1
|
Aziz DA, Bajwa RA, Viquar W, Siddiqui F, Abbas A. Asthma exacerbations and body mass index in children and adolescents: experience from a tertiary care center. Monaldi Arch Chest Dis 2023. [PMID: 37367834 DOI: 10.4081/monaldi.2023.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
The prevalence and incidence of asthma continue to rise globally. Obesity has been identified as a potential risk factor for asthma exacerbations. The association between body mass index (BMI) and asthma is not well studied in some regions. This study aims to investigate the impact of BMI in pediatric asthmatic patients. This retrospective study was conducted at the Aga Khan University Hospital from 2019 to 2022. Children and adolescents with asthma exacerbation were included. The patients were classified into four groups based on their BMI: underweight, healthy weight, overweight, and obese. The demographic characteristics, medications used, predicted FEV1 measurements, asthma exacerbations per year, length of stay per admission, and the number of patients requiring High Dependency Unit (HDU) care were recorded and analyzed. Our results demonstrated that patients in the healthy weight category had the highest percentage of FEV1 (91.46±8.58) and FEV1/FVC (85.75±9.23) (p<0.001). The study found a significant difference in the average number of asthma exacerbations per year between the four groups. Obese patients had the highest number of episodes (3.22±0.94), followed by the underweight group (2.42±0.59) (p<0.01). The length of stay per admission was significantly shorter for patients with a healthy weight (2.0±0.81), and there was a statistically significant difference observed in the number of patients requiring HDU care among the four groups, as well as in the average length of stay at the HDU (p<0.001). Elevated BMI is related to an increased number of annual asthma exacerbations, a low FEV1 and FEV1/FVC, increased length of stay at admission, and increased stay in the HDU.
Collapse
Affiliation(s)
- Danish Abdul Aziz
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi.
| | | | | | | | - Aiza Abbas
- Medical College, Aga Khan University, Karachi.
| |
Collapse
|
2
|
Pediatric obesity and severe asthma: Targeting pathways driving inflammation. Pharmacol Res 2023; 188:106658. [PMID: 36642111 DOI: 10.1016/j.phrs.2023.106658] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
Asthma affects more than 300 million people of all ages worldwide, including about 10-15% of school-aged children, and its prevalence is increasing. Severe asthma (SA) is a particular and rare phenotype requiring treatment with high-dose inhaled corticosteroids plus a second controller and/or systemic glucocorticoid courses to achieve symptom control or remaining "uncontrolled" despite this therapy. In SA, other diagnoses have been excluded, and potential exacerbating factors have been addressed. Notably, obese asthmatics are at higher risk of developing SA. Obesity is both a major risk factor and a disease modifier of asthma in children and adults: two main "obese asthma" phenotypes have been described in childhood with high or low levels of Type 2 inflammation biomarkers, respectively, the former characterized by early onset and eosinophilic inflammation and the latter by neutrophilic inflammation and late-onset. Nevertheless, the interplay between obesity and asthma is far more complex and includes obese tissue-driven inflammatory pathways, mechanical factors, comorbidities, and poor response to corticosteroids. This review outlines the most recent findings on SA in obese children, particularly focusing on inflammatory pathways, which are becoming of pivotal importance in order to identify selective targets for specific treatments, such as biological agents.
Collapse
|
3
|
Farooq S, Khatri S. Life Course of Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:43-76. [PMID: 37464116 DOI: 10.1007/978-3-031-32259-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma is a heterogeneous chronic airway disease that can vary over a lifetime. Although broad categories of asthma by severity and type have been constructed, there remains a tremendous opportunity to discover an approach to managing asthma with additional factors in mind. Many in the field have suggested and are pursuing a novel paradigm shift in how asthma might be better managed, considering the life course of exposures, management priorities, and predicted trajectory of lung function growth. This approach will require a more holistic view of prenatal, postnatal, adolescence, hormonal and gender aspects, and the aging process. In addition, the environment, externally and internally, including in one's genetic code and epigenetic changes, are factors that affect how asthma progresses or becomes more stable in individuals. This chapter focuses on the various influences that may, to differing degrees, affect people with asthma, which can develop at any time in their lives. Shifting the paradigm of thought and strategies for care and advocating for public policies and health delivery that focus on this philosophy is paramount to advance asthma care for all.
Collapse
Affiliation(s)
- Sobia Farooq
- National Heart, Lung, and Blood Institute, CMO Division of Lung Diseases, Bethesda, MD, USA
| | - Sumita Khatri
- National Heart, Lung, and Blood Institute, CMO Division of Lung Diseases, Bethesda, MD, USA.
| |
Collapse
|
4
|
Cao TBT, Moon JY, Yoo HJ, Ban GY, Kim SH, Park HS. Down-regulated surfactant protein B in obese asthmatics. Clin Exp Allergy 2022; 52:1321-1329. [PMID: 35294785 DOI: 10.1111/cea.14124] [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: 11/21/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Obesity is a common comorbid condition in adult asthmatics and known as a feature of asthma severity. However, the molecular mechanism under obesity-induced inflammation has not yet been fully understood. OBJECTIVE Considering the essential role of hydrophobic surfactant protein B (SP-B) in lung function, SP-B was targeted to examine its involvement in the development of obesity-induced airway inflammation in asthmatics. METHODS The aim was to examine an alteration in circulating SP-B according to obesity in adult asthmatics, 129 asthmatics were enrolled and classified into 3 groups (obese, overweight and normal-weight groups) according to body mass index (BMI). Circulating SP-B levels were determined by enzyme-linked immunosorbent assay. Four single nucleotide polymorphisms of SFTPB gene were genotyped. Serum ceramide levels were measured by liquid chromatography-tandem mass spectrometry. RESULTS Significantly lower serum SP-B levels were noted in the obese group than in the overweight or normal-weight group (p = .002). The serum SP-B level was significantly correlated with serum levels of C18:0 ceramide and transforming growth factor beta 1 as well as BMI (r = -0.200; r = -0.215; r = -0.332, p < .050 for all). An inverse correlation was noted between serum SP-B and fractional exhaled nitric oxide levels in female asthmatics (r = -0.287, p = .009). Genetic predisposition of the SFTPB gene at 9306 A>G to the obese and overweight groups was noted. CONCLUSION Obesity altered ceramide metabolism leading to pulmonary surfactant dysfunction and impaired resolution of airway inflammation, finally contributing to the phenotypes of obese asthmatics.
Collapse
Affiliation(s)
- Thi Bich Tra Cao
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ji-Young Moon
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun-Ju Yoo
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ga-Young Ban
- Department of Pulmonary, Allergy, and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine Institute for Life Sciences, Seoul, Korea
| | - Seung-Hyun Kim
- Translational Research Laboratory for Inflammatory Disease, Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
5
|
Comparison of Pulmonary Function and Inflammation in Children/Adolescents with New-Onset Asthma with Different Adiposity Statuses. Nutrients 2022; 14:nu14142968. [PMID: 35889925 PMCID: PMC9319926 DOI: 10.3390/nu14142968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: The relationship between obesity and asthma is still uncertain. This study aimed to investigate the effect of overweight/obesity on the pulmonary function of patients with new-onset pediatric asthma and explore the possible causative factors related to concomitant obesity and asthma. (2) Methods: Patients aged 5 to 17 years old with newly diagnosed mild to moderate asthma were recruited from June 2018 to May 2019, from a respiratory clinic in Shanghai, China. Participants were categorized into three groups: normal weight, overweight, and obese asthma. A family history of atopy and patients’ personal allergic diseases were recorded. Pulmonary function, fractional exhaled nitric oxide (FeNO), eosinophils, serum-specific immunoglobulins E (sIgE), serum total IgE (tIgE), and serum inflammatory biomarkers (adiponectin, leptin, Type 1 helper T, and Type 2 helper T cytokines) were tested in all participants. (3) Results: A total of 407 asthma patients (197 normal weight, 92 overweight, and 118 obese) were enrolled. There was a reduction in forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC), FEV1/FVC%, and FEF25–75% in the overweight/obese groups. No difference was found between the study groups in the main allergy characteristics. Leptin levels were higher while adiponectin was lower in asthmatics with obesity. Higher levels of IL-16 were found in overweight/obese asthmatic individuals than in normal-weight individuals. (4) Conclusions: Obesity may have an effect on impaired pulmonary function. While atopic inflammation plays an important role in the onset of asthma, nonatopic inflammation (including leptin and adiponectin) increases the severity of asthma in overweight/obese patients. The significance of different levels of IL-16 between groups needs to be further studied.
Collapse
|
6
|
Experiences of exercise in patients with asthma: qualitative analysis of discussions in a UK asthma online community. BJGP Open 2022; 6:BJGPO.2021.0162. [PMID: 35487580 DOI: 10.3399/bjgpo.2021.0162] [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: 09/06/2021] [Revised: 12/28/2021] [Accepted: 01/31/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Engagement with exercise in adults with asthma is suboptimal. Limited information is available regarding factors affecting engagement with exercise. AIM To explore experiences of exercise and linked unmet needs in adults with asthma. DESIGN & SETTING Qualitative thematic analysis of posts in a UK asthma online community, written between 2015 and 2020. METHOD Posts were identified using keywords searches. Posts in the 'Exercise' topic section were additionally included. Thematic analysis of posts was undertaken. RESULTS 143 relevant posts were analysed. 92 participants were identified through posts (11M, 33F, 48 gender not stated, aged 26-73 years). Emerging themes included: fear of experiencing asthma symptoms during exercise, lack of information about how to deal with symptoms, external barriers, emotional response, and involvement of healthcare providers. Environmental factors, concomitant life stressors, distrust of healthcare professionals and embarrassment of displaying asthma symptoms during exercise were barriers to engagement. Facilitators included experiencing positive health outcomes following exercise and positive discussions regarding exercise with healthcare professionals. Strategies participants developed to enable exercise were warming up, increasing reliever and preventer inhalers when exercising and finding exercises felt as enjoyable. CONCLUSION Future interventions to address fears of exercise-induced physical symptoms, and clear instructions on the use of inhalers when exercising are needed. Exploring patients' attitudes to exercise in clinical consultations, especially in primary care, may be beneficial.
Collapse
|
7
|
Seyni-Boureima R, Zhang Z, Antoine MMLK, Antoine-Frank CD. A review on the anesthetic management of obese patients undergoing surgery. BMC Anesthesiol 2022; 22:98. [PMID: 35382771 PMCID: PMC8985303 DOI: 10.1186/s12871-022-01579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/27/2022] [Indexed: 12/01/2022] Open
Abstract
There has been an observed increase in theprevalence of obesity over the past few decades. The prevalence of anesthesiology related complications is also observed more frequently in obese patients as compared to patients that are not obese. Due to the increased complications that accompany obesity, obese patients are now more often requiring surgical interventions. Therefore, it is important that anesthesiologists be aware of this development and is equipped to manage these patients effectively and appropriately. As a result, this review highlights the effective management of obese patients undergoing surgery focusing on the preoperative, perioperative and postoperative care of these patients.
Collapse
Affiliation(s)
- Rimanatou Seyni-Boureima
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, East Lake Road, 430071, Wuhan, Hubei, China
| | - Zongze Zhang
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, East Lake Road, 430071, Wuhan, Hubei, China.
| | - Malyn M L K Antoine
- Department of Endocrinology, Zhongnan Hospital, Wuhan University, East Lake Road, 430071, Wuhan, Hubei, China
| | - Chrystal D Antoine-Frank
- Department of Anatomical Sciences, St. George's University, True Blue,Grand Anse, West Indies, St. George, Grenada
| |
Collapse
|
8
|
Papamichael MM, Katsardis C, Tsoukalas D, Itsiopoulos C, Erbas B. Plasma lipid biomarkers in relation to BMI, lung function, and airway inflammation in pediatric asthma. Metabolomics 2021; 17:63. [PMID: 34175992 DOI: 10.1007/s11306-021-01811-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There is limited understanding of how plasma fatty acid levels affect pulmonary function in pediatric years. It has been speculated that polyunsaturated fatty acids influence asthma via anti or pro-inflammatory mechanisms. Metabolomics presents a new and promising resource for identifying molecular processes involved in asthma pathology. OBJECTIVES We investigated the relationship of plasma fatty acid metabolites as biomarkers of the 'mild-asthma' phenotype and lung function including airway inflammation in children. METHODS This cross-sectional study involved 64 children (5-12 years, 33 male) with mild-asthma phenotype attending an outpatient pediatric clinic in Athens, Greece. Clinical examination included spirometry (FVC, FEV1, FEV1/FVC, PEF, FEF25-75%) and Fractional exhaled Nitric Oxide (FeNO). Targeted metabolomic profiling was used to quantify plasma fatty acid composition. Associations between lipids and pulmonary function indices were investigated applying linear regression. RESULTS Targeted GC-MS identified 25 unique plasma fatty acids in mild-asthmatic children. Linear regression revealed significant associations between linoleic, oleic, erucic, cis-11-eicosenoic, arachidic acids and FEV1, FVC, FEV1/FVC, PEF, FEF25-75% and FeNO in the overweight/obese group, adjusting for age and sex; and in the normo-weight between stearic and arachidic acids versus FEV1 and FEV1/FVC respectively. No associations were observed for arachidonic, α-linolenic, EPA and DHA. CONCLUSION Metabolomics is a novel science that is useful to discover metabolic signatures specific to disease. Evaluation of fatty acid status could assist clinicians in decision-making about a dietary modification that can be used for personalized nutrition therapies to achieve better asthma control, optimum lung function, and therapeutic response in children.
Collapse
Affiliation(s)
- Maria Michelle Papamichael
- Department of Dietetics, Nutrition & Sport, School of Allied Health, La Trobe University, Melbourne, Australia.
- European Institute of Nutritional Medicine, Rome, Italy.
| | | | | | - Catherine Itsiopoulos
- Department of Dietetics, Nutrition & Sport, School of Allied Health, La Trobe University, Melbourne, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Bircan Erbas
- Department of Public Health, School of Psychology & Public Health, La Trobe University, Melbourne, Australia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
9
|
Ha TW, Jung HU, Kim DJ, Baek EJ, Lee WJ, Lim JE, Kim HK, Kang JO, Oh B. Association Between Environmental Factors and Asthma Using Mendelian Randomization: Increased Effect of Body Mass Index on Adult-Onset Moderate-to-Severe Asthma Subtypes. Front Genet 2021; 12:639905. [PMID: 34093643 PMCID: PMC8172971 DOI: 10.3389/fgene.2021.639905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
Although asthma is one of the most common chronic diseases throughout all age groups, its etiology remains unknown, primarily due to its heterogeneous characteristics. We examined the causal effects of various environmental factors on asthma using Mendelian randomization and determined whether the susceptibility to asthma due to the causal effect of a risk factor differs between asthma subtypes, based on age of onset, severity of asthma, and sex. We performed Mendelian randomization analyses (inverse variance weighted, weighted median, and generalized summary-data-based Mendelian randomization) using UK Biobank data to estimate the causal effects of 69 environmental factors on asthma. Additional sensitivity analyses (MR-Egger regression, Cochran’s Q test, clumping, and reverse Mendelian randomization) were performed to ensure minimal or no pleiotropy. For confirmation, two-sample setting analyses were replicated using BMI SNPs that had been reported by a meta-genome-wide association study in Japanese and European (GIANT) populations and a genome-wide association study in control individuals from the UK Biobank. We found that BMI causally affects the development of asthma and that the adult-onset moderate-to-severe asthma subtype is the most susceptible to causal inference by BMI. Further, it is likely that the female subtype is more susceptible to BMI than males among adult asthma cases. Our findings provide evidence that obesity is a considerable risk factor in asthma patients, particularly in adult-onset moderate-to-severe asthma cases, and that weight loss is beneficial for reducing the burden of asthma.
Collapse
Affiliation(s)
- Tae-Woong Ha
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hae-Un Jung
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Dong Jun Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Eun Ju Baek
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Won Jun Lee
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Ji Eun Lim
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Han Kyul Kim
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Ji-One Kang
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Bermseok Oh
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, South Korea
| |
Collapse
|
10
|
Dias de Castro E, Pinhão S, Paredes S, Cernadas JR, Ribeiro L. Obesity markers in patients with drug allergy and body fat as a predictor. Ann Allergy Asthma Immunol 2021; 127:100-108. [PMID: 33771681 DOI: 10.1016/j.anai.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/13/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Obesity is a chronic low-grade inflammation state associated with several diseases. OBJECTIVE To investigate a potential link between drug allergy and obesity, exploring whether the association depends on the type (immediate vs nonimmediate) or the severity of the reaction. METHODS Anthropometric measurements, bioimpedance, and biochemical analysis, including serum adipokines, were performed in 90 consecutive adult patients studied for suspected drug allergy. Logistic regression models were developed to identify predictors of drug allergy. RESULTS A total of 84 patients completed the diagnostic workup (78.6% women; mean age 39.58 ± 13.3 years). Drug allergy was confirmed in 39 patients and excluded in 45 (controls). Regarding body mass index, 42.2% had normal weight and 55.3% were overweight/obese. A total of 58% of women and 41% of men fulfilled the criteria for central obesity. Patients with drug allergy exhibited considerably higher body mass index, waist and hip circumferences, waist-hip ratio, fat mass, body fat percentage (BFP), trunk fat mass, leptin levels, and leptin-adiponectin ratio than controls. Similar results were obtained in the subgroup with immediate reactions, compared with the nonimmediate or unknown reactions. The higher the BFP and the number of reactions, the greater the odds of drug allergy (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.14 and OR, 2.82; 95% CI, 1.31-6.10, respectively). An immediate reaction was also a predictor of drug allergy (OR, 3.81; 95% CI, 1.30-11.14, P = .02), compared with nonimmediate or unknown reactions. In patients with drug allergy, BFP was a predictor of having an immediate reaction (OR, 1.12; 95% CI, 1.02-1.24, P = .02). CONCLUSION Our study illustrates, for the first time, evidence of a link between obesity and drug allergy, particularly immediate reactions. The BFP emerged as a potential predictor of drug allergy.
Collapse
Affiliation(s)
- Eunice Dias de Castro
- Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal; MedInUP-Center for Drug Discover and Innovative Medicines, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Sílvia Pinhão
- Nutrition Department, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal; Faculty of Food and Nutrition Sciences, University of Porto, Porto, Portugal
| | - Sílvia Paredes
- Public Health and Forensic Sciences and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Josefina R Cernadas
- Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal
| | - Laura Ribeiro
- Public Health and Forensic Sciences and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal; Biomedicine Department, Faculty of Medicine, University of Porto, Porto, Portugal; I3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| |
Collapse
|
11
|
Effect of 8 Weeks of Incremental Aerobic Training on Inflammatory Mediators, Cardiorespiratory Indices, and Functional Capacity in Obese Children With Bronchial Asthma. Pediatr Exerc Sci 2021; 33:23-31. [PMID: 33761464 DOI: 10.1123/pes.2020-0076] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To appraise the effects of incremental aerobic training (IAT) on systemic inflammatory mediators, cardiorespiratory indices, and functional capacity in obese children with bronchial asthma. METHODS This study included 30 children with asthma (age = 8-16 y) allocated randomly into either the control group (n = 15; received the traditional pulmonary rehabilitation program) or IAT group (n = 15; engaged in 8 weeks of IAT in addition to the traditional pulmonary rehabilitation program). The systemic inflammatory mediators (high-sensitivity C-reactive protein and interleukin-6), cardiorespiratory indices (peak oxygen uptake, minute ventilation, maximum heart rate, heart rate recovery at 1 min after exercises, and oxygen pulse), and functional capacity (represented by 6-min walk test) were analyzed pretreatment and posttreatment. RESULTS A significant reduction in the level of high-sensitivity C-reactive protein and interleukin-6 and increase in peak oxygen uptake, minute ventilation, maximum heart rate, and heart rate recovery at 1 minute after exercises was observed among the IAT group as compared with the control group. In addition, the IAT group covered a longer distance in the 6-minute walk test than the control group, suggesting favorable functional capacity. CONCLUSION The study results imply that IAT has the potential to improve the inflammatory profile, cardiorespiratory fitness, and functional capacity of obese children with bronchial asthma.
Collapse
|
12
|
Hossain N, Arhi C, Borg CM. Is Bariatric Surgery Better than Nonsurgical Weight Loss for Improving Asthma Control? A Systematic Review. Obes Surg 2021; 31:1810-1832. [PMID: 33590422 DOI: 10.1007/s11695-021-05255-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 01/01/2023]
Abstract
Obesity is associated with increased severity of asthma. Bariatric surgery can be effective in weight loss and improvement in asthma. Two reviewers conducted a systematic review using search terms: 'weight loss', 'bariatric surgery', and 'asthma'. Adult studies including all bariatric procedures and nonsurgical weight loss regimes were included. Thirty-nine studies, including twenty-six bariatric studies and thirteen nonsurgical studies, were found. No study directly compared bariatric surgery to nonsurgical techniques. Bariatric surgery offered greater weight loss (22-36%) than nonsurgical programmes (4.1-14.2%) and more consistently improved medication use, airway hyperresponsiveness, hospitalisation rate or ED attendance and lung function, while change in inflammatory markers were variable. Bariatric surgery appears to be superior in treating asthma; however, further study on surgery for both mild and severe asthma is required.
Collapse
Affiliation(s)
- Naveed Hossain
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK. .,Department of General Surgery, Whittington Hospital, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK.
| | - Chanpreet Arhi
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
| | - Cynthia-Michelle Borg
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
| |
Collapse
|
13
|
RNA-Seq Expression Analysis of Chronic Asthmatic Mice with Bu-Shen-Yi-Qi Formula Treatment and Prediction of Regulated Gene Targets of Anti-Airway Remodeling. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3524571. [PMID: 33531915 PMCID: PMC7834776 DOI: 10.1155/2021/3524571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/03/2020] [Accepted: 01/07/2021] [Indexed: 12/17/2022]
Abstract
Airway remodeling is one of the typical pathological characteristics of asthma, while the structural changes of the airways in asthma are complex, which impedes the development of novel asthma targeted therapy. Our previous study had shown that Bu-Shen-Yi-Qi formula (BSYQF) could ameliorate airway remodeling in chronic asthmatic mice by modulating airway inflammation and oxidative stress in the lung. In this study, we analysed the lung transcriptome of control mice and asthmatic mouse model with/without BSYQF treatment. Using RNA-sequencing (RNA-seq) analysis, we found that 264/1746 (15.1%) of transcripts showing abnormal expression in asthmatic mice were reverted back to completely or partially normal levels by BSYQF treatment. Additionally, based on previous results, we identified 21 differential expression genes (DEGs) with fold changes (FC) > (±) 2.0 related to inflammatory, oxidative stress, mitochondria, PI3K/AKT, and MAPK signal pathways which may play important roles in the mechanism of the anti-remodeling effect of BSYQF treatment. Through inputting 21 DEGs into the IPA database to construct a gene network, we inferred Adipoq, SPP1, and TNC which were located at critical nodes in the network may be key regulators of BSYQF's anti-remodeling effect. In addition, the quantitative real-time polymerase chain reaction (qRT-PCR) result for the selected four DEGs matched those of the RNA-seq analysis. Our results provide a preliminary clue to the molecular mechanism of the anti-remodeling effect of BSYQF in asthma.
Collapse
|
14
|
Fedele D, De Francesco A, Riso S, Collo A. Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: An overview. Nutrition 2021; 81:111016. [PMID: 33059127 PMCID: PMC7832575 DOI: 10.1016/j.nut.2020.111016] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023]
Abstract
The world is currently facing the coronavirus disease (COVID-19) pandemic which places great pressure on health care systems and workers, often presents with severe clinical features, and sometimes requires admission into intensive care units. Derangements in nutritional status, both for obesity and malnutrition, are relevant for the clinical outcome in acute illness. Systemic inflammation, immune system impairment, sarcopenia, and preexisting associated conditions, such as respiratory, cardiovascular, and metabolic diseases related to obesity, could act as crucial factors linking nutritional status and the course and outcome of COVID-19. Nevertheless, vitamins and trace elements play an essential role in modulating immune response and inflammatory status. Overall, evaluation of the patient's nutritional status is not negligible for its implications on susceptibility, course, severity, and responsiveness to therapies, in order to perform a tailored nutritional intervention as an integral part of the treatment of patients with COVID-19. The aim of this study was to review the current data on the relevance of nutritional status, including trace elements and vitamin status, in influencing the course and outcome of the disease 3 mo after the World Health Organization's declaration of COVID-19 as a pandemic.
Collapse
Affiliation(s)
- Debora Fedele
- Dietetic and Clinical Nutrition Unit, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy.
| | - Antonella De Francesco
- Dietetic and Clinical Nutrition Unit, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, Novara, Italy
| | - Alessandro Collo
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, Novara, Italy
| |
Collapse
|
15
|
Vieira CP, de Oliveira LP, Da Silva MB, Majolli Andre D, Tavares EBG, Pimentel ER, Antunes E. Role of metalloproteinases and TNF-α in obesity-associated asthma in mice. Life Sci 2020; 259:118191. [PMID: 32777302 DOI: 10.1016/j.lfs.2020.118191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
Numerous population studies conducted worldwide indicate that the prevalence of asthma is higher in obese versus lean individuals. It has been reported that sensitized lean mice has a better recovery of lung inflammation in asthma. Extracellular matrix (ECM) plays an essential role in the structural support of the lungs regulating the airways diameter, thus preventing its collapse during expiration. ECM renewal by metalloproteinase (MMPs) enzymes is critical for pulmonary biology. There seems to be an imbalance of MMPs activity in asthma and obesity, which can impair the lung remodeling process. In this study, we characterized the pulmonary ECM of obese and lean mice, non-sensitized and sensitized with ovalbumin (OVA). Pharmacological intervention was performed by using anti-TNF-α, and MMP-8 and MMP-9 inhibitors in obese and lean sensitized mice. Activity of MMPs was assessed by gelatinase electrophorese, western blotting and zymogram in situ. Unbalance of MMP-2, MMP-8, MMP-9 and MMP-12 was detected in lung tissue of OVA-sensitized obese mice, which was accompanied by high degradation, corroborating an excessive deposition of types I and III collagen in pulmonary matrix of obese animals. Inhibitions of TNF-α and MMP-9 reduced this MMP imbalance, clearly suggesting a positive effect on pulmonary ECM. Obese and lean mice presented diverse phenotype of asthma regarding the ECM compounds and the inhibition of MMPs pathway could be a good alternative to regulate the activity in ECM lungs of asthmatic obese individuals.
Collapse
Affiliation(s)
- Cristiano Pedrozo Vieira
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | - Leticia Prado de Oliveira
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas, 13083-863 CP 6109, Campinas, Sao Paulo, Brazil
| | - Mariana Bombardi Da Silva
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas, 13083-863 CP 6109, Campinas, Sao Paulo, Brazil
| | - Diana Majolli Andre
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Edith Bastos Gandra Tavares
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Edson Rosa Pimentel
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas, 13083-863 CP 6109, Campinas, Sao Paulo, Brazil
| | - Edson Antunes
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| |
Collapse
|
16
|
Boutou AK, Daniil Z, Pitsiou G, Papakosta D, Kioumis I, Stanopoulos I. Cardiopulmonary exercise testing in patients with asthma: What is its clinical value? Respir Med 2020; 167:105953. [PMID: 32280032 DOI: 10.1016/j.rmed.2020.105953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 01/28/2023]
Abstract
Asthma is one of the most common respiratory disorders, characterized by fully or largely reversible airflow limitation. Asthma symptoms can be triggered or magnified during exertion, while physical activity limitation is often present among asthmatic patients. Cardiopulmonary exercise testing (CPET) is a dynamic, non-invasive technique which provides a thorough assessment of exercise physiology, involving the integrative assessment of cardiopulmonary, neuromuscular and metabolic responses during exercise. This review summarizes current evidence regarding the utility of CPET in the diagnostic work-up, functional evaluation and therapeutic intervention among patients with asthma, highlighting its potential role for thorough patient assessment and physician clinical desicion-making.
Collapse
Affiliation(s)
- Afroditi K Boutou
- Department of Respiratory Medicine, "G. Papanikolaou" Hospital, Thessaloniki, Greece.
| | - Zoi Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Georgia Pitsiou
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Papakosta
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
17
|
Kirketerp-Møller N, Bayarri-Olmos R, Krogfelt KA, Garred P. C1q/TNF-Related Protein 6 Is a Pattern Recognition Molecule That Recruits Collectin-11 from the Complement System to Ligands. THE JOURNAL OF IMMUNOLOGY 2020; 204:1598-1606. [PMID: 32041782 DOI: 10.4049/jimmunol.1901316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022]
Abstract
C1q/TNF-related protein (CTRP) 6 is a member of the CTRP protein family associated with the regulation of cellular and endocrine processes. CTRP6 contains collagen and globular structures, resembling the pattern recognition molecules (PRMs) of the classical and lectin complement pathways. We expressed human CTRP6 in Chinese hamster ovary cells and investigated the binding to different putative ligands (acetylated BSA [AcBSA], zymosan, mannan, and LPS from Escherichia coli and Salmonella as well as to the monosaccharides l-fucose, d-mannose, N-acetylglucosamine, N-acetylgalactosamine, and galactose). Furthermore, we investigated the binding of CTRP6 to various Gram-negative bacteria as well as PRMs and enzymes of the lectin complement pathway. We found that CTRP6 bound to AcBSA and to a lesser extent to zymosan. Using EDTA as chelating agent, we observed an increased binding to AcBSA, zymosan and the two strains of LPS. We detected no binding to mannan and BSA. We identified l-fucose as a ligand for CTRP6 and that it bound to certain enteroaggregative Escherichia coli and Pseudomonas aeruginosa isolates, whereas to other bacterial isolates, no binding was observed. CTRP6 did not appear to interact directly with the activating enzymes of the lectin pathway; however, we could show the specific recruitment of collectin-11 and subsequent initiation of the complement cascade through deposition of C4. In conclusion, our results demonstrate the binding of CTRP6 to a variety of microbial and endogenous ligands identifying CTRP6 as a novel human lectin and PRM of importance for complement recognition and innate immunity.
Collapse
Affiliation(s)
- Nikolaj Kirketerp-Møller
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, 2200 Copenhagen, Denmark
| | - Rafael Bayarri-Olmos
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, 2200 Copenhagen, Denmark
| | - Karen Angeliki Krogfelt
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, 2300 Copenhagen, Denmark; and.,Department of Science and Environment, Molecular and Medical Biology, Roskilde University, 4000 Roskilde, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Copenhagen University Hospital, 2200 Copenhagen, Denmark;
| |
Collapse
|
18
|
Copley SJ, Jones LC, Soneji ND, Cousins J, Edey A, Ahmed AR, Wells AU. Lung Parenchymal and Tracheal CT Morphology: Evaluation before and after Bariatric Surgery. Radiology 2020; 294:669-675. [DOI: 10.1148/radiol.2020191060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Park S, Jung SY, Kwon JW. Sex differences in the association between asthma incidence and modifiable risk factors in Korean middle-aged and older adults: NHIS-HEALS 10-year cohort. BMC Pulm Med 2019; 19:248. [PMID: 31842862 PMCID: PMC6916451 DOI: 10.1186/s12890-019-1023-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 12/09/2019] [Indexed: 01/14/2023] Open
Abstract
Background This study investigated the sex-specific incidence of asthma and the effects of modifiable risk factors, particularly obesity, on asthma incidence among middle-aged and older individuals in Korea. Methods We used data from the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS), which includes health examinees aged 40–79 years in 2002–2003. In total, 459,529 participants with baseline anthropometric measurements were followed-up for 10 years and the development of asthma was evaluated (2004–2013). For subgroup analysis, 246,019 participants who had body mass index (BMI) and waist circumference (WC) measurements taken in 2008–2009 were included in the analysis of the asthma incidence for 2010–2013. Factors associated with asthma were analysed using Cox proportional hazard models. Results The cohort comprised 4,248,813 (men, 2,358,541; women, 1,890,272) person-years of follow-up for 2004–2013. The asthma incidence was 10.58 and 15.03 per 1000 person-years for men and women, respectively. Asthma incidence increased with age, notably so in men. Obesity based on the baseline BMI was significantly associated with asthma development in both sexes (men, HR = 1.23, 95% confidence interval (CI) = 1.13–1.34; women, HR = 1.40 95% CI = 1.32–1.48). High WC was also related to asthma incidence in both sexes with statistical significance (men, HR = 1.34, 95% CI = 1.16–1.57; women, HR = 1.19 95% CI = 1.03–1.37). Analysis of the combined effects of BMI and WC showed that men had a higher asthma risk in the group with both general obesity and abdominal obesity than in the group with non-abdominal obesity and normal BMI. However, obese women had a higher risk of asthma regardless of abdominal obesity. Similarly, smoking was associated with asthma in both sexes but drinking and physical activity showed different associations between the sexes. Conclusions Our results revealed that asthma incidence was substantially high at old age and lifestyle factors were associated with asthma development. Practical strategies including weight control and healthy lifestyle modification are required to prevent asthma in older people.
Collapse
Affiliation(s)
- Susan Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, South Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, South Korea.
| |
Collapse
|
20
|
Nieto-Fontarigo JJ, González-Barcala FJ, San José E, Arias P, Nogueira M, Salgado FJ. CD26 and Asthma: a Comprehensive Review. Clin Rev Allergy Immunol 2019; 56:139-160. [PMID: 27561663 PMCID: PMC7090975 DOI: 10.1007/s12016-016-8578-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a heterogeneous and chronic inflammatory family of disorders of the airways with increasing prevalence that results in recurrent and reversible bronchial obstruction and expiratory airflow limitation. These diseases arise from the interaction between environmental and genetic factors, which collaborate to cause increased susceptibility and severity. Many asthma susceptibility genes are linked to the immune system or encode enzymes like metalloproteases (e.g., ADAM-33) or serine proteases. The S9 family of serine proteases (prolyl oligopeptidases) is capable to process peptide bonds adjacent to proline, a kind of cleavage-resistant peptide bonds present in many growth factors, chemokines or cytokines that are important for asthma. Curiously, two serine proteases within the S9 family encoded by genes located on chromosome 2 appear to have a role in asthma: CD26/dipeptidyl peptidase 4 (DPP4) and DPP10. The aim of this review is to summarize the current knowledge about CD26 and to provide a structured overview of the numerous functions and implications that this versatile enzyme could have in this disease, especially after the detection of some secondary effects (e.g., viral nasopharyngitis) in type II diabetes mellitus patients (a subset with a certain risk of developing obesity-related asthma) upon CD26 inhibitory therapy.
Collapse
Affiliation(s)
- Juan J Nieto-Fontarigo
- Department of Biochemistry and Molecular Biology, Faculty of Biology-Biological Research Centre (CIBUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Francisco J González-Barcala
- Department of Biochemistry and Molecular Biology, Faculty of Biology-Biological Research Centre (CIBUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Respiratory Department, Clinic University Hospital (CHUS), Santiago de Compostela, Spain
| | - Esther San José
- Clinical Analysis Service, Clinic University Hospital (CHUS), Santiago de Compostela, Spain
| | - Pilar Arias
- Department of Biochemistry and Molecular Biology, Faculty of Biology-Biological Research Centre (CIBUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Montserrat Nogueira
- Department of Biochemistry and Molecular Biology, Faculty of Biology-Biological Research Centre (CIBUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Francisco J Salgado
- Department of Biochemistry and Molecular Biology, Faculty of Biology-Biological Research Centre (CIBUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain.
| |
Collapse
|
21
|
Amarsaikhan N, Tsoggerel A, Hug C, Templeton SP. The Metabolic Cytokine Adiponectin Inhibits Inflammatory Lung Pathology in Invasive Aspergillosis. THE JOURNAL OF IMMUNOLOGY 2019; 203:956-963. [PMID: 31253725 DOI: 10.4049/jimmunol.1900174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
Systemic immunity and metabolism are coregulated by soluble factors, including the insulin-regulating adipose tissue cytokine adiponectin. How these factors impact detrimental inflammatory responses during fungal infection remains unknown. In this study, we observed that mortality, fungal burden, and tissue histopathology were increased in adiponectin-deficient mice in a neutropenic model of invasive aspergillosis. Lung RNA sequencing, quantitative RT-PCR, and subsequent pathway analysis demonstrated activation of inflammatory cytokine pathways with upstream regulation by IL-1 and TNF in adiponectin-deficient mice with decreased/inhibited anti-inflammatory genes/pathways, suggesting broad cytokine-mediated pathology along with ineffective fungal clearance. Quantitative RT-PCR analysis confirmed increased transcription of IL-1a, IL-6, IL-12b, IL-17A/F, and TNF in adiponectin-deficient mice at early time points postinfection, with a specific increase in intracellular TNF in alveolar macrophages. Although eosinophil recruitment and activation were increased in adiponectin-deficient mice, mortality was delayed, but not decreased, in mice deficient in both adiponectin and eosinophils. Interestingly, neutrophil depletion was required for increased inflammation in adiponectin-deficient mice in response to swollen/fixed conidia, suggesting that immune suppression enhances detrimental inflammation, whereas invasive fungal growth is dispensable. Our results suggest that adiponectin inhibits excessive lung inflammation in invasive aspergillosis. Our study has therefore identified the adiponectin pathway as a potential source for novel therapeutics in immune-compromised patients with detrimental immunity to invasive fungal infection.
Collapse
Affiliation(s)
- Nansalmaa Amarsaikhan
- Department of Microbiology and Immunology, Indiana University School of Medicine-Terre Haute, Terre Haute, IN 47809; and
| | - Angar Tsoggerel
- Department of Microbiology and Immunology, Indiana University School of Medicine-Terre Haute, Terre Haute, IN 47809; and
| | | | - Steven P Templeton
- Department of Microbiology and Immunology, Indiana University School of Medicine-Terre Haute, Terre Haute, IN 47809; and
| |
Collapse
|
22
|
Ma M, Percopo CM, Sturdevant DE, Sek AC, Komarow HD, Rosenberg HF. Cytokine Diversity in Human Peripheral Blood Eosinophils: Profound Variability of IL-16. THE JOURNAL OF IMMUNOLOGY 2019; 203:520-531. [PMID: 31182481 DOI: 10.4049/jimmunol.1900101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/20/2019] [Indexed: 01/07/2023]
Abstract
Eosinophilic leukocytes develop in the bone marrow and migrate from peripheral blood to tissues, where they maintain homeostasis and promote dysfunction via release of preformed immunomodulatory mediators. In this study, we explore human eosinophil heterogeneity with a specific focus on naturally occurring variations in cytokine content. We found that human eosinophil-associated cytokines varied on a continuum from minimally (coefficient of variation [CV] ≤ 50%) to moderately variable (50% < CV ≤ 90%). Within the moderately variable group, we detected immunoreactive IL-27 (953 ± 504 pg/mg lysate), a mediator not previously associated with human eosinophils. However, our major finding was the distinct and profound variability of eosinophil-associated IL-16 (CV = 103%). Interestingly, eosinophil IL-16 content correlated directly with body mass index (R 2 = 0.60, ***p < 0.0001) in one donor subset. We found no direct correlation between eosinophil IL-16 content and donor age, sex, total leukocytes, lymphocytes, or eosinophils (cells per microliter), nor was there any relationship between IL-16 content and the characterized -295T/C IL-16 promoter polymorphism. Likewise, although eosinophil IL-1β, IL-1α, and IL-6 levels correlated with one another, there was no direct association between any of these cytokines and eosinophil IL-16 content. Finally, a moderate increase in total dietary fat resulted in a 2.7-fold reduction in eosinophil IL-16 content among C57BL/6-IL5tg mice. Overall, these results suggest that relationships between energy metabolism, eosinophils, and IL-16 content are not direct or straightforward. Nonetheless, given our current understanding of the connections between asthma and obesity, these findings suggest important eosinophil-focused directions for further exploration.
Collapse
Affiliation(s)
- Michelle Ma
- Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Caroline M Percopo
- Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Daniel E Sturdevant
- Genomics Unit, Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840; and
| | - Albert C Sek
- Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Hirsh D Komarow
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Helene F Rosenberg
- Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892;
| |
Collapse
|
23
|
Ross MK, Romero T, Sim MS, Szilagyi PG. Obese- and allergic-related asthma phenotypes among children across the United States. J Asthma 2019; 56:512-521. [PMID: 29672178 PMCID: PMC6195487 DOI: 10.1080/02770903.2018.1466317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Pediatric asthma is heterogeneous with phenotypes that reflect differing underlying inflammation and pathophysiology. Little is known about the national prevalence of certain obesity- and allergy-related asthma phenotypes or associated characteristics. We therefore assessed the national prevalence, risk factors, and caregiver-reported severity of four asthma phenotypes: not-allergic-not-obese, allergic-not-obese, obese-not-allergic, and allergic-and-obese. METHODS We analyzed data from the 2007-2008 National Survey of Children's Health (NSCH) of 10-17 year-olds with caregiver-reported asthma. We described sociodemographic and health risk factors of each phenotype and then applied logistic and ordinal regression models to identify associated risk factors and level of severity of the phenotypes. RESULTS Among 4427 children with asthma in this NSCH cohort, the association between race and phenotype was statistically significant (p < 0.0001); white children with asthma were most likely to have allergic-not-obese asthma while black and Hispanic children with asthma were most likely to have the obese-nonallergic phenotype (p < 0.001). Attention-deficit disorder/attention-deficit hyperactivity disorder was more likely to be present in allergic-not-obese children (odds ratio (OR) 1.50, confidence interval (CI) 1.14-1.98, p = 0.004). The phenotype with the highest risk for more severe compared to mild asthma was the obese-and-allergic asthma phenotype (OR 3.34, CI 2.23-5.01, p < 0.001). CONCLUSIONS Allergic-not-obese asthma comprised half of our studied asthma phenotypes, while obesity-related asthma (with or without allergic components) comprised one-fifth of asthma phenotypes in this cohort representative of the US population. Children with both obese and allergic asthma are most likely to have severe asthma. Future management of childhood asthma might consider more tailoring of treatment and management plans based upon different childhood asthma phenotypes.
Collapse
Affiliation(s)
- Mindy K Ross
- a University of California, Pediatrics, Pediatric Pulmonology , Los Angeles , California , United States
| | - Tahmineh Romero
- b University of California , Department of Medicine, Statistics Core , Los Angeles , California , United States
| | - Myung S Sim
- b University of California , Department of Medicine, Statistics Core , Los Angeles , California , United States
| | - Peter G Szilagyi
- a University of California, Pediatrics, Pediatric Pulmonology , Los Angeles , California , United States
| |
Collapse
|
24
|
Kytikova OY, Antonyuk MV, Gvozdenko TA, Novgorodtseva TР. Metabolic aspects of the relationship of asthma and obesity. OBESITY AND METABOLISM 2019. [DOI: 10.14341/omet9578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Asthma and obesity are serious medical and social world problems, and their combined course is characterized by a decrease in the quality of life, an increase in the frequency and duration of hospitalization. The present review summarizes the current views on the mechanisms of formation of asthma phenotype combined with obesity, role of leptin and adiponectin imbalance in the development of systemic inflammation in obesity in the pathophysiology of asthma, its interrelations with metabolic syndrome. We present data that shows that syndrome is closely related not only to the debut of asthma, but also to a decrease in its control. Along with obesity, the role of other components of metabolic syndrome, in particular insulin resistance, as a predictor of asthma development is considered. Insulin resistance may be the most likely factor in the relationship between asthma and obesity, independent of other components of the metabolic syndrome. Insulin resistance associated with obesity can lead to disruption of nitric oxide synthesis. We reveal common mechanism of metabolic disorders of nitric oxide and arginine in metabolic syndrome and asthma and show that insulin resistance treatment can be therapeutically useful in patients with asthma in combination with obesity.
Collapse
|
25
|
Park JS, Son JH, Park CS, Chang HS. Clinical Implications of Single Nucleotide Polymorphisms in Diagnosis of Asthma and its Subtypes. Yonsei Med J 2019; 60:1-9. [PMID: 30554485 PMCID: PMC6298887 DOI: 10.3349/ymj.2019.60.1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/11/2018] [Accepted: 09/15/2018] [Indexed: 11/27/2022] Open
Abstract
For the past three decades, a large number of genetic studies have been performed to examine genetic variants associated with asthma and its subtypes in hopes of gaining better understanding of the mechanisms underlying disease pathology and to identify genetic biomarkers predictive of disease outcomes. Various methods have been used to achieve these objectives, including linkage analysis, candidate gene polymorphism analysis, and genome-wide association studies (GWAS); however, the degree to which genetic variants contribute to asthma pathogenesis has proven to be much less significant than originally expected. Subsequent application of GWAS to well-defined phenotypes, such as occupational asthma and non-steroidal anti-inflammatory drugexacerbated respiratory diseases, has overcome some of these limitations, although with only partial success. Recently, a combinatorial analysis of single nucleotide polymorphisms (SNPs) identified by GWAS has been used to develop sets of genetic markers able to more accurately stratify asthma subtypes. In this review, we discuss the implications of the identified SNPs in diagnosis of asthma and its subtypes and the progress being made in combinatorial analysis of genetic variants.
Collapse
Affiliation(s)
- Jong Sook Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Hye Son
- Department of Interdisciplinary Program in Biomedical Science, Graduate School, Soonchunhyang University, Bucheon, Korea
| | - Choon Sik Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hun Soo Chang
- Department of Interdisciplinary Program in Biomedical Science, Graduate School, Soonchunhyang University, Bucheon, Korea.
| |
Collapse
|
26
|
Upala S, Thavaraputta S, Sanguankeo A. Improvement in pulmonary function in asthmatic patients after bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis 2018; 15:794-803. [PMID: 30709751 DOI: 10.1016/j.soard.2018.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/24/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association between obesity and asthma is well-established. Some evidence suggests that weight loss may improve asthma outcomes; however, the effect of bariatric surgery on pulmonary function in asthmatic patients remains inconclusive. This systematic review and meta-analysis of observational studies assessed the impact of bariatric surgery on patients with asthma. OBJECTIVES To investigate the effect of bariatric surgery on pulmonary function in patients with asthma. SETTING Systematic review and meta-analysis of published studies. METHODS A comprehensive search of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted. The sole inclusion criterion was published studies that evaluated the effects of bariatric surgery on pulmonary function in asthmatic patients. The outcomes of interest were forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC. A meta-analysis of studies comparing pre- and postsurgery spirometric measures, and of studies comparing surgery and control groups was performed. RESULTS From 25 full-text articles, 6 observational studies met the inclusion criteria and were included in this meta-analysis based on the random-effects model. A significant increase in FEV1 and FVC was observed after bariatric surgery among studies without a control group (mean difference: .21 L, 95% confidence interval: .07-.35 for FEV1, and mean difference: .34 L, 95% confidence interval: .14-.53 for FVC). There was no significant change in FEV1/FVC after bariatric surgery compared with control. CONCLUSIONS FEV1 and FVC were both found to be significantly improved after bariatric surgery; however, no significant postsurgical improvement was observed for FEV1/FVC.
Collapse
Affiliation(s)
- Sikarin Upala
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Subhanudh Thavaraputta
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Anawin Sanguankeo
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
27
|
Wu Y, Yue J, Wu J, Zhou W, Li D, Ding K, Barnie PA, Xu X, Xu H, Shi W. Obesity May Provide Pro-ILC3 Development Inflammatory Environment in Asthmatic Children. J Immunol Res 2018; 2018:1628620. [PMID: 30622974 PMCID: PMC6304845 DOI: 10.1155/2018/1628620] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/27/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023] Open
Abstract
The prevalence of obesity in children has dramatically increased in the last few decades, and obesity has also emerged as an important risk factor for asthma. Innate mechanisms have been shown to be involved in both diseases, particularly through the recently described innate lymphoid cells (ILCs), in which ILC3s have been linked to obesity both in human and in murine models. The aim of this study was to explore whether being overweight in asthmatic children was associated with elevated circulating ILC3 or elevated messenger RNA (mRNA) levels of RORC, IL-17A, and IL-22. Our results showed significantly elevated ILC3 frequencies in overweight asthmatic children compared with nonoverweight controls based on the detection of Lin+CD127+IL-23R+ cells by flow cytometry. Moreover, elevated ILC3 frequencies positively correlated with the mRNA expression of RORC which has been identified as a transcription factor of ILC3s. The relative mRNA expression level of IL-17A was also upregulated in overweight compared to nonoverweight children, as was the relative mRNA level of IL-22. However, there were no correlations between ILC3 frequencies or the expressions of RORC, IL-17A, and IL-22 and asthma severity. These results suggested that childhood obesity is an independent factor that is associated with an elevated frequency of circulating ILC3s and higher expressions of RORC, IL-22, and IL-17A.
Collapse
Affiliation(s)
- Yumin Wu
- Department of Laboratory Medicine, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Jiawei Yue
- Department of Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Juncheng Wu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Wei Zhou
- Department of Laboratory Medicine, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Dapeng Li
- Department of Orthopaedics, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu Province 212001, China
| | - Kai Ding
- Department of Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Prince Amoah Barnie
- Department of Biomedical Science, School of Allied Health Sciences, University of Cape Coast, Ghana
| | - Xu Xu
- Department of Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Huaxi Xu
- Department of Immunology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Weifeng Shi
- Department of Laboratory Medicine, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| |
Collapse
|
28
|
Liu Y, Zheng J, Zhang HP, Zhang X, Wang L, Wood L, Wang G. Obesity-Associated Metabolic Signatures Correlate to Clinical and Inflammatory Profiles of Asthma: A Pilot Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:628-647. [PMID: 30306746 PMCID: PMC6182193 DOI: 10.4168/aair.2018.10.6.628] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/27/2018] [Accepted: 06/01/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE Obesity is associated with metabolic dysregulation, but the underlying metabolic signatures involving clinical and inflammatory profiles of obese asthma are largely unexplored. We aimed at identifying the metabolic signatures of obese asthma. METHODS Eligible subjects with obese (n = 11) and lean (n = 22) asthma underwent body composition and clinical assessment, sputum induction, and blood sampling. Sputum supernatant was assessed for interleukin (IL)-1β, -4, -5, -6, -13, and tumor necrosis factor (TNF)-α, and serum was detected for leptin, adiponectin and C-reactive protein. Untargeted gas chromatography time-of-flight mass spectrometry (GC-TOF-MS)-based metabolic profiles in sputum, serum and peripheral blood monocular cells (PBMCs) were analyzed by orthogonal projections to latent structures-discriminate analysis (OPLS-DA) and pathway topology enrichment analysis. The differential metabolites were further validated by correlation analysis with body composition, and clinical and inflammatory profiles. RESULTS Body composition, asthma control, and the levels of IL-1β, -4, -13, leptin and adiponectin in obese asthmatics were significantly different from those in lean asthmatics. OPLS-DA analysis revealed 28 differential metabolites that distinguished obese from lean asthmatic subjects. The validation analysis identified 18 potential metabolic signatures (11 in sputum, 4 in serum and 2 in PBMCs) of obese asthmatics. Pathway topology enrichment analysis revealed that cyanoamino acid metabolism, caffeine metabolism, alanine, aspartate and glutamate metabolism, phenylalanine, tyrosine and tryptophan biosynthesis, pentose phosphate pathway in sputum, and glyoxylate and dicarboxylate metabolism, glycerolipid metabolism and pentose phosphate pathway in serum are suggested to be significant pathways related to obese asthma. CONCLUSIONS GC-TOF-MS-based metabolomics indicates obese asthma is characterized by a metabolic profile different from lean asthma. The potential metabolic signatures indicated novel immune-metabolic mechanisms in obese asthma with providing more phenotypic and therapeutic implications, which needs further replication and validation.
Collapse
Affiliation(s)
- Ying Liu
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zheng
- Department of Integrated Traditional Chinese and Western Medicine, Xinqiao Hospital, Third Military University, Chongqing, China
| | - Hong Ping Zhang
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Zhang
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Wang
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lisa Wood
- Center for Asthma and Respiratory Diseases, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - Gang Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
29
|
Gemicioglu B, Bayram H, Cimrin A, Abadoglu O, Cilli A, Uzaslan E, Gunen H, Akyildiz L, Suerdem M, Ozlu T, Misirligil Z. Asthma control and adherence in newly diagnosed young and elderly adult patients with asthma in Turkey. J Asthma 2018; 56:553-561. [PMID: 29714602 DOI: 10.1080/02770903.2018.1471707] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study aimed to evaluate the factors that affect asthma control and adherence to treatment in newly diagnosed elderly asthmatics in Turkey compared with younger patients. METHODS This real-life prospective observational cohort study was conducted at 136 centers. A web-based questionnaire was administered to the patients who were followed up for 12 months. RESULTS Analysis included 1037 young adult asthma patients (age <65 years) and 79 elderly asthma patients (age ≥65 years). The percentage of patients with total control in the elderly and young groups were 33.9% and 37.1% at visit 1, 20.0% and 42.1% (p = 0.012) at visit 2, and 50.0% and 49.8% at visit 3, respectively. Adherence to treatment was similar for both groups. Visit compliance was better in the elderly group than in the young group at visit 1 (72.2% vs. 60.8%, p = 0.045), visit 2 (51.9% vs. 34.9%, p = 0.002), and visit 3 (32.9% vs. 19.4%, p = 0.004). Adherence to treatment increased with asthma control in both groups (both p < 0.001) but decreased with the presence of gastritis/ulcer, gastroesophageal reflux, and coronary artery disease in the elderly. CONCLUSIONS Asthma control and adherence to treatment were similar for the elderly and young asthma patients, though the follow-up rate was lower in young patients. The presence of gastritis/ulcer, gastroesophageal reflux and coronary artery disease had negative impacts on the adherence to treatment in elderly adult patients.
Collapse
Affiliation(s)
- Bilun Gemicioglu
- a Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Hasan Bayram
- b Department of Pulmonary Diseases, Koç University , Medical School
| | - Arif Cimrin
- c Department of Pulmonary Diseases, Faculty of Medicine , Dokuz Eylul University , Izmir , Turkey
| | - Oznur Abadoglu
- d Department of Pulmonary Diseases, Faculty of Medicine , Cumhuriyet University , Sivas , Turkey
| | - Aykut Cilli
- e Department of Pulmonary Diseases, Faculty of Medicine , Akdeniz University , Antalya , Turkey
| | - Esra Uzaslan
- f Department of Pulmonary Diseases, Faculty of Medicine , Uludag University , Bursa , Turkey
| | - Hakan Gunen
- g Department of Pulmonary Diseases , Sureyyapasa Pulmonary Diseases Hospital and Research Center , Istanbul , Turkey
| | - Levent Akyildiz
- h Department of Pulmonary Diseases , Memorial Dicle Hospital , Diyarbakir , Turkey
| | - Mecit Suerdem
- i Department of Pulmonary Diseases, Faculty of Medicine , Selcuk University , Konya , Turkey
| | - Tevfik Ozlu
- j Department of Pulmonary Diseases, Faculty of Medicine , Karadeniz Teknik University , Trabzon , Turkey
| | - Zeynep Misirligil
- k Department of Pulmonary Diseases, Faculty of Medicine , Ankara University , Ankara , Turkey
| |
Collapse
|
30
|
Sharma N, Akkoyunlu M, Rabin RL. Macrophages-common culprit in obesity and asthma. Allergy 2018; 73:1196-1205. [PMID: 29178573 DOI: 10.1111/all.13369] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 12/29/2022]
Abstract
Macrophages are essential innate immune cells that also regulate local metabolism. Endogenous or exogenous stimuli may polarize macrophages toward phenotypes that serve distinct innate immunological metabolic functions. IFN-γ or lipopolysaccharide (LPS) polarizes macrophages toward the M1, or "classically activated" phenotype that participates in defense against intracellular pathogens. IL-4, IL-13, or chitin polarizes macrophages toward the M2, or "alternatively activated" phenotype, which defends against multicellular nematodes and fungi. As macrophages polarize in local environments, M1 and M2 macrophages may coexist in different organs and may differentially affect asthma and obesity, two comorbid diseases where polarized macrophages contribute to their pathogenesis. While M1 macrophages are considered beneficial in asthma and contribute to the pathology of obesity, M2 macrophages contribute to the pathology of asthma, but limit metabolic syndrome associated with obesity. Here, we discuss the roles for M1 and M2 macrophages in asthma and obesity, and propose a model by which M1-mediated inflammation in adipose tissue enhances M2-mediated inflammation in the asthmatic lung.
Collapse
Affiliation(s)
- N. Sharma
- Division of Bacterial, Parasitic and Allergenic Products Center for Biologics Evaluation and Research Office of Vaccines Research and Review U.S. Food and Drug Administration Silver Spring MD USA
| | - M. Akkoyunlu
- Division of Bacterial, Parasitic and Allergenic Products Center for Biologics Evaluation and Research Office of Vaccines Research and Review U.S. Food and Drug Administration Silver Spring MD USA
| | - R. L. Rabin
- Division of Bacterial, Parasitic and Allergenic Products Center for Biologics Evaluation and Research Office of Vaccines Research and Review U.S. Food and Drug Administration Silver Spring MD USA
| |
Collapse
|
31
|
Han J, Nguyen J, Kim Y, Geng B, Romanowski G, Alejandro L, Proudfoot J, Xu R, Leibel S. Effect of inhaled corticosteroid use on weight (BMI) in pediatric patients with moderate-severe asthma. J Asthma 2018; 56:263-269. [PMID: 29672188 DOI: 10.1080/02770903.2018.1455853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Assess the relationship between inhaled corticosteroid use (ICS) and weight (BMI) in pediatric patients with moderate-severe asthma. Assess if the number of emergency department (ED) visits correlates with overall BMI trajectory. Assess the trend of prescribing biologic therapy in pediatric patients with moderate-severe asthma and determine its relationship with weight (BMI). METHODS A retrospective chart review was performed on 93 pediatric patients with moderate-severe asthma to determine the relationship between ICS use and weight (BMI), biologic therapy and BMI, and number of ED visits and BMI trajectory. A mixed effects model was employed with the correlation between repeated measures accounted for through the random effects. RESULTS There is a statistically significant increase of 0.369 kg/m2 in BMI trajectory per year in subjects on high-dose steroids compared to an increase of 0.195 kg/m2 in the low dose group (p < 0.05). The BMI of subjects initiated on biologic therapy (omalizumab or mepolizumab) had a statistically significant decrease in BMI trajectory of 0.818 kg/m2 per year (p < 0.05). Subjects with ≥5 ED visits due to asthma exacerbations had a significantly higher BMI trajectory (p < 0.05). CONCLUSIONS The potency of ICS use in pediatric patients with moderate-severe asthma affects BMI trajectory; the higher the dose, the greater the projected BMI increase per year. Initiation of biologic therapy decreased BMI trajectory over time. Lastly, those with frequent ED visits had a higher BMI trend. Future prospective studies are warranted that further evaluate the potential metabolic impacts of ICS and assess the effects of biologic therapy on BMI.
Collapse
Affiliation(s)
| | | | - Yuna Kim
- a Rady Children's Hospital San Diego , CA
| | - Bob Geng
- b UCSD Department of Pediatrics and Medicine San Diego , CA
| | | | | | - James Proudfoot
- c Altman Clinical and Translational Research Institute, UCSD La Jolla , CA
| | - Ronghui Xu
- c Altman Clinical and Translational Research Institute, UCSD La Jolla , CA
| | | |
Collapse
|
32
|
Giesler A, Mukherjee M, Radford K, Janssen L, Nair P. Modulation of human airway smooth muscle biology by human adipocytes. Respir Res 2018; 19:33. [PMID: 29486749 PMCID: PMC5830317 DOI: 10.1186/s12931-018-0741-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/19/2018] [Indexed: 12/18/2022] Open
Abstract
Background Asthma and obesity, two growing epidemics worldwide, may share an underlying causal relationship. Airway hyperresponsiveness (AHR), a defining component of asthma, has been documented in both ‘obese’ animal models and non-asthmatic obese individuals. However, there is a paucity of evidence that obesity-derived factors directly affect human airway smooth muscles (ASM). Methods Experiments were designed with primary ASM and adipocytes isolated from the same human tissue explants (n = 6). The modulatory effects of human adipocytes extracted from subcutaneous (extrathoracic) and visceral (intrathoracic) depots, on ASM biology was examined with respect to proliferation, migration, contractility and pro-inflammatory cytokine synthesis. Results Adipocyte-conditioned media as well as myocyte-adipocyte co-cultures failed to show any significant changes in the proliferative or migrational properties of the ASM. Adipocyte-conditioned media also had no effect on the contractility or relaxation of bovine tracheal muscle strips. In contrast, there was a moderate yet significant increase of IL-6 and eotaxin release by ASM incubated with adipocyte-conditioned media (P = 0.0035 and P = 0.0067, vs. control, respectively), thereby further consolidating the altered inflammatory state reported for both diseases. Conclusion We report, for the first time, that adipocytes from either subcutaneous or visceral depots can trigger an inflammatory state in the ASM, with negligible modulatory effects on hyperplasia, hypertrophy or contractile properties. Electronic supplementary material The online version of this article (10.1186/s12931-018-0741-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Amanda Giesler
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Manali Mukherjee
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Katherine Radford
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Luke Janssen
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Parameswaran Nair
- Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| |
Collapse
|
33
|
Chong L, Zhang W, Yu G, Zhang H, Zhu L, Li H, Shao Y, Li C. High-fat-diet induces airway hyperresponsiveness partly through activating CD38 signaling pathway. Int Immunopharmacol 2018; 56:197-204. [PMID: 29414651 DOI: 10.1016/j.intimp.2018.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 01/05/2023]
Abstract
CD38 is a plasma membrane bound multifunctional enzyme. It can be activated by inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-13, inducing calcium responses to agonist in airway smooth muscle cells (ASMC). Previous studies have found that high-fat-diet (HFD) induced obesity exhibited innate airway hyperresponsiveness (AHR). This study aimed to detect the effect of CD38 signaling pathway on the AHR of overweight/obese mice. The HFD-fed mice exhibited a significantly higher baseline airway resistance (Rn), and the increasing rates of Rn responded to increasing doses of methacholine compared with the LFD-fed mice. High-fat-diet increased CD38 expressions both in lung tissues and primary cultured ASMCs. Besides, preincubation with TNF-α led to a higher expression of CD38 protein and increased intracellular calcium in ASMC of the HFD-fed mice. Furthermore, CD38 gene knockdown through transfection of CD38 siRNA decreased the concentration of intracellular calcium. Additionally, the upregulations of CD38 protein and CD38 mRNA were also found in the lung tissues of HFD-fed mice challenged by ovalbumin (OVA). Collectively, our findings demonstrated a role of CD38 signaling pathway on the AHR of obesity and might be a potential therapeutic target for treating difficult-to-control obese asthma phenotype.
Collapse
Affiliation(s)
- Lei Chong
- Institute of Pediatrics, National Key Clinical Specialty of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weixi Zhang
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Gang Yu
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hailin Zhang
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lili Zhu
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haiyan Li
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Youyou Shao
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Changchong Li
- Discipline of Pediatric Respiratory Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| |
Collapse
|
34
|
Kruse RL, Vanijcharoenkarn K. Drug repurposing to treat asthma and allergic disorders: Progress and prospects. Allergy 2018; 73:313-322. [PMID: 28880396 DOI: 10.1111/all.13305] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2017] [Indexed: 12/18/2022]
Abstract
Allergy and atopic asthma have continued to become more prevalent in modern society despite the advent of new treatments, representing a major global health problem. Common medications such as antihistamines and steroids can have undesirable long-term side-effects and lack efficacy in some resistant patients. Biologic medications are increasingly given to treatment-resistant patients, but they can represent high costs, complex dosing and management, and are not widely available around the world. The field needs new, cheap, and convenient treatment options in order to bring better symptom relief to patients. Beyond continued research and development of new drugs, a focus on drug repurposing could alleviate this problem by repositioning effective and safe small-molecule drugs from other fields of medicine and applying them toward the treatment for asthma and allergy. Herein, preclinical models, case reports, and clinical trials of drug repurposing efficacy in allergic disease are reviewed. Novel drugs are also proposed for repositioning based on their mechanism of action to treat asthma and allergy. Overall, drug repurposing could become increasingly important as a way of advancing allergy and atopic asthma therapy, filling a need in treatment of patients today.
Collapse
Affiliation(s)
- R. L. Kruse
- Medical Scientist Training Program; Baylor College of Medicine; Houston TX USA
| | - K. Vanijcharoenkarn
- Division of Allergy & Immunology; Department of Pediatrics; Emory University School of Medicine; Atlanta GA USA
| |
Collapse
|
35
|
Yang MS, Choi S, Choi Y, Jin KN. Association Between Airway Parameters and Abdominal Fat Measured via Computed Tomography in Asthmatic Patients. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:503-515. [PMID: 30088370 PMCID: PMC6082818 DOI: 10.4168/aair.2018.10.5.503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022]
Abstract
Purpose We aimed to investigate whether airway parameters, assessed via computed tomography (CT), are associated with abdominal fat areas and to compare the clinical characteristics of asthmatic patients with and without elevated visceral to subcutaneous fat area ratio (EV). Methods Asthmatic patients (aged ≥40 years) were prospectively recruited. Chest (airway) and fat areas were assessed via CT. Airway parameters, including bronchial wall thickness (WT), lumen diameter (LD), lumen area (LA), wall area (WA), total area (TA), as well as WA/TA percentage (wall area %) were measured at the apical segmental bronchus in the right upper lobe. Visceral (VFA), subcutaneous (SFA) and total (TFA) fat areas (cm2) were also measured. The correlations between abdominal fat areas and airway parameters were assessed. EV was defined as VFA/SFA ≥ 0.4. Results Fifty asthmatic patients were included (mean age 62.9 years; 52% female); 38% had severe asthma. Significant correlations were found between VFA and both LD and LA (r = −0.35, P = 0.01; r = −0.34, P = 0.02, respectively), and SFA and both WA and TA (r = 0.38, P = 0.007; r = 0.34, P = 0.02, respectively). Exacerbations, requiring corticosteroid therapy or ER visitation, were significantly more frequent in subjects without EV (83% vs. 34%, P = 0.05). Conclusions Abdominal fat is associated with asthma, according to the location of fat accumulation. In asthmatic subjects, visceral fat seems to be attributable to the bronchial luminal narrowing, while subcutaneous fat may be related to thickening of bronchial wall.
Collapse
Affiliation(s)
- Min Suk Yang
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sanghun Choi
- Department of Mechanical Engineering, Kyungpook National University, Daegu, Korea
| | - Yera Choi
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
| |
Collapse
|
36
|
Machluf Y, Farkash R, Fink D, Chaiter Y. Asthma severity and heterogeneity: Insights from prevalence trends and associated demographic variables and anthropometric indices among Israeli adolescents. J Asthma 2017; 55:826-836. [PMID: 28872935 DOI: 10.1080/02770903.2017.1373809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES While asthma presents various clinical forms with different levels of severity, it is unclear whether asthma severities are a consequence of disease management or varied etiologies. We sought to investigate this question. METHODS This paper presents a cross-sectional study of 113,671 Israeli adolescents. Prevalence rates of mild and moderate-to-severe asthma over a 24-year period were calculated and multivariate regression models (outcomes: different asthma severity, reference: subjects without asthma) were performed to analyze associations with anthropometric indices and socio-demographic variables, in males and females separately. RESULTS The prevalence of mild asthma increased until birth years 1976-1980 and then steadily decreased. In contrast, the prevalence of moderate-to-severe asthma was relatively stable until birth years 1976-1980, then rose steeply until 1986-1990 and subsequently plateaued in the early 1990s. Obesity was positively associated with both mild and moderate-to-severe asthma in males (Odds Ratio (OR) [95%CIs]: 1.61 [1.37-1.89] and 1.63 [1.34-1.98], respectively) and females (1.54 [1.10-2.16] and 1.54 [1.20-1.98], respectively). Family size greater than three siblings was negatively associated with both mild and moderate-to-severe asthma in males (0.62 [0.56-0.68] and 0.59 [0.52-0.68]) and females (0.71 [0.60-0.83] and 0.73 [0.63-0.83]). In contrast, in males, underweight was only associated with mild asthma (1.54 [1.22-1.94]) but not with moderate-to-severe asthma. In females, overweight was only associated with moderate-to-severe asthma (1.21 [1.00-1.46]) and rural residence was only associated with mild asthma (1.26 [1.09-1.47]). CONCLUSIONS The differences between mild and moderate-to-severe asthma enhance asthma phenotype characterization, with respect to secular trends and associated variables, and indicate varied etiologies.
Collapse
Affiliation(s)
| | | | - Daniel Fink
- b Shaarei Zedek Medical Center , Jerusalem , Israel
| | | |
Collapse
|
37
|
Everaere L, Ait Yahia S, Bouté M, Audousset C, Chenivesse C, Tsicopoulos A. Innate lymphoid cells at the interface between obesity and asthma. Immunology 2017; 153:21-30. [PMID: 28880992 DOI: 10.1111/imm.12832] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/24/2017] [Accepted: 08/31/2017] [Indexed: 02/06/2023] Open
Abstract
Obesity and asthma prevalence has dramatically and concomitantly increased over the last 25 years, and many epidemiological studies have highlighted obesity as an important risk factor for asthma. Although many studies have been performed, the underlying mechanisms remain poorly understood. Innate mechanisms have been involved in both diseases, in particular through the recently described innate lymphoid cells (ILCs). ILCs are subdivided into three groups that are defined by their cytokine production and by their master transcription factor expression, in sharp correlation with their T helper counterparts. However, unlike T helper cells, ILCs do not express antigen-specific receptors, but respond to damage-induced signals. ILCs have been found in target tissues of both diseases, and data have implicated these cells in the pathogenesis of both diseases. In particular group 2 ILCs (ILC2) are activated in both the adipose and lung tissues under the effect of interleukin-33 and interleukin-25 expression. However, counter-intuitively to the well-known association between obesity and asthma, ILC2 are beneficial for obesity but deleterious for asthma. This review will examine the roles of ILCs in each disease and recent data highlighting ILCs as a putative link between obesity and asthma.
Collapse
Affiliation(s)
- Laetitia Everaere
- Institut National de la Santé et de la Recherche Médicale, Lille, France.,CNRS, UMR 8204, Centre for Infection and Immunity of Lille, Lille, France.,Institut Pasteur de Lille, Lille, France.,Université de Lille, Lille, France
| | - Saliha Ait Yahia
- Institut National de la Santé et de la Recherche Médicale, Lille, France.,CNRS, UMR 8204, Centre for Infection and Immunity of Lille, Lille, France.,Institut Pasteur de Lille, Lille, France.,Université de Lille, Lille, France
| | - Mélodie Bouté
- Institut National de la Santé et de la Recherche Médicale, Lille, France.,CNRS, UMR 8204, Centre for Infection and Immunity of Lille, Lille, France.,Institut Pasteur de Lille, Lille, France.,Université de Lille, Lille, France
| | - Camille Audousset
- Institut National de la Santé et de la Recherche Médicale, Lille, France.,CNRS, UMR 8204, Centre for Infection and Immunity of Lille, Lille, France.,Institut Pasteur de Lille, Lille, France.,Université de Lille, Lille, France.,Clinique des Maladies Respiratoires et Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Cécile Chenivesse
- Institut National de la Santé et de la Recherche Médicale, Lille, France.,CNRS, UMR 8204, Centre for Infection and Immunity of Lille, Lille, France.,Institut Pasteur de Lille, Lille, France.,Université de Lille, Lille, France.,Clinique des Maladies Respiratoires et Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Anne Tsicopoulos
- Institut National de la Santé et de la Recherche Médicale, Lille, France.,CNRS, UMR 8204, Centre for Infection and Immunity of Lille, Lille, France.,Institut Pasteur de Lille, Lille, France.,Université de Lille, Lille, France.,Clinique des Maladies Respiratoires et Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| |
Collapse
|
38
|
Garshick E, Walia P, Goldstein RL, Teylan M, Lazzari AA, Tun CG, Hart JE. Plasma Leptin and Reduced FEV 1 and FVC in Chronic Spinal Cord Injury. PM R 2017; 10:276-285. [PMID: 28827209 DOI: 10.1016/j.pmrj.2017.08.437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/28/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adipose tissue produces leptin, which is pro-inflammatory, and adiponectin, which has anti-inflammatory properties. Participants with chronic spinal cord injury (SCI) have increased body fat and are at increased risk for respiratory illness. OBJECTIVE To assess the associations between leptin and adiponectin with pulmonary function in a chronic SCI cohort. DESIGN Cross-sectional study. SETTING Veterans Affairs Medical Center. PARTICIPANTS A total of 285 participants (237 men and 48 women) with chronic SCI with mean (standard deviation) injury duration 17.8 (13.2) years from the VA Boston and the community participating in an epidemiologic study assessing factors associated with respiratory health. METHODS Participants (24.6% cervical American Spinal Injury Association Impairment Scale (AIS) level A, B, and C; 33.6% other AIS A, B, and C; 41.8% AIS D) provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma leptin and adiponectin with spirometric measures of pulmonary function adjusted for age, race, gender, and height. Level and severity of SCI, mobility mode, body mass index, smoking, chronic obstructive pulmonary disease, asthma, chest injury history, laboratory batch, and other potential confounders were also considered. MAIN OUTCOME MEASUREMENTS forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC. RESULTS There was a statistically significant inverse relationship between plasma leptin assessed in quartiles or as a continuous covariate with FEV1 and FVC. In fully adjusted models, each interquartile range (16,214 pg/mL) increase in leptin was associated with a significant decrease in FEV1 (-93.1 mL; 95% confidence interval = -166.2, -20.0) and decrease in FVC (-130.7 mL; 95% confidence interval = -219.4, -42.0). There were no significant associations between leptin and FEV1/FVC or between plasma adiponectin with FEV1, FVC, or FEV1/FVC. CONCLUSION Plasma leptin in individuals with chronic SCI is inversely associated with FEV1 and FVC, independently of SCI level and severity and other covariates. This finding suggests that plasma leptin may contribute to reduced pulmonary function in chronic SCI. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Palak Walia
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rebekah L Goldstein
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Merilee Teylan
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Antonio A Lazzari
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Carlos G Tun
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jaime E Hart
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
39
|
Trinh HKT, Ban GY, Lee JH, Park HS. Leukotriene Receptor Antagonists for the Treatment of Asthma in Elderly Patients. Drugs Aging 2017; 33:699-710. [PMID: 27709465 DOI: 10.1007/s40266-016-0401-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Elderly asthma (EA) is regarded as a distinct phenotype of asthma and is associated with age-related changes in airway structure and alterations in lung function and immune responses. EA is difficult to diagnose because of aging and co-morbidities, and overlaps with fixed airway obstructive disease. Novel modalities to differentiate between EA and chronic obstructive pulmonary disease (COPD) are necessary. A multifaceted approach, including clinical history, smoking habits, atopy, and measurement of lung function, is mandatory to differentiate asthma from COPD. There are a variety of co-morbidities with EA, of which COPD, upper airway diseases, depression, obesity, and hypertension are the most common, and these co-morbidities can affect the control status of EA. However, leukotriene receptor antagonists (LTRAs) can facilitate the management of EA, and thus addition of an LTRA to inhaled corticosteroid (ICS) monotherapy or ICS plus long-acting β2-agonist therapy improves symptoms in EA patients. LTRA treatment is safe and beneficial in patients who are unable to use inhalation devices properly or who have co-morbid diseases. Therefore, clinical studies targeting a specific population of EA patients are warranted to help achieve a better therapeutic strategy in EA patients.
Collapse
Affiliation(s)
- Hoang Kim Tu Trinh
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ji-Ho Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea. .,Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, South Korea.
| |
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW We are in the era of rapid aging of the global population. Elderly asthmatic patients have an increased frequency of hospitalization and a high mortality rate. In this review, we focus on comorbidities and treatment issues in terms of the predictors of asthma control in the elderly. RECENT FINDINGS Some frequent comorbidities, such as chronic obstructive pulmonary disease, chronic sinusitis, obesity, and depression, are associated with uncontrolled asthma in elderly asthmatic patients. Smoking status in elderly asthmatic patients was associated with more frequent exacerbations. Management of comorbidities should be taken into account when we treat elderly asthmatic patients. Low treatment adherence, which is common in elderly asthmatic patients, predicts poor asthma control status. A poor knowledge about asthma, cognitive function impairment, and inappropriate inhaler technique result in low treatment adherence. Polypharmacy is associated with low treatment adherence, adverse drug reactions, and drug-drug interactions, and it is supposed to be a predictor of asthma control. SUMMARY Multifactorial assessments, including comorbidities, treatment adherence, and polypharmacy, are important for better asthma control in elderly asthmatic patients. Further studies on the strategy for the management of elderly asthmatic patients in a real-world setting are warranted.
Collapse
|
41
|
Pathway discovery using transcriptomic profiles in adult-onset severe asthma. J Allergy Clin Immunol 2017; 141:1280-1290. [PMID: 28756296 DOI: 10.1016/j.jaci.2017.06.037] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/08/2017] [Accepted: 06/21/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Adult-onset severe asthma is characterized by highly symptomatic disease despite high-intensity asthma treatments. Understanding of the underlying pathways of this heterogeneous disease is needed for the development of targeted treatments. Gene set variation analysis is a statistical technique used to identify gene profiles in heterogeneous samples. OBJECTIVE We sought to identify gene profiles associated with adult-onset severe asthma. METHODS This was a cross-sectional, observational study in which adult patients with adult-onset of asthma (defined as starting at age ≥18 years) as compared with childhood-onset severe asthma (<18 years) were selected from the U-BIOPRED cohort. Gene expression was assessed on the total RNA of induced sputum (n = 83), nasal brushings (n = 41), and endobronchial brushings (n = 65) and biopsies (n = 47) (Affymetrix HT HG-U133+ PM). Gene set variation analysis was used to identify differentially enriched predefined gene signatures of leukocyte lineage, inflammatory and induced lung injury pathways. RESULTS Significant differentially enriched gene signatures in patients with adult-onset as compared with childhood-onset severe asthma were identified in nasal brushings (5 signatures), sputum (3 signatures), and endobronchial brushings (6 signatures). Signatures associated with eosinophilic airway inflammation, mast cells, and group 3 innate lymphoid cells were more enriched in adult-onset severe asthma, whereas signatures associated with induced lung injury were less enriched in adult-onset severe asthma. CONCLUSIONS Adult-onset severe asthma is characterized by inflammatory pathways involving eosinophils, mast cells, and group 3 innate lymphoid cells. These pathways could represent useful targets for the treatment of adult-onset severe asthma.
Collapse
|
42
|
Xie S, Greenblatt R, Levy MZ, Himes BE. Enhancing Electronic Health Record Data with Geospatial Information. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2017; 2017:123-132. [PMID: 28815121 PMCID: PMC5543367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Electronic Health Record (EHR)-derived data is a valuable resource for research, and efforts are underway to overcome some of its limitations by using data from external sources to gain a fuller picture of patient characteristics, symptoms, and exposures. Our goal was to assess the utility of augmenting EHR data with geocoded patient addresses to identify geospatial variation of disease that is not explained by EHR-derived demographic factors. Using 2011-2014 encounter data from 27,604 University of Pennsylvania Hospital System asthma patients, we identified factors associated with asthma exacerbations: risk was higher in female, black, middle aged to elderly, and obese patients, as well as those with positive smoking history and with Medicare or Medicaid vs. private insurance. Significant geospatial variability of asthma exacerbations was found using generalized additive models, even after adjusting for demographic factors. Our work shows that geospatial data can be used to cost-effectively enhance EHR data.
Collapse
Affiliation(s)
- Sherrie Xie
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Greenblatt
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Z Levy
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Blanca E Himes
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
43
|
Ferreira PG, Freitas PD, Silva AG, Porras DC, Stelmach R, Cukier A, Fernandes FLA, Martins MA, Carvalho CRF. Dynamic hyperinflation and exercise limitations in obese asthmatic women. J Appl Physiol (1985) 2017; 123:585-593. [PMID: 28684597 DOI: 10.1152/japplphysiol.00655.2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 06/13/2017] [Accepted: 07/03/2017] [Indexed: 01/27/2023] Open
Abstract
Obese individuals and patients with asthma can develop dynamic hyperinflation (DH) during exercise; however, no previous study has investigated DH as a factor associated with reduced exercise capacity in obese asthmatic women. The aim of the present study was to examine the occurrence of DH and exercise limitations in obese asthmatics. Obese grade II [obese group (Ob-G); BMI 35-39.9 kg/m2; n=36] and nonobese [nonobese group (NOb-G); BMI 18.5-29.9 kg/m2; n=18] asthmatic patients performed a cardiopulmonary test to quantify peak V̇o2 and a submaximal exercise test to assess DH. Anthropometric measurements, quadriceps endurance, and lung function were also evaluated. A forward stepwise regression was used to evaluate the association between exercise tolerance (wattage) and limiting exercise factors. Fifty-four patients completed the protocol. The Ob-G (n = 36) presented higher peak V̇o2 values but lower power-to-weight ratio values than the NOb-G (P <0 .05). DH was more common in the Ob-G (72.2%) than in the NOb-G (38.9%, P < 0.05). The Ob-G had a greater reduction in the inspiratory capacity (-18 vs. -4.6%, P < 0.05). Exercise tolerance was associated with quadriceps endurance (r = 0.65; p<0.001), oxygen pulse (r = 0.52; p=0.001), and DH (r = -0.46, P = 0.005). The multiple regression analysis showed that the exercise tolerance could be predicted from a linear association only for muscular endurance (r = 0.82 and r2 = 0.67). This study shows that dynamic hyperinflation is a common condition in obese asthmatics; they have reduced fitness for activities of daily living compared to nonobese asthmatics. However, peripheral limitation was the main factor associated with reduced capacity of exercise in these patients.NEW & NOTEWORTHY This is the first study to investigate the occurrence of dynamic hyperinflation (DH) in obese asthmatics. Our results demonstrate that obese asthmatics present a higher frequency and intensity of DH than nonobese asthmatics. We also show that physical deconditioning in this population is linearly associated with cardiac (O2 pulse), respiratory (DH), and peripheral muscle (resistance) limitation. However, multiple linear regression demonstrated that peripheral muscle limitation may explain the exercise limitation in this population.
Collapse
Affiliation(s)
| | | | - Aline Grandi Silva
- Department of Physical Therapy, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Desidério Cano Porras
- Department of Physical Therapy, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; and
| | - Alberto Cukier
- Pulmonary Division, Heart Institute (InCor), Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; and
| | | | - Milton Arruda Martins
- Department of Medicine, Laboratory of Experimental Therapeutics, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Celso R F Carvalho
- Department of Physical Therapy, Medical School, University of Sao Paulo, Sao Paulo, Brazil;
| |
Collapse
|
44
|
Lugogo N, Green CL, Agada N, Zhang S, Meghdadpour S, Zhou R, Yang S, Anstrom KJ, Israel E, Martin R, Lemanske RF, Boushey H, Lazarus SC, Wasserman SI, Castro M, Calhoun W, Peters SP, DiMango E, Chinchilli V, Kunselman S, King TS, Icitovic N, Kraft M. Obesity's effect on asthma extends to diagnostic criteria. J Allergy Clin Immunol 2017. [PMID: 28624608 DOI: 10.1016/j.jaci.2017.04.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of inflammatory biomarkers to delineate the type of lung inflammation present in asthmatic subjects is increasingly common. However, the effect of obesity on these markers is unknown. OBJECTIVES We aimed to determine the effect of obesity on conventional markers of inflammation in asthmatic subjects. METHODS We performed secondary analysis of data from 652 subjects previously enrolled in 2 Asthma Clinical Research Network trials. We performed linear correlations between biomarkers and logistic regression analysis to determine the predictive value of IgE levels, blood eosinophil counts, and fraction of exhaled nitric oxide values in relationship to sputum eosinophil counts (>2%), as well as to determine whether cut points existed that would maximize the sensitivity and specificity for predicting sputum eosinophilia in the 3 weight groups. RESULTS Overall, statistically significant but relatively weak correlations were observed among all 4 markers of inflammation. Within obese subjects, the only significant correlation found was between IgE levels and blood eosinophil counts (r = 0.33, P < .001); furthermore, all other correlations between inflammatory markers were approximately 0, including correlations with sputum eosinophil counts. In addition, the predictive value of each biomarker alone or in combination was poor in obese subjects. In fact, in obese subjects none of the biomarkers of inflammation significantly predicted the presence of high sputum eosinophil counts. Obese asthmatic subjects have lower cut points for IgE levels (268 IU), fraction of exhaled nitric oxide values (14.5 ppb), and blood eosinophil counts (96 cells/μL) than all other groups. CONCLUSIONS In obese asthmatic subjects conventional biomarkers of inflammation are poorly predictive of eosinophilic airway inflammation. As such, biomarkers currently used to delineate eosinophilic inflammation in asthmatic subjects should be approached with caution in these subjects.
Collapse
Affiliation(s)
- Njira Lugogo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich.
| | - Cynthia L Green
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Noah Agada
- Division of Pediatric Allergy and Immunology, Department of Pediatric Pulmonology, Riley Children's Hospital, and Eli Lilly and Company, Indianapolis, Ind
| | - Siyi Zhang
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Susanne Meghdadpour
- Department of Pediatrics, Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Duke University, Durham, NC
| | - Run Zhou
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Siyun Yang
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Kevin J Anstrom
- Department of Biostatistics and BioInformatics, Duke University, Durham, NC
| | - Elliot Israel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Richard Martin
- Department of Medicine, National Jewish Health and University of Colorado Denver, Denver, Colo
| | - Robert F Lemanske
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Homer Boushey
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, Calif
| | - Stephen C Lazarus
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, Calif
| | - Stephen I Wasserman
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of California, San Diego, Calif
| | - Mario Castro
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, Saint Louis, Mo
| | - William Calhoun
- Division of Pulmonary, Critical Care, and Sleep and Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex
| | - Stephen P Peters
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, NC
| | - Emily DiMango
- Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, Columbia University, New York, NY
| | - Vernon Chinchilli
- Department of Public Health Services, Penn State College of Medicine, Division of Biostatistics, Hershey, Pa
| | - Susan Kunselman
- Department of Public Health Services, Penn State College of Medicine, Division of Biostatistics, Hershey, Pa
| | - Tonya S King
- Department of Public Health Services, Penn State College of Medicine, Division of Biostatistics, Hershey, Pa
| | - Nikolina Icitovic
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Monica Kraft
- Department of Medicine, University of Arizona, Tucson, Ariz
| |
Collapse
|
45
|
Abstract
OBJECTIVE Studies show high comorbidity of mood disorders in asthma. As asthma is a highly heterogeneous disease with different phenotypes it can be expected that there is a difference in this association with different asthma phenotypes. The aim of our cross-sectional study was to assess the association of specific asthma phenotypes with anxiety and/or depression and their impact on asthma control. METHODS A cross-sectional study in 201 consecutive adult outpatients with asthma (≥18 years of age) was conducted. Each patient underwent physical examination, detailed medical history, Hospital Anxiety and Depression Scale, Asthma Control Questionnaire, Asthma Control Test, together with measurements of lung function and fraction of exhaled nitric oxide. Phenotypes were assessed using cluster analysis, and a multivariate analysis was used to identify associations of mood disorders with different phenotypes. RESULTS Five asthma phenotypes were identified: allergic (AA, 43.8%), aspirin-exacerbated respiratory disease (AERD, 21.9%), late-onset (LOA, 18.9%), obesity-associated (OAA, 10.0%), and respiratory infections associated asthma (RIAA, 5.5%). A multivariate analysis showed a significant association of anxiety with LOA and comorbid hypertension (LOA, odds ratio (OR) = 2.12; hypertension, OR = 2.37, p = 0.012), and depression with AA, RIAA, hypertension, and ACQ score (AA, OR = 6.07; RIAA, OR = 4.73; hypertension, OR = 5.67; ACQ, OR = 1.87; p < 0.001). Comorbid anxiety/depression was associated with AA, LOA, RIAA, hypertension, and ACQ score (AA, OR = 10.15; LOA, OR = 2.98; RIAA, OR = 6.29; hypertension, OR = 5.15; ACQ, OR = 1.90; p < 0.001. CONCLUSION Mood disorders were significantly associated with AA, LOA, and infection-associated asthma, together with comorbid hypertension and the level of asthma control.
Collapse
Affiliation(s)
- Marina Labor
- a Department of Pulmonology , University Hospital Center Osijek , Osijek , Croatia.,b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia
| | - Slavica Labor
- a Department of Pulmonology , University Hospital Center Osijek , Osijek , Croatia.,b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia
| | - Iva Jurić
- c Department of Medicine , University Hospital Center Osijek , Osijek , Croatia
| | - Vladimir Fijačko
- a Department of Pulmonology , University Hospital Center Osijek , Osijek , Croatia.,b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia
| | - Sanja Popović Grle
- d Department of Pulmonology , University Hospital Center Zagreb , Zagreb , Croatia
| | - Davor Plavec
- b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia.,e Research Department , Children's Hospital Srebrnjak , Zagreb , Croatia
| |
Collapse
|
46
|
Pérez-Pérez A, Vilariño-García T, Fernández-Riejos P, Martín-González J, Segura-Egea JJ, Sánchez-Margalet V. Role of leptin as a link between metabolism and the immune system. Cytokine Growth Factor Rev 2017; 35:71-84. [PMID: 28285098 DOI: 10.1016/j.cytogfr.2017.03.001] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 12/24/2022]
Abstract
Leptin is an adipocyte-derived hormone not only with an important role in the central control of energy metabolism, but also with many pleiotropic effects in different physiological systems. One of these peripheral functions of leptin is a regulatory role in the interplay between energy metabolism and the immune system, being a cornerstone of the new field of immunometabolism. Leptin receptor is expressed throughout the immune system and the regulatory effects of leptin include cells from both the innate and adaptive immune system. Leptin is one of the adipokines responsible for the inflammatory state found in obesity that predisposes not only to type 2 diabetes, metabolic syndrome and cardiovascular disease, but also to autoimmune and allergic diseases. Leptin is an important mediator of the immunosuppressive state in undernutrition status. Placenta is the second source of leptin and it may play a role in the immunomodulation during pregnancy. Finally, recent work has pointed to the participation of leptin and leptin receptor in the pathophysiology of inflammation in oral biology. Therefore, leptin and leptin receptor should be considered for investigation as a marker of inflammation and immune activation in the frontier of innate-adaptive system, and as possible targets for intervention in the immunometabolic mediated pathophysiology.
Collapse
Affiliation(s)
- Antonio Pérez-Pérez
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School and Department of Clinical Biochemistry, Virgen Macarena University Hospital, University of Seville, Spain
| | - Teresa Vilariño-García
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School and Department of Clinical Biochemistry, Virgen Macarena University Hospital, University of Seville, Spain
| | - Patricia Fernández-Riejos
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School and Department of Clinical Biochemistry, Virgen Macarena University Hospital, University of Seville, Spain
| | - Jenifer Martín-González
- Department of Stomatology (Endodontics Section), School of Dentistry, University of Seville, Seville, Spain
| | - Juan José Segura-Egea
- Department of Stomatology (Endodontics Section), School of Dentistry, University of Seville, Seville, Spain
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School and Department of Clinical Biochemistry, Virgen Macarena University Hospital, University of Seville, Spain.
| |
Collapse
|
47
|
Russell MA, Janson C, Real FG, Johannessen A, Waatevik M, Benediktsdóttir B, Holm M, Lindberg E, Schlünssen V, Raza W, Dharmage SC, Svanes C. Physical activity and asthma: A longitudinal and multi-country study. J Asthma 2017. [PMID: 28635546 DOI: 10.1080/02770903.2017.1281293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the impact of physical activity on asthma in middle-aged adults, in one longitudinal analysis, and one multi-centre cross-sectional analysis. METHODS The Respiratory Health in Northern Europe (RHINE) is a population-based postal questionnaire cohort study. Physical activity, height and weight were self-reported in Bergen, Norway, at RHINE II (1999-2001) and all centres at RHINE III (2010-2012). A longitudinal analysis of Bergen data investigated the association of baseline physical activity with follow-up asthma, incident asthma and symptoms, using logistic and zero-inflated Poisson regression (n = 1782). A cross-sectional analysis of all RHINE III centres investigated the association of physical activity with concurrent asthma and symptoms (n = 13,542) using mixed-effects models. Body mass index (BMI) was categorised (<20, 20-24.99, 25-29.99, 30+ kg/m2) and physical activity grouped by amount and frequency of lighter (no sweating/heavy breathing) and vigorous (sweating/heavy breathing) activity. RESULTS In the Bergen longitudinal analysis, undertaking light activity 3+ times/week at baseline was associated with less follow-up asthma (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.22, 0.89), whilst an effect from undertaking vigorous activity 3+ times/week was not detected (OR 1.22, 95% CI 0.44, 2.76). The associations were attenuated with BMI adjustment. In the all-centre cross-sectional analysis an interaction was found, with the association between physical activity and asthma varying across BMI categories. CONCLUSION These findings suggest potential longer-term benefit from lighter physical activity, whilst improvement in asthma outcomes from increasing activity intensity was not evident. Additionally, it appears the benefit from physical activity may differ according to BMI.
Collapse
Affiliation(s)
- Melissa A Russell
- a Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health , University of Melbourne , Melbourne , Australia.,b Gastro & Food Allergy Group , Murdoch Children's Research Institute , Melbourne , Australia
| | - Christer Janson
- c Department of Medical Sciences: Respiratory , Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
| | - Francisco Gómez Real
- d Department of Clinical Science , University of Bergen , Bergen , Norway.,e Department of Gynaecology and Obstetrics , Haukeland University Hospital , Bergen , Norway
| | - Ane Johannessen
- f Center for International Health , University of Bergen , Bergen , Norway
| | - Marie Waatevik
- g Center for Clinical Research , Haukeland University Hospital , Bergen , Norway
| | - Bryndis Benediktsdóttir
- h Faculty of Medicine , University of Iceland , Reykjavik , Iceland.,i Department of Respiratory Medicine and Sleep , The National University Hospital of Iceland , Reykjavik , Iceland
| | - Mathias Holm
- j Department of Occupational and Environmental Medicine , Sahlgrenska University Hospital , Göteborg , Sweden
| | - Eva Lindberg
- c Department of Medical Sciences: Respiratory , Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
| | - Vivi Schlünssen
- k Department of Public Health , Aarhus University , Aarhus , Denmark.,l The National Research Centre for the Working Environment , Copenhagen , Denmark
| | - Wasif Raza
- m Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Shyamali C Dharmage
- a Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health , University of Melbourne , Melbourne , Australia.,b Gastro & Food Allergy Group , Murdoch Children's Research Institute , Melbourne , Australia
| | - Cecilie Svanes
- f Center for International Health , University of Bergen , Bergen , Norway.,n Department of Occupational Medicine , Haukeland University Hospital , Bergen , Norway
| |
Collapse
|
48
|
Greenblatt R, Mansour O, Zhao E, Ross M, Himes BE. Gender-specific determinants of asthma among U.S. adults. Asthma Res Pract 2017; 3:2. [PMID: 28138394 PMCID: PMC5259982 DOI: 10.1186/s40733-017-0030-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/05/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Asthma, a chronic respiratory disease affecting over 18.7 million American adults, has marked disparities by gender, race/ethnicity and socioeconomic status. Our goal was to identify gender-specific demographic and socioeconomic determinants of asthma prevalence among U.S. adults using data from the Behavioral Risk Factors Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES). METHODS Gender-specific regression analyses were performed to model the relationship between asthma prevalence with age, race/ethnicity, income, education level, smoking status, and body mass index (BMI), while taking into account the study designs. RESULTS Based on BRFSS data from 1,003,894 respondents, weighted asthma prevalence was 6.2% in males and 10.6% in females. Asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese women was 2.5 and 3.5 times higher, respectively, while that in men was 1.7 and 2.4 times higher; asthma prevalence among current vs. never smoker women was 1.4 times higher, while that in men was 1.1 times higher. Similar results were obtained with NHANES data from 13,364 respondents: asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese respondents was 2.0 and 3.3 times higher for women, though there was no significant difference for men; asthma prevalence among current vs. never smokers was 1.8 times higher for women and not significantly different in men. Asthma prevalence by race/ethnicity and income levels did not differ considerably between men and women. CONCLUSIONS Our results underscore the importance of obesity and smoking as modifiable asthma risk factors that most strongly affect women.
Collapse
Affiliation(s)
- Rebecca Greenblatt
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 219 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Omar Mansour
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Edward Zhao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 219 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Michelle Ross
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 219 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Blanca E Himes
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 219 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
| |
Collapse
|
49
|
Lucas JA, Moonie S, Olsen-Wilson K, Hogan MB. Asthma, allergy, and obesity: Examining the relationship among Nevada children. J Asthma 2016; 54:594-599. [PMID: 27739908 DOI: 10.1080/02770903.2016.1244829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The majority of pediatric asthma is atopic, but whether pediatric obese asthma is atopic is indeterminate in the literature. In Nevada, children become sensitized to aeroallergens, a risk factor for asthma, at young ages. Additionally, Nevada children have high rates of obesity. Our objective is to determine whether elevated body mass index (BMI) is associated with asthma severity, allergen sensitization, and polysensitization. METHODS Medical records from a pediatric allergy clinic provided BMI percentile, physician-diagnosed asthma severity, skin prick test data, and sociodemographics such as age, race, sex, and insurance status from asthmatic patients. Descriptive statistics and binary and multinomial logistic regression were conducted. RESULTS In this population (N = 125) aged 1-16, 61% were male, 65% were white, and 74% had private health insurance. Sixty-five percent of children were under/healthy weight and 29% were overweight/obese. Asthma symptoms were moderate in 66% of the population, and severe in 18%. Nearly 85% of this population was atopic, and 82% were polysensitized. Sensitization and polysensitization occurred in all weight categories. Asthma severity and elevated BMI were not associated significantly. Overweight/obese children (≥85th percentile) had lower odds of allergen sensitization (adjusted odds ratio 0.26, 95% CI = 0.85-0.78, p = 0.016) and polysensitization (adjusted odds ratio 0.30, 95% CI = 0.11-0.85, p = 0.023) than healthy weight children (<85th percentile). CONCLUSION Although overweight children did show allergen sensitization, those who were overweight had lower odds of allergen sensitization and lower odds of polysensitization, as compared to normal weight asthmatic children. Elevated BMI was not a significant predictor of asthma severity.
Collapse
Affiliation(s)
- Jennifer A Lucas
- a School of Community Health Sciences, University of Nevada , Las Vegas, Las Vegas , Nevada , USA
| | - Sheniz Moonie
- a School of Community Health Sciences, University of Nevada , Las Vegas, Las Vegas , Nevada , USA
| | - Kimberly Olsen-Wilson
- b University of Nevada School of Medicine , Department of Pediatrics , Las Vegas , Nevada , USA
| | - Mary Beth Hogan
- b University of Nevada School of Medicine , Department of Pediatrics , Las Vegas , Nevada , USA
| |
Collapse
|
50
|
Zhang L, Yin Y, Zhang H, Zhong W, Zhang J. Association of asthma diagnosis with leptin and adiponectin: a systematic review and meta-analysis. J Investig Med 2016; 65:57-64. [PMID: 27473714 DOI: 10.1136/jim-2016-000127] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 01/16/2023]
Abstract
There is some evidence which shows that higher levels of serum leptin and lower levels of serum adiponectin are associated with the diagnosis of asthma. This meta-analysis evaluated the association of serum leptin and adiponectin levels with the diagnosis of asthma. We searched the MEDLINE, Cochrane, EMBASE and CINAHL Plus databases up to July 2015. Eligible studies were randomized controlled trials, prospective studies, retrospective studies, case-control studies and cohort studies. 13 studies with 3642 patients were included in the study. The meta-analysis found that in the overall study population, the diagnosis of asthma was associated with higher levels of leptin (pooled standardized difference in means=0.867, 95% CI 0.416 to 1.318, p<0.001) and lower levels of adiponectin (pooled standardized difference in means=-0.371, 95% CI -0.728 to -0.014, p=0.042) in patients with asthma compared with controls. Subgroup analysis found that higher leptin levels were associated with asthma both in adults (standardized difference in means=1.374, 95% CI 0.621 to 2.126, p<0.001) and children (standardized difference in means=0.302, 95% CI 0.010 to 0.594, p=0.042). However, borderline association of adiponectin with asthma was seen in adults (p=0.05), but not in children (p=0.509). Sensitivity analysis indicated that the findings for leptin were robust. Our findings are consistent with higher levels of serum leptin being associated with asthma regardless of age, and low adiponectin levels being associated with asthma in adults only.
Collapse
Affiliation(s)
- Lei Zhang
- Department of Pulmonary, Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong Yin
- Department of Pulmonary, Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Zhang
- Department of Pulmonary, Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenwei Zhong
- Department of Pulmonary, Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Pulmonary, Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|