1
|
Fainardi V, Caffarelli C, Deolmi M, Zambelli G, Palazzolo E, Scavone S, Bergamini BM, Bertelli L, Biserna L, Bottau P, Corinaldesi E, De Paulis N, Di Palmo E, Dondi A, Gallucci M, Guidi B, Lombardi F, Magistrali MS, Marastoni E, Pastorelli S, Piccorossi A, Poloni M, Tagliati S, Vaienti F, Gregori G, Sacchetti R, Antodaro F, Bergomi A, Reggiani L, De Fanti A, Marchetti F, Grandinetti R, Mussi N, Ricci G, Esposito S. Maintenance Therapy for Children and Adolescents with Asthma: Guidelines and Recommendations from the Emilia-Romagna Asthma (ERA) Study Group. J Clin Med 2023; 12:5467. [PMID: 37685533 PMCID: PMC10487522 DOI: 10.3390/jcm12175467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Asthma is the most frequent chronic disease of childhood, affecting up to 20% of children worldwide. The main guidelines on asthma maintenance therapy in pediatrics suggest different approaches and describe different stages of asthma to determine the most appropriate treatment. This project aims to summarize the most recent evidence regarding maintenance therapy for asthma in children and adolescents. A multidisciplinary panel of experts was asked clinical questions regarding the treatment of children and adolescents with asthma. Overall, 10 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results showed that the choice of medication depends on the severity of the child's asthma, phenotype, age, preference, and individual factors. In addition to medications, the identification of comorbidities and modifiable factors is crucial to obtaining good control. Asthma in children is heterogeneous, and its evolution varies over time. Since most recommendations for asthma management in childhood are extrapolated from clinical studies performed in adults, more clinical trials specifically designed for young children should be conducted.
Collapse
Affiliation(s)
- Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Carlo Caffarelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Michela Deolmi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Giulia Zambelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Elisabetta Palazzolo
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Sara Scavone
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Barbara Maria Bergamini
- Paediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Luca Bertelli
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Loretta Biserna
- Paediatrics and Neonatology Unit, Ravenna Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 48121 Ravenna, Italy; (L.B.); (F.M.)
| | - Paolo Bottau
- Paediatrics Unit, Imola Hospital, 40026 Imola, Italy;
| | | | - Nicoletta De Paulis
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (N.D.P.)
| | - Emanuela Di Palmo
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Arianna Dondi
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Marcella Gallucci
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Battista Guidi
- Hospital and Territorial Paediatrics Unit, 41026 Pavullo, Italy;
| | | | - Maria Sole Magistrali
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (N.D.P.)
| | - Elisabetta Marastoni
- Paediatrics Unit, Santa Maria Nuova Hospital, Azienda Unità Sanitaria Locale (AUSL)-Scientific Institute for Research and Healthcare (IRCCS) of Reggio Emilia, 42123 Reggio Emilia, Italy (A.D.F.)
| | | | - Alessandra Piccorossi
- Paediatrics and Paediatric Intensive Care Unit, Cesena Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47521 Cesena, Italy
| | - Maurizio Poloni
- Paediatrics Unit, Rimini Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47921 Rimini, Italy;
| | | | - Francesca Vaienti
- Paediatrics Unit, G.B. Morgagni Pierantoni Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47121 Forlì, Italy;
| | - Giuseppe Gregori
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Piacenza, 29121 Piacenza, Italy; (G.G.); (R.S.)
| | - Roberto Sacchetti
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Piacenza, 29121 Piacenza, Italy; (G.G.); (R.S.)
| | - Francesco Antodaro
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Modena, 41125 Modena, Italy; (F.A.)
| | - Andrea Bergomi
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Modena, 41125 Modena, Italy; (F.A.)
| | - Lamberto Reggiani
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Imola, 40026 Imola, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, Azienda Unità Sanitaria Locale (AUSL)-Scientific Institute for Research and Healthcare (IRCCS) of Reggio Emilia, 42123 Reggio Emilia, Italy (A.D.F.)
| | - Federico Marchetti
- Paediatrics and Neonatology Unit, Ravenna Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 48121 Ravenna, Italy; (L.B.); (F.M.)
| | - Roberto Grandinetti
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Nicole Mussi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Giampaolo Ricci
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| |
Collapse
|
2
|
García-Marcos L, Chiang CY, Asher MI, Marks GB, El Sony A, Masekela R, Bissell K, Ellwood E, Ellwood P, Pearce N, Strachan DP, Mortimer K, Morales E, Ajeagah GA, Alkhayer G, Alomary SA, Ambriz-Moreno MJ, Arias-Cruz A, Awasthi S, Badellino H, Behniafard N, Bercedo-Sanz A, Brożek G, Bucaliu-Ismajli I, Cabrera-Aguilar A, Chinratanapisit S, Del-Río-Navarro BE, Douros K, El Sadig H, Escalante-Dominguez AJ, Falade AG, Gacaferri-Lumezi B, García-Almaráz R, Garcia-Muñoz R, Ghashi V, Ghoshal AG, González-Díaz C, Hana-Lleshi L, Hernández-Mondragón LO, Huang JL, Jiménez-González CA, Juan-Pineda MÁ, Kochar SK, Kuzmicheva K, Linares-Zapien FJ, Lokaj-Berisha V, López-Silvarrey A, Lozano-Sáenz JS, Mahesh PA, Mallol J, Martinez-Torres AE, Masekela R, Mérida-Palacio JV, Mohammad Y, Moreno-Gardea HL, Navarrete-Rodriguez EM, Ndikum AE, Noor M, Ochoa-Lopez G, Pajaziti L, Pellegrini-Belinchon J, Perez-Fernández V, Priftis K, Ramos-García BC, Ranasinghe JC, Robertson S, Rodriguez-Perez N, Rutter CE, Sacre-Hazouri JA, Salvi S, Sanchez JF, Sánchez JF, Sanchez-Coronel MG, Saucedo-Ramirez OJ, Singh M, Singh N, Singh V, Sinha S, Sit N, Sosa-Ferrari SM, Soto-Martínez ME, Urrutia-Pereira M, Yeh KW, Zar HJ, Zhjeqi V. Asthma management and control in children, adolescents, and adults in 25 countries: a Global Asthma Network Phase I cross-sectional study. Lancet Glob Health 2023; 11:e218-e228. [PMID: 36669806 PMCID: PMC9885426 DOI: 10.1016/s2214-109x(22)00506-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Asthma is one of the most common non-communicable diseases globally. This study aimed to assess asthma medicine use, management plan availability, and disease control in childhood, adolescence, and adulthood across different country settings. METHODS We used data from the Global Asthma Network Phase I cross-sectional epidemiological study (2015-20). A validated, written questionnaire was distributed via schools to three age groups (children, 6-7 years; adolescents, 13-14 years; and adults, ≥19 years). Eligible adults were the parents or guardians of children and adolescents included in the surveys. In individuals with asthma diagnosed by a doctor, we collated responses on past-year asthma medicines use (type of inhaled or oral medicine, and frequency of use). Questions on asthma symptoms and health visits were used to define past-year symptom severity and extent of asthma control. Income categories for countries based on gross national income per capita followed the 2020 World Bank classification. Proportions (and 95% CI clustered by centre) were used to describe results. Generalised structural equation multilevel models were used to assess factors associated with receiving medicines and having poorly controlled asthma in each age group. FINDINGS Overall, 453 473 individuals from 63 centres in 25 countries were included, comprising 101 777 children (6445 [6·3%] with asthma diagnosed by a doctor), 157 784 adolescents (12 532 [7·9%]), and 193 912 adults (6677 [3·4%]). Use of asthma medicines varied by symptom severity and country income category. The most used medicines in the previous year were inhaled short-acting β2 agonists (SABA; range across age groups, 29·3-85·3% participants) and inhaled corticosteroids (12·6-51·9%). The proportion of individuals with severe asthma symptoms not taking inhaled corticosteroids (inhaled corticosteroids alone or with long-acting β2 agonists) was high in all age groups (934 [44·8%] of 2085 children, 2011 [60·1%] of 3345 adolescents, and 1142 [55·5%] of 2058 adults), and was significantly higher in middle-to-low-income countries. Oral SABA and theophylline were used across age groups and country income categories, contrary to current guidelines. Asthma management plans were used by 4049 (62·8%) children, 6694 (53·4%) adolescents, and 3168 (47·4%) adults; and 2840 (44·1%) children, 6942 (55·4%) adolescents, and 4081 (61·1%) adults had well controlled asthma. Independently of country income and asthma severity, having an asthma management plan was significantly associated with the use of any type of inhaled medicine (adjusted odds ratio [OR] 2·75 [95% CI 2·40-3·15] for children; 2·45 [2·25-2·67] for adolescents; and 2·75 [2·38-3·16] for adults) or any type of oral medicine (1·86 [1·63-2·12] for children; 1·53 [1·40-1·68] for adolescents; and 1·78 [1·55-2·04] for adults). Poor asthma control was associated with low country income (lower-middle-income and low-income countries vs high-income countries, adjusted OR 2·33 [95% CI 1·32-4·14] for children; 3·46 [1·83-6·54] for adolescents; and 4·86 [2·55-9·26] for adults). INTERPRETATION Asthma management and control is frequently inadequate, particularly in low-resource settings. Strategies should be implemented to improve adherence to asthma treatment guidelines worldwide, with emphasis on access to affordable and quality-assured essential asthma medicines especially in low-income and middle-income countries. FUNDING International Union Against Tuberculosis and Lung Disease, Boehringer Ingelheim New Zealand, AstraZeneca, UK National Institute for Health Research, UK Medical Research Council, European Research Council, the Spanish Instituto de Salud Carlos III. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Luis García-Marcos
- Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children‘s Hospital, University of Murcia and IMIB Bio-medical Research Institute, Murcia, Spain,ARADyAL Allergy Network, Murcia, Spain,Correspondence to: Prof Luis García-Marcos, Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children‘s Hospital, University of Murcia and IMIB Bio-medical Research Institute, 30120 Murcia, Spain
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France,Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, and Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - M Innes Asher
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Guy B Marks
- Respiratory and Environmental Epidemiology, University of New South Wales, Sydney, NSW, Australia
| | - Asma El Sony
- Epidemiological Laboratory for Public Health, Research and Development, Khartoum, Sudan
| | - Refiloe Masekela
- Inkosi Albert Luthuli Central Hospital, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Karen Bissell
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eamon Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - David P Strachan
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kevin Mortimer
- Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK,Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Eva Morales
- Department of Public Health Sciences, University of Murcia and IMIB Bio-medical Research Institute, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Muacevic A, Adler JR, Haque SN, Tasha T, Arko SB, Agrawal H, Razu MI, Parisapogu A, Maisha S, Siddique MA, Abbasi FK, Shama N, Dev Nath S, Ghosh AS, Quader F. The Impact of Tezepelumab in Uncontrolled Severe Asthma: A Systematic Review of Randomized Controlled Trials. Cureus 2022; 14:e32156. [PMID: 36601189 PMCID: PMC9807140 DOI: 10.7759/cureus.32156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/07/2022] Open
Abstract
Asthma, a chronic illness, is characterized by inflammation and airway constriction. Uncontrolled severe asthma is related to poor quality of life and increased utilization of health resources. Conventional treatments are associated with a significant amount of adverse effects. Recent years have seen the identification of various molecular effectors and signaling pathways as interesting targets for the biological therapy of severe asthma that is resistant to current therapies. Because they only target some downstream components of the inflammatory response in asthma, leaving other components unaffected, current biologic treatments only lower the exacerbation rate by 50%. If we focus on the upstream mediators of the inflammatory response in asthma, it might have a greater effect and be more efficient. Tezepelumab is a human monoclonal IgG2 antibody that specifically binds to thymic stromal lymphopoietin (TSLP) at the level of its TSLPR (thymic stromal lymphopoietin receptor) binding site, inhibiting the interaction between human TSLP and TSLPR. It is being used to treat the cytokines on the respiratory epithelial layer known as "alarmins." It is the only biologic drug available for treating severe uncontrolled asthma, despite limitations in biomarker and phenotype. In light of recent developments, the lack of knowledge on tezepelumab prompts us to publish a comprehensive systematic review. We discovered that regardless of blood eosinophil level and fractional exhaled nitric oxide levels, tezepelumab dramatically lowers asthma exacerbation in patients with severe uncontrolled asthma when compared to placebo. Tezepelumab also lessens patients' demand for healthcare resources while improving clinical indicators of lung function, health-related quality of life, and asthma management in patients. Tezepelumab plays a role in enhancing pre-bronchodilator FEV1 and lowering blood eosinophil count and fractional exhaled nitric oxide in patients with or without chronic allergies (FeNO). There have been no reports of fatalities or severe adverse events connected to tezepelumab.
Collapse
|
4
|
Obesity-associated asthma in childhood. Allergol Select 2020; 4:76-85. [PMID: 33134805 PMCID: PMC7592418 DOI: 10.5414/alx02178e] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023] Open
Abstract
Obesity and bronchial asthma are very common diseases in children and adolescents, associated with a considerable burden of disease, reduced quality of life and comorbidities. Obesity is a significant risk factor for bronchial asthma. On the one hand, obesity leads to changes in the mechanics and function of the lungs and chest. On the other hand, obesity-associated inflammatory processes with increased production of leptin and cytokines may trigger bronchial inflammation with the appearance of asthmatic symptoms. The diseases are also linked by genetic factors. Physical activity and weight reduction have a significant benefit. Pharmacotherapy must be based on the pattern of inflammation. This article summarizes the current state of the literature on the association of asthma and obesity and presents current and possible future treatment options.
Collapse
|
5
|
de Gouveia Belinelo P, Nielsen A, Goddard B, Platt L, Da Silva Sena CR, Robinson PD, Whitehead B, Hilton J, Gulliver T, Roddick L, Pearce K, Murphy VE, Gibson PG, Collison A, Mattes J. Clinical and lung function outcomes in a cohort of children with severe asthma. BMC Pulm Med 2020; 20:66. [PMID: 32188435 PMCID: PMC7081619 DOI: 10.1186/s12890-020-1101-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/28/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Uncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC). METHODS This retrospective analysis uses data collected from children referred by a paediatric respiratory specialist to a nurse-led SAC for uncontrolled severe asthma between 2014 and 2019. The pre-clinical assessments included a home visit to assess modifiable factors that could be addressed to improve control. A comprehensive lung function analysis was conducted at each visit. Interventions were personalised and included biologic agents. Statistical analysis was performed using nonparametric, two-tailed Mann-Whitney U-test, the parametric Student's t-test, or analysis of variance (ANOVA) as appropriate. RESULTS Twenty-three children with a median age of 12 years were seen once, and 16 were followed up. Compared to a non-asthmatic (NA) and asthmatic (A) age-matched cohort, children with severe asthma (SA) had a lower FEV1, and FVC% predicted before and after bronchodilator inhalation, and a higher mean Lung Clearance Index [LCI] (10.5 [SA] versus 7.3 [NA] versus 7.6 [A], p = 0.003). Almost 80% of children with SA had an abnormal LCI, and 48% had a reduced FEV1% at the first SAC visit. Asthma control and FEV1% predicted significantly improved at a follow-up visit, while LCI remained abnormal in the majority of children (83%). CONCLUSION Over time, many children with severe asthma showed improved clinical outcomes and lung function while lung ventilation inhomogeneities persisted. Future appropriately controlled studies are required to determine if a nurse-led multidisciplinary SAC is associated with better outcomes.
Collapse
Affiliation(s)
- Patricia de Gouveia Belinelo
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Aleisha Nielsen
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Bernadette Goddard
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Lauren Platt
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Carla Rebeca Da Silva Sena
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Bruce Whitehead
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Jodi Hilton
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Tanya Gulliver
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Laurence Roddick
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Kasey Pearce
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
| | - Peter G Gibson
- Priority Research Centre Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
- Respiratory & Sleep Medicine Department, John Hunter Hospital, Newcastle, Australia
| | - Adam Collison
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia.
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia.
| |
Collapse
|
6
|
Liu LW, Xing QQ, Zhao X, Tan M, Lu Y, Dong YM, Dai C, Zhang Y. Proteomic Analysis Provides Insights Into the Therapeutic Effect of GU-BEN-FANG-XIAO Decoction on a Persistent Asthmatic Mouse Model. Front Pharmacol 2019; 10:441. [PMID: 31133848 PMCID: PMC6514195 DOI: 10.3389/fphar.2019.00441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/08/2019] [Indexed: 01/21/2023] Open
Abstract
Gubenfangxiao decoction (GBFXD) is a traditional Chinese medicine based on a combination of Yu-Ping-Feng-San and Erchen decoctions. GBFXD has been widely used for decades in treating asthma at the Affiliated Hospital of Nanjing University of Chinese Medicine. Previously, GBFXD was found to reduce lung inflammation and airway remodeling; however, the underlying mechanism remains unknown. In this study, the effects of GBFXD on asthmatic mice were evaluated based on pathology and lung function; airway hyperresponsiveness (AHR) and pathology were compared among the two different mouse models utilized. Furthermore, the mechanism of action of GBFXD on asthmatic mice was analyzed using iTRAQ labeling technology combined with ingenuity pathway analysis (IPA). Modeling analysis of pre- and post-treatment proteins identified 75 differentially expressed proteins. These proteins were related to B-cell development, calcium-induced lymphocyte apoptosis, antigen presentation, and Th1 and Th2 activation pathways. Moreover, 68 differentially expressed proteins were identified in the GBFXD treatment group compared with the model group. Upstream regulatory factors predicted that interleukin (IL)-4 (necessary for inducing polarization of type 2 [M2] macrophages), cyclooxygenase, and prostaglandin E2 are significantly elevated in the model group. Based on IPA analysis, it was concluded that several pathways, including mitochondrial dysfunction and oxidative phosphorylation, are closely associated with the therapeutic effects of GBFXD in asthma. Moreover, the differential expression of several proteins, including the M2 markers, MRC1, ARG1, Retnla, Chil3, and CHIA, were validated by western blotting, confirming that GBFXD can reduce airway inflammation, which fits the pattern of an alternative M2 activation state, and attenuate AHR. Overall, our findings indicate that GBFXD significantly suppresses M2 macrophage polarization, providing further insights into the mechanism underlying the protective effects of GBFXD.
Collapse
Affiliation(s)
- Li-Wei Liu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qiong-Qiong Xing
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xia Zhao
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Nanjing University of Chinese Medicine, Nanjing, China
| | - Min Tan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuan Lu
- Children's Hospital of Soochow University, Suzhou, China
| | - Ying-Mei Dong
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Dai
- College of Life Sciences, Nanjing Agricultural University, Nanjing, China
| | - Yang Zhang
- Department of Chemistry and Institute of Biomedical Sciences of Shanghai Medical School, Fudan University, Shanghai, China
| |
Collapse
|