Immunoglobulin E-mediated airway inflammation is active in most patients with asthma

Do nocturnal asthma attacks influence sleep parameters and inflammatory markers? A cross-sectional population-based study

PURPOSE

To evaluate the effects of nocturnal asthma on sleep parameters and inflammatory markers according to the severity of the condition in participants in the São Paulo Epidemiologic Sleep Study (EPISONO).

METHODS

Data from the 2007 and 2018 editions of the EPISONO study were utilized. Subjects completed validated sleep and respiratory questionnaires, underwent nocturnal polysomnography and spirometry tests, and provided blood samples for the assessment of inflammatory parameters.

RESULTS

Of 72 participants (67% women), 53% (n = 38) had intermittent nocturnal asthma symptoms and 47% (n = 34) had persistent asthma (mild, moderate, and severe). Individuals with persistent nocturnal symptoms had a higher body mass index (BMI), were more likely to have respiratory symptoms, and had worse lung function, a higher apnea-hypopnea index (AHI), and higher desaturation index than individuals with intermittent nocturnal symptoms. Positive associations were identified between nocturnal asthma and obstructive sleep apnea (OSA). A higher frequency of OSA was observed in participants with persistent asthma and participants with OSA were more likely to have persistent than intermittent asthma. However, there were no significant differences between the immunological parameters of those with intermittent or persistent asthma.

CONCLUSIONS

This study highlights the relevance of nocturnal symptoms as a valuable indicator of asthma severity. The findings also add to the existing body of evidence linking nocturnal asthma and OSA.

Effect of gestational and lactational nonylphenol exposure on airway inflammation in ovalbumin-induced asthmatic rat pups

To investigate the effect of gestational and lactational nonylphenol (NP) exposure on airway inflammation in ovalbumin (OVA)-induced asthmatic pups. Dams were gavaged with NP at dose levels of 25 mg/kg/day (low dose), 50 mg/kg/day (middle dose), 100 mg/kg/day (high dose) and groundnut oil alone (vehicle control) respectively from gestational day 7 to postnatal day 21. The results showed that the NP content in the lung tissues of pups in the 100 mg/kg NP group was significantly higher than that of the control group (P = 0.004). In the 100 mg/kg NP group, the infiltration of lymphocytes and eosinophils with thicken smooth muscle layer and inflammatory cells in the lumen were observed in the lung tissues of pups. Osmiophilic lamellar bodies were found in the cytoplasm of type II epithelial cells; mitochondria were clearly swollen. Compared with the control group, the levels of interleukin-4 (IL-4) in BALF (P = 0.042) and ovalbumin-specific serum immunoglobulin E (OVA-sIgE) (P = 0.005) in the OVA group were significantly higher. 25 mg/kg NP-OVA co-exposure synergistically decreased nuclear factor-κB (NF-κB) mRNA expression in the lung tissues of pups; Exposure to 50 mg/kg NP combined with OVA antagonized the increased expression of high mobility group box 1 (HMGB1) mRNA in the lung tissue. The combined exposure to 50 mg/kg NP and OVA synergistically increased HMGB1 protein expression in the lung tissues. 25 mg/kg NP-OVA co-exposure antagonized the increased nuclear factor-κB (NF-κB) protein expression in the lung tissues. There was a positive correlation between NP content and HMGB1 protein expression in the lung tissue of asthmatic pups (r = 0.602, P < 0.001). In conclusion, gestational and lactational exposure to 100 mg/kg NP in maternal rats exacerbated airway inflammation in OVA-induced asthmatic pups, and there is an interactive effect between NP and OVA. When the perinatal rats were exposed to 100 mg/kg NP, the levels of HMGB1 and NF-κB in the lung tissues of OVA-induced asthmatic pups were increased.

Omalizumab as a new therapeutic approach for children with severe asthma

Omalizumab has been shown to improve asthma control when added to a regimen of guideline-based therapy for inner-city children and adolescents, nearly eliminating seasonal peaks in exacerbation and reducing the need for other medications to control asthma. Below, we describe a case of a 17-year-old non-smoker with a history of severe asthma admitted to our clinic after unsuccessful 10-year immunotherapy. The patient fulfilled the criteria for anti-IgE therapy, he was prescribed omalizumab 600 mg every 2 weeks. During therapy he was able to reduce his use of ICS and did not require any oral corticosteroids. He experienced an increase in his ability to exercise and noted no exacerbation of asthma symptoms. It is possible that in our patient, specific immunotherapy could be successfully continued after the initiation of omalizumab therapy.