Systemic Inflammation in Asthma: What Are the Risks and Impacts Outside the Airway?

Relationship between advanced lung cancer inflammation index and all-cause and cause-specific mortality among chronic inflammatory airway diseases patients: a population-based study

Background

Chronic inflammatory airway diseases (CIAD), such as asthma, chronic bronchitis, and chronic obstructive pulmonary disease, pose a significant threat to public health, with its prognosis closely tied to the body's inflammation level and nutritional status. As a composite indicator, the advanced lung cancer inflammation index (ALI) integrates inflammation and nutritional status. Despite its potential utility, the link between ALI and the prognosis of patients with CIAD remains unexplored. This study aimed to investigate this relationship.

Methods

We gathered data from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. The National Death Index was used to calculate mortality until December 31, 2019. Kaplan-Meier analysis was employed to investigate the relationships between ALI and all-cause and cause-specific mortality in patients with CIAD. Furthermore, weighted univariable and multivariable Cox proportional hazards models were employed to further examine their relationship. Multiple factors that could impact the results were adjusted in the analysis. We also utilized a restricted cubic spline analysis to estimate the non-linear relationships between ALI and all-cause and cause-specific mortality rates in patients with CIAD. Finally, subgroup and sensitivity analyses were conducted to ensure the reliability of the findings.

Results

The study involved 2,884 CIAD patients. An elevated ALI was significantly related to a decreased risk of all-cause mortality, as well as mortality from cardiovascular and respiratory diseases among CIAD patients. Results from RCS analysis revealed a reverse J-shaped non-linear association between ALI and all-cause mortality in CIAD patients, with an inflection point at 99 (p for nonlinearity <0.0001). The inflection point in the J-shaped relationship represents the ALI value with the lowest risk of mortality. For ALI values below 99, a 10-unit rise in ALI was linked to a 14% reduction in the risk of all-cause mortality (HR: 0.86, 95% CI:0.81-0.92, Ptrend=0.01). Conversely, if ALI exceeded 99, a 10-unit increase in ALI resulted in a 3% rise in the risk of all-cause mortality (HR: 1.03, 95% CI:1.01-1.06, Ptrend=0.02). A similar J-shaped association was observed in mortality due to cardiovascular and respiratory diseases, with inflection points at 94 and 96, respectively. These findings were consistent across sociodemographic and prior disease-related subgroups, and remained stable in sensitivity analyses.

Conclusion

This study revealed a novel association between elevated ALI level and reduced all-cause and cause-specific mortality risk in patients with CIAD. Furthermore, the relationship between ALI and mortality rates from all cause, as well as cardiovascular and respiratory diseases, exhibited an non-linear, J-shaped curve. These findings underscore the importance of maintaining optimal ALI levels within a specific range to promote long-term survival in CIAD patients. The dynamic variation in ALI over time also can help clinicians establish personalized ALI standards to maximize the long-term outcomes for CIAD patients.

Burden of asthma by severity and exacerbation frequency among adult patients naive to biologic asthma therapy: A Finnish cohort study

Background

Understanding the disease burden and characteristics of asthmatic patients with frequent exacerbations is important for optimal disease management and outcomes. Asthma, and especially severe uncontrolled asthma, associates with an increased disease burden, but the comparison across asthma severity and exacerbation frequency is largely missing.

Objective

We sought to assess the association of asthma severity and exacerbation frequency with medication use, mortality, sick leaves, disability pensions, health care contacts, and comorbidities among Finnish patients with asthma.

Methods

National longitudinal retrospective data on adult patients naive to biologic asthma therapy were used to match patients on the basis of age, sex, and region across 4 subgroups (5525 patients in each) of nonsevere or severe asthma with infrequent or frequent exacerbations. The clinical characteristics, mortality rates, and morbidity across the subgroups were analyzed.

Results

Exacerbation frequency associated with an increased disease burden regardless of asthma severity. Comorbidities, health care contacts, sick leaves, and disability pensions cumulated in patients with frequent exacerbations, peaking with severe asthma. In patients with severe asthma and frequent exacerbations, the all-cause mortality rate ratio was 1.9-fold (P < .001) versus patients with nonsevere asthma and infrequent exacerbations. Patients with frequent exacerbations were also exposed to high cumulative corticosteroid doses.

Conclusions

Despite improved outcomes in asthma over the past decades, a substantial proportion of patients experience frequent exacerbations. These patients are multimorbid and at increased risk of mortality. Exacerbation frequency, rather than asthma severity, seems to be the main factor associated with an increased disease burden. Clinical awareness should be raised to improve the management and outcomes for these patients.

Symptoms of Depression and Inhaler Adherence Among Adolescents With Asthma: Is There an Association?

BACKGROUND

The prevalence of depression among adolescents with asthma is reported to be 27%-34% across different geographical regions. Asthma control depends on inhaler adherence. Studies on the association of depression and inhaler adherence among adolescents with asthma are few, especially in the Indian subcontinent. Therefore, this study was carried out to find the prevalence of depression and its association with inhaler adherence among adolescents with asthma.

METHODS

A hospital-based analytical cross-sectional study was carried out among 102 adolescents with asthma in a tertiary care setting. Symptoms of depression were assessed using the Center for Epidemiological Studies-Depression Scale for Children (CES-DC) and inhaler adherence using Test of Adherence to Inhalers (TAI).

RESULT

Among the 102 adolescents with asthma, depression was detected in 39 (38.2%). As per the TAI scores, good, intermediate, and poor adherence to inhalers were, respectively, found among 35 (34.3%), 41 (40.2%), and 26 (25.5%) of the adolescents with asthma. On multivariable binary logistic regression analysis, the adolescents with intermediate and poor adherence to inhalers, respectively, had 7.093 odds (95% CI 2.189-22.977) and 9.002 odds (95% CI: 2.501-32.405) of having depression compared to those with good adherence. Those adolescents with families whose monthly income was INR 12,000 or less had 2.490 odds (95% CI: 1.002-6.187) of depression compared to those with more than INR 12,000 monthly family income.

CONCLUSION

The level of inhaler adherence in a dose-dependent manner and lower family income were independent predictors of depression among adolescents with asthma. The findings indicate the need to screen and assess adherence and symptoms of depression among them and manage appropriately, focusing on those with low family income.

Association between heavy metal exposure and asthma in adults: Data from the Korean National Health and Nutrition Examination Survey 2008-2013

Risk factors for asthma include genetic, host, and environmental factors such as allergens, smoking, and exposure to chemicals. Heavy metals from air pollution or contaminated water and food can also trigger asthma. This study aimed to identify the biological exposure levels of blood lead, mercury, and cadmium, and determine the association of asthma with single and multiple exposures to these heavy metals using data from the Korean National Health and Nutrition Examination Survey (KNHANES) conducted between 2008 and 2013. A weighted analysis of 40,328 adults aged ≥ 20 years was conducted. Variables included blood heavy metal levels, health behaviors, demographic characteristics, and asthma status. Logistic regression was used to identify the association between the blood heavy metal levels and the odds ratio (OR) of asthma in adults. The overall asthma prevalence was 3.0%. The geometric mean values for blood lead, mercury, and cadmium were 2.14 μg/dL, 3.72 μg/L, and 0.96 μg/L, respectively. An association between asthma and high blood lead levels was observed, with the highest level group showing a statistically significant association. Blood mercury and cadmium were significantly associated with asthma in the highest quartile of blood levels. After adjusting for the demographic and health behavior variables, significant associations with asthma persisted for the highest quartiles of all heavy metals. Multiple exposures in the highest quartile also showed a significant association with asthma. This study demonstrated a significant association between blood heavy metal levels and asthma in adults, emphasizing the need to reduce exposure to lead, cadmium, and mercury as a preventive measure against asthma in adults.

Joint association of systemic immune-inflammation index and phenotypic age acceleration with chronic respiratory disease: a cross-sectional study

BACKGROUND

Chronic respiratory diseases (CRD) represents a series of lung disorders and is posing a global health burden. Systemic inflammation and phenotypic ageing have been respectively reported to associate with certain CRD. However, little is known about the co-exposures and mutual associations of inflammation and ageing with CRD. Here, we aim to systematically elucidate the joint and mutual mediating associations of systemic immune-inflammation index (SII) and phenotypic age acceleration (PhenoAgeAccel) with CRD based on data from National Health and Nutrition Examination Survey (NHANES).

METHODS

Data for this study was obtained from NHANES 2007-2010 and 2015-2018. The single and combined associations of SII and PhenoAgeAccel with CRD were analyzed using multivariable logistic regression models. The dose-response relationship between exposures and outcomes was determined by restricted cubic splines (RCS) regression. Subgroup and mediation analyses were further conducted.

RESULTS

Totally, 15,075 participants were enrolled in this study including 3,587 CRD patients. Compare with controls, CRD patients tended to be older, females and present higher SII and PhenoAgeAccel values. Single-index analysis indicated that either SII or PhenoAgeAccel demonstrated a significantly positive association with CRD via logistic regressions and RCS curves. Furthermore, the joint-indexes analysis revealed that compared to individuals with lower SII and PhenoAgeAccel, those with higher SII and PhenoAgeAccel exhibited remarkably stronger associations with CRD (adjusted OR [aOR], 1.56; 95% CI, 1.31-1.85; P < 0.001), chronic obstructive pulmonary disease (aOR, 1.56; 95% CI, 1.22-2.00; P = 0.001) and asthma (aOR, 1.40; 95% CI, 1.16-1.70; P = 0.001), which were predominant among those aged above 40 years, females and smokers. Eventually, mediation analyses suggested the mutual mediating effects of SII and PhenoAgeAccel on CRD and PhenoAgeAccel mediated SII resulting in CRD more significantly.

CONCLUSION

This study confirmed the coexposure effect and mutual mediation between SII and PhenoAgeAccel on CRD. We recommend that the joint assessment may conduce to the accurate identification for populations susceptible to CRD and early prevention of chronic respiratory diseases.

Omalizumab safety concerns

IgE and mast cells play key roles in the pathophysiology of allergic diseases. In 2003, omalizumab was the first anti-IgE mAb licensed in the United States when initially US Food and Drug Administration-approved for the treatment of allergic asthma. Since that time, the number of US Food and Drug Administration-approved indications for treatment with omalizumab has grown to include chronic spontaneous urticaria, chronic rhinosinusitis with nasal polyps, and food allergy. Although omalizumab is generally considered relatively safe and well tolerated, a number of safety concerns have been raised since its initial approval. These concerns focus on specific adverse events of interest, including anaphylaxis, pregnancy, malignancy, cardiovascular events, and infections. For each of these issues, data from clinical trials and postmarketing surveillance have been evaluated extensively. In this review, we examine these safety data, provide context for safety and risk assessments, and summarize a safety profile for each of the adverse events of interest. In doing so, we aim to provide a resource for shared decision making when treatment with omalizumab is being considered.

The U-shaped correlation between serum VD concentration and systemic immune-inflammatory index: results from the NHANES database prospective cohort study

BACKGROUND

Vitamin D (VD) plays a critical role in regulating systemic inflammation, but its correlation with the systemic immune-inflammatory index (SII) remains unclear. This study aimed to explore the relationship between serum VD concentration, dietary VD intake, and SII using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

Data from NHANES 2007-2018 and NHANES 2007-2020 were analyzed for serum VD levels and dietary VD intake, respectively. Restricted cubic splines (RCS) and logistic regression were used to assess associations between VD and SII. Mediation analysis was conducted to evaluate the role of SII in VD-related disease outcomes and mortality.

RESULTS

Serum VD concentration exhibited a U-shaped correlation with SII (P-overall = 0.005; P-non-linear = 0.002). Severe VD deficiency significantly elevated SII levels compared to insufficiency or sufficiency groups. No association was observed between dietary VD intake and SII. Mediation analysis revealed that SII mediated the effects of VD on all-cause and cardiovascular disease-related mortality, but not on cancer, hypertension, or diabetes development.

CONCLUSION

A U-shaped relationship exists between serum VD and SII, with VD supplementation potentially reducing systemic inflammation and improving cardiovascular outcomes. Future studies should explore VD's role in systemic inflammation and its clinical implications.

Evaluation of Dynamic Respiratory Muscle Strength, Physical Fitness, and Physical Activity in Children with Asthma and Healthy Peers

Background: Systemic inflammation, attacks, deterioration of thoracic region mechanics, medications used, and decreased physical activity level (PAL) and fitness negatively may affect respiratory muscle strength. The primary aim of this study was to evaluate dynamic inspiratory muscle strength (S-index), PAL, and physical fitness in children with asthma compared to healthy peers. The secondary aim of this study was to investigate the relationships between S-index and peak inspiratory flow (PIF) values and functional parameters in childhood asthma. Methods: This cross-sectional prospective study consisted of participants of 6-11 years of age, specifically, 20 children with asthma and 20 healthy peers. The device (POWERbreathe K5) evaluated PIF and S-index variables. PAL was determined with the Physical Activity Questionnaire-Child (PAQ-C) and fitness was evaluated with the FITNESSGRAM test battery. Results: The PIF Average (Avg): 1.8 ± 0.6, Best: 2.6 ± 0.6 (asthmatic children) vs. Avg: 2.4 ± 0.7, Best: 3.1 ± 0.9 (healthy children); p = 0.017, p = 0.027, respectively) and S-index (Avg: 34.1 ± 10.3, Best: 45.6 ± 9.9 (asthmatic children) vs. Avg: 43.2 ± 12.1, Best: 56.6 ± 14.7 (healthy children); p = 0.015, p = 0.008 respectively) values of children with asthma were significantly lower compared to healthy peers. The PAL and physical fitness of asthmatic and healthy peers were similar (p > 0.05). There were significant relationships between S-indexavg and S-indexbest with the PAQ-C score (r = 0.498, p < 0.025 r = 0.547, p < 0.013, respectively) and PIFavg and PIFbest with the PAQ-C score (r = 0.490, p < 0.028 r = 0.602, p < 0.005) in children with asthma. Conclusions: Dynamic respiratory muscle strength is negatively affected in children with asthma whereas their physical activity and fitness levels are comparable to their peers. However, it was found that children with a higher S-index and PIF rate had higher PALs. These findings suggest that pulmonary rehabilitation interventions to improve respiratory muscle function should be considered an important strategy to maintain and increase physical activity levels in children with asthma.

The dietary inflammatory index and asthma prevalence: a cross-sectional analysis from NHANES

Background

Inflammation is a key factor in the development of asthma, and diet significantly influences inflammatory responses. This study examines the relationship between the Dietary Inflammatory Index (DII) and asthma prevalence.

Methods

We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Demographic details, anthropometric measurements, dietary habits, lifestyle factors, and asthma status were recorded for all participants. Multivariable logistic regression was utilized to assess the relationship between DII and asthma prevalence. Additionally, restricted cubic spline (RCS) analysis was employed to explore the nonlinearity and dose-response relationship between DII and asthma risk. Subgroup analyses were stratified by gender, age, race, body mass index (BMI), poverty income ratio (PIR), education, smoking status, alcohol use, and family medical history to dissect the association between DII and asthma across diverse populations.

Results

The analysis included 37,283 adults from NHANES. After adjusting for potential confounders in the multivariable logistic regression model, a significant positive association was identified between DII and asthma (OR, 95% CI: 1.05, 1.02-1.09, per 1 SD increase). The RCS analysis revealed a nonlinear association (p for nonlinearity = 0.0026), with an inflection point at 1.366, beyond which an increase in DII was significantly associated with asthma risk. Furthermore, the stratified analyses indicated a positive association between DII and asthma in the majority of subgroups.

Conclusion

The findings underscore a significant and nonlinear association between DII and asthma. To enhance asthma prevention and management, greater emphasis should be placed on modulating dietary-induced inflammation.

Yunpi Xiefei Huatan Tang decoction reduces airway inflammation and airway remodeling in asthmatic mice through Wnt/β-catenin signaling pathway

BACKGROUND

Asthma is one of the most prevalent chronic respiratory diseases among children, markedly impairing patient's health and imposing an increasing burden on the healthcare system. Several traditional Chinese medicines have demonstrated efficacy in alleviating asthma symptoms through studies conducted on animal models. Recent studies have shown that the Yunpi Xiefei Huatan Tang decoction (YPD) exhibits significant therapeutic outcomes in treating phlegm-obstructed pulmonary asthma. However, the precise regulatory effects of YPD on the progression of asthma require additional investigation.

OBJECTIVE

To explore the functions of YPD in asthma progression.

MATERIAL AND METHODS

The asthma rat model triggered by ovalbumin (OVA) was established successfully. The pathological changes of lung tissues were examined through Hematoxylin and Eosin (H&E) staining. The levels of Interleukin 6 (IL-6) and IL-1β were tested through Enzyme-Linked-Immunosorbent Serologic Assay (ELISA). The number of total cells or eosinophils in bronchoalveolar lavage fluid was confirmed through cell counter. The collagen deposition in bronchi was assessed through Masson staining. The protein expressions were measured through western blot.

RESULTS

This study demonstrated that YPD could mitigate airway inflammation in an OVA-triggered asthma rat model. Furthermore, YPD was found to decrease the production of inflammatory cytokines in the lungs and suppress the infiltration of inflammatory cells into bronchoalveolar lavage fluid. Additionally, the airway remodeling stimulated by OVA could be suppressed following YPD treatment. Finally, it was disclosed that YPD inhibited the wingless-related integration site-beta-catenin (Wnt/β-catenin) signaling pathway in the OVA-stimulated asthma rat model.

CONCLUSION

YPD alleviated airway inflammation and remodeling in asthmatic mice via the Wnt/β-catenin signaling pathway. This research offers significant insights into the potential application of YPD in the treatment of asthma.

Prevalence of Obesity and Its Associated Comorbidities in Adults with Asthma: A Single-Center Study in Saudi Arabia

Background and Objectives: Asthma is associated with several comorbidities, one of which is obesity. The worldwide increase in obesity has been accompanied by a parallel rise in asthma prevalence, with obesity recognized as a significant risk factor for both the development and severity of asthma. Obesity is often linked to various comorbidities, which can complicate asthma management and lead to poorer clinical outcomes. This study aims to investigate the prevalence of obesity and its comorbidities in adults with asthma in a single center in Saudi Arabia, providing an overview of the associated health implications. Materials and Methods: This single-center, retrospective study aimed to assess the prevalence of obesity and other comorbidities in asthma patients. Data were collected from King Khalid University Hospital in Saudi Arabia between July 2023 and December 2023. Results: This study revealed that 72.1% of asthma patients were either obese or overweight. Female patients had significantly higher BMI values compared to males. Our study revealed that 38.21% of female asthma patients (mean age = 57 ± 13.85 years) had comorbidities compared to 24.14% of male asthma patients (mean age = 59 ± 14.02 years). Furthermore, the proportion of obese asthmatic patients with comorbidities was significantly greater than those without comorbidities. Conclusions: This study investigates obesity prevalence and associated comorbidities in adult asthmatics in a single center in Saudi Arabia. The findings reveal a 72.1% rate of obesity and overweight among asthmatic patients, with higher BMI and comorbidity prevalence in females. These results underscore the need for targeted interventions addressing obesity and comorbidities, especially in female asthmatics.

Elevated inflammatory burden index increases mortality in adults with chronic inflammatory airway diseases: a nationwide cohort study

OBJECTIVE

The objective of this study was to investigate the potential association between the inflammatory burden index (IBI) and the prevalence of chronic inflammatory airway diseases (CIAD), as well as mortality rates among individuals diagnosed with CIAD.

METHODS

Participants were sourced from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2010. The IBI was calculated using the formula: IBI = C-reactive protein * neutrophils / lymphocytes. CIAD comprised self-reported asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). Mortality outcomes, including all-cause and respiratory disease mortality, were determined through linked data from the National Death Index (NDI) up to December 2019.

RESULTS

A total of 27,495 adults were included. IBI was divided into quartiles, with the lowest quartile as the reference group. After adjusting for confounding variables, a positive correlation was observed between higher IBI and increased prevalence of total CIAD (OR = 1.383 [1.215-1.575]), asthma (OR = 1.267 [1.096-1.465]), chronic bronchitis (OR = 1.568 [1.263-1.946]), and COPD (OR = 1.907 [1.311-2.774]). Over a median follow-up of 12.33 [9.92-16.00] years, there were 1221 deaths from all causes and 220 deaths from respiratory disease among 4499 patients with CIAD. Following multivariate adjustments, the fourth quartile was significantly associated with increased risk of all-cause mortality (HR = 2.227 [1.714-2.893]) and respiratory disease mortality (HR = 2.748 [1.383-5.459]) compared to the first quartile of IBI in CIAD participants. Moreover, variable importance analysis using a random survival forest model demonstrated the significance of IBI in predicting mortality from both all-cause and respiratory diseases.

CONCLUSION

IBI exhibited an association with the prevalence of CIAD, with higher IBI levels correlating with elevated all-cause and respiratory disease mortality among individuals with CIAD.