Trends in worldwide asthma prevalence

CEACAM5 exacerbates asthma by inducing ferroptosis and autophagy in airway epithelial cells through the JAK/STAT6-dependent pathway

OBJECTIVES

Asthma, a prevalent chronic disease, poses significant health threats and burdens healthcare systems. This study focused on the role of bronchial epithelial cells in asthma pathophysiology.

METHODS

Bioinformatics was used to identify key asthmarelated genes. An ovalbumin-sensitized mouse model and an IL-13-stimulated Beas-2B cell model were established for further investigation.

RESULTS

Carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5) was identified as a crucial gene in asthma. CEACAM5 expression was elevated in asthmatic mouse lung tissues and IL-13-stimulated Beas-2B cells, primarily in bronchial epithelial cells. CEACAM5 induced reactive oxygen species (ROS), lipid peroxidation, and ferroptosis. Interfering with CEACAM5 reduced ROS, malondialdehyde levels, and enhanced antioxidant capacity, while inhibiting iron accumulation and autophagy. Overexpression of CEACAM5 in IL-13-stimulated cells activated the JAK/STAT6 pathway, which was necessary for CEACAM5-induced autophagy, ROS accumulation, lipid peroxidation, and ferroptosis.

CONCLUSION

CEACAM5 promotes ferroptosis and autophagy in airway epithelial cells via the JAK/STAT6 pathway, exacerbating asthma symptoms. It represents a potential target for clinical treatment.

Exploring the causal link between childhood maltreatment and asthma: a Mendelian randomization study

Background: Prior research indicates a potential connection between childhood maltreatment and asthma. In response, we designed a Mendelian Randomization (MR) study to further investigate this association.Methods: Utilizing the MR approach, we leveraged Genome-Wide Association Studies (GWAS) data from the UK Biobank (UKB). Our primary outcome was asthma, analyzed through GWAS datasets termed AsthmaUKB and AsthmaIEU, sourced from two distinct studies. Additionally, we conducted stratified analyses focusing on pediatric asthma and adult asthma to address different asthma phenotypes. The causal impact of childhood maltreatment (CM) on asthma was assessed using inverse-variance weighted (IVW) methods, MR-Egger, and MR-PRESSO tests, thereby enhancing the robustness and generalizability of our findings.Results: The IVW analyses identified significant associations between CM and increased risks for AsthmaUKB (OR = 1.59, 95% CI = 1.23-2.05, p < .001), AsthmaIEU (OR = 1.04, 95% CI = 1.02-1.06, p < .001), pediatric asthma (OR = 1.72, 95% CI = 1.26-2.35, p = .001), and adult asthma (OR = 1.71, 95% CI = 1.17-2.48, p = .005). The MR-Egger and MR-PRESSO results confirmed the absence of pleiotropy, reinforcing our causal inferences. Although Cochran's Q test indicated some heterogeneity among asthma subtypes (p > .05), the robustness of the IVW results remains reliable.Conclusions: Our findings suggest a potential causal relationship between CM and various asthma phenotypes, as validated through rigorous Mendelian randomization analyses. These results emphasize the importance of considering CM in asthma prevention and intervention strategies and lay the groundwork for further investigation into how early-life adversities may predispose individuals to asthma, contributing to a deeper understanding of its etiological pathways.

Illness Expectations and Asthma Symptoms: A 6-Month Longitudinal Study

BACKGROUND

After receiving a diagnosis, individuals often develop expectations about how their condition will evolve. This cognitive framework, known as 'Illness Expectations' (IEs), encompasses future-oriented beliefs regarding the course of the illness and its symptoms. In chronic conditions such as asthma, IEs may play a critical role in shaping patient-reported outcomes and clinical markers of disease progression. This study aims to empirically evaluate the impact of IEs on asthma symptoms and respiratory function.

METHODS

A cohort of 310 individuals diagnosed with asthma was followed over a 6-month period, with three assessment points. Asthma control was measured using the Asthma Control Test (ACT), while respiratory function was evaluated through forced expiratory volume in 1 s (FEV1) using spirometry. IEs were assessed using the validated 'Illness Expectation Test' (IET), which captures both explicit (conscious) and implicit (unconscious) expectations. Predictive analyses were conducted using latent growth modelling and linear regression to examine the influence of IEs on asthma symptoms and respiratory function over time.

RESULTS

People with more negative explicit IEs about their asthma reported worse symptoms over time (β = -0.50, SE = 0.21, p = 0.01). Implicit IEs were not statistically significant (β = -0.014, SE = 0.008, p = 0.09). Explicit IEs about symptom progression were also associated with changes in lung function, with more negative expectations predicting greater declines in respiratory performance (β = 0.51, SE = 0.11, p = 0.001).

CONCLUSIONS

These findings suggest that IEs may be meaningfully associated with asthma outcomes, highlighting their potential relevance in understanding patient experiences and symptom perception. These results support further research into interventions targeting cognitive frameworks, with the aim of informing more personalised, patient-centred approaches to asthma management.

PATIENT OR PUBLIC CONTRIBUTION

This study was developed in response to patient-reported challenges in asthma management, particularly around understanding and managing IEs. Patients contributed to identifying key areas of concern, and their perspectives informed the choice of outcomes and tools. While direct involvement in recruitment and dissemination was limited due to the pandemic, the study's design and focus were guided by patient priorities, with potential applications in clinical consultations and future co-designed interventions.

Epidemiology of adult asthma within the Hungarian population between 2009 and 2019 - A retrospective financial database analysis

Background

Asthma is the most common chronic obstructive respiratory disease and is a considerable burden on the patients, caregivers and healthcare providers. However, data on epidemiology, healthcare expenditures, inhalation medication usage and comorbidities are scarce on a country-wide level.

Methods

A retrospective analysis was performed on the Hungarian National Health Insurance Fund's financial database. All patients who had filled at least one prescription for asthma maintenance therapy between 2009-'19 had been enrolled. Prevalence for each year was assessed, based on prescriptions filled for asthma annually. Incidence was assessed only for 2011-'19. Frequency of exacerbations and their costs were calculated.

Results

Through the study period 439,977 patients filled at least one prescription for asthma maintenance therapy. The number of patients having at least one prescription in 12 months increased by 20.34 % (from 132,292 to 159,225 patients). Between 2011-'19 an average of 20,742.1 new patients used asthma maintenance medications. Between 2009 and '19 an average of 4308 patients were hospitalized due to asthma, on an average 5129 times. Healthcare expenditure on hospitalizations and outpatient treatment of asthmatics increased by 28.05 %.

Conclusion

Through our study period a substantial increase in patient numbers and overall expenditure was seen. Number and frequency of exacerbations however decreased over the years.

The epidemiology of asthma and its attributable risk factors from 1990 to 2021: A systematic analysis based on the Global Burden of Disease Study 2021 and Mendelian Randomization Studies

OBJECTIVES

Asthma is a commonly occurring condition due to chronic inflammation of the lower respiratory tract. This study aims to assess the global burden of asthma from 1990 to 2021 and the mortality trends caused by specific risk factors.

STUDY DESIGN

Systematic analysis based on the Global Burden of Disease Study 2021 and Mendelian Randomization studies.

METHODS

Based on a global asthma scale spanning from 1990 to 2021, we performed a secondary analysis to explore the incidence, mortality, and disability-adjusted life-years (DALYs), along with risk factors for asthma. Mendelian randomization (MR) analyses were performed to verify the results.

RESULTS

In 2021, there were 41,555,628 incident cases of asthma worldwide. Cases of asthma decreased by 0.09 % (95 % uncertainty interval [UI]: 0.12,0.06) from 1990 to 2021. Over the past three decades, asthma-associated deaths increased from 374,377 (95 % UI: 304,600-492,653) to 436,192 (95 % UI: 357,795-555,604). The global incidence rate decreased from 736.99 (95 % UI: 615.03-905.18) to 516.70 (95 % UI: 425.36-646.13) per 100,000 population; the asthma-associated mortality rate decreased from 9.64 (95 % UI: 7.76-12.80) to 5.20 (95 % UI: 4.27-6.59) per 100,000 population. Age-specific incidence and prevalence rates peaked in individuals under nine years old. The prevalence and incidence rates of asthma were relatively higher in individuals in countries with higher Socio-demographic Index (SDI); however, mortality and DALYs rates of individuals with asthma showed a reverse trend. Globally, occupational asthmagens, body mass index, smoking, and air pollution were key risk factors for asthma-associated mortality and DALYs in 2021. MR analyses further confirmed the strongly related correlation between body mass index, occupational asthmagens and asthma.

CONCLUSIONS

Although a mild decrease in total incidence cases of asthma was observed from 1990 to 2021, asthma has still continued to pose a life-threatening burden worldwide overall. Generally, asthma frequently occurred at younger ages and is more prevalent in high-SDI countries, indicating that specific periodic and regional features exist. Improved understanding of the epidemiology of asthma could facilitate future interventions to better manage the disease globally and support future investigation on the diagnosis and treatment of asthma.

Linking common mental disorders and asthma in Brazilian adolescents: a cross-sectional analysis of the ERICA study

OBJECTIVE

Asthma is a heterogeneous chronic disease of the airways, affecting all age groups, especially children and adolescents. The aim of this study was to evaluate several factors associated with asthma in Brazilian adolescents.

METHODS

Cross-sectional study of a national representative sample of school-based adolescents aged 12-17 years from The Study of Cardiovascular Risk in Adolescents (ERICA) stratified by region and conglomerate by schools. The authors studied the following variables: sociodemographic characteristics, lifestyle, smoking, eating habits, sleeping and mental conditions.

RESULTS

Data from 66,567 adolescents were analyzed, 50.2 % of whom were female. Of the total, 52.7 % were between 12 and 14 years old. The overall prevalence of asthma was 14.5 % (95 %CI: 13.6-15.5). Asthma was associated with female sex (PR 1.35; 95 %CI: 1.15-1.57), white skin color (PR 1.25; 95 %CI: 1.04-1.50), private school (PR 1.26; 95 %CI: 1.05-1.52), smoking (PR 1.93; 95 %CI: 1.54-2.38); and alcohol consumption (PR 1.74; 95 %CI: 1.52-2.03). Excessive screen time (PR 1.19; 95 %CI 1.01-1.42) and short sleep duration (PR 1.28; 95 %CI 1.05-1.57) were also associated. Healthy eating habits, such as adolescents who ate breakfast, drank water, and ate meals with their parents, were associated with a lower prevalence of asthma. In relation to comorbidities, asthma was associated with common mental disorders (CMD) (PR 1.94; 95 %CI 1.64-2.27; p < 0,00001), but not with overweight or obesity (PR 1.09; 95 %CI 0.87-1.38). In the correspondence analysis, CMD was the strongest factor associated with asthma.

CONCLUSION

Asthma was associated with several determinants in Brazilian adolescents, but the association with CMD deserves special attention in this age group.

Work Stressors and Asthma in Female and Male US Workers: Findings From the National Health Interview Survey

BACKGROUND

Prior work has linked work stressors to asthma. However, research related to gender-specific associations remains sparse and yielded mixed results. We aimed to address this gap.

METHODS

We drew on cross-sectional data from the 2015 National Health Interview Survey (individual-level response rate = 79.7%). Included were participants in employment who were aged 18-70 (n = 18,701). Work-to-family conflict, workplace bullying, and job insecurity were assessed as work stressors. Asthma was defined based on self-reports of a lifetime diagnosis by a doctor or other health professional. To account for the complex sampling design, variance estimation was used to compute weighted descriptive statistics and odds ratios (ORs) as well as corresponding 95% confidence intervals (CIs) using multivariable logistic regression. To test for interaction, interaction terms for work stressors and gender were included in additional models.

RESULTS

In the full sample, work-to-family conflict, workplace bullying and job insecurity showed positive associations with asthma (OR = 1.20, 95%CI = 1.03-1.40; OR = 1.45, 95%CI = 1.17-1.80; and OR = 1.20, 95%CI = 0.99-1.45, respectively). We did not observe meaningful gender differences in the magnitudes of the ORs. All interaction terms were not statistically significant.

CONCLUSIONS

Work stressors were positively associated with asthma, but there was no evidence of gender differences. Prospective studies are needed to determine the potential temporal relation of these associations.

Global research trends in obesity-related asthma (2004-2023): a bibliometric analysis

Background

In recent years, an increasing body of evidence has revealed a complex interplay between obesity and asthma, prompting academic and medical communities to intensify their focus on this area of research. The objective of this study is to undertake a comprehensive bibliometric analysis of the research literature pertaining to obesity-related asthma from 2004 to 2023. This analysis aims to provide precise and valuable insights, as well as to systematically reflect upon the current status and emerging trends within the field.

Methods

Literature data on obesity and asthma research was sourced from the Web of Science Core Collection database. CiteSpace and VOSviewer were utilized to visually analyze bibliometric indicators such as co-authorship, citation networks, and publication frequency of the data to facilitate the identification of patterns and trends.

Results

A total of 3,118 papers were included in the analysis, encompassing 2,539 articles and 579 reviews. Throughout the last 20 years, the volume of publications has shown a consistent upward trend. The United States and Harvard University are at the forefront of this research field. Professor Dixon Anne E. is recognized as a pioneer and leading figure in the cultivation of obesity-related asthma research. Keyword analysis identified topics such as "childhood asthma," "bariatric surgery," "physical activity," "gut microbiota," "COVID-19," "food allergy," "asthma control," "nutrition examination," and "severe asthma."

Conclusion

The research domain of obesity-related asthma has experienced a substantial growth, with the United States, the United Kingdom, and China leading the global landscape. The focus on asthma in obese adolescents and children, the role of bariatric surgery, and lifestyle interventions remains a consistent area of interest, with considerable potential for further study. These findings provide a scientific basis for the development of personalized treatment programs for obese asthma patients. In addition, this study highlights the importance of further research in the fields of gut microbiota, COVID-19, and food allergy, providing directions for future policymaking.

Determinants of Exercise Capacity in Children and Adolescents with Asthma: A Comparative Case-Control Study

BACKGROUND

Asthma is a chronic disease that may affect exercise capacity. Despite the variety of existing tools for assessing exercise capacity, whether patients with asthma have lower exercise capacity than healthy controls and its potential determinants are still poorly understood.

AIM

The primary aim of this study was to identify potential determinants of exercise capacity. The secondary aim was to compare exercise capacity, pulmonary function, and muscle strength of children and adolescents with asthma with healthy controls.

METHODS

Volunteers aged 7-17 participated in the study and were divided into two groups: the asthma (n = 60) and the healthy control (n = 40). Asthma control questionnaire, six-minute walk test, pulmonary function test, maximum inspiratory (MIP) and expiratory (MEP) pressure measurements, and 30-second sit-to-stand test (30-STST) were performed.

RESULTS

The study showed that exercise capacity and respiratory and peripheral muscle strength were significantly lower compared to controls (P < 0.001, P = 0.031, P = 0.001, P = 0.025, respectively). Another critical finding was MIP, 30-STST, and MEP were the determinants of exercise capacity in children with asthma (R2 = 0.403, P < 0.001).

CONCLUSION

Clinicians should not ignore that exercise capacity may be reduced in children and adolescents with asthma and add assessment and training of respiratory and peripheral muscle strength in pulmonary rehabilitation programs.

Effect of the Antibody-mediated Immune Responses on COPD, Asthma, and Lung Function: A Mendelian Randomization Study

INTRODUCTION

The precise cause of antibody-mediated immune responses on chronic obstructive pulmonary disease (COPD), asthma, and lung function remains unclear. We characterized the relationship between antibody-mediated immune responses to COPD, asthma, and lung function, ultimately achieve the prevention or treatment.

METHODS

We obtained summary data from published genome-wide association studies, including antibody-mediated immune responses, COPD, asthma, forced expiratory volume in the first second (FEV1), forced expiratory volume (FVC), and FEV1/FVC. Bidirectional two-sample mendelian randomization (MR) analysis was used to assess causal relationships of antibody-mediated immune responses, COPD, asthma, FEV1, FVC, and FEV1/FVC.

RESULTS

A total of 20 antibody-mediated immune responses were identified have a significant causal effect on COPD, asthma, FEV1, and FVC, with six exhibiting reverse causality. Importantly, the results of the five MR analyses were almost identical with respect to the causal effect of anti-polyomavirus 2 IgG seropositivity and varicella zoster virus glycoprotein E and I antibody levels on the risk of COPD, asthma, FEV1, and FVC.

CONCLUSIONS

This study contributes to existing knowledge by investigating the causal relationship between antibody-mediated immune responses and respiratory conditions, including COPD, asthma, and lung function, using a two-sample MR design. The key findings can aid in identifying individuals at risk of these conditions and facilitate early prevention and diagnosis.

Prenatal exposure to heavy metals and childhood atopic disease

INTRODUCTION

Our objective was to determine the relationship between biomarkers of exposure to eleven heavy metals measured at birth and atopic disease in offspring up to 5.5 years.

METHODS

Heavy metals were measured in women of the ELFE cohort from: maternal urine (n = 804; arsenic [As], cadmium [Ca], cesium [Cs], chromium [Cr], cobalt [Co], nickel [Ni], antimony [Sb], tin [Sn] and vanadium [V]), hair (n = 1649; mercury [Hg]), and cord blood (n = 1525; lead [Pb]) collected at birth. Data on atopic diseases (eczema, food allergy, wheezing, asthma, and rhinitis) were collected from 2 months to 5.5 years. Five multimorbidity clusters were previously identified using latent class analysis: "asymptomatic", "early wheeze without asthma", "allergies without asthma", "asthma only", and "multimorbidity". Multinomial logistic regression was performed, using the asymptomatic cluster as the reference, to determine the relationship between heavy metal concentrations and atopic diseases.

RESULTS

Concentrations of Co were negatively associated with the multimorbidity cluster in the whole sample (OR 0.66 [95% CI 0.49, 0.89]). In boys, Cs was associated with lower odds of belonging to the early wheeze without asthma (0.71 [0.52, 0.97]) and multimorbidity clusters (0.54 [0.35, 0.82), while Sn was negatively associated with the multimorbidity cluster (0.66 [0.46, 0.96]). Results with binary outcomes supported findings from cluster analyses.

CONCLUSION

Exposure to some heavy metals assessed at delivery was inversely associated with the risk of atopic diseases, especially among boys. Further research should focus on heavy metal subtypes to distinguish between the more and less toxic forms.

Asthma incidence, prevalence, and mortality in the United States and worldwide, 1990-2019: Findings from the Global Burden of Disease study

INTRODUCTION

Asthma is a serious global health issue, contributing to premature deaths and reduced quality of life.

OBJECTIVE

This study examines trends in the incidence, prevalence, and mortality of asthma in the US and globally from 1990 to 2019.

METHODS

Data from the Global Burden of Disease database were used to calculate age-standardized incidence (ASIR), prevalence (ASPR), and mortality (ASMR) rates per 100,000 individuals, stratified by gender. Joinpoint regression analysis determined annual percent changes (APCs), and average annual percentage changes (AAPCs) were calculated as weighted averages of these trends.

RESULTS

In the US, ASIR increased by 10.2%, rising from 1404.6 in 1990 to 1547.2 in 2019, with an overall AAPC of 0.33. Globally, ASIR decreased by 13%, declining from 580.1 to 504.3, with an overall AAPC of -0.46. ASPR in the US rose from 9374.0 to 10399.3, reflecting a 0.37% annual increase, whereas globally, ASPR dropped by 24.1%, decreasing from 4496.9 to 3415.5 with an overall AAPC of -0.91. Females consistently exhibited higher ASPR rates than males in both settings. US asthma mortality decreased by 50%, with ASMR dropping from 1.66 to 0.87 and an AAPC of -2.15. Globally, ASMR decreased by 51.3%, falling from 11.91 to 5.80, with an overall AAPC of -2.47.

CONCLUSION

Males globally showed higher ASMR, whereas in the US, females had higher rates. While asthma incidence and prevalence increased in the US, global rates declined. Both the US and global populations experienced substantial reductions in asthma-related mortality, highlighting the need for targeted interventions and international collaboration.

Rural Health: Low Obesity Rates Among Students in Portugal's Countryside

Dietary habits significantly influence students' health status, with overweight and obesity posing serious global challenges linked to chronic diseases like type 2 diabetes and cardiovascular conditions. Our cross-sectional study assessed overweight and obesity prevalence among students in Guarda, Portugal, analyzing the nutritional and lifestyle habits of 2083 students aged 6 to 58 years. The sample included 1762 school children and 321 higher education adults, grouped into age intervals: 5-12, 13-19, 20-39, and 40-59 years. BMI analysis revealed obesity rates of 9.1% in children and 9.7% in adults, with younger children, particularly males, showing higher rates compared to older children. Increased physical activity and reduced sedentary time were correlated with a lower BMI. The observed obesity rates suggest that factors such as physical activity levels, traditional dietary patterns, and access to fresh foods in this region of Portugal may contribute to better health outcomes among students.

The J-shaped relationship between body roundness index and adult asthma: insights from NHANES 2001-2018

Background

Many studies have used Body Mass Index (BMI) to define obesity and examine its potential link to adult asthma. However, BMI overlooks body fat distribution, which may significantly impact health. Unlike BMI, the Body Roundness Index (BRI) can more accurately reflect body fat distribution. Therefore, this study examined BRI's relationship with asthma prevalence in U.S. adults.

Methods

This study was based on data from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018 and covered 40,052 adult participants. Participants were categorized into four quartile groups based on their BRI levels: Quartile 1 (1.05, 3.80); Quartile 2 (3.80, 5.06); Quartile 3 (5.06, 6.61); Quartile 4 (6.61, 23.48). The association between BRI and asthma prevalence was assessed via weighted multivariate logistic regression, smoothed curve fitting, threshold effects, subgroup, and sensitivity analysis. BRI's predictive power was compared to BMI and waist circumference using z-scores.

Results

Of the study population, 5,605 participants had asthma (13.99% prevalence). After adjusting for possible confounders, the results showed that higher BRI was linked to greater asthma prevalence (OR = 1.41, 95% CI:1.27, 1.56, p < 0.0001). A J-shaped relationship between BRI and asthma prevalence (p-nonlinearity = 0) was found, with asthma prevalence rising significantly when BRI surpassed 4.34. BRI outperformed BMI and waist circumference in predicting asthma (BRI: OR = 1.180; BMI: OR = 1.169; W.C.: OR = 1.166). Subgroup and sensitivity analyses confirmed our results' robustness.

Conclusion

Adult asthma prevalence increases with increasing BRI levels, showing a J-shaped relationship. Keeping BRI under 4.34 is vital for lowering asthma prevalence, especially for overweight or obese individuals. In addition, BRI outperformed BMI and waist circumference in predicting asthma occurrence.

Prevalence and risk of cognitive impairment among patients with asthma: A systematic review and meta-analysis

BACKGROUND

Asthma, a prevalent chronic respiratory condition, is hypothesized to influence cognitive health; however, the precise nature of this association remains unclear. This systematic review and meta-analysis aimed to elucidate the prevalence and risk of cognitive impairment in individuals with asthma.

METHODS

A comprehensive literature search was performed in databases such as PubMed, EMBASE, and Web of Science, spanning publications up to December 25, 2023. This search aimed to identify studies that assessed cognitive impairment in patients with asthma. We used the random effects model in the R v4.3 software for the meta-analysis to evaluate the prevalence and risk of cognitive decline, including dementia and Alzheimer's disease, among asthma patients. To ensure robustness and validity, the quality of the studies was assessed using Newcastle-Ottawa scale.

RESULTS

Twelve studies met the inclusion criteria, of these 10 were eligible for meta-analysis. The pooled prevalence of cognitive impairment in patients with asthma was 16.3%. The analysis also revealed an increased hazard ratio of 1.47 (95% confidence interval [1.09; 1.84]) for cognitive impairment in patients with asthma compared to the control group (individuals without asthma). Significant heterogeneity and publication bias were observed across the studies. The results underscored the substantial correlation between asthma and heightened risks of cognitive decline, dementia, and Alzheimer's disease.

CONCLUSION

This review found a notable association between asthma and an increased risk of cognitive decline, including dementia and Alzheimer's disease. These findings highlight the importance of integrating cognitive health assessments into asthma care. Further research is required to understand this relationship and develop effective treatments. Emphasizing a holistic approach to asthma management, these findings highlight the need to consider both respiratory and cognitive health for comprehensive patient care.

Screening and Validation of Potential Biomarkers of Immune Cells in Childhood Asthma Patients via Mendelian Randomization and Machine Learning

Purpose

Asthma is one of the most common chronic respiratory diseases affecting children, and there is currently no clear remedy. Immune cells play a key role in childhood asthma. Therefore, a deeper investigation of the correlation between immune cells and childhood asthma could lead to a better understanding of asthma's origin, the identification of potential treatment targets, and the development of personalized treatment strategies.

Patients and Methods

We used a two-sample Mendelian randomization (MR) analysis to investigate the possible causal relationship between childhood asthma and a total of 731 immune cells, including B cell (190), Maturation stages of T cell (79), Monocyte (43), Myeloid cell (64), TBNK (124), Treg (167), and CDC (64). LASSO logistic regression and SVM algorithms were used to identify key genes associated with childhood asthma. Specific signaling pathways associated with these key genes were further explored through gene set variation analysis (GSVA) and gene set enrichment analysis (GSEA). Subsequently, the four key genes FCGR3A, TCTN3, ALOX5, and IL4R were verified in an established asthma mouse model using quantitative real-time PCR and Western blotting.

Results

MR analysis showed that 60 immune cells were associated with childhood asthma, of which 32 were associated with high risk and 28 were associated with low risk. LASSO logistic regression and SVM algorithm identified six key genes that affect childhood asthma as ATF4, FCGR3A, GAS5, MGAT3, TAB1, and TCTN3. In addition, four genes, FCGR3A, TCTN3, ALOX5, and IL4R, were verified through animal experiments.

Conclusion

Our findings confirmed that immune cells contribute to childhood asthma, highlighting the importance of key genes in the role of the immune microenvironment in this disease. These insights provide a new path for the exploration of the biological underpinnings of childhood asthma and the development of early intervention therapies.

Association between platelet/high-density lipoprotein cholesterol ratio and blood eosinophil counts in American adults with asthma: a population-based study

OBJECTIVE

This study aims to evaluate the relationship between the platelet-to-high-density lipoprotein cholesterol ratio (PHR) and blood eosinophil counts (BEOC) in asthmatic patients, using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018.

METHODS

This research explored the link between PHR and BEOC among adults with asthma, drawing on data from a representative U.S. population sample (n = 3034; NHANES 2011-2018). To assess this relationship, multivariable linear models were employed, alongside subgroup and interaction analyses to identify any potential variations across different groups. Additionally, generalized additive models, smooth curve fitting, and threshold effect analysis were employed to explore the relationships in greater detail. Sensitivity tests were performed to ensure the robustness of the findings.

RESULTS

The weighted multivariable linear regression analysis showed that after adjusting for all covariables, each one-unit rise in PHR was linked to an increase of 41.61 in BEOC (β: 41.61, 95% CI: 25.25-57.97). Subgroup analyses demonstrated consistency across various categories, reinforcing the significant positive association between PHR and BEOC. Interaction tests indicated that this positive association remained stable regardless of factors such as body mass index, smoking, hypertension, or diabetes, with all interaction P-values greater than 0.05. Additionally, the application of generalized additive models and two-piece linear regression models further confirmed the linear association between PHR and BEOC.

CONCLUSIONS

Our study indicates that a higher PHR may be associated with an increased risk of elevated BEOC in American adults with asthma. Thus, PHR might be considered a potential marker for predicting elevated BEOC levels in this population.

Air Pollution and Childhood Asthma Hospitalizations in Chengdu, China: A Time-Series Study

Purpose

Research on the relationship between air pollutants and hospitalization for asthma in children in developing countries remains inadequate. This study aimed to assess the short-term effects of air pollutants, including sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), particulate matter ≤ 2.5 µm (PM2.5), and particulate matter ≤ 10 µm (PM10), on children hospitalized for asthma in Chengdu, China, from 2017-2022.

Patients and Methods

During the study period, 5592 children were hospitalized for asthma. A generalized additive model was used to control for seasonality, long-term trends, weather, day of the week, and holidays. The analysis was further stratified by age, sex, and season to estimate the associations.

Results

PM2.5, PM10, SO2, NO2, and CO were significantly associated with an increased risk of hospitalization due to asthma. A 10 μg/m3 increase in PM2.5, PM10, and CO at lag04 corresponded to an increase of 2.07%, 1.56%, and 0.33% in daily hospital admissions for asthma, respectively. A 10 μg/m3 increase in SO2 and NO2 at lag05 corresponded to an increase of 45.69% and 8.16% in daily hospital admissions for asthma, respectively. Further analysis by age found that PM10 and PM2.5 had a greater impact on children aged 5-6 years old while NO2 and CO mainly affected children under 7 years old. Analysis by by sex found that pollutants had a greater impact on hospital admissions in girls. Seasonal analysis revealed that pollutants had a more significant effect on admission during the winter.

Conclusion

Our results suggest that increased concentrations of PM2.5, PM10, SO2, NO2, and CO in Chengdu lead to hospitalization for asthma in children and that a lag effect was observed, especially with SO2. These findings highlight the need for stricter air quality controls to reduce childhood asthma hospitalizations.

Clinical and Pathophysiological Tangles Between Allergy and Autoimmunity: Deconstructing an Old Dichotomic Paradigm

Allergic and autoimmune disorders are characterised by dysregulation of the immune responses to otherwise inert environmental substances and autoantigens, leading to inflammation and tissue damage. Their incidence has constantly increased in the last decades, and their co-occurrence defies current standards in patient care. For years, allergy and autoimmunity have been considered opposite conditions, with IgE and Th2 lymphocytes cascade driving canonical allergic manifestations and Th1/Th17-related pathways accounting for autoimmunity. Conversely, growing evidence suggests that these conditions not only share some common inciting triggers but also are subtended by overlapping pathogenic pathways. Permissive genetic backgrounds, along with epithelial barrier damage and changes in the microbiome, are now appreciated as common risk factors for both allergy and autoimmunity. Eosinophils and mast cells, along with autoreactive IgE, are emerging players in triggering and sustaining autoimmunity, while pharmacological modulation of B cells and Th17 responses has provided novel clues to the pathophysiology of allergy. By combining clinical and therapeutic evidence with data from mechanistic studies, this review provides a state-of-the-art update on the complex interplay between allergy and autoimmunity, deconstructing old dichotomic paradigms and offering potential clues for future research.

The extract from Quzhou Aurantii Fructus attenuates cough variant asthma through inhibiting the TRPV1/Ca2+/NFAT/TSLP pathway and ferroptosis via TRPV1 mediation in ovalbumin-induced mice

ETHNOPHARMACOLOGICAL RELEVANCE

Cough variant asthma (CVA), a prevalent chronic inflammatory disease, is the most common cause of chronic cough. Over the years, the aqueous extract of Quzhou Aurantii Fructus (QAFA) has been widely used to treat respiratory diseases, particularly cough.

AIM OF THE STUDY

This study aimed to elucidate the therapeutic effect of QAFA on allergen-induced CVA, providing deep insights into the underlying mechanisms.

MATERIALS AND METHODS

Ultra-high performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) was employed to characterize the compositions, while UPLC was used to quantify the contents of its major components in QAFA. CVA model was established via sensitization and atomization with ovalbumin (OVA), and received 600 and 1200 mg/kg of QAFA via intragastric gavage. Cough response was assessed by stimulation with capsaicin (CAP). Then, airway hyperresponsiveness (AHR), ELISA, western blotting, RT-qPCR, and histological analyses, were applied to assess pulmonary function, pathological changes, and investigate mechanisms in CVA mice following QAFA treatment through the TRPV1/Ca2+-dependent NFAT-induced expression of TSLP and ferroptosis. Additionally, the effects and mechanisms of QAFA were validated using IL-4, CAP for stimulation, capsazepine (CPZ) for inhibition, and TRPV1 siRNA transfection in cells.

RESULTS

Chemical analysis revealed that QAFA primarily contained sixteen compounds, with four main components including narirutin, naringin, hesperidin, and neohesperidin. In vivo, QAFA treatment alleviated cough and AHR, while concurrently reducing airway inflammation and mucus secretion in CVA mice. These effects were achieved by suppressing the TRPV1/NFAT/TSLP pathway and modulating the expression of ferroptosis-related proteins. In vitro, siTRPV1-transfected BEAS-2B cells demonstrated the involvement of the TRPV1 channel in IL-4-mediated Ca2+ influxes, ferroptosis, and regulation of TSLP production. QAFA and CPZ suppressed IL-4-induced TSLP production via the TRPV1/NFAT pathway and regulated the levels of ferroptosis-related proteins, while CAP counteracted the effect of QAFA on TSLP production in BEAS-2B cells. Furthermore, QAFA reduced IL-4 or CAP induced Ca2+ influx and IL-4 induced ferroptosis through TRPV1 mediation.

CONCLUSIONS

This study demonstrated that QAFA improved pulmonary function and alleviated asthmatic inflammatory response in treating CVA probably through suppressing the TRPV1/Ca2+/NFAT/TSLP pathway and ferroptosis via TRPV1 mediation.

Oscillometry-defined small airways dysfunction as a treatable trait in asthma

The small airways, also referred to as the lung's silent zone, are closely associated with poor symptom control and more frequent asthma exacerbations. The oscillometry technique superimposes sound or airwaves onto normal tidal breathing and provides information on resistance and reactance, that is, obstacles to airflow occurring inside and outside of the bronchi. More recently, a management paradigm based on so-called "treatable traits" has been proposed to personalize and improve asthma care for individuals by proactively identifying and targeting modifiable pulmonary, extrapulmonary, and behavioral traits affecting asthma control. In this review article, we evaluate the literature on small airways dysfunction as a potential treatable trait in persistent asthma. In particular, we discuss whole- and intrabreath oscillometry and the impact of extrafine inhaled corticosteroids and systemic biologics on the peripheral airways.

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.

How the early life microbiome shapes immune programming in childhood asthma and allergies

Despite advances in our understanding of their diagnosis and treatment, pediatric allergies impose substantial burdens on affected children, families, and healthcare systems. Further, the prevalence of allergic diseases has dramatically increased over the past half-century, leading to additional concerns and concerted efforts to identify the origins, potential predictors and preventions, and therapies of allergic diseases. Together with the increase in allergic diseases, changes in lifestyle and early-life environmental influences have corresponded with changes in colonization patterns of the infant gut microbiome. The gut microbiome plays a key role in developing the immune system, thus greatly influencing the development of allergic disease. In this review, we specifically highlight the importance of the proper maturation and composition of the gut microbiome as an essential step in healthy child development or disease progression. By exploring the intertwined development of the immune system and microbiome across pediatric allergic diseases, we provide insights into potential novel strategies for their prevention and management.

Oscillometry in the diagnosis, assessment, and monitoring of asthma in children and adults

Diagnosing asthma typically relies on clinical history, physical examination, and objective lung function test results. Spirometry, the gold standard for assessing lung function, is universally recommended for the diagnostic, assessment, and monitoring of asthma. It requires maximal respiratory effort that limits cooperation in certain populations and has limitations in detecting small airway dysfunction. Oscillometry requires minimal patient effort, is noninvasive, and provides valuable information on both large and small airways. Recent task force reports have suggested oscillometry as an alternative or a complementary lung function test to spirometry in the management of individuals with asthma. This review explores the scientific evidence and psychometric properties regarding oscillometry in the main purposes served by lung function testing in asthma, namely diagnosis, assessment of control and future risk, as well as longitudinal monitoring, including clinical utility. Furthermore, it addressed challenges and facilitators to implementation and future directions regarding its positioning as lung function testing in individuals with asthma.

Global, regional, and national epidemiology of allergic diseases in children from 1990 to 2021: findings from the Global Burden of Disease Study 2021

BACKGROUND

Asthma and atopic dermatitis (AD) represent significant global health challenges in children. This study aimed to investigate trends in incidence, prevalence, and disability-adjusted life years (DALYs) for childhood asthma and AD from 1990 to 2021.

METHODS

The study utilized information from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study 2021. The sample size for this study consisted of children with asthma or AD between the ages of 0 and 14. From 1990-2021, we calculated asthma and AD's age-standardized incidence, prevalence, and DALYs by area, age, sex, and socio-demographic index.

RESULTS

In 2021, global childhood asthma prevalence reached 95.7 million cases (age-standardized rate: 4,758 per 100,000), with the Low SDI region recording 25.4 million cases. For AD, global prevalence was 72.4 million cases (age-standardized rate: 3,600 per 100,000), predominantly in Middle SDI regions (19.7 million cases). Between 1990 and 2021, age-standardized incidence rates decreased for both conditions. Geographic variations were notable: High-income North America showed the highest asthma incidence, while Western Europe led in AD prevalence. The global burden of asthma-related DALYs declined from 6.9 million in 1990 to 4.6 million in 2021, with significant regional disparities.

CONCLUSIONS

Despite decreasing age-standardized rates, childhood asthma and AD continue to pose substantial health burdens globally, with marked variations across regions and socioeconomic strata. These findings emphasize the need for targeted, region-specific interventions.

Trends, seasonal variations and forecasting of chronic respiratory disease morbidity in charcoal producing areas, northwest Ethiopia: time series analysis

Objective

This study analyzed the trend, seasonal variations and forecasting of chronic respiratory disease morbidity in charcoal producing areas, northwest Ethiopia, aiming to provide evidences in planning, designing strategies, and decision-makings for preparedness and resource allocation to prevent CRD and reduce public health burden in the future.

Materials and methods

The trend, seasonal variation, and forecasting for CRD were estimated using data collected from the three zones of Amhara region annual reports of DHIS2 records. Smoothing decomposition analysis was employed to demonstrate the trend and seasonal component of CRD. The ARIMA (2, 1, 2) (0, 0, 0) model was used to forecast CRD morbidity. The model's fitness was checked based on Bayesian information criteria. The stationarity of the data was assessed with a line chart and statistically with the Ljung-Box Q-test. SPSS version 27 was utilized for statistical analysis.

Results

The annual morbidity rate of CRD has shown an increasing trend in both sexes over a seven-year period among people aged 15 years and older. Seasonal variation in CRD morbidity was observed. The smoothing decomposition analysis depicted that the seasonal component was attributed to 44.47% and 19.16% of excess CRD cases in the period between September to November, and June to August, respectively. A substantial difference among the three zones of the Amhara region in CRD morbidity rate was noted, with the highest observed in the Awi zone. Forecasting with the ARIMA model revealed that CRD-related morbidity will continue to increase from 2020 to 2030.

Conclusion

The study revealed that the CRD morbidity rate has shown an increasing trend from 2013 to 2019. Seasonal variation in the CRD morbidity rate was observed, with the highest peak from September to November. The morbidity attributed to CRD will continue to increase for the next ten years (2020-2030). Therefore, this study could potentially play a groundbreaking role. Further study is warranted to understand the risk factors and facility readiness through a further understanding of seasonality and future trends.

Inhaling arsenic aggravates airway hyperreactivity by upregulating PNEC-sourced 5-HT in OVA-induced allergic asthma

Increasing epidemiological evidence has proved that early-life exposure to inorganic arsenic (As) elevates the risks of childhood asthma. The present research aimed to explore susceptibility of respiratory As exposure to allergic asthma in a mouse model. BALB/c mice on postnatal day (PND) 28 were exposed to ddH2O or NaAsO2 aerosol for 4 hours daily over 5 consecutive weeks via respiratory tract. Mice were sensitized by intraperitoneal injection of ovalbumin (OVA) combined with Alum Adjuvant on PND42 and PND56. Subsequently, mice were challenged with ddH2O or 1 %OVA through a nebulizer for 3 days starting from PND63. In As-exposed mice, OVA-sensitized goblet cell hyperplasia and airway mucosal secretion did not worsen. OVA-induced inflammatory cell infiltration and upregulation of Th2 cytokines, including IL-4, IL-5, and IL-13, were not aggravated in As-exposed mice. Interestingly, airway hyperreactivity was intensified in As-exposed asthmatic mice. Mechanistically, OVA-induced elevation of 5-hydroxytryptamine (5-HT), probably secreted by pulmonary neuroendocrine cells (PNECs), was exacerbated in As-exposed mice. OVA-induced upregulation of tryptophan hydroxylase (TPH)1 and TPH2, two 5-HT synthases, was aggravated in As-exposed mouse lungs. LX1032, a specific TPH inhibitor, suppressed As-induced elevation of pulmonary 5-HT content in asthmatic mice. Moreover, LX1032 alleviated As-evoked airway hyperreactivity in asthmatic mice. These results suggest that respiratory As exposure elevates airway hyperreactivity partially through upregulating PNEC-sourced 5-HT in OVA-induced allergic asthma, which provides significant insight about the hazards of environmental As exposure.

Associations between maternal fish intake and polyunsaturated fatty acid status with childhood asthma in a high fish-eating population

BACKGROUND

Studies investigating associations between prenatal polyunsaturated fatty acid status (PUFAs), in particular the anti-inflammatory n-3 PUFAs, and the development of childhood asthma have yielded conflicting results.

OBJECTIVE

To determine the associations between maternal fish intake (a rich source of the n-3 PUFAs), maternal or cord PUFAs with the prevalence of childhood asthma in a high fish-eating population.

METHODS

We examined these associations between fish intake and PUFA concentrations with childhood asthma prevalence in the Seychelles Child Development Study Nutrition Cohort 2, a large observational study in a high fish-eating population. Maternal fish intake during pregnancy and child's fish intake at 7 years were assessed by questionnaire, with frequency reported as meals/week. Serum concentrations of PUFAs were quantified in maternal blood collected at 28 weeks' gestation (n = 1448) and in cord blood (n = 1088). Asthma in children at 7 years was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire (n = 1098).

RESULTS

A total of 97 children (10.5%) were reported to have asthma. In regression analysis, the odds of childhood asthma were not associated with maternal fish intake or maternal PUFA status. Cord DHA concentrations were associated with increased asthma prevalence when the highest quartile (≥0.123 mg/mL) was compared with the lowest (<0.061 mg/mL).

CONCLUSION

The results from this current study add to the growing body of evidence that fish consumption during pregnancy is not associated with asthma development in offspring. The associations between cord blood DHA and asthma prevalence are unexpected and warrant further investigation.

Occupational psychosocial stressors and ergonomic strain during pregnancy and sex-specific risk of childhood asthma

OBJECTIVES

Previous studies have indicated that maternal occupational psychosocial stressors may affect the risk of asthma in the offspring, but their results are inconsistent. Maternal occupational ergonomic strain is associated with predictors of fetal lung development, including preterm birth and low birthweight; however, it is not known, whether ergonomic strain during pregnancy is a risk factor for asthma in offspring. The aim was to investigate maternal psychosocial stressors and ergonomic strain during pregnancy relative to the risk of offspring asthma.

METHODS

Live- and firstborn singletons (1996-2018) and their mothers were identified from Danish nationwide registers. Job code at time of conception was assigned to each mother and linked with exposure estimates from job exposure matrices (JEMs) of psychosocial stressors and ergonomic strain. Diagnoses of childhood asthma were retrieved from the Danish National Patient Register. Incidence rate ratios (IRR) of asthma were estimated using Poisson regression; adjusted for maternal asthma, age at conception, socioeconomic position, and body mass index, and calendar year.

RESULTS

Maternal employment in occupations with low decision authority (IRR: 1.08, 95% CI 1.00-1.16) and high ergonomic strain (IRR: 1.09, 95% CI 1.02-1.16) was associated with increased risk of asthma among male offspring. Largely similar, but less consistent, associations were observed among female offspring due to low decision authority.

CONCLUSION

We found a minor increased risk of asthma among offspring whose mothers worked in an occupation with low decision authority or high ergonomic strain, most pronounced among male offspring.

Early family socioeconomic status and asthma-related outcomes in school-aged children: Results from seven birth cohort studies

OBJECTIVE

To examine the associations between maternal education and household income during early childhood with asthma-related outcomes in children aged 9-12 years in the UK, the Netherlands, Sweden, Australia, the USA and Canada.

METHODS

Data on 31 210 children were obtained from 7 prospective birth cohort studies across six countries. Asthma-related outcomes included ever asthma, wheezing/asthma attacks and medication control for asthma. Relative social inequalities were estimated using pooled risk ratios (RRs) adjusted for potential confounders (child age, sex, mother ethnic background and maternal age) for maternal education and household income. The Slope Index of Inequality (SII) was calculated for each cohort to evaluate absolute social inequalities.

RESULTS

Ever asthma prevalence ranged from 8.3% (Netherlands) to 29.1% (Australia). Wheezing/asthma attacks prevalence ranged from 3.9% (Quebec) to 16.8% (USA). Pooled RRs for low (vs high) maternal education and low (vs high) household income were: ever asthma (education 1.24, 95% CI 1.13 to 1.37; income 1.28, 95% CI 1.15 to 1.43), wheezing/asthma attacks (education 1.14, 95% CI 0.97 to 1.35; income 1.22, 95% CI 1.03 to 1.44) and asthma with medication control (education 1.16, 95% CI 0.97 to 1.40; income 1.25, 95% CI 1.01 to 1.55). SIIs supported the lower risk for children with more highly educated mothers and those from higher-income households in most cohorts, with few exceptions.

CONCLUSIONS

Social inequalities by household income on the risk of ever asthma, wheezing/asthma attacks, and medication control for asthma were evident; the associations were attenuated for maternal education. These findings support the need for prevention policies to address the relatively high risks of respiratory morbidity in children in families with low socioeconomic status.

The epithelial barrier theory and its associated diseases

The prevalence of many chronic noncommunicable diseases has been steadily rising over the past six decades. During this time, over 350,000 new chemical substances have been introduced to the lives of humans. In recent years, the epithelial barrier theory came to light explaining the growing prevalence and exacerbations of these diseases worldwide. It attributes their onset to a functionally impaired epithelial barrier triggered by the toxicity of the exposed substances, associated with microbial dysbiosis, immune system activation, and inflammation. Diseases encompassed by the epithelial barrier theory share common features such as an increased prevalence after the 1960s or 2000s that cannot (solely) be accounted for by the emergence of improved diagnostic methods. Other common traits include epithelial barrier defects, microbial dysbiosis with loss of commensals and colonization of opportunistic pathogens, and circulating inflammatory cells and cytokines. In addition, practically unrelated diseases that fulfill these criteria have started to emerge as multimorbidities during the last decades. Here, we provide a comprehensive overview of diseases encompassed by the epithelial barrier theory and discuss evidence and similarities for their epidemiology, genetic susceptibility, epithelial barrier dysfunction, microbial dysbiosis, and tissue inflammation.

Investigating the relationship between asthma symptoms and severity with television watching, computer use, and internet access among 13-14-year-old children in Yazd, Iran

BACKGROUND

Asthma is a prevalent chronic respiratory disease that affects individuals from childhood to adulthood. This study aimed to investigate the association between symptoms and severity of asthma with television viewing, computer and Internet use in adolescents, considering the lifestyle changes in recent decades.

METHODS

This study was conducted in early 2020 as part of the Global Asthma Network 2020 survey, among 13-14-year-olds in Yazd, Iran. Participants were classified into case and control groups based on the presence and severity of asthma symptoms. The data was collected and analyzed using SPSS-20 software to compare the participants based on their screen time.

RESULTS

The analysis of data collected from a total of 5141 students produced noteworthy results. A significant correlation was identified between the occurrence of wheezing in the past year, the presence of severe asthma, and the amount of time spent watching television, using a computer, or internet. The unadjusted model revealed that screen time of more than three hours, pet ownership, current smoking, and ever smoking were all significant predictors of wheezing and severe asthma. Smoking was the strongest predictor of asthma and its severity. After adjusting for confounding factors, the multiple logistic regression model confirmed that screen time of more than three hours remained a significant predictor of both asthma and its severity.

CONCLUSION

This study finds a significant association between media usage and asthma symptoms and severity. However, this association is influenced by lifestyle factors such as physical activity, obesity, diet, and exposure to indoor allergens. Further research is needed to better understand the complex interplay between media usage and asthma, considering the impact of these factors.

Occupational agents-mediated asthma: From the perspective of autophagy

Occupational asthma (OA) is a common occupational pulmonary disease that is frequently underdiagnosed and underreported. The complexity of diagnosing and treating OA creates a significant social and economic burden, making it an important public health issue. In addition to avoiding allergens, patients with OA require pharmacotherapy; however, new therapeutic targets and strategies need further investigation. Autophagy may be a promising intervention target, but there is a lack of relevant studies summarizing the role of autophagy in OA. In this review consolidates the current understanding of OA, detailing principal and novel agents responsible for its onset. Additionally, we summarize the mechanisms of autophagy in HMW and LMW agents induced OA, revealing that occupational allergens can induce autophagy disorders in lung epithelial cells, smooth muscle cells, and dendritic cells, ultimately leading to OA through involving inflammatory responses, oxidative stress, and cell death. Finally, we discuss the prospects of targeting autophagy as an effective strategy for managing OA and even steroid-resistant asthma, encompassing autophagy interventions focused on organoids, organ-on-a-chip systems, nanomaterials vehicle, and nanobubbles; developing combined exposure models, and the role of non-classical autophagy in occupational asthma. In briefly, this review summarizes the role of autophagy in occupational asthma, offers a theoretical foundation for OA interventions based on autophagy, and identifies directions and challenges for future research.

The Prevalence of Childhood Asthma, Respiratory Symptoms and Associated Air Pollution Sources Among Adolescent Learners in Selected Schools in Vhembe District, South Africa

This study investigated the prevalence of childhood asthma and respiratory symptoms with their associated air pollution sources among adolescents aged 13-14 years residing in a Malaria-endemic region.

METHODS

A cross-sectional survey was conducted with 2855 adolescents from fourteen (14) selected schools in communities exposed to high levels of air pollution from indoor residual spraying (IRS) that is used for malaria vector control in the Vhembe region. Data were collected using a self-administered standardized International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Statistical software STATA version 17 was used to analyze the data. Binary logistic regression was used to determine the relationship between air pollution sources and childhood asthma/symptoms.

RESULTS

The prevalences of asthma, 'wheeze ever' and 'wheeze in the past' were 18.91%, 37.69% and 24.69%, respectively. The results from the adjusted binary logistic regression model indicated that exposure to tobacco smoke (OR = 1.84; 95% CI: 1.08-3.16), smoking a water pipe (OR = 1.65; 95% CI: 1.16-2.36) and the use of paraffin as fuel for heating (OR = 1.70; 95% CI: 0.97-2.88) and cooking (OR = 0.48; 95% CI: 0.29-1.00) were significant risk factors for asthma. Trucks passing through the streets, having a cat at home and using open fires were significantly associated with 'wheeze in the past'. Finally, using gas for cooking (OR = 0.72; 95% CI: 0.53-0.99), open fires for heating (OR = 0.53; 95% CI: 0.35-0.80) and smoking a water pipe (OR = 2.47; 95% CI: 1.78-3.44) were associated with 'wheeze ever'.

CONCLUSIONS

School children living in these communities had an increased risk of developing asthma and presenting with wheezing due to exposure to environmental air pollution sources.

Validation of the adult asthma epidemiological score: a secondary analysis of the EPI-ASTHMA population-based study

OBJECTIVE

The A2 score is an eight-question patient-reported outcome measure that has been validated for ruling in (score ≥4) and ruling out (score 0-1) asthma. However, this screening tool has been validated in a cohort similar to the derivation cohort used. This study aims to validate the predictive accuracy of the A2 score in a primary care population against general practitioner (GP) clinical assessment and to determine whether the proposed cut-offs are the most appropriate.

DESIGN

This accuracy study is a secondary analysis of the EPI-ASTHMA population-based study.

SETTING

Primary care centres in Portugal.

PARTICIPANTS

Random adult participants answered the A2 score by phone interview.

OUTCOMES

Those with an A2 score ≥1 (plus 5% with an A2 score of 0) were invited to a diagnostic visit carried out by a GP to confirm or not a diagnosis of asthma. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves.

RESULTS

A total of 1283 participants (median 54 (p25-p75 43-66) years; 60% women) were analysed. The A2 score showed high discriminatory power in identifying asthma, with an area under the ROC curve of 82.9% (95% CI 80.4% to 85.4%). The proposed cut-off ≥4 was the most appropriate to rule in asthma (specificity 83.1%, positive predictive value 62.4%, accuracy 78%). Similarly, the proposed cut-off<2 was the most suitable for excluding asthma (sensitivity 92.7%, negative predictive value 93.7%, accuracy 60.5%).

CONCLUSIONS

The A2 score is a useful tool to identify patients with asthma in a primary care population.

TRIAL REGISTRATION NUMBER

NCT0516961.

Mechanisms of mechanical stimulation in the development of respiratory system diseases

During respiration, mechanical stress can initiate biological responses that impact the respiratory system. Mechanical stress plays a crucial role in the development of the respiratory system. However, pathological mechanical stress can impact the onset and progression of respiratory diseases by influencing the extracellular matrix and cell transduction processes. In this article, we explore the mechanisms by which mechanical forces communicate with and influence cells. We outline the basic knowledge of respiratory mechanics, elucidating the important role of mechanical stimulation in influencing respiratory system development and differentiation from a microscopic perspective. We also explore the potential mechanisms of mechanical transduction in the pathogenesis and development of respiratory diseases such as asthma, lung injury, pulmonary fibrosis, and lung cancer. Finally, we look forward to new research directions in cellular mechanotransduction, aiming to provide fresh insights for future therapeutic research on respiratory diseases.

30-day Spirometry Holter method design and prospective observational study

Asthma underdiagnosis and overdiagnosis remain significant problems for healthcare systems worldwide and indicate considerable pain points with current guidelines and diagnostic methods; therefore, new, targeted approaches seem crucial. This study introduces a novel spirometry-based approach using digital tools for objective asthma diagnosis support. This was a single-centre (Warsaw Medical University, Poland) prospective cohort study. It included adults with suspected asthma per GINA 2020, without confirmed obstruction in ambulatory spirometry. Patients were equipped and trained with a portable spirometer with built-in manoeuvre quality features AioCare® (HealthUp, Poland). The protocol included twice-daily spirometry examinations over four weeks and symptom reporting in the mobile app. The number of obstructions detected, probability of finding obstruction over time, spirometry values' variability, technical correctness, and reported symptoms were evaluated. 26 patients enrolled (14 females, mean age 37.6 years old, BMI 24.7 kg/m^2), with a primary outcome of observed obstruction in 42% of participants (3.08 per patient, 95%CI: 0.78-5.37). The detection probability of obstruction plateaued at 100% within the first 21 days of monitoring. Diurnal PEF and FEV1 variability were exceeded (≥ 10%) in 73% and 66% of patients, respectively. 88% of participants performed over half of their tests correctly. 85% of patients reported symptoms at least once. The Spirometry Holter is a novel and feasible tool for monitoring airway limitation variability in line with GINA guidelines. It shows promise in objectively supporting asthma diagnoses in treatment-naive patients lacking documented prior obstruction.

Non-invasive positive pressure ventilation for acute asthma in children

BACKGROUND

Asthma is one of the most common reasons for hospital admission among children, with significant economic burden and impact on quality of life. Non-invasive positive pressure ventilation (NPPV) is increasingly used in the care of children with acute asthma, although the evidence supporting it is weak, and clinical guidelines do not offer any recommendations on its routine use. However, NPPV might be an effective way to improve outcomes for some children with asthma. A previous review did not demonstrate a clear benefit, but was limited by few studies with small sample sizes. This is an update of the previous review.

OBJECTIVES

To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children (< 18 years) with acute asthma.

SEARCH METHODS

We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, and Embase. We also conducted a search of ClinicalTrials.gov and the WHO ICTRP. We searched all databases from their inception to March 2023, with no restrictions on language of publication.

SELECTION CRITERIA

We included randomised clinical trials (RCTs) assessing NPPV as add-on therapy to usual care versus usual care for children hospitalised for acute asthma exacerbations.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods.

MAIN RESULTS

We included three RCTs randomising 60 children with acute asthma to NPPV and 60 children to control. All included trials assessed the effects of bilevel positive airway pressure (BiPAP) for acute asthma in a paediatric intensive care unit (PICU) setting. None of the trials used continuous positive airway pressure (CPAP). The controls received standard care. The median age of children ranged from three to six years, and asthma severity ranged from moderate to severe. Our primary outcome measures were all-cause mortality, serious adverse events, and asthma symptom score. Secondary outcomes were non-serious adverse events, health-related quality of life, arterial blood gases and pH, pneumonia, cost, and PICU length of stay. None of the trials reported any deaths or serious adverse events (except one trial that reported intubation rate). Two trials reported asthma symptom score, each demonstrating reductions in asthma symptoms in the BiPAP group. In one trial, the asthma symptom score was (mean difference (MD) -2.50, 95% confidence interval (CI) -4.70 to -0.30, P = 0.03; 19 children) lower in the BiPAP group. In the other trial, a cross-over trial, BiPAP was associated with a lower mean asthma symptom score (MD -3.7; 16 children; very low certainty evidence) before cross-over, but investigators did not report a standard deviation, and it could not be estimated from the first phase of the trial before cross-over. The reduction in both trials was above our predefined minimal important difference. Overall, NPPV with standard care may reduce asthma symptom score compared to standard care alone, but the evidence is very uncertain. The only reported serious adverse event was intubation rate in one trial. The trial had an intubation rate of 40% and showed that BiPAP may result in a large reduction in intubation rate (risk ratio 0.47, 95% CI 0.23 to 0.95; 78 children), but the evidence is very uncertain. Post hoc analysis showed that BiPAP may result in a slight decrease in length of PICU stay (MD -0.87 day, 95% CI -1.52 to -0.22; 100 children), but the evidence is very uncertain. Meta-analysis or Trial Sequential Analysis was not possible because of insufficient reporting and different scoring systems. All three trials had high risk of bias with serious imprecision of results, leading to very low certainty of evidence.

AUTHORS' CONCLUSIONS

The currently available evidence for NNPV is uncertain. NPPV may lead to an improvement in asthma symptom score, decreased intubation rate, and slightly shorter PICU stay; however, the evidence is of very low certainty. Larger RCTs with low risk of bias are warranted.

Association of pyrethroids exposure with asthma in US children and adolescents: a nationally representative cross-sectional study

Pyrethroids (PYR) are among the most widely used insecticides in households, leading to substantial exposure. Children and adolescents, especially during growth spurts, have a reduced capacity to effectively metabolize these insecticides. The relationship between PYR exposure and asthma in these age groups remains poorly understood, highlighting the need for further research.We used data from the 2007-2014 National Health and Nutrition Examination Survey, which included 1181 children aged 6-11 years and 1258 adolescents aged 12-19 years. The concentration of the PYR metabolite 3-phenoxybenzoic acid (3-PBA) in urine was quantified using solid-phase extraction-high-performance liquid chromatography-heated electrospray ionization tandem mass spectrometry. Asthma was defined based on self-reported doctor diagnoses from the questionnaire. PYR exposure was measured using urine samples collected simultaneously with the questionnaire. We explored the association between PYR exposure and asthma using multiple logistic regression analyses, adjusting for potential confounders.Multiple logistic regression analyses revealed no significant association between PYR exposure and asthma in children and adolescent boys (all P > 0.05). In contrast, PYR exposure was significantly associated with asthma in adolescent girls aged 12-19 years. Specifically, for "ever asthma," the odds ratios (ORs) were 2.49 (95% CI = 1.03-5.97) in the second quartile of PYR exposure and 2.48 (95% CI = 1.04-5.91) in the third quartile, each in comparison to the first quartile. For "current asthma," in comparison to the first quartile, the ORs were 3.99 (95% CI = 1.55-10.26) in the second quartile of PYR exposure, 3.39 (95% CI = 1.32-8.70) in the third quartile, and 2.93 (95% CI = 1.24-6.90) in the fourth quartile.Conclusions:Our study found a significant association between PYR exposure and asthma in adolescent girls, whereas no significant association was observed in children and adolescent boys. These findings suggest potential sex and age differences in susceptibility to PYR exposure. Further research is warranted to confirm these results and elucidate the underlying mechanisms.

The miR-9-5p/KLF5/IL-1β Axis Regulates Airway Smooth Muscle Cell Proliferation and Apoptosis to Aggravate Airway Remodeling and Inflammation in Asthma

The aim of this study was to investigate the underlying mechanism of miR-9-5p in airway smooth muscle cells (ASMCs) of asthmatic mice. An asthmatic mouse model was established through the intraperitoneal injection of ovalbumin. Histopathological changes in lung tissues of asthmatic mice were observed using HE staining. ASMCs was identified using immunofluorescence staining and cell morphology. The mRNA expressions of miR-9-5p, KLF5, and IL-1β were measured using RT-qPCR. Additionally, CCK8 assay and flow cytometry were applied for ASMC proliferation and apoptosis, respectively. The protein levels of OPN, KLF5, and IL-1β were assessed using western blotting. The results showed that miR-9-5p was abnormally downregulated in lung tissues and ASMCs of asthmatic mice. Dual-Luciferase Reporter Assay and Chromatin immunoprecipitation confirmed that miR-9-5p targeted KLF5 that bounds to IL-1β promoter. Besides, miR-9-5p negatively regulated IL-1β mRNA and protein level via KLF5. Moreover, miR-9-5p was found to positively regulate ASMC apoptosis, negatively regulate ASMC proliferation and OPN protein expression, albeit with partial reversal by KLF5. Mechanistically, the regulation of ASMC proliferation and apoptosis by miR-9-5p is achieved by targeting KLF5/IL-1β axis.

High ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 increases the risk of asthma attack in American asthma adults: a population study

OBJECTIVE

The relationship between vitamin D3 and asthma remains controversial. However, previous studies have largely overlooked the impact of epi-25-(OH)-vitamin D3. This study aims to investigate the effects of different forms of vitamin D3 on asthma attack in adults.

METHODS

In this cross-sectional study, a total of 3,873 eligible adult participants were extracted from the national health and nutrition examination survey (NHANES) database from 2007 to 2018. Based on quartiles method, different levels of vitamin D were divided into four groups (Quartile 1-4). Bivariate correlation analysis was performed for vitamin D and covariates to avoid multicollinearity. Multivariate logistic regression was used to investigate the association between serum levels of vitamin D3 (epi-25-(OH)-vitamin D3 and 25-(OH)-vitamin D3) and asthma attack, adjusting for covariates including age, gender, race, length of time in the U.S., house poverty income ratio (PIR), education level, smoking history, hypertension history, and diabetes history. The ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 was used for secondary analysis of its association with asthma attack. The outcomes were assessed by odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Among the 3,873 eligible adults American with asthma, 1,508 (38.94%) had experienced at least one acute asthma attack in the past year. There was no significant correlation between vitamin D and covariates. After adjusting for covariates including age, gender, race, length of time in the U.S., house poverty income ratio (PIR), education level, smoking history, hypertension history and diabetes history, we found a positive correlation between the ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 and asthma attack. Additionally, a high ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 was more common among elder, male, of normal weight, non-Hispanic American, have a long time stay in the U.S., a high house PIR, and a history of hypertension individuals.

CONCLUSION

Our findings suggest that attention should be given to asthma attack associated with a high ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 in American adults who are elderly, male, of normal weight, non-Hispanic Americans, have long-term residence in the U.S., a high house PIR, and a history of hypertension.

Prevalence, symptomatology and factors associated with asthma in adolescents aged 13-14 years from rural Sri Lanka: an analytical cross-sectional study

BACKGROUND

Asthma is the most common chronic disease affecting children. However, the epidemiology of asthma in adolescents from rural geographies is lacking.

METHODS

An analytical cross-sectional study was conducted in secondary schools located in the municipal council area of the rural district of Anuradhapura, Sri Lanka. Random sampling was used to select 32 grade 8 classes from 6 out of 9 schools. The prevalence and symptomatology of asthma were determined using the validated International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire and asthma symptom control using the asthma control test (ACT) translated into Sinhalese.

RESULTS

The study sample consisted of 1029 participants aged 13-14 years, including 528 (51.3%) boys and 501 (48.7%) girls. The prevalence of wheeze ever, current wheeze and wheeze while playing was 32.6% (n=335), 23.7% (n=244) and 25.2% (n=259), respectively. The prevalence of parent-reported physician-diagnosed asthma was 19.0% (n=196; 95% CI 16.7 to 21.6). Severe asthma was reported by 157 (15.3%; 95% CI 13.1 to 17.6) adolescents. The independent factors associated with severe asthma were sleeping on a cloth laid on the floor instead of a bed (p<0.02, adjusted-OR 9.72; 95% CI 1.56 to 60.78), cooking using sawdust (p=0.04, adjusted-OR 8.71; 95% CI 1.10 to 68.69) eczema (p<0.01; adjusted-OR 7.39; 95% CI 3.34 to 16.39) and allergic rhinitis (p<0.01; adjusted-OR 5.50; 95% CI 3.80 to 7.98). While having a cemented floor in the house (p<0.04; adjusted-OR 0.68; 95% CI 0.47 to 0.99) was a protective factor. Poor control of asthma symptoms was detected in 29 (29.9%) adolescents which was associated with comorbid allergic rhinitis (p<0.01; unadjusted-OR 5.40; 95% CI 1.84 to 15.82).

CONCLUSION

Almost one in four adolescents had current wheeze, and 15.3% had severe asthma. Severe asthma was independently associated with allergic rhinitis, eczema, cooking using sawdust as fuel and sleeping on a cloth on the floor instead of a bed. Poor symptom control was found in 29.9% of severe asthmatics which was associated with comorbid allergic rhinitis.

Preclinical Evaluation of Electronic Health Records (EHRs) to Predict Poor Control of Chronic Respiratory Diseases in Primary Care: A Novel Approach to Focus Our Efforts

Background/Objectives: Managing chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) within the Spanish Sistema Nacional de Salud (SNS) presents significant challenges, particularly due to their high prevalence and poor disease control rates-approximately 45.1% for asthma and 63.2% for COPD. This study aims to develop a novel predictive model using electronic health records (EHRs) to estimate the likelihood of poor disease control in these patients, thereby enabling more efficient management in primary care settings. Methods: The Seleida project employed a bioinformatics approach to identify significant clinical variables from EHR data in primary care centers in Seville and Valencia. Statistically significant variables were incorporated into a logistic regression model to predict poor disease control in patients with asthma and COPD patients. Key variables included the number of short-acting β-agonist (SABA) and short-acting muscarinic antagonist (SAMA) canisters, prednisone courses, and antibiotic courses over the past year. Results: The developed model demonstrated high accuracy, sensitivity, and specificity in predicting poorly controlled disease in both asthma and COPD patients. These findings suggest that the model could serve as a valuable tool for the early identification of at-risk patients, allowing healthcare providers to prioritize and optimize resource allocation in primary care settings. Conclusions: Integrating this predictive model into primary care practice could enhance the proactive management of asthma and COPD, potentially improving patient outcomes and reducing the burden on healthcare systems. Further validation in diverse clinical settings is warranted to confirm the model's efficacy and generalizability.

The impact of exposure to tobacco smoke and e-cigarettes on asthma-related outcomes: Systematic review informing the EAACI guidelines on environmental science for allergic diseases and asthma

To inform the clinical practice guidelines' recommendations developed by the European Academy of Allergy and Clinical Immunology systematic reviews (SR) assessed using GRADE on the impact of environmental tobacco smoke (ETS) and active smoking on the risk of new-onset asthma/recurrent wheezing (RW)/low lung function (LF), and on asthma-related outcomes. Only longitudinal studies were included, almost all on combustion cigarettes, only one assessing e-cigarettes and LF. According to the first SR (67 studies), prenatal ETS increases the risk of RW (moderate certainty evidence) and may increase the risk of new-onset asthma and of low LF (low certainty evidence). Postnatal ETS increases the risk of new-onset asthma and of RW (moderate certainty evidence) and may impact LF (low certainty evidence). Combined in utero and postnatal ETS may increase the risk of new-onset asthma (low certainty evidence) and increases the risk of RW (moderate certainty evidence). According to the second SR (24 studies), ETS increases the risk of severe asthma exacerbations and impairs asthma control and LF (moderate certainty evidence). According to the third SR (25 studies), active smoking increases the risk of severe asthma exacerbations and of suboptimal asthma control (moderate certainty evidence) and may impact asthma-related quality-of-life and LF (low certainty evidence).

Evolving Trends in Pediatric Allergic Diseases: A Cross-Sectional Study Over 20 Years in the Central Black Sea Region of Turkey

Background: In the past two decades, the prevalence of asthma, eczema, and allergic rhinitis has increased among school-aged children in the Central Black Sea region of Turkey. This increase is consistent with national and international data, reflecting the impact and temporal changes of allergic diseases on the community. A similar increasing trend is also observed worldwide. This study aims to contribute to the development of health policies related to allergic diseases among Turkish children in the Central Black Sea region. Materials and Methods: This study compares the results of two cross-sectional surveys conducted in schools in and around Samsun, Turkey, between the years 2006 and 2022, examining changes in the prevalence of specific allergic diseases such as asthma, allergic rhinitis, and atopic eczema. Utilizing the Turkish translation of the International Study of Asthma and Allergies in Childhood protocol, the research encompassed a total of 1,310 and 3,219 children, respectively. Results: In the recent study conducted in 2022, the prevalence of asthma and allergic bronchitis diagnosed by physicians was found to be 10.5% and 4.6%, respectively. In addition, the prevalence of allergic rhinitis was determined to be 3.1% and the prevalence of atopic dermatitis was 2.5%. Moreover, previously unidentified rates of food allergy were determined to be 2.5%, and drug allergy was found to be 2.4%. Furthermore, a comparison with a cross-sectional study conducted in the same region 20 years ago revealed a statistically significant increase in the prevalence of physician-diagnosed asthma and allergic bronchitis (with P-values of 0.0375 and 0.0107, respectively). Discussion: The findings of this study suggest a similar trend of increasing prevalence of allergic diseases when compared with similar studies at national and global levels. Consistent with trends identified in the international literature, Turkey is also affected by the rising prevalence of allergic diseases.

Using a survey, analyzing the current situation of allergic March in elementary and junior high school students of oyama and tochigi cities, Japan

BACKGROUND

Over the past few decades, allergic diseases have become more prevalent and impact around 20% of the global population. There is clinical significance of allergic march as it places a burden on the quality of life of children and their families.

OBJECTIVES

To assess the current situation of allergy conditions experienced by children attending elementary and junior high schools in Oyama and Tochigi cities, Japan.

METHODS

A letter was sent to parents informing them about an opt-in online survey concerning children's allergies along with a weblink and a QR code. A video explained the survey process and informed parents that their replies could not be retracted. Parents who had watched the explanation video and answered yes to participating were considered to have provided consent for the survey.

RESULTS

A total of 2038 valid replies were gathered. Allergic Rhinitis was the most commonly diagnosed allergy, followed by Asthma, Food Allergy, and Atopic Dermatitis. Around 70% of the children were affected by the allergies, of whom half had been affected by multiple allergies. Most children affected by Atopic Dermatitis, Food Allergy or Asthma were affected by other allergies. Atopic Dermatitis and Food Allergy were mostly diagnosed before Asthma and Allergic Rhinitis.

CONCLUSIONS

Children who are diagnosed with either Atopic Dermatitis or a Food Allergy will likely be affected by other allergies later in life. Allergic march perpetuated an earlier peak diagnosis incident rate for allergic rhinitis. Allergic Rhinitis can occur independently from other allergies compared to Atopic Dermatitis, Food Allergy and Asthma.

N-acetyl cysteine augments adipose tissue-derived stem cell efficacy on inflammatory markers and regulatory T cell system balance in an allergic asthma model

BACKGROUND

Allergic asthma is a destructive inflammatory process in the respiratory system. The anti-inflammatory and antioxidant effects of N-acetylcysteine (NAC) have been reported in patients with obstructive pulmonary disease. On the other hand, several studies have shown the modulatory effects of mesenchymal stem cells on the immune system and inflammatory responses. Accordingly, the purpose of the current study was to evaluate the effect of administration of adipose tissue-derived stem cells (ADSCs) plus NAC on regulatory T cell system balance in an allergic asthma model.

METHODS

Eighty Sprague- Dawley rats were randomly divided into the following groups: Control, Plasmalite, Allergic asthma, Allergic asthma + ADSCs, NAC, Allergic asthma + NAC, Allergic asthma + ADSCs + NAC and Allergic asthma + Prednisolone. at the end of the experiment, arterial blood gas analysis, inflammatory cell counts in bronchoalveolar lavage fluid (BALF), inflammatory cytokine concentration, total IgE and specific OVA-IgE levels, gene expression levels of CD4+-T cell subsets, pulmonary indicators, edema, and lung histopathology were evaluated in all groups.

RESULTS

Administration of NAC plus ADSCs demonstrated a significant decrease in total WBC and eosinophil counts, which was in line with remarkable decrease in IL-17 and TNF-α concentrations and increases in IL-10 level compared with other treated groups. NAC plus ADSC treatment showed significant increases in Treg gene expression, although Th17 and Th2 expression significantly decreased compared with that in prednisolone- treated rats.

CONCLUSION

The results of the present study documented that the administration of ADSCs plus NAC has an inhibitory effect on the inflammation caused by allergic asthma in a rat model. The improvement of inflammatory indexes was significantly higher than that with prednisolone treatment.

Use of telerehabilitation platforms for delivering patient education among patients with asthma: a scoping review

OBJECTIVE

Use of tele-technology for monitoring symptoms, functional parameters, and quality-of-life of people with asthma is essential. Delivering this information among patients is mandated for a better outcome and made possible via patient education (PE). This review aims to summarize the types of telerehabilitation modalities, dosage, and outcome measures used to assess the effectiveness of PE among people with asthma.

METHODS

We adopted a scoping review methodology. Thematic analysis was used to synthesize the data. The Preferred Reporting System for Meta-Analysis for Scoping Reviews (PRISMA-ScR) was followed during the review process.

RESULTS

PubMed, Embase, and Scopus were searched, with 34 studies meeting inclusion criteria. Results are presented in three themes: telerehabilitation platforms used to deliver PE among patients with asthma; content, duration, and frequency of the PE administered; and patient-reported outcome measures used to evaluate the effectiveness of PE.

CONCLUSION

This scoping study detailed the types of telerehabilitation modalities, dosage, and outcome measures used to assess the effectiveness of PE in people with asthma. This review will be especially beneficial to those considering where additional research or implementation of telerehabilitation for asthma patients is required. The studies emphasized the involvement of several healthcare experts, emphasizing the significance of a multidisciplinary approach to efficient PE delivery and possible improvements in asthma management through telerehabilitation. Although a range of telerehabilitation platforms were generally accepted, hybrid models that integrate online and in-person sessions could further enhance patient satisfaction and quality-of-life. Comprehensive economic analyses are also required, and solving technology issues is essential to maximizing the efficacy of these initiatives.

Identification of cross-reactive IgE-binding proteins from Philippine allergenic grass pollen extracts

Background

Respiratory allergies are one of the most common allergic diseases that affect Filipinos. Grass pollen accounts for the majority of the outdoor allergens triggering these respiratory allergies. Cross-reactivity among the Philippine grass pollen grains has not been extensively studied.

Objective

This study aims to investigate the cross-reactivity of our local grasses and identify the cross-reactive allergens.

Methods

Grass pollen grains were collected and processed into crude allergenic extracts. The IgE-reactivity of these crude allergenic pollen extracts was studied using sera from patients who tested positive for the mentioned extracts. The proteins from the immunoblots of cross-reactive pollen allergen extracts were sequenced and identified.

Results

Allergenic pollen proteins were identified as cross-reactive among the grass pollen extracts. Four of these have not been listed yet as grass allergens in the World Health Organization/International Union of Immunological Societies allergen nomenclature database.

Conclusion

Local grass pollen allergens are cross-reactive with probable new allergens identified.