metabolism between the asthma group and the control group with three different metabolites screened out, including traumatic acid, dodecanedioic acid, and glucobrassicin, and the levels of traumatic acid and dodecanedioic acid in the urine samples of asthmatic children were lower than those of healthy controls therein. Pathway enrichment analysis of differentially abundant metabolites suggested that α-linolenic acid metabolism was an asthma-related pathway.

CONCLUSIONS

This study suggests that there are significant metabolic differences in the urine of asthmatic children and healthy controls, and α-linolenic acid metabolic pathways may be involved in the pathogenesis of asthma.

Quality-of-Life Assessment in Children with Mild to Moderate Bronchial Asthma

Background and Objectives: Assess the quality of life of children aged 2-10 with mild to moderate bronchial asthma. To evaluate the general health condition of children with mild and moderate severity bronchial asthma. To determine health changes in children with mild- and moderate-severity bronchial asthma as they grow older. To evaluate the impact of mild- and moderate-severity bronchial asthma on children's daily and social activities, physical health, emotional state, and general well-being. Materials and Methods: A comparative cross-sectional study was conducted in March-June 2020. Parents or guardians of 2-10-year-old children without bronchial asthma and children with mild to moderate bronchial asthma were interviewed after receiving their written informed consent. The questionnaire was based on the standardized quality-of-life quiz SF-36. A total of 248 questionnaires were collected-106 from the parents or guardians of children with bronchial asthma and 142 from parents/guardians of children without bronchial asthma. For further analysis, 106 children without bronchial asthma and with no chronic conditions were selected. Quantitative variables were compared using the Mann-Whitney U test and qualitative data using the chi-square (χ2) criteria. Quantitative data were described by giving means, medians, and standard deviations (SD); qualitative features by giving relative frequencies. Statistical data were analyzed using SPSS and Excel 2020. Results: Children with mild and moderate asthma exhibit poorer health compared to their healthy counterparts. Only 20.7% of respondents with asthma reported excellent or very good health, contrasting with 64.1% of healthy children (p < 0.001). As children with asthma age, their general condition improves, with 46.2% showing improvement in the past year, while 42.5% of healthy children had a stable condition (p < 0.05). In various activities, children with asthma face more constraints than healthy children (p < 0.05), including energetic activities (sick-59.5%; healthy-10.3%), moderate activities (sick-24.5%; healthy-4.7%), climbing stairs (sick-22.7%; healthy-3.8%), and walking over 100 m (sick-9.4%; healthy-0%). Children with asthma are more likely to experience exhaustion, anxiety, tiredness, lack of energy, and restraint in public activities (p < 0.05). Conclusions: Parents/caregivers of children with mild to moderate bronchial asthma rate their health worse than those of healthy children do. As children with mild to moderate bronchial asthma grow, the disease impact on their overall well-being decreases. Children with mild to moderate bronchial asthma, compared to healthy children, experience more limitations in vigorous or moderate activities; face more difficulties climbing stairs or walking more than 100 m; frequently feel exhaustion, anxiety, fatigue, or lack of energy; and encounter restrictions in social activities.

Psychometric test of the Turkish version of the Family Management Scale for Children with Asthma (FMSCA)

INTRODUCTION

Asthma is the most common chronic disease among children. The management of asthma in children requires ongoing effort and is heavily dependent on the effectiveness of family management. This study aimed to evaluate the validity and reliability of the Family Management Scale for Children with Asthma (FMSCA) by adapting it to Turkish.

METHODS

This methodological research comprised 293 parents between December 2020 and May 2021. Inclusion criteria were having a child with a diagnosis of asthma for more than six months, being literate, and not having problems in communication. FMSCA was examined for language, content and construct validity. Internal consistency was calculated using Cronbach's α coefficient, item-total correlation, and test-retest equivalence. Ethical principles were adhered to.

RESULTS

The content validity index scores of the items in the FMSCA ranged from 0.90 to 1.0. The Kaiser-Meyer-Olkin value was determined to be 0.965 and the Bartlett's Test of Sphericity value was χ2 = 18,296.335 (p ≤ .001). Many indices were used to examine the fit of the FMSCA model. Of these, the χ2/SD value was determined to be 1.61. The total FMSCA Cronbach α coefficient was 0.981. The relationship between the test-retest results was statistically significant, high, and positive (p < .05).

CONCLUSION

FMSCA is a valid and reliable tool that can be used to objectively evaluate family management in families with children with asthma and to determine the effectiveness of interventions.

Uncontrolled asthma in school-aged children-a nationwide specialist care study

Background

Uncontrolled asthma (UCA) is different from severe asthma and can be identified in children across all ranges of prescribed treatment.

Objective

Our aim was to characterize uncontrolled childhood asthma in pediatric specialist care.

Methods

We performed a nationwide cross-sectional study of 5497 children (aged 6-17 years) with asthma who were treated by pediatricians at outpatient clinics during 2019 and registered in the Swedish National Airway Register. UCA was defined as an Asthma Control Test score of 19 or lower and/or 2 or more exacerbations in the past year and/or an FEV1 value less than 80% predicted. Treatment was categorized from step 1 to step 5 according to the Global Initiative for Asthma.

Results

UCA was identified in 1690 children (31%), of whom 64% had an Asthma Control Test score of 19 or lower, 20% had recurrent exacerbations, and 31% had an FEV1 value less than 80% predicted. UCA was associated with female sex (odds ratio [OR] = 1.29 [95% CI = 1.15-1.45]), older age (OR = 1.02 [95% CI = 1.00-1.04]), obesity (OR = 1.43 [95% CI = 1.12-1.83]), and more treatment using steps 1 and 2 as a reference (step 3, OR = 1.28 [95% CI = 1.12-1.46]); steps 4-5, OR = 1.32 [95% CI = 1.10-1.57]). UCA in children prescribed treatment steps 1 and 2 (group UCA1-2) occurred in 28% of all children at this treatment step (n = 887). Children in group UCA1-2 had exacerbations more frequently than did those children with UCA who were prescribed steps 4 and 5 treatment (24% vs 15% [P = .001]).

Conclusion

UCA was common and associated with female sex, increasing age, obesity, and higher Global Initiative for Asthma treatment step. Surprisingly, UCA was also common in children prescribed less than the maximum treatment, and those children could be considered undertreated patients.

Long-chain acyl-CoA synthetase 4-mediated mitochondrial fatty acid metabolism and dendritic cell antigen presentation

OBJECTIVE

This study aims to investigate the role of Acyl-CoA synthetase 4 (ACSL4) in mediating mitochondrial fatty acid metabolism and dendritic cell (DC) antigen presentation in the immune response associated with asthma.

METHODS

RNA sequencing was employed to identify key genes associated with mitochondrial function and fatty acid metabolism in DCs. ELISA was employed to assess the levels of fatty acid metabolism in DCs. Mitochondrial morphology was evaluated using laser confocal microscopy, structured illumination microscopy, and transmission electron microscopy. Flow cytometry and immunofluorescence were utilized to detect changes in mitochondrial superoxide generation in DCs, followed by immunofluorescence co-localization analysis of ACSL4 and the mitochondrial marker protein COXIV. Subsequently, pathological changes and immune responses in mouse lung tissue were observed. ELISA was conducted to measure the levels of fatty acid metabolism in lung tissue DCs. qRT-PCR and western blotting were employed to respectively assess the expression levels of mitochondrial-associated genes (ATP5F1A, VDAC1, COXIV, TFAM, iNOS) and proteins (ATP5F1A, VDAC1, COXIV, TOMM20, iNOS) in lung tissue DCs. Flow cytometry was utilized to analyze changes in the expression of surface antigens presented by DCs in lung tissue, specifically the MHCII molecule and the co-stimulatory molecules CD80/86.

RESULTS

The sequencing results reveal that ACSL4 is a crucial gene regulating mitochondrial function and fatty acid metabolism in DCs. Inhibiting ACSL4 reduces the levels of fatty acid oxidases in DCs, increases arachidonic acid levels, and decreases A-CoA synthesis. Simultaneously, ACSL4 inhibition leads to an increase in mitochondrial superoxide production (MitoSOX) in DCs, causing mitochondrial rupture, vacuolization, and sparse mitochondrial cristae. In mice, ACSL4 inhibition exacerbates pulmonary pathological changes and immune responses, reducing the fatty acid metabolism levels within lung tissue DCs and the expression of mitochondria-associated genes and proteins. This inhibition induces an increase in the expression of MHCII antigen presentation molecules and co-stimulatory molecules CD80/86 in DCs.

CONCLUSIONS

The research findings indicate that ACSL4-mediated mitochondrial fatty acid metabolism and dendritic cell antigen presentation play a crucial regulatory role in the immune response of asthma. This discovery holds promise for enhancing our understanding of the mechanisms underlying asthma pathogenesis and potentially identifying novel targets for its prevention and treatment.

Antibiotic administration aggravates asthma by disrupting gut microbiota and the intestinal mucosal barrier in an asthma mouse model

In humans, gut microbiota can determine the health status. The regulatory mechanisms of the gut microbiota in asthma must be elucidated. Although antibiotics (ABXs) can clear infections, they markedly alter the composition and abundance of gut microbiota. The present study used ABX-treated mice to examine the time-dependent effects of ABX administration on the gut microbiota and intestinal mucosal barrier. The mouse asthma model was established using ovalbumin (OVA) and gavaged with an ABX cocktail for different durations (1 or 2 weeks) and stacked sequences. The pathology of the model, model 2, OVA-ABX, OVA-ABX 2, ABX-OVA and ABX-OVA was severe when compared with the control group as evidenced by the following results: i) significantly increased pulmonary and colonic inflammatory cell infiltration; ii) enhanced pause values and iii) OVA-induced immunoglobulin E (IgE) and TGF-β expression levels, and significantly downregulated Tight Junction Protein 1 (TJP1), claudin 1 and Occludin expression levels. Furthermore, the intestinal bacterial load in the OVA-ABX and OVA-ABX 2 groups was significantly lower than that in the ABX-OVA and ABX-OVA 2 groups, respectively. The predominant taxa were as follows: phyla, Firmicutes and Proteobacteria, genera, Escherichia-Shigella, Lactobacillus and Lachnospira. The abundances of Lachnospira and Escherichia-Shigella were correlated with the expression of OVA-induced IgE and TJPs. These findings indicated that ABX administration, which modifies microbiome diversity and bacterial abundance, can disrupt colonic integrity, downregulate TJ proteins, damage the intestinal barrier, enhance enterocyte permeability, and promote the release of inflammatory factors, adversely affecting asthma alleviation and long-term repair.

Research on the intelligent internet nursing model based on the child respiratory and asthma control test scale for asthma management of preschool children

BACKGROUND

Childhood asthma is a common respiratory ailment that significantly affects preschool children. Effective asthma management in this population is particularly challenging due to limited communication skills in children and the necessity for consistent involvement of a caregiver. With the rise of digital healthcare and the need for innovative interventions, Internet-based models can potentially offer relatively more efficient and patient-tailored care, especially in children.

AIM

To explore the impact of an intelligent Internet care model based on the child respiratory and asthma control test (TRACK) on asthma management in preschool children.

METHODS

The study group comprised preschoolers, aged 5 years or younger, that visited the hospital's pediatric outpatient and emergency departments between January 2021 and January 2022. Total of 200 children were evenly and randomly divided into the observation and control groups. The control group received standard treatment in accordance with the 2016 Guidelines for Pediatric Bronchial Asthma and the Global Initiative on Asthma. In addition to above treatment, the observation group was introduced to an intelligent internet nursing model, emphasizing the TRACK scale. Key measures monitored over a six-month period included the frequency of asthma attack, emergency visits, pulmonary function parameters (FEV1, FEV1/FVC, and PEF), monthly TRACK scores, and the SF-12 quality of life assessment. Post-intervention asthma control rates were assessed at six-month follow-up.

RESULTS

The observation group had fewer asthma attacks and emergency room visits than the control group (P < 0.05). After six months of treatment, the children in both groups had higher FEV1, FEV1/FVC, and PEF (P < 0.05). Statistically significant differences were observed between the two groups (P < 0.05). For six months, children in the observation group had a higher monthly TRACK score than those in the control group (P < 0.05). The PCS and MCSSF-12 quality of life scores were relatively higher than those before the nursing period (P < 0.05). Furthermore, the groups showed statistically significant differences (P < 0.05). The asthma control rate was higher in the observation group than in the control group (P < 0.05).

CONCLUSION

TRACK based Intelligent Internet nursing model may reduce asthma attacks and emergency visits in asthmatic children, improve lung function, quality of life, and the TRACK score and asthma control rate. The effect of nursing was significant, allowing for development of an asthma management model.