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Liang Y, Shen S, Ye X, Zhang W, Lin X. Celastrol alleviates airway hyperresponsiveness and inflammation in obese asthma through mediation of alveolar macrophage polarization. Eur J Pharmacol 2024; 972:176560. [PMID: 38604543 DOI: 10.1016/j.ejphar.2024.176560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
Obese asthma is a unique asthma phenotype that decreases sensitivity to inhaled corticosteroids, and currently lacks efficient therapeutic medication. Celastrol, a powerful bioactive substance obtained naturally from the roots of Tripterygium wilfordii, has been reported to possess the potential effect of weight loss in obese individuals. However, its role in the treatment of obese asthma is not fully elucidated. In the present study, diet-induced obesity (DIO) mice were used with or without ovalbumin (OVA) sensitization, the therapeutic effects of celastrol on airway hyperresponsiveness (AHR) and airway inflammation were examined. We found celastrol significantly decreased methacholine-induced AHR in obese asthma, as well as reducing the infiltration of inflammatory cells and goblet cell hyperplasia in the airways. This effect was likely due to the inhibition of M1-type alveolar macrophages (AMs) polarization and the promotion of M2-type macrophage polarization. In vitro, celastrol yielded equivalent outcomes in Lipopolysaccharide (LPS)-treated RAW264.7 macrophage cells, featuring a reduction in the expression of M1 macrophage makers (iNOS, IL-1β, TNF-α) and heightened M2 macrophage makers (Arg-1, IL-10). Mechanistically, the PI3K/AKT signaling pathway has been implicated in these processes. In conclusion, we demonstrated that celastrol assisted in mitigating various parameters of obese asthma by regulating the balance of M1/M2 AMs polarization.
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Affiliation(s)
- Yafeng Liang
- Department of Pediatric Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Sijia Shen
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Xiaoxiao Ye
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Weixi Zhang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China.
| | - Xixi Lin
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China.
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Stridsman C, Martinsen Ø, Selberg S, Ödling M, Konradsen JR. Uncontrolled asthma in school-aged children-a nationwide specialist care study. J Allergy Clin Immunol Glob 2024; 3:100227. [PMID: 38439947 PMCID: PMC10910119 DOI: 10.1016/j.jacig.2024.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/09/2023] [Accepted: 12/28/2023] [Indexed: 03/06/2024]
Abstract
Background Uncontrolled asthma (UCA) is different from severe asthma and can be identified in children across all ranges of prescribed treatment. Objective Our aim was to characterize uncontrolled childhood asthma in pediatric specialist care. Methods We performed a nationwide cross-sectional study of 5497 children (aged 6-17 years) with asthma who were treated by pediatricians at outpatient clinics during 2019 and registered in the Swedish National Airway Register. UCA was defined as an Asthma Control Test score of 19 or lower and/or 2 or more exacerbations in the past year and/or an FEV1 value less than 80% predicted. Treatment was categorized from step 1 to step 5 according to the Global Initiative for Asthma. Results UCA was identified in 1690 children (31%), of whom 64% had an Asthma Control Test score of 19 or lower, 20% had recurrent exacerbations, and 31% had an FEV1 value less than 80% predicted. UCA was associated with female sex (odds ratio [OR] = 1.29 [95% CI = 1.15-1.45]), older age (OR = 1.02 [95% CI = 1.00-1.04]), obesity (OR = 1.43 [95% CI = 1.12-1.83]), and more treatment using steps 1 and 2 as a reference (step 3, OR = 1.28 [95% CI = 1.12-1.46]); steps 4-5, OR = 1.32 [95% CI = 1.10-1.57]). UCA in children prescribed treatment steps 1 and 2 (group UCA1-2) occurred in 28% of all children at this treatment step (n = 887). Children in group UCA1-2 had exacerbations more frequently than did those children with UCA who were prescribed steps 4 and 5 treatment (24% vs 15% [P = .001]). Conclusion UCA was common and associated with female sex, increasing age, obesity, and higher Global Initiative for Asthma treatment step. Surprisingly, UCA was also common in children prescribed less than the maximum treatment, and those children could be considered undertreated patients.
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Affiliation(s)
- Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine/OLIN Unit, Umeå University, Umeå, Sweden
| | - Øyvind Martinsen
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Stina Selberg
- Department of Public Health and Clinical Medicine, Division of Medicine/OLIN Unit, Umeå University, Umeå, Sweden
| | - Maria Ödling
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jon R. Konradsen
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
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Matsunaga M, Sato Y, Nagao M, Ikeda M, Motomura C, Kameda M, Yoshida Y, Terada A, Miyairi I, Fujisawa T. Development and validation of a new asthma questionnaire to help achieve a high level of control in school-age children and adolescents. Allergol Int 2024; 73:224-230. [PMID: 38065704 DOI: 10.1016/j.alit.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/17/2023] [Accepted: 11/01/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Maintaining good asthma control minimizes the risk of exacerbations and lung function decline and is a primary goal of asthma management. The Japanese Pediatric Asthma Guidelines (JPGL) employs different classification criteria for control status from other guidelines, stressing a higher level of control. Based on JPGL, we previously developed a caregiver-completed questionnaire for assessing and achieving best asthma control in preschoolers. In this study, we aimed to develop a questionnaire for school-age children and adolescents. METHODS A working questionnaire comprising 14 items for patients and 34 items for caregivers was administered to 362 asthma patients aged 6-15 years and their caregivers. Separately, physicians filled out a questionnaire to determine JPGL-defined control. Logistic regression analysis was performed to construct a model to predict control levels using data from a randomly selected set of completed questionnaires from two-thirds of the subjects. Validation was performed using the remaining questionnaires. RESULTS A set of 7 questions, encompassing self-assessed control status at the time of the visit and in the past month, and nocturnal/early morning asthma symptoms for patients and frequency of asthma symptoms, dyspnea, rescue beta-agonist use, and asthma hospitalization for caregivers, were selected and the 7-item model showed a good statistical fit with AIC of 110.5. The model has been named the Best Asthma Control Test for School Children and Adolescents (Best ACT-S). Best ACT-S scores differed significantly in the hypothetical direction among the groups of different JPGL-defined control levels, step-up/down treatment decisions, and presence/non-presence of exacerbations in the previous year. CONCLUSIONS The Best ACT-S is a valid questionnaire for children/adolescents aiming for best asthma control.
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Affiliation(s)
- Mayumi Matsunaga
- Allergy Center, National Hospital Organization Mie National Hospital, Mie, Japan; Department of Pediatrics, Hamamatsu University Graduate School of Medicine, Hamamatsu, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Mizuho Nagao
- Allergy Center, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Masanori Ikeda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Chikako Motomura
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Makoto Kameda
- Department of Pediatrics, Osaka Habikino Medical Center, Osaka, Japan
| | - Yukinori Yoshida
- Department of Pediatrics, Osaka Habikino Medical Center, Osaka, Japan
| | | | - Isao Miyairi
- Department of Pediatrics, Hamamatsu University Graduate School of Medicine, Hamamatsu, Japan
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Mie, Japan.
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Wu HF, Chen AC, Wei CC. Correlation between impulse oscillometry parameters and test for respiratory and asthma control in kids (TRACK) in asthma control of preschoolers with asthma. J Formos Med Assoc 2024; 123:366-373. [PMID: 37689546 DOI: 10.1016/j.jfma.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Little research has been conducted to evaluate the correlation between impulse oscillometry (IOS), Childhood Asthma Control Test (C-ACT), and Test for Respiratory and Asthma Control in Kids (TRACK). METHODS This study was conducted at China Medical University Hospital between September 1, 2019, and March 31, 2021. Children aged 2-6 years who had been diagnosed with asthma with acute exacerbation were enrolled and followed-up until the end of the study. Correlations between the parameters of IOS, C-ACT and TRACK were assessed. The validity and reliability of TRACK were verified. RESULTS A total of 114 children with asthma and acute exacerbations were recruited. Their mean age was 4.1 ± 1.1 years, and 60.5% were males. After a year of treatment, the change of R5-R20 from baseline 0.64 ± 0.38 kPa/L/s to 12th month 0.48 ± 0.2 kPa/L/s (p = 0.022). TRACK and C-ACT scores were significantly correlated during the observation period. R5-R20 in IOS at baseline and at the 12th month of follow-up as well as the change in IOS parameters were significantly associated with C-ACT (p = 0.003, 0.015, and 0.001, respectively). R5% and R5-R20 changes in IOS were associated with TRACK (p = 0.04 and 0.025, respectively). Sensitivity and specificity of TRACK were 80.8% (67.5-90.4) and 100% (94.1-100), respectively, with cut-off points >95 and AUC 93.8%. CONCLUSION TRACK score appears to have a stronger association with the IOS parameter than C-ACT score. Our findings indicate that TRACK is a valid tool for assessing asthma control in preschool children.
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Affiliation(s)
- Hsiang-Fan Wu
- Department of Pediatrics, Kung Tien General Hospital, Taichung, Taiwan
| | - An-Chyi Chen
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Chang-Ching Wei
- School of Medicine, China Medical University, Taichung, Taiwan; Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan.
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Lei J, Liu C, Meng X, Sun Y, Huang S, Zhu Y, Gao Y, Shi S, Zhou L, Luo H, Kan H, Chen R. Associations between fine particulate air pollution with small-airway inflammation: A nationwide analysis in 122 Chinese cities. Environ Pollut 2024; 344:123330. [PMID: 38199484 DOI: 10.1016/j.envpol.2024.123330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/24/2023] [Accepted: 01/06/2024] [Indexed: 01/12/2024]
Abstract
Alveolar nitric oxide is a non-invasive indicator of small-airway inflammation, a key pathophysiologic mechanism underlying lower respiratory diseases. However, no epidemiological studies have investigated the impact of fine particulate matter (PM2.5) exposure on the concentration of alveolar nitric oxide (CANO). To explore the associations between PM2.5 exposure in multiple periods and CANO, we conducted a nationwide cross-sectional study in 122 Chinese cities between 2019 and 2021. Utilizing a satellite-based model with a spatial resolution of 1 × 1 km, we matched long-term, mid-term, and short-term PM2.5 exposure for 28,399 individuals based on their home addresses. Multivariable linear regression models were applied to estimate the associations between PM2.5 at multiple exposure windows and CANO. Stratified analyses were also performed to identify potentially vulnerable subgroups. We found that per interquartile range (IQR) unit higher in 1-year average, 1-month average, and 7-day average PM2.5 concentration was significantly associated with increments of 17.78% [95% confidence interval (95%CI): 12.54%, 23.26%], 8.76% (95%CI: 7.35%, 10.19%), and 4.00% (95%CI: 2.81%, 5.20%) increment in CANO, respectively. The exposure-response relationship curves consistently increased with the slope becoming statistically significant beyond 20 μg/m3. Males, children, smokers, individuals with respiratory symptoms or using inhaled corticosteroids, and those living in Southern China were more vulnerable to PM2.5 exposure. In conclusion, our study provided novel evidence that PM2.5 exposure in long-term, mid-term, and short-term periods could significantly elevate small-airway inflammation represented by CANO. Our results highlight the significance of CANO measurement as a non-invasive tool for early screening in the management of PM2.5-related inflammatory respiratory diseases.
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Affiliation(s)
- Jian Lei
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China; Department of Occupational and Environmental Health, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, China.
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Yiqing Sun
- Eberly College of Science, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Suijie Huang
- Guangzhou Homesun Medical Technology Co., Ltd, Guangdong, 518040, China
| | - Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Ya Gao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Su Shi
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Lu Zhou
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Huihuan Luo
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
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Del Duca E, Dahabreh D, Kim M, Bar J, Da Rosa JC, Rabinowitz G, Facheris P, Gómez-Arias PJ, Chang A, Utti V, Chowdhury A, Liu Y, Estrada YD, Laculiceanu A, Agache I, Guttman-Yassky E. Transcriptomic evaluation of skin tape-strips in children with allergic asthma uncovers epidermal barrier dysfunction and asthma-associated biomarkers abnormalities. Allergy 2024. [PMID: 38375886 DOI: 10.1111/all.16060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Tape-strips, a minimally invasive method validated for the evaluation of several skin diseases, may help identify asthma-specific biomarkers in the skin of children with allergic asthma. METHODS Skin tape-strips were obtained and analyzed with RNA-Seq from children with moderate allergic asthma (MAA) (n = 11, mean age 7.00; SD = 1.67), severe allergic asthma (SAA) (n = 9, mean age 9.11; SD = 2.37), and healthy controls (HCs) (n = 12, mean age 7.36; SD = 2.03). Differentially expressed genes (DEGs) were identified by fold change ≥2 with a false discovery rate <0.05. Transcriptomic biomarkers were analyzed for their accuracy in distinguishing asthma from HCs, their relationships with asthma-related outcomes (exacerbation rate, lung function-FEV1, IOS-R5-20, and lung inflammation-FeNO), and their links to skin (barrier and immune response) and lung (remodeling, metabolism, aging) pathogenetic pathways. RESULTS RNA-Seq captured 1113 in MAA and 2117 DEGs in SAA. Epidermal transcriptomic biomarkers for terminal differentiation (FLG/filaggrin), cell adhesion (CDH19, JAM2), lipid biosynthesis/metabolism (ACOT2, LOXL2) were significantly downregulated. Gene set variation analysis revealed enrichment of Th1/IFNγ pathways (p < .01). MAA and SAA shared downregulation of G-protein-coupled receptor (OR4A16, TAS1R3), upregulation of TGF-β/ErbB signaling-related (ACVR1B, EGFR, ID1/2), and upregulation of mitochondrial-related (HIGD2A, VDAC3, NDUFB9) genes. Skin transcriptomic biomarkers correlated with the annualized exacerbation rate and with lung function parameters. A two-gene classifier (TSSC4-FAM212B) was able to differentiate asthma from HCs with 100% accuracy. CONCLUSION Tape-strips detected epithelial barrier and asthma-associated signatures in normal-appearing skin from children with allergic asthma and may serve as an alternative to invasive approaches for evaluating asthma endotypes.
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Affiliation(s)
- Ester Del Duca
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Dante Dahabreh
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Madeline Kim
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Jonathan Bar
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Joel Correa Da Rosa
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Grace Rabinowitz
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Paola Facheris
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
- Department of Dermatology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Pedro Jesús Gómez-Arias
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
- Department of Dermatology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Annie Chang
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Vivian Utti
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Amira Chowdhury
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Ying Liu
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Yeriel D Estrada
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
| | - Alexandru Laculiceanu
- Department of Allergy and Clinical Immunology, Transylvania University, Brasov, Romania
| | - Ioana Agache
- Department of Allergy and Clinical Immunology, Transylvania University, Brasov, Romania
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai, New York, New York, USA
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Maue DK, Cater DT, Rogerson CM, Ealy A, Tori AJ, Abu-Sultaneh S. Outcomes of a respiratory therapist driven high flow nasal cannula management protocol for pediatric critical asthma patients. Pediatr Pulmonol 2023; 58:2881-2888. [PMID: 37606224 DOI: 10.1002/ppul.26606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION This study aimed to determine if a respiratory therapist (RT)-driven high flow nasal cannula (HFNC) protocol could decrease duration of HFNC use, pediatric intensive care unit (PICU) and hospital length of stay (LOS), and duration of continuous albuterol use in pediatric patients with critical asthma. METHODS This was a quality improvement project performed at a quaternary academic PICU. Patients admitted to the PICU between 2 and 18 years of age with a diagnosis of asthma requiring continuous albuterol and HFNC were included. Implementation of an RT-driven HFNC protocol [Plan-Do-Study-Act (PDSA) 1] occurred in October 2017. Additional interventions included weaning continuous albuterol and HFNC simultaneously (PDSA 2; March 2019), adjusting HFNC wean rate (PDSA 3; July 2020), and a HFNC holiday (PDSA 4; October 2021). HFNC duration was the primary outcome. Secondary outcomes included LOS data and continuous albuterol duration. Noninvasive ventilation (NIV), invasive mechanical ventilation (IMV), and 7-day PICU and hospital readmission rates were used as balancing measures. RESULTS A total of 410 patients were included. Patient demographics and adjunct therapy use did not differ among the groups. After PDSA 2, mean HFNC duration decreased (26.8-18.1 h). Mean PICU LOS decreased (41-31.8 h). Mean hospital LOS also decreased (86.5-68 h). These outcomes remained stable during PDSA 3 and 4. Continuous albuterol duration and NIV use were unchanged, while IMV use decreased. CONCLUSIONS An RT-driven HFNC protocol led to decreased length of HFNC and PICU and hospital LOS for pediatric patients with critical asthma without an increase in adverse events.
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Affiliation(s)
- Danielle K Maue
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel T Cater
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Colin M Rogerson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aimee Ealy
- Department of Respiratory Care Services, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Alvaro J Tori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Samer Abu-Sultaneh
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Maabreh R, Alrabab'a MH, Morsy MA, Al-Akash HY, Rajeh Saifan A, Al-Yateem N. Guideline Implementation for Improved Asthma Management and Treatment Adherence in Children in Jordan. Healthcare (Basel) 2023; 11:1693. [PMID: 37372811 DOI: 10.3390/healthcare11121693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Asthma imposes a significant social burden on children, their families, and society at large. As a chronic health condition, effective management could greatly benefit from consistent adherence to guidelines. Despite this, minimal effort has been exerted to examine the impact of asthma management guidelines and adherence to treatment on children with asthma and the mothers caring for them. This study was designed to evaluate the influence of asthma management guidelines on the knowledge and treatment adherence among children with asthma and their mothers. A quasi-experimental design was utilized, and the study was conducted at two large hospitals in Jordan: Princess Rahma Hospital and King Hussein Medical Center. A purposive sample of children aged 6-12 years (n = 100) who were accompanied by their mothers (n = 100) were recruited for this study. Data were collected using a structured questionnaire and an observation checklist before and after the implementation of guidelines. Statistical analyses were performed using SPSS. The results revealed a statistically significant improvement in knowledge related to asthma among children and their mothers (p < 0.001). Additionally, a statistically significant difference was observed in the children's adherence to their treatment regimen before and after the implementation of asthma management guidelines (p < 0.001). Moreover, the improvements in knowledge and practice related to asthma were sustained in the follow-up assessments. In conclusion, the guidelines had a beneficial effect on the children's adherence to their treatment regimen both before and after their implementation. Thus, asthma patients should adhere to conventional guidelines at various health services to manage their condition effectively.
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Affiliation(s)
- Roqia Maabreh
- Faculty of Nursing, Al-Balqa Applied University, Alsalt 19117, Jordan
| | | | - Madiha Amin Morsy
- Pediatric Nursing Department, Faculty of Nursing, Ain Shams University, Cairo 11517, Egypt
| | | | - Ahmad Rajeh Saifan
- Faculty of Nursing, Applied Science Private University, Amman 11937, Jordan
| | - Nabeel Al-Yateem
- College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
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Onisor MO, Turner S. Routine FEV 1 measurement is essential in diagnosis and monitoring of childhood asthma: myth or maxim? Breathe (Sheff) 2023; 19:230048. [PMID: 37645020 PMCID: PMC10461742 DOI: 10.1183/20734735.0048-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/11/2023] [Indexed: 08/31/2023] Open
Abstract
Childhood asthma is a common condition in children. This review describes the evidence from seven asthma guidelines for using spirometry in the diagnosis and monitoring of childhood asthma. All guidelines recommend spirometry as the primary test to be performed for diagnosing asthma in children aged >5 years. Spirometry is often normal in children with asthma. Guidelines are not consistent with respect to whether forced expiratory volume in 1 s (FEV1) or FEV1/forced vital capacity (FVC) should be measured, or their threshold for "abnormal" spirometry, and we describe the sensitivity and specificity for these different cut-offs. The role of spirometry in monitoring asthma is less clear in the guidelines, and some do not suggest spirometry should be done. There is no consensus on what spirometric measurement should be used, how often it should be measured and what is a minimum clinically important change in spirometry. The role of spirometry in diagnosing asthma is more clearly established when compared to its role in monitoring asthma. The potential of spirometry to aid decision making for asthma diagnosis and monitoring in children remains to be fully evaluated. Educational aims To provide knowledge of the commonly used guidelines for asthma diagnosis and management.To give insight into the opportunities and challenges in using spirometry to diagnose and monitor asthma in children.To provide an understanding of the precision of spirometry for diagnosing asthma.
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Affiliation(s)
| | - Steve Turner
- Division of Women and Children, NHS Grampian, Aberdeen, UK
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10
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Thomas ET, Thomas ST, Perera R, Gill PJ, Moloney S, Heneghan CJ. The quality of paediatric asthma guidelines: evidence underpinning diagnostic test recommendations from a meta-epidemiological study. Fam Pract 2023:7169412. [PMID: 37196169 DOI: 10.1093/fampra/cmad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Asthma is one of the most frequent reasons children visit a general practitioner (GP). The diagnosis of childhood asthma is challenging, and a variety of diagnostic tests for asthma exist. GPs may refer to clinical practice guidelines when deciding which tests, if any, are appropriate, but the quality of these guidelines is unknown. OBJECTIVES To determine (i) the methodological quality and reporting of paediatric guidelines for the diagnosis of childhood asthma in primary care, and (ii) the strength of evidence supporting diagnostic test recommendations. DESIGN Meta-epidemiological study of English-language guidelines from the United Kingdom and other high-income countries with comparable primary care systems including diagnostic testing recommendations for childhood asthma in primary care. The AGREE-II tool was used to assess the quality and reporting of the guidelines. The quality of the evidence was assessed using GRADE. RESULTS Eleven guidelines met the eligibility criteria. The methodology and reporting quality varied across the AGREE II domains (median score 4.5 out of 7, range 2-6). The quality of evidence supporting diagnostic recommendations was generally of very low quality. All guidelines recommended the use of spirometry and reversibility testing for children aged ≥5 years, however, the recommended spirometry thresholds for diagnosis differed across guidelines. There were disagreements in testing recommendations for 3 of the 7 included tests. CONCLUSIONS The variable quality of guidelines, lack of good quality evidence, and inconsistent recommendations for diagnostic tests may contribute to poor clinician adherence to guidelines and variation in testing for diagnosing childhood asthma.
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Affiliation(s)
- Elizabeth T Thomas
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah T Thomas
- Department of Neurology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter J Gill
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Carl J Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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11
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Miyake K, Kushima M, Shinohara R, Horiuchi S, Otawa S, Akiyama Y, Ooka T, Kojima R, Yokomichi H, Yamagata Z. Maternal smoking status before and during pregnancy and bronchial asthma at 3 years of age: a prospective cohort study. Sci Rep 2023; 13:3234. [PMID: 36828882 PMCID: PMC9958124 DOI: 10.1038/s41598-023-30304-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
The association between maternal pre-pregnancy smoking status and asthma risk is unclear. This study aimed to investigate the association between pre- and post-pregnancy maternal smoking status and bronchial asthma at 3 years of age in a large birth cohort. Data of 75,411 mother-child pairs from the Japan Environment and Children's Study (JECS) were analysed using multivariate logistic regression analysis. Overall, 7.2% of the children had bronchial asthma. The maternal smoking status before childbirth was as follows: Never = 60.0%, Quit before recognising current pregnancy = 24.1%, Quit after finding out about current pregnancy = 12.3%, and Still smoking = 3.6%. Children of mothers who sustained smoking during pregnancy had an increased risk of bronchial asthma at 3 years of age even after adjusting for pre- and postnatal covariates (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.15-1.56). Children of mothers who quit before (aOR 1.09, 95% CI 1.02-1.18) or after (aOR 1.11, 95% CI 1.01-1.23) recognising the current pregnancy had an increased risk of bronchial asthma at 3 years of age. Maternal smoking throughout pregnancy and smoking exposure pre-pregnancy or in early pregnancy increases the risk of bronchial asthma in children.
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Affiliation(s)
- Kunio Miyake
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
| | - Megumi Kushima
- grid.267500.60000 0001 0291 3581Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Ryoji Shinohara
- grid.267500.60000 0001 0291 3581Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Sayaka Horiuchi
- grid.267500.60000 0001 0291 3581Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Sanae Otawa
- grid.267500.60000 0001 0291 3581Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Yuka Akiyama
- grid.267500.60000 0001 0291 3581Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898 Japan
| | - Tadao Ooka
- grid.267500.60000 0001 0291 3581Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898 Japan
| | - Reiji Kojima
- grid.267500.60000 0001 0291 3581Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898 Japan
| | - Hiroshi Yokomichi
- grid.267500.60000 0001 0291 3581Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898 Japan
| | - Zentaro Yamagata
- grid.267500.60000 0001 0291 3581Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898 Japan ,grid.267500.60000 0001 0291 3581Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
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12
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Li C, Zhao Y, Cai C, Liu Z, Ma J, Song Y, Zhang Y, Guo W, Lu Y, Xing J, Wang Y, Li W, Shi W, Qu H. MiR-185-5p measurement assists in reflecting Th1/Th2 cell imbalance, inflammatory cytokine production, and exacerbation risk for childhood asthma. Allergol Immunopathol (Madr) 2023; 51:91-98. [PMID: 37169565 DOI: 10.15586/aei.v51i3.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND MicroRNA (miR)-185-5p participates in the pathology of asthma by regulating immune imbalance, inflammation, periostin synthesis, and smooth muscle contraction. This study intended to explore the dysregulation of miR-185p and its correlation with T-helper (Th)1, Th2 cells, and inflammatory cytokines in childhood asthma. METHODS In 150 childhood asthma patients and 30 healthy controls (HCs), miR-185-5p from peripheral blood mononuclear cells was detected using reverse transcription-quantitative polymerase chain reaction, Th cells from peripheral blood samples were detected using flow cytometry, inflammatory cytokines from serum samples were detected using enzyme-linked immunosorbent assay. RESULTS MiR-185-5p was increased in childhood asthma patients versus HCs [median (interquartile range (IQR)): 2.315 (1.770-3.855) versus 1.005 (0.655-1.520)] (P < 0.001). Meanwhile, miR-185-5p was negatively associated with Th1 cells (P = 0.035) but positively correlated with Th2 cells (P = 0.006) and IL-4 (P = 0.003) in childhood asthma patients; however, miR-185-5p was not linked to Th1 cells, Th2 cells, IFN-γ, or IL-4 in HCs (all P > 0.05). In addition, miR-185-5p was positively related to TNF-α (P < 0.001), IL-1β (P = 0.015), and IL-6 (P = 0.008) in childhood asthma patients, miR-185-5p was only linked to TNF-α (P = 0.040) but not IL-1β or IL-6 (both P > 0.05) in HCs. Moreover, miR-185-5p was increased in exacerbated childhood asthma patients versus remissive patients [median (IQR): 3.170 (2.070-4.905) versus 1.900 (1.525-2.615)] (P < 0.001). Besides, miR-185-5p was highest in patients with severe exacerbation followed by patients with moderate exacerbation, and lowest in patients with mild exacerbation (P = 0.010). CONCLUSION MiR-185-5p is associated with imbalanced Th1/Th2 cells, increased inflammatory cytokines along with elevated exacerbation risk, and severity in childhood asthma patients.
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Affiliation(s)
- Chunmei Li
- Tianjin Medical University, Tianjin, China
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Yiran Zhao
- Tianjin Medical University, Tianjin, China
- Department of Pediatric, Maternal and Child Health Hospital of Tangshan, Tangshan, China
| | - Chunquan Cai
- Department of Neurosurgery, Tianjin Institute of Pediatrics, Tianjin Children's Hospital, Tianjin, China;
| | - Zhenkui Liu
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Junshuai Ma
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Yanhong Song
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Yanwen Zhang
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Weiping Guo
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Yanhui Lu
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Jing Xing
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Yanfei Wang
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Wenbin Li
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Wei Shi
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Haixin Qu
- Department of Pediatric, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
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13
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Dahan E, El Ghazal N, Nakanishi H, El Haddad J, Matar RH, Tosovic D, Beran A, Than CA, Stiasny D. Dexamethasone versus prednisone/prednisolone in the management of pediatric patients with acute asthmatic exacerbations: a systematic review and meta-analysis. J Asthma 2022:1-12. [PMID: 36461938 DOI: 10.1080/02770903.2022.2155189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Acute asthmatic exacerbation is a common condition for pediatric emergency visits. Recently, dexamethasone has increasingly been used as an alternative to prednisone. This study aimed to evaluate the safety and efficacy of dexamethasone (DEX) against prednisone/prednisolone (PRED) in managing pediatric patients with acute asthmatic exacerbation. DATA SOURCES Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to August 2022 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42022353462). STUDY SELECTIONS From 316 studies screened, seventeen studies met the eligibility criteria, with 5967 pediatric patients experiencing an asthma exacerbation requiring treatment with either DEX (n = 2865) or PRED (n = 3102). Baseline patient characteristics (age, sex, PRAM (pediatric respiratory assessment measure), previous corticosteroid and beta-agonist inhaler) were comparable between groups. RESULTS After treatment administration, the DEX group had fewer vomiting incidents (OR = 0.24, 95% CI: 0.11, 0.51, I2 = 58%) and reduced noncompliance events (OR = 0.12, 95% CI: 0.04, 0.34, I2 = 0%) when compared to the PRED group. Regarding emergency-department (ED)-related outcomes, there were no differences in hospital admission rates (OR = 0.83, 95% CI: 0.58, 1.19, I2 = 15%), time spent in the ED (MD= -0.11 h, 95% CI: -0.52; 0.30, I2 = 82%) or relapse occurrences (OR = 0.67, 95% CI: 0.30, 1.49, I2 = 52%) between both groups. CONCLUSION Although there were no differences between the DEX and PRED groups in terms of hospital admission rates, time spent in the ED or relapse events, pediatric patients receiving DEX experienced lower noncompliance and vomiting rates.
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Affiliation(s)
- Elise Dahan
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Nour El Ghazal
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Hayato Nakanishi
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Joe El Haddad
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Reem H Matar
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus.,Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Danijel Tosovic
- School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
| | - Christian A Than
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus.,School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
| | - David Stiasny
- Pediatrics Department Swedish Medical Group, Chicago, IL, USA
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14
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Demoly P, Liu AH, Rodriguez Del Rio P, Pedersen S, Casale TB, Price D. A Pragmatic Primary Practice Approach to Using Specific IgE in Allergy Testing in Asthma Diagnosis, Management, and Referral. J Asthma Allergy 2022; 15:1069-1080. [PMID: 35996427 PMCID: PMC9392458 DOI: 10.2147/jaa.s362588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022] Open
Abstract
Asthma afflicts an estimated 339 million people globally and is associated with ill health, disability, and early death. Strong risk factors for developing asthma are genetic predisposition and environmental exposure to inhaled substances that may provoke allergic reactions. Asthma guidelines recommend identifying causal or trigger allergens with specific IgE (sIgE) testing after a diagnosis of asthma has been made. Allergy testing with sIgE targets subpopulations of patients considered at high risk, such as those with frequent exacerbations, emergency visits or hospitalizations, or uncontrolled symptoms. Specific recommendations apply to preschool children, school-age children, patients with persistent or difficult-to-control asthma, patients needing oral corticosteroids or high-dose inhaled steroids, patients seeking understanding and guidance about their disease, and candidates for advanced therapies (biologics, allergen immunotherapy). Allergen skin testing is common in specialized settings but less available in primary care. Blood tests for total and sIgE are accessible and yield quantifiable results for tested allergens, useful for detecting sensitization. Results are interpreted in the context of the patient’s clinical presentation, age, and relevant allergen exposures. Incorporating sIgE testing into asthma management adds objective information to identify specific allergies and can guide personalized treatment plans, which reinforce patient-doctor communication. Test results can also be used to predict exacerbations and response to therapies. Additional diagnostic information can be gleaned from (i) eosinophil count ≥300 μL, which significantly increases the odds of having exacerbations, and emerging eosinophil biomarkers (eg, eosinophil-derived neurotoxin), which can be measured in plasma or serum samples, and (ii) fractional exhaled nitric oxide (FeNO), with values ≥25 ppb regarded as the cutoff for diagnosis, evaluating inhaled corticosteroid response, and of probable response to anti-IgE, anti-IL4 and anti-IL5 receptor biologics. Referral to asthma/allergy specialists is warranted when the initial diagnosis is uncertain, and when asthma symptoms, impairment, or exacerbations are repeated or severe.
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Affiliation(s)
- Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, Montpellier, France.,IDESP Inserm, University, Hospital of Montpellier, Montpellier, France
| | - Andrew H Liu
- Airway Inflammation, Resilience & the Environment (AIRE) Program, Breathing Institute, Section of Pediatric Pulmonary & Sleep Medicine, Children's Hospital Colorado, Professor of Pediatrics, University of Colorado School of Medicine, Adjunct Professor of Pediatrics, National Jewish Health, Denver, CO, USA
| | | | - Soren Pedersen
- GINA Program, Department of Pediatrics, Kolding Hospital, Kolding, Denmark
| | - Thomas B Casale
- Food Allergy Research and Education (FARE), McLean, VA, USA.,Department of Medicine and Pediatrics, University of South Florida, Tampa, FL, USA
| | - David Price
- Observational and Pragmatic Research Institute, Singapore
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15
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Papapostolou N, Makris M. Allergic Asthma in the Era of Personalized Medicine. J Pers Med 2022; 12:1162. [PMID: 35887659 PMCID: PMC9321181 DOI: 10.3390/jpm12071162] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/17/2023] Open
Abstract
Allergic asthma is the most common asthma phenotype and is characterized by IgE sensitization to airborne allergens and subsequent typical asthmatic symptoms after exposure. A form of type 2 (T2) airway inflammation underlies allergic asthma. It usually arises in childhood and is accompanied by multimorbidity presenting with the occurrence of other atopic diseases, such as atopic dermatitis and allergic rhinitis. Diagnosis of the allergic endotype is based on in vivo (skin prick tests) and/or in vitro (allergen-specific IgE levels, component-resolved diagnosis (CRD)) documentation of allergic sensitization. Biomarkers identifying patients with allergic asthma include total immunoglobulin E (IgE) levels, fractional exhaled nitric oxide (FeNO) and serum eosinophil counts. The treatment of allergic asthma is a complex procedure and requires a patient-tailored approach. Besides environmental control involving allergen avoidance measurements and cornerstone pharmacological interventions based on inhaled drugs, allergen-specific immunotherapy (AIT) and biologics are now at the forefront when it comes to personalized management of asthma. The current review aims to shed light on the distinct phenotype of allergic asthma, ranging over its current definition, clinical characteristics, pathophysiology and biomarkers, as well as its treatment options in the era of precision medicine.
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16
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Mitselou N, Stephansson O, Melén E, Ludvigsson JF. Exposure to Allergen-Specific Immunotherapy in Pregnancy and Risk of Congenital Malformations and Other Adverse Pregnancy Outcomes. J Allergy Clin Immunol Pract 2022; 10:1635-1641.e2. [PMID: 35487856 DOI: 10.1016/j.jaip.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Owing to insufficient data, current guidelines recommend against initiating allergen-specific immunotherapy (AIT) during pregnancy but suggest that well-tolerated ongoing immunotherapy may be continued. OBJECTIVE To evaluate the safety of AIT in pregnancy, especially the risk for congenital malformations. METHODS This nationwide Swedish cohort study identified pregnancies exposed to AIT, both subcutaneous and sublingual, through the Swedish Medical Birth register and the Prescribed Drug Register between 2005 and 2014. Information on congenital malformations in offspring was retrieved from the National Patient Register. Using the personal identity number, we linked data between registers. Using logistic regression, we calculated odds ratios (ORs) with 95% CIs for congenital malformations and other adverse pregnancy outcomes after adjusting for potential confounders. RESULTS From 2005 to 2014, we identified 924,790 singleton pregnancies. Among these, 743 pregnancies had been exposed to AIT 3 months before conception up until gestational week 22. Allergen-specific immunotherapy in pregnancy was not linked to congenital malformations (OR = 0.90; 95% CI, 0.63-1.27) or other adverse pregnancy outcomes (preterm birth: OR = 0.98; 95% CI, 0.71-1.35; stillbirth: OR = 0.79; 95% CI, 0.26-2.47; or cesarean delivery: OR = 0.91; 95% CI, 0.76-1.09). Stratification by route of immunotherapy, subcutaneous or sublingual, resulted in similar ORs. Restricting the pregnancy cohort to women with asthma or pulmonary disease, nulliparous women, births in 2012 to 2014, or Swedish-born women yielded similar results. CONCLUSIONS This nationwide study found no evidence of congenital malformations or other adverse pregnancy outcomes in women treated with AIT in pregnancy.
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Affiliation(s)
- Niki Mitselou
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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17
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Sereme Y, Michel M, Mezouar S, Guindo CO, Kaba L, Grine G, Mura T, Mège JL, Tran TA, Corbeau P, Filleron A, Vitte J. A Non-Invasive Neonatal Signature Predicts Later Development of Atopic Diseases. J Clin Med 2022; 11:jcm11102749. [PMID: 35628877 PMCID: PMC9143112 DOI: 10.3390/jcm11102749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Preterm birth is a major cause of morbidity and mortality in infants and children. Non-invasive methods for screening the neonatal immune status are lacking. Archaea, a prokaryotic life domain, comprise methanogenic species that are part of the neonatal human microbiota and contribute to early immune imprinting. However, they have not yet been characterized in preterm neonates. Objective: To characterize the gut immunological and methanogenic Archaeal (MA) signature in preterm neonates, using the presence or absence of atopic conditions at the age of one year as a clinical endpoint. Methods: Meconium and stool were collected from preterm neonates and used to develop a standardized stool preparation method for the assessment of mediators and cytokines and characterize the qPCR kinetics of gut MA. Analysis addressed the relationship between immunological biomarkers, Archaea abundance, and atopic disease at age one. Results: Immunoglobulin E, tryptase, calprotectin, EDN, cytokines, and MA were detectable in the meconium and later samples. Atopic conditions at age of one year were positively associated with neonatal EDN, IL-1β, IL-10, IL-6, and MA abundance. The latter was negatively associated with neonatal EDN, IL-1β, and IL-6. Conclusions: We report a non-invasive method for establishing a gut immunological and Archaeal signature in preterm neonates, predictive of atopic diseases at the age of one year.
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Affiliation(s)
- Youssouf Sereme
- IHU Méditerranée Infection, 13005 Marseille, France; (Y.S.); (M.M.); (S.M.); (C.O.G.); (L.K.); (G.G.); (J.-L.M.)
- IRD, APHM, MEPHI, Aix-Marseille Université, 13284 Marseille, France
| | - Moïse Michel
- IHU Méditerranée Infection, 13005 Marseille, France; (Y.S.); (M.M.); (S.M.); (C.O.G.); (L.K.); (G.G.); (J.-L.M.)
- IRD, APHM, MEPHI, Aix-Marseille Université, 13284 Marseille, France
- Immunology Department, University Hospital Nîmes, 30900 Nîmes, France
| | - Soraya Mezouar
- IHU Méditerranée Infection, 13005 Marseille, France; (Y.S.); (M.M.); (S.M.); (C.O.G.); (L.K.); (G.G.); (J.-L.M.)
- IRD, APHM, MEPHI, Aix-Marseille Université, 13284 Marseille, France
| | - Cheick Oumar Guindo
- IHU Méditerranée Infection, 13005 Marseille, France; (Y.S.); (M.M.); (S.M.); (C.O.G.); (L.K.); (G.G.); (J.-L.M.)
- IRD, APHM, MEPHI, Aix-Marseille Université, 13284 Marseille, France
| | - Lanceï Kaba
- IHU Méditerranée Infection, 13005 Marseille, France; (Y.S.); (M.M.); (S.M.); (C.O.G.); (L.K.); (G.G.); (J.-L.M.)
- IRD, AP-HM, SSA, VITROME, Aix-Marseille Université, 13284 Marseille, France
| | - Ghiles Grine
- IHU Méditerranée Infection, 13005 Marseille, France; (Y.S.); (M.M.); (S.M.); (C.O.G.); (L.K.); (G.G.); (J.-L.M.)
- IRD, APHM, MEPHI, Aix-Marseille Université, 13284 Marseille, France
- UFR Odontologie, Aix-Marseille Université, 13284 Marseille, France
| | - Thibault Mura
- INSERM, University of Montpellier, U1061, Neuropsychiatry: Epidemiological and Clinical Research, 34093 Montpellier, France;
- Laboratoire de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Groupe Hospitalier Caremeau, CHU de Nîmes, Nîmes University Hospital, 30900 Nîmes, France
| | - Jean-Louis Mège
- IHU Méditerranée Infection, 13005 Marseille, France; (Y.S.); (M.M.); (S.M.); (C.O.G.); (L.K.); (G.G.); (J.-L.M.)
- IRD, APHM, MEPHI, Aix-Marseille Université, 13284 Marseille, France
| | - Tu Anh Tran
- Paediatrics Department, University Hospital Nîmes, 30900 Nîmes, France;
- INSERM U1183, Institute for Regenerative Medicine & Biotherapy, 34295 Montpellier, France
- Faculty de Medicine, Montpellier University, 34000 Montpellier, France
| | - Pierre Corbeau
- Immunology Department, University Hospital Nîmes, 30900 Nîmes, France
- Faculty de Medicine, Montpellier University, 34000 Montpellier, France
- CNRS UMR 9002, Institute of Human Genetics, 34090 Montpellier, France
- Correspondence: (P.C.); (A.F.); (J.V.); Tel.: +33-4-13-73-20-51 (J.V.); Fax: +33-4-13-73-20-52 (J.V.)
| | - Anne Filleron
- Paediatrics Department, University Hospital Nîmes, 30900 Nîmes, France;
- INSERM U1183, Institute for Regenerative Medicine & Biotherapy, 34295 Montpellier, France
- Faculty de Medicine, Montpellier University, 34000 Montpellier, France
- Correspondence: (P.C.); (A.F.); (J.V.); Tel.: +33-4-13-73-20-51 (J.V.); Fax: +33-4-13-73-20-52 (J.V.)
| | - Joana Vitte
- IHU Méditerranée Infection, 13005 Marseille, France; (Y.S.); (M.M.); (S.M.); (C.O.G.); (L.K.); (G.G.); (J.-L.M.)
- IRD, APHM, MEPHI, Aix-Marseille Université, 13284 Marseille, France
- Faculty de Medicine, Montpellier University, 34000 Montpellier, France
- IDESP, INSERM UMR UA11, Institut Desbrest d’Epidemiologie et de Santé Publique (IDESP) Campus Sante, 34093 Montpellier, France
- Correspondence: (P.C.); (A.F.); (J.V.); Tel.: +33-4-13-73-20-51 (J.V.); Fax: +33-4-13-73-20-52 (J.V.)
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18
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Padró C, Gutiérrez D, Moreno F, Parra A, Rial MJ, Lleonart R, Torán‐Barona C, Justicia JL, Roger A. Effectiveness and safety of a microcrystalline tyrosine‐adjuvanted
Dermatophagoides pteronyssinus
allergoid immunotherapy in adult patients with allergic asthma and rhinitis: A real‐life prospective observational study. Immun Inflamm Dis 2022; 10:e585. [PMID: 35478444 PMCID: PMC9017636 DOI: 10.1002/iid3.585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/18/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Although clinical trials have shown the efficacy and safety of allergen‐specific immunotherapy (AIT) in the treatment of allergic asthma, there is a need for real‐life studies. We aimed to assess the effectiveness and safety of a microcrystalline tyrosine‐adjuvanted Dermatophagoides pteronyssinus allergoid (Acarovac Plus®) in patients with house dust mite (HDM)‐induced allergic asthma in a real‐life study. Methods A subanalysis of a multicenter, prospective, observational, real‐life study. Patients with rhinitis and allergic asthma caused by HDMs were assessed before AIT with Acarovac Plus® and at 6 and 12 months after this treatment. Assessment parameters were percentage of days with asthma symptoms, percentage of days on asthma medication, classification of asthma according to Spanish guidelines for the management of asthma, asthma‐related quality of life (quality of life in adults with asthma questionnaire [QLAAQ]), perception of symptoms (visual analog scale [VAS]), and treatment satisfaction (treatment satisfaction questionnaire for medication [TSQM]). Safety was assessed by the number and severity of adverse reactions. Results This subanalysis included 55 patients. Treatment with Acarovac Plus® showed significant differences in the analyzed variables when the baseline visit was compared with the 12‐month visit: reduction of the mean (SD) percentage of days with asthma symptoms (23.9 [9.2] vs. 5.1 [12.8]; p = .002), of the mean [SD] percentage of days on asthma medication (67.6 [42.9] vs. 45.1 [46.8]; p = .002), and of the percentage of patients with persistent asthma (78.2% vs. 38.9%; p = .009). Acarovac Plus® significantly improved asthma‐related quality of life, as shown by a decrease of 1.39 points in QLAAQ score at 12 months (p < .001), and in the subjective perception of symptoms on the VAS (−3.50, p < .0001). Patients showed high treatment satisfaction according to the TSQM, and it was well tolerated. No serious adverse events were reported. Conclusions Acarovac Plus® was effective and safe for the treatment of patients with HDM‐induced allergic asthma in a real‐life study.
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Affiliation(s)
- Clara Padró
- Allergy Section Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Diego Gutiérrez
- Clínica Médico Asistencial Virgen del Rosario Algeciras Spain
| | | | - Antonio Parra
- Allergy Department Complexo Hospitalario Universitario A Coruña A Coruña Spain
| | - Manuel J. Rial
- Allergy Department Complexo Hospitalario Universitario A Coruña A Coruña Spain
| | - Ramón Lleonart
- Allergy Unit Hospital Universitari de Bellvitge L'Hospitalet de Llobregat Spain
| | | | | | - Albert Roger
- Allergy Section Hospital Universitari Germans Trias i Pujol Badalona Spain
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19
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Rolke LJ, Griffin SF, Hamilton J, Mayo R, Williams JE, Rennert L, Sease KK. Parent/Guardian Experiences With the Healthcare System and Community Supports for Pediatric Asthma Management. J Patient Exp 2022; 9:23743735221089458. [PMID: 35465409 PMCID: PMC9019383 DOI: 10.1177/23743735221089458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Determinants of pediatric asthma management include child, family, healthcare, and community factors. The purpose of this study is to investigate how parents/guardians are impacted by and act on these factors to aid in their child’s asthma self-management. Interviews were conducted in Fall 2020 with 12 female parents/guardians of Black/African American children who participated in a community paramedic pilot study with their child in South Carolina. Children in the initial study had an asthma diagnosis of moderate persistent asthma, had Medicaid insurance, and were determined high-risk for emergency room presentation. Inductive and deductive qualitative analysis identified that child management self-efficacy and independence, parent/guardian health literacy, parent and child negative experiences related to asthma diagnosis and management, asthma management tools, and social support from multiple sources impact child self-management. Findings from this study highlight the importance of clear asthma education and management tool recommendations from healthcare and community providers, particularly for parents/guardians with low health literacy. Health literacy impacted parental responses and likely how families comprehend Medicaid and clinical asthma guidance.
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Affiliation(s)
- Laura J Rolke
- College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA
- Texas A&M AgriLife Research, Dallas, TX, USA
| | - Sarah F Griffin
- College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA
| | - Joel Hamilton
- College of Agriculture, Forestry, and Life Sciences, Clemson University, Clemson, SC, USA
| | - Rachel Mayo
- College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA
| | - Joel E Williams
- College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA
| | - Lior Rennert
- College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA
| | - Kerry K Sease
- Bradshaw Institute for Community Child Health & Advocacy, Prisma Health Children's Hospital, Greenville, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
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20
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Maurer DJ, Liu C, Xepapadaki P, Stanic B, Bachert C, Finotto S, Gao Y, Graser A, Jartti T, Kistler W, Kowalski M, Lukkarinen H, Pasioti M, Tan G, Villiger M, Zhang L, Zhang N, Akdis M, Papadopoulos NG, Akdis CA. Physical activity in asthma control and its immune modulatory effect in asthmatic preschoolers. Allergy 2022; 77:1216-1230. [PMID: 34547110 PMCID: PMC9291774 DOI: 10.1111/all.15105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The impact of physical activity on immune response is a hot topic in exercise immunology, but studies involving asthmatic children are scarce. Our aims were to examine whether there were any differences in the level of physical activity and daily TV attendance, to assess its role on asthma control and immune responses to various immune stimulants. METHODS Weekly physical activity and daily television attendance were obtained from questionnaires at inclusion of the PreDicta study. PBMC cultures were stimulated with phytohemagglutinin (PHA), R848, poly I:C, and zymosan. A panel of cytokines was measured and quantified in cell culture supernatants using luminometric multiplex immunofluorescence beads-based assay. RESULTS Asthmatic preschoolers showed significantly more TV attendance than their healthy peers (58.6% vs. 41.5% 1-3 h daily and only 25.7% vs. 47.2% ≤1 h daily) and poor asthma control was associated with less frequent physical activity (PA) (75% no or occasional activity in uncontrolled vs. 20% in controlled asthma; 25% ≥3 times weekly vs. 62%). Asthmatics with increased PA exhibited elevated cytokine levels in response to polyclonal stimulants, suggesting a readiness of circulating immune cells for type 1, 2, and 17 cytokine release compared to subjects with low PA and high TV attendance. This may also represent a proinflammatory state in high PA asthmatic children. Low physical activity and high TV attendance were associated with a decrease in proinflammatory cytokines. Proinflammatory cytokines were correlating with each other in in vitro immune responses of asthmatic children, but not healthy controls, this correlation was more pronounced in children with sedentary behavior. CONCLUSION Asthmatic children show more sedentary behavior than healthy subjects, while poor asthma control is associated with a substantial decrease in physical activity. Our results suggest that asthmatic children may profit from regular exercise, as elevated cytokine levels in stimulated conditions indicate an immune system prepared for responding strongly in case of different types of infections. However, it has to be considered that a hyperinflammatory state in high PA may not be beneficial in asthmatic children.
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Affiliation(s)
- Debbie J. Maurer
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Department of Sports Medicine Davos Hospital Davos Switzerland
| | - Chengyao Liu
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University Beijing China
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Barbara Stanic
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Claus Bachert
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - Susetta Finotto
- Department of Molecular Pneumology Friedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum Erlangen Erlangen Germany
| | - Ya‐Dong Gao
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Anna Graser
- Department of Molecular Pneumology Friedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum Erlangen Erlangen Germany
| | - Tuomas Jartti
- Department of Pediatrics and Adolescent Medicine University of Turku and Turku University Hospital Turku Finland
- PEDEGO Research Unit, Medical Research Center University of Oulu Oulu Finland
- Department of Pediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
| | - Walter Kistler
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Department of Sports Medicine Davos Hospital Davos Switzerland
| | - Marek Kowalski
- Department of Immunology, Rheumatology and Allergy Central University Hospital Lodz Poland
| | - Heikki Lukkarinen
- Department of Pediatrics and Adolescent Medicine University of Turku and Turku University Hospital Turku Finland
| | - Maria Pasioti
- Allergy Department, 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Ge Tan
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Michael Villiger
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Department of Sports Medicine Davos Hospital Davos Switzerland
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University Beijing China
- Department of Allergy, Beijing TongRen Hospital Capital Medical University Beijing China
| | - Nan Zhang
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection, Immunity & Respiratory Medicine University of Manchester Manchester UK
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
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21
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Maeda S, Kobayashi S, Takahashi K, Miyata S. Association of comorbidities and medications with risk of asthma exacerbation in pediatric patients: a retrospective study using Japanese claims data. Sci Rep 2022; 12:5509. [PMID: 35365694 PMCID: PMC8975995 DOI: 10.1038/s41598-022-08789-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/11/2022] [Indexed: 11/24/2022] Open
Abstract
Asthma exacerbation impairs the quality of life of pediatric patients and negatively impacts future respiratory function and health economics. Several risk factors associated with exacerbations have been identified; however, most studies report the risk of each factor. Therefore, this study aimed to evaluate the risk of each factor and a combination of factors. We performed a retrospective cohort study using Japanese claims data and extracted factors associated with exacerbations using multivariate Cox proportional hazards regression and stepwise method. Risk scores were then calculated from the extracted factors and validated by tenfold cross validation. Of the 1,748,111 asthma patients in the database, the data of 14,980 were extracted, and 1988 (13.3%) had exacerbation. Factors associated with asthma exacerbation were age of 3–5 years, exacerbation history before cohort entry date, allergic rhinitis, chronic sinusitis, otitis externa, blepharitis, upper respiratory infections, urticaria, LTRA prescription, were determined. A four-level risk score was calculated from 9-factors and the AUC derived from cross validation was 0.700. Most factors extracted in our study are consistent with those of previous studies. We showed that combining each factor is more helpful in assessing the increased risk of asthma exacerbation than assessing each factor alone.
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Affiliation(s)
- Shotaro Maeda
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan.,Medical Affairs, Kyorin Pharmaceutical, Tokyo, Japan
| | | | - Kenzo Takahashi
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan
| | - Satoshi Miyata
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga Itabashi-ku, Tokyo, 173-8605, Japan.
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22
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Abstract
Asthma is the the most common chronic respiratory condition of childhood worldwide, with around 14% of children and young people affected. Despite the high prevalence, paediatric asthma outcomes are inadequate, and there are several avoidable deaths each year. Characteristic asthma features include wheeze, shortness of breath and cough, which are typically triggered by a number of possible stimuli. There are several diagnostic challenges, and as a result, both overdiagnosis and underdiagnosis of paediatric asthma remain problematic.Effective asthma management involves a holistic approach addressing both pharmacological and non-pharmacological management, as well as education and self-management aspects. Working in partnership with children and families is key in promoting good outcomes. Education on how to take treatment effectively, trigger avoidance, modifiable risk factors and actions to take during acute attacks via personalised asthma action plans is essential.This review aimed to provide an overview of good clinical practice in the diagnosis and management of paediatric asthma. We discuss the current diagnostic challenges and predictors of life-threatening attacks. Additionally, we outline the similarities and differences in global paediatric asthma guidelines and highlight potential future developments in care. It is hoped that this review will be useful for healthcare providers working in a range of child health settings.
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Affiliation(s)
- Joanne Martin
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Northern Foundation School, Health Education England North East, Newcastle upon Tyne, UK.,James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - Jennifer Townshend
- Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK .,Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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23
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Rodriguez Del Rio P, Liu AH, Borres MP, Södergren E, Iachetti F, Casale TB. Asthma and Allergy: Unravelling a Tangled Relationship with a Focus on New Biomarkers and Treatment. Int J Mol Sci 2022; 23:3881. [PMID: 35409241 DOI: 10.3390/ijms23073881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 12/19/2022] Open
Abstract
Asthma is a major driver of health care costs across ages. Despite widely disseminated asthma-treatment guidelines and a growing variety of effective therapeutic options, most patients still experience symptoms and/or refractoriness to standard of care treatments. As a result, most patients undergo a further intensification of therapy to optimize symptom control with a subsequent increased risk of side effects. Raising awareness about the relevance of evaluating aeroallergen sensitizations in asthmatic patients is a key step in better informing clinical practice while new molecular tools, such as the component resolved diagnosis, may be of help in refining the relationship between sensitization and therapeutic recommendations. In addition, patient care should benefit from reliable, easy-to-measure and clinically accessible biomarkers that are able to predict outcome and disease monitoring. To attain a personalized asthma management and to guide adequate treatment decisions, it is of paramount importance to expand clinicians' knowledge about the tangled relationship between asthma and allergy from a molecular perspective. Our review explores the relevance of allergen testing along the asthma patient's journey, with a special focus on recurrent wheezing children. Here, we also discuss the unresolved issues regarding currently available biomarkers and summarize the evidence supporting the eosinophil-derived neurotoxin as promising biomarker.
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24
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Liu L, Gao Y, Si Y, Liu B, Liu X, Li G, Wang R. MALT1 in asthma children: A potential biomarker for monitoring exacerbation risk and Th1/Th2 imbalance-mediated inflammation. J Clin Lab Anal 2022; 36:e24379. [PMID: 35353938 PMCID: PMC9102527 DOI: 10.1002/jcla.24379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1) participates in the immune-related allergic response and inflammation flare, while its clinical role in asthma children is still unknown. Herein, this study aimed to investigate MALT1 expression, and its correlation with exacerbation risk, T helper (Th)1, Th2 cells (and their secreted cytokines), as well as inflammatory cytokines in asthma children. METHODS Sixty children with asthma exacerbation and 60 children with remission asthma were enrolled in this study; then their blood MALT1, Th1, Th2 cells, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interferon-gamma (IFN-γ), and interleukin-4 (IL-4) were detected. Besides, blood MALT1 in another 20 health controls was also determined. RESULTS Mucosa-associated lymphoid tissue lymphoma translocation protein 1 was highest in children with asthma exacerbation, followed by children with remission asthma, and lowest in health controls (p < 0.001). MALT1 could distinguish children with asthma exacerbation from children with remission asthma (area under the curve (AUC): 0.757, 95% CI: 0.670-0.843). In children with asthma exacerbation, MALT1 was negatively linked with IFN-γ (p = 0.002) and Th1 cells (p = 0.050), but positively related to Th2 cells (p = 0.027) and exhibited a positive correlation trend (without statistical significance) with IL-4 (p = 0.066); meanwhile, MALT1 was positively correlated with exacerbation severity (p = 0.010) and TNF-α (p = 0.003), but not linked with IL-6 (p = 0.096). In children with remission asthma, MALT1 only was negatively associated with Th1 cells (p = 0.023), but positively linked with TNF-α (p = 0.023). CONCLUSION Mucosa-associated lymphoid tissue lymphoma translocation protein 1 serves as a potential biomarker for monitoring exacerbation risk and Th1/Th2 imbalance-mediated inflammation of asthma children.
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Affiliation(s)
- Liying Liu
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, China
| | - Yang Gao
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, China
| | - Yonghua Si
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, China
| | - Baohuan Liu
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, China
| | - Xingyue Liu
- Department of Pediatrics, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China
| | - Guanhui Li
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, China
| | - Rong Wang
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, China
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25
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Clark M, Romano C, Olayinka-Amao O, Whalley D, Crawford R, Pathak P, Brindicci C, Garg K, Kordy K, Everhard F, Patalano F, Roesler Z, Sutton T, Göransson O, Landles R, Naujoks C, Marvel J, Keininger DL. Development and content validation of a self-completed, electronic Pediatric Asthma Symptom Diary. J Patient Rep Outcomes 2022; 6:25. [PMID: 35306621 PMCID: PMC8934788 DOI: 10.1186/s41687-022-00432-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Childhood asthma is an important unmet need. To date, patient-reported outcome measures (PROMs) for children with asthma have used a combination of caregiver or proxy-reported and self-reported measures. No comprehensive measure is available to assess the severity and impact of daytime and nighttime asthma symptoms and rescue medication use for self-completion by children aged 6–11 years. This study aimed to develop a novel, interactive, electronic Pediatric Asthma Symptom Diary (ePASD) measuring self-reported key symptom severity and proximal impacts of asthma in young children with varying reading ability and disease severity, consistent with US Food and Drug Administration (FDA) PRO guidance and the International Society for Health Economics and Outcomes Research (ISPOR) good research practices. Methods A targeted literature review and clinician interviews were undertaken to characterize symptoms and impacts experienced by children with mild-to-severe asthma. Concept elicitation interviews (CEIs) were conducted with 44 children and their caregivers (30 US; 14 UK). Following item and digital application development, the ePASD was assessed for relevance, understanding, and interpretability through cognitive debriefing interviews (CDIs) with 21 US children. Face validity/translatability assessments were also performed. Results Key measurement concepts included cough, wheeze, difficulty breathing, chest tightness/discomfort, nighttime awakening, and daytime activity limitations. Concept saturation was reached during CEIs for primary asthma-related daytime and nighttime symptoms and core impacts. Most CDI participants found the ePASD items clear, understandable, and comprehensive. Standardized training is anticipated to facilitate reliable child self-report. Conclusion The ePASD, a novel PROM for children aged 6–11 years with asthma, uses an innovative multimedia approach and has been developed in accordance with FDA PRO guidance and ISPOR good research practices, directly capturing the child’s self-reported asthma symptoms, impacts on daily activities and nighttime awakening, and rescue medication use. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00432-3.
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Affiliation(s)
| | - Carla Romano
- RTI Health Solutions, Research Triangle Park, NC, USA
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26
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Poeran-Bahadoer SD, van Meel ER, Gaillard R, Jaddoe VWV, Duijts L. Influence of maternal vomiting during early pregnancy on school-age respiratory health. Pediatr Pulmonol 2022; 57:367-375. [PMID: 34738332 PMCID: PMC9299134 DOI: 10.1002/ppul.25747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hyperemesis gravidarum, a clinical entity characterized by severe nausea and excess vomiting, might lead to a suboptimal maternal nutritional status during pregnancy and subsequently to adverse respiratory health in the offspring. The role of common vomiting symptoms on offspring's respiratory health is unclear. We examined the associations of maternal daily vomiting during early pregnancy with childhood respiratory outcomes, and potential explaining factors. METHODS This study was embedded in a population-based prospective cohort study from early pregnancy onwards among 4232 mothers and their children. Maternal vomiting during early pregnancy was assessed by a questionnaire. At age 10 years, information on current wheezing and ever asthma was obtained by a questionnaire, and lung function was measured by spirometry at our research center. We used multiple regression analyses to assess the associations of maternal daily vomiting during early pregnancy with childhood respiratory outcomes. RESULTS Compared to children from mothers without daily vomiting during early pregnancy, children from mothers with daily vomiting during early pregnancy had a higher forced expiratory flow when 75% of the forced vital capacity (FVC) is exhaled (Z-score difference [95% confidence interval, CI]: 0.13 [0.03, 0.23]), and an increased risk of current wheezing and ever asthma ([odds ratio, OR] [95% CI]: 1.75 [1.10, 2.79] and 1.61 [1.13, 2.31], respectively). These associations were fully explained by sociodemographic factors, but not sex or lifestyle-, infectious-, or growth-related factors. Maternal daily vomiting during early pregnancy was not associated with forced expiratory volume in 1 s (FEV1 ), FVC, and FEV1 /FVC. CONCLUSION Only sociodemographic factors explain the associations of maternal daily vomiting during early pregnancy with childhood respiratory outcomes.
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Affiliation(s)
- Sunayna D Poeran-Bahadoer
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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27
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Wu Z, Zheng Y, Chen Y, He B, Wu L, Lin L, Xu Y, Chen Y, Xing G. The Role of Acupoint Application of Herbal Medicine for Asthma: Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials. Evidence-Based Complementary and Alternative Medicine 2022; 2022:1-14. [PMID: 36118096 PMCID: PMC9477641 DOI: 10.1155/2022/5589433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/04/2021] [Accepted: 01/03/2022] [Indexed: 12/25/2022]
Abstract
Background Acupoint application of herbal medicine (AAHM) has been widely used in China. At present, there is no systematic review of AAHM versus placebo in the treatment of asthma. This systematic review aims to assess the efficacy of AAHM for asthma. Methods Searches were conducted in five English databases and four Chinese databases from their inceptions until December 2020. Randomized double-blind placebo-controlled trials were screened, and included studies evaluated routine pharmacotherapy (RP) plus AAHM versus RP plus placebo or AAHM versus placebo. The Cochrane risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were performed to evaluate the methodological quality and quality of evidence separately. Results Sixteen studies involving 1,730 participants were included in this review. Compared with placebo plus RP, participants receiving long-term AAHM plus RP showed improvement in asthma quality of life questionnaire (AQLQ) with moderate-quality evidence (MD 6.53 points, 95% CI 2.70 to 10.36). Low-quality evidence indicated that AAHM plus RP was associated with improved FEV1 (%) compared with placebo plus RP, whether long- or short-term use (MD 11.80%, 95% CI 2.84 to 20.76; MD 10.57%, 95% CI 8.40 to 12.74; respectively). Moderate-quality evidence showed that participants receiving short-term AAHM were associated with a higher AQLQ score (MD 6.57 points, 95% CI 3.76 to 9.38) and a lower frequency of acute exacerbations (MD –1.84, 95% CI –2.32 to –1.36) compared with placebo. Low-quality evidence also indicated that AAHM was associated with improved FEV1 (L) compared with placebo, whether long- or short-term use (MD 0.35 litres, 95% CI 0.03 to 0.67; MD 0.66 litres, 95% CI 0.59 to 0.73; respectively). Conclusions Moderate-quality evidence is promising that AAHM can improve the quality of life and reduce acute exacerbations in patients with asthma. AAHM also shows a positive role in improving lung function, but the evidence is so indefinite due to low quality.
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Worgall TS. Sphingolipids and Asthma. Sphingolipid Metabolism and Metabolic Disease 2022; 1372:145-155. [DOI: 10.1007/978-981-19-0394-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Xu Y, Cao L, Chen J, Jiang D, Ruan P, Ye Q. CLCA1 mediates the regulatory effect of IL-13 on pediatric asthma. Front Pediatr 2022; 10:959439. [PMID: 36313877 PMCID: PMC9597202 DOI: 10.3389/fped.2022.959439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE CLCA1 is a secreted protein with protease activity, and its expression is associated with inflammatory airway diseases. This study aimed to investigate the role of CLCA1 and IL-13 in pediatric asthma. METHODS In asthmatic and healthy children, the correlation between CLCA1 expression and blood IL-4, and IL-13 levels were investigated by serological analyses such as RT-qPCR and ELISA. The effects on the activity and apoptosis of bronchial epithelial cells following IL-13 stimulation were explored in vitro by the CCK-8 assay and flow cytometry, respectively. CLCA1 siRNA was used to knock down the expression level of bronchial epithelial cells and the effect of IL-13 stimulation on these cells was assessed by the CCK-8 assay and flow cytometry. RESULTS CLCA1, IL-4, and IL-13 were highly expressed in the serum of children with asthma. CLCA1 expression was highly correlated to serum IL-13. IL-13 stimulation reduced the activity of bronchial epithelial cells in vitro and promoted apoptosis. Lastly, knockdown of CLCA1 rescued the IL-13-induced decrease in activity and apoptosis. CONCLUSION CLCA1 is highly expressed in children with asthma and mediates the contributory effect of IL-13 on the occurrence and development of pediatric asthma.
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Affiliation(s)
- Yanan Xu
- Department of Research, Ningbo Women's and Children's Hospital, Ningbo, China
| | - Lili Cao
- Department of PICU, Ningbo Women's and Children's Hospital, Ningbo, China
| | - Jiong Chen
- Department of Pediatrics 3, Ningbo Women's and Children's Hospital, Ningbo, China
| | - Danyan Jiang
- Department of Pediatrics 3, Ningbo Women's and Children's Hospital, Ningbo, China
| | - Peisen Ruan
- Department of PICU, Ningbo Women's and Children's Hospital, Ningbo, China
| | - Qinsong Ye
- Department of Asthma Center, Ningbo Women's and Children's Hospital, Ningbo, China
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Conrad LA, Buchinsky N, Acosta LM, Nugent JD, Savary KW, Miller RL, Emanet N, Herbstman J, Beebe B, Myers MM, Fifer WP, Perzanowski MS. Increased Heart Rate Variability Response Among Infants with Reported Rhinorrhea and Watery Eyes: A Pilot Study. J Asthma Allergy 2021; 14:1349-1354. [PMID: 34785908 PMCID: PMC8590960 DOI: 10.2147/jaa.s329347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Previously, we found that reported infant rhinorrhea and watery eyes without a cold (RWWC) predicted school age exercise-induced wheeze, emergency department visits, and hospitalizations. These findings were independent of allergic sensitization, and we theorized that increased parasympathetic tone underlay the association. We also reported that increased heart-rate variability (HRV) in infants predicted wheeze in 2–3 year-olds. In a convenience sample of children participating in a birth cohort study, we tested the hypothesis that infants with RWWC would have elevated HRV, indicating increased parasympathetic tone. Methods RWWC symptoms since birth were queried for 3-month-old children. At 4-months, HRV was assessed (root mean square of successive differences [RMSSD]) during a standardized infant–mother still-face paradigm, which included 2 minutes of mother/child play immediately followed by 2 minutes of the mother maintaining a still-face. Results Among participants (n=38), RWWC was common for girls (32%) and boys (21%). The children with the greatest decrease in RMSSD between play and still-face challenge (lowest tertile) had a higher prevalence of RWWC as compared with children in the higher tertiles (50% vs 16%, P=0.045). In a logistic regression model controlling for sex, age and time between HRV and RWWC assessment, children with greater decrease in HRV between play and still-face (lowest tertile) had greater odds of having RWWC (odds ratio=6.0, P=0.029). Conclusion In this relatively small study, we demonstrated greater decreases in HRV in response to a stressor among children with reported RWWC, suggesting that these children might have increased parasympathetic tone and/or overall greater vagal reactivity.
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Affiliation(s)
- Laura A Conrad
- Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - Natalie Buchinsky
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Luis M Acosta
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - J David Nugent
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Khalil W Savary
- Department of Pediatrics, Rutgers University, Newark, NJ, USA
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nurdant Emanet
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Beatrice Beebe
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Michael M Myers
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - William P Fifer
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Hoffmann-Petersen B, Suffolk R, Petersen JJH, Petersen TH, Brasch-Andersen C, Høst A, Halken S, Sorensen GL, Agertoft L. Association of serum surfactant protein D and SFTPD gene variants with asthma in Danish children, adolescents, and young adults. Immun Inflamm Dis 2021; 10:189-200. [PMID: 34780682 PMCID: PMC8767520 DOI: 10.1002/iid3.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surfactant Protein D (SP-D) is a pattern recognition molecule belonging to the family of collectins expressed in multiple human organ systems, including the lungs. Previous studies have shown that SP-D levels in bronchoalveolar lavage samples decrease and serum levels increase in patients suffering from asthma, possibly due to a combination of induced SP-D synthesis and decreased air-blood barrier integrity. The aims of this study were to investigate whether serum levels of SP-D and common variants in the SP-D gene were associated with asthma in adolescents and young adults. METHODS Prospective observational study including 449 adolescents and young adults (age 11-27 years) previously diagnosed with asthma during a 2-year period from 2003 to 2005 (0-16 years). At follow-up from 2016 to 2017, 314 healthy controls with no history of asthma were recruited. Serum SP-D was analyzed on samples obtained at baseline as well as samples obtained at follow-up. SP-D genotyping was performed for rs721917, rs2243639, and rs3088308. RESULTS No differences were found in mean levels of sSP-D and SFTPD genotype among subjects with current asthma, no current asthma, and controls. Serum SP-D and SFTPD genotype were not associated with any clinical parameters of asthma. Furthermore, baseline sSP-D was not associated with asthma at follow-up. CONCLUSION Serum surfactant protein D and common SP-D gene variants were not associated with asthma in Danish adolescents and young adults with mild to moderate asthma. Serum surfactant protein D did not demonstrate any value as a clinical biomarker of asthma.
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Affiliation(s)
- Benjamin Hoffmann-Petersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Raymond Suffolk
- Department of Pediatrics, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Jens J H Petersen
- Department of Pediatrics, Hospital of Southern Jutland, Esbjerg, Denmark
| | - Thomas H Petersen
- Department of Pediatrics, Hospital of Southern Jutland, Kolding, Denmark
| | | | - Arne Høst
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Grith L Sorensen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Lone Agertoft
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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Hanssen-Doose A, Jaeschke R, Niessner C, Oriwol D, Worth A. Physical fitness of children and youth with asthma in comparison to the reference population : Cross-sectional results of the population-based MoMo study in Germany. BMC Sports Sci Med Rehabil 2021; 13:131. [PMID: 34686219 PMCID: PMC8539881 DOI: 10.1186/s13102-021-00359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Physical fitness is an essential marker of health. The literature regarding the question of whether individuals with asthma have reduced physical fitness compared to their non-asthmatic peers is inconsistent and focuses on the cardiorespiratory endurance dimension. This study provides a comparison of different dimensions of physical fitness in individuals with and without asthma on the basis of the German population-based study "KiGGS" (German Health Interview and Examination Survey for Children and Adolescents) and its in-depth study "MoMo" (2009-2012: wave 1 and 2014-2017: wave 2). METHODS In total, 7731 individuals aged 6-30 years were included in this cross-sectional analysis at two measurement waves, including 353 individuals with and 7378 without asthma. The 12-month prevalence of physician-diagnosed asthma was assessed by interview. Physical fitness was measured by six test items of the MoMo test profile. "Cardiorespiratory endurance" was measured by an ergometric test, "muscular strength" by standing long jump, push-ups and sit-ups and "coordination" by jumping sideways and balancing backwards. Because of the broad age range of the sample, age- and sex-specific percentiles were used. Physical activity, age, gender and general state of health were assessed by questionnaire. RESULTS The individuals with asthma reported a poorer general state of health at both measurement waves. However, the results of the fitness tests indicated that they were as physically fit as their peers without asthma in relation to cardiorespiratory endurance and muscular strength. The mean percentiles were all within the same range. The results of the comparisons of coordination performance were inconsistent. At wave 1 they were within the same range, at wave 2 individuals with asthma showed a poorer coordination performance (p = 0.041; HL = 4.125, CI of HL 0.155-8.125). CONCLUSIONS To the best of our knowledge, this is the first study to compare the physical fitness of individuals with and without asthma by considering several dimensions of physical fitness. The study demonstrates that cardiorespiratory endurance and muscular strength are not reduced in individuals with asthma. The results of the comparisons at the two measurement waves were remarkably stable.
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Affiliation(s)
- Anke Hanssen-Doose
- University of Education Karlsruhe, Bismarckstr. 10, 76133, Karlsruhe, Germany.
| | - Robert Jaeschke
- Rehabilitation Centre for Children With Respiratory Diseases, Fachkliniken Wangen, Am Vogelherd 14, 88239, Wangen, Germany
| | - Claudia Niessner
- Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Doris Oriwol
- University of Education Karlsruhe, Bismarckstr. 10, 76133, Karlsruhe, Germany
- Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Annette Worth
- University of Education Karlsruhe, Bismarckstr. 10, 76133, Karlsruhe, Germany
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Cantarutti A, Barbiellini Amidei C, Valsecchi C, Scamarcia A, Corrao G, Gregori D, Giaquinto C, Ludvigsson JF, Canova C. Association of Treated and Untreated Gastroesophageal Reflux Disease in the First Year of Life with the Subsequent Development of Asthma. Int J Environ Res Public Health 2021; 18:9633. [PMID: 34574556 DOI: 10.3390/ijerph18189633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 12/11/2022]
Abstract
Introduction: Gastroesophageal reflux disease (GERD) as well as its treatment with acid-suppressive medications have been considered possible risk factors for the development of asthma, but few studies have disentangled the role of GERD with that of its treatment. The present study aimed at estimating the association of treated and untreated GERD in the first year of life with the risk of asthma. Methods: Retrospective cohort study including all children born between 2004 and 2015 registered in Pedianet, an Italian primary care database. We analyzed the association of children exposed to GERD (both treated and untreated) in the first year of life with the risk of developing clinically assessed asthma (clinical asthma) after 3 years. Secondary outcomes included asthma identified by anti-asthmatic medications (treated asthma) and wheezing after 3 years. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated comparing children with and without GERD, stratifying by treatment with acid-suppressive medications. Results: Out of 86,381 children, 1652 (1.9%) were affected by GERD in the first year of life, of which 871 (53%) were treated with acid-suppressive medications. Compared with controls, children with GERD were at increased risk of clinical asthma (HR: 1.40, 95% CI 1.15–1.70). Risks were similar between treated and untreated GERD (p = 0.41). Comparable results were found for treated asthma, but no risk increase was seen for wheezing. Discussion: Early-life GERD was associated with subsequent childhood asthma. Similar risks among children with treated and untreated GERD suggest that acid-suppressive medications are unlikely to play a major role in the development asthma.
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Li W, Wang X, Sun S, An H. LncRNA CRNDE correlates negatively with miR-33a and miR-495 and positively with inflammatory cytokines in asthmatic children. Clin Respir J 2021; 15:1175-1184. [PMID: 34288494 PMCID: PMC9291623 DOI: 10.1111/crj.13424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/02/2022]
Abstract
Objectives It is reported that long non‐coding RNA (lncRNA) colorectal neoplasia differentially expressed (CRNDE) targets microRNA (miR)‐33a, miR‐181a and miR‐495 to regulate inflammation process, while few studies report their clinical application for paediatric asthma management. Therefore, this study aimed to explore the interaction of lncRNA CRNDE with miR‐33a, miR‐181a and miR‐495, as well as their correlation with inflammation, exacerbation risk and severity in paediatric patients with asthma. Methods Asthmatic exacerbation children (N = 65), asthmatic controlled children (N = 65) and controls (N = 65) were recruited. LncRNA CRNDE, miR‐33a, miR‐181a and miR‐495 expressions in peripheral blood mononuclear cells were detected by RT‐qPCR. Besides, serum inflammatory cytokines (including TNF‐α, IL‐1β, IL‐6 and IL‐17) were determined by enzyme‐linked immunosorbent assay (ELISA). Results LncRNA CRNDE, miR‐33a and miR‐495 expressions were different, while miR‐181a expression was similar among asthmatic exacerbation children, asthmatic controlled children and controls. Moreover, lncRNA CRNDE negatively correlated with miR‐33a and miR‐495 in asthmatic exacerbation children and asthmatic controlled children, but not in controls. Further analyses showed that lncRNA CRNDE positively correlated with TNF‐α, IL‐1β, IL‐17 and exacerbation severity, while it negatively correlated with FEV1/FVC in asthmatic exacerbation children. Meanwhile, miR‐33a, miR‐181a and miR‐495 all negatively correlated with some individual inflammatory cytokines, while only miR‐33a negatively correlated with exacerbation severity in asthmatic exacerbation children. Conclusion LncRNA CRNDE correlates negatively with miR‐33a and miR‐495 and positively with inflammatory cytokines in asthmatic children.
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Affiliation(s)
- Weina Li
- Second Department of Pediatrics, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Xiaoxue Wang
- Second Department of Pediatrics, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Shixin Sun
- Second Department of Pediatrics, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Hong An
- Second Department of Pediatrics, Xingtai People's Hospital, Xingtai, Hebei, China
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Manti S, Licari A, Leonardi S, Marseglia GL. Management of asthma exacerbations in the paediatric population: a systematic review. Eur Respir Rev 2021; 30:30/161/200367. [PMID: 34261742 PMCID: PMC9488496 DOI: 10.1183/16000617.0367-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Asthma exacerbations in children is one of the most common medical conditions requiring urgent visits to primary healthcare providers or emergency departments, and even hospitalisations. Currently, there is significant variation in the management of asthma exacerbations expressed in guideline recommendations versus clinical practice. This disconnect affects diagnostic and treatment decisions for the clinician and patient. Objective We systematically reviewed the available guidelines providing recommendations for diagnostic and therapeutic management of asthma exacerbations in the paediatric population. Methods A systematic review of the literature for guidelines published between January 2009 and October 2019 was conducted, using a protocol registered with the international prospective register of systematic reviews (PROSPERO CRD42020221562). Results 16 asthma exacerbation clinical practice guidelines for children were included. Despite general agreement between guidelines on the definition of asthma exacerbation, there was great variability in the definition of disease severity and assessment of asthma control. This systematic review also highlighted a paucity of recommendations for criteria for hospitalisation and discharge. Many guidelines scored poorly when measured for stakeholder involvement and editorial independence. Conclusion Comprehensive and updated guidelines compliant with international standards for clinical guidelines may significantly improve clinical practice quality, promote evidence-based recommendations and provide uniformity of treatment between countries. There is wide variation in the management of asthma exacerbations in children. This systematic review suggests that updated guidelines aligned with international standards for clinical guidelines may improve uniformity of treatment and clinical practice quality.https://bit.ly/32Pgdiz
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Affiliation(s)
- Sara Manti
- Dept of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Joint co-first authors
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy .,Joint co-first authors
| | - Salvatore Leonardi
- Dept of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Mathioudakis AG, Miligkos M, Boccabella C, Alimani GS, Custovic A, Deschildre A, Ducharme FM, Kalayci O, Murray C, Garcia AN, Phipatanakul W, Price D, Sheikh A, Agache IO, Bacharier L, Beloukas A, Bentley A, Bonini M, Castro-Rodriguez JA, De Carlo G, Craig T, Diamant Z, Feleszko W, Felton T, Gern JE, Grigg J, Hedlin G, Hossny EM, Ierodiakonou D, Jartti T, Kaplan A, Lemanske RF, Le Souëf PN, Mäkelä MJ, Mathioudakis GA, Matricardi P, Mitrogiorgou M, Morais-Almeida M, Nagaraju K, Papageorgiou E, Pité H, Pitrez PMC, Pohunek P, Roberts G, Tsiligianni I, Turner S, Vijverberg S, Winders TA, Wong GW, Xepapadaki P, Zar HJ, Papadopoulos NG. Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank. BMJ Open 2021; 11:e048338. [PMID: 34215609 PMCID: PMC8256789 DOI: 10.1136/bmjopen-2020-048338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Clinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted. METHODS AND ANALYSIS Standard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively.Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence. ETHICS AND DISSEMINATION Ethics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank. PROSPERO REGISTRATION NUMBERS CRD42020132990, CRD42020171624.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Athens Breath Centre, Athens, Greece
| | - Michael Miligkos
- First Department of Pediatrics, "Aghia Sofia" Children's Hospital, University of Athens, Athens, Attica, Greece
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Milano, Lombardia, Italy
| | - Gioulinta S Alimani
- Athens Breath Centre, Athens, Greece
- Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, UK
| | - A Deschildre
- Unité de Pneumologie et Allergologie Pédiatriques, Hôpital Jeanne de Flandre, CHU Lille, Lille, Hauts-de-France, France
| | | | - Omer Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe Universitesi, Ankara, Turkey
| | - Clare Murray
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Antonio Nieto Garcia
- Pulmonology and Allergy Unity, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Leonard Bacharier
- Department of Allergy, Immunology, and Pulmonary Medicine, University of Washington, Seattle, Washington, USA
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Andrew Bentley
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Acute Intensive Care Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Milano, Lombardia, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | - Giuseppe De Carlo
- Allergy and Airway Diseases Patient's Associations, European Federation of Pharmaceutical Industries and Associations, Brussels, Belgium
| | - Timothy Craig
- Allergy, Asthma and Immunology, Penn State University, Hershey, Pennsylvania, USA
| | - Zuzana Diamant
- Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital Lund Hematological Clinic, Lund, Skåne, Sweden
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center of Groningen and QPS-NL, Groningen, Netherlands
| | - Wojciech Feleszko
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Warszawa, Poland
| | - Tim Felton
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - James E Gern
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Gunilla Hedlin
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Elham M Hossny
- Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethimno, Greece
| | - Tuomas Jartti
- Department of Paediatrics, University of Turku, Turku, Finland
| | - Alan Kaplan
- Family Physician, Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada
| | - Robert F Lemanske
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Peter N Le Souëf
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Mika J Mäkelä
- Department of Allergy, University of Helsinki, Helsinki, Uusimaa, Finland
| | | | - Paolo Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - University Medicine, Berlin, Germany
| | - Marina Mitrogiorgou
- Third Department of Paediatrics, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | | | | | - Effie Papageorgiou
- Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece
| | - Helena Pité
- Allergy Center, Hospital CUF Descobertas, Lisboa, Portugal
- Allergy Center, CUF Infante Santo Hospital, Lisbon, Portugal
- Chronic Diseases Research Center (CEDOC), NOVA Medical School / Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Paulo M C Pitrez
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Petr Pohunek
- Paediatric Department, Motol University Hospital, Praha, Czech Republic
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK
- Faculty of Medicine, Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton, Southampton, UK
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethimno, Greece
| | - Stephen Turner
- Department of Child Health, University of Aberdeen, Aberdeen, Aberdeen, UK
| | - Susanne Vijverberg
- Department of Respiratory Medicine and Department of Pediatric Pulmonology, University of Amsterdam, Amsterdam, Netherlands
| | - Tonya A Winders
- Allergy & Asthma, Global Patient Platform, Virginia, Virginia, USA
| | - Gary Wk Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
- Unit on Child and Adolescent Health, Medical Reaserch Council, Cape Town, South Africa
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Attica, Greece
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Pelak G, Wiese AM, Maskarinec JM, Phillips WL, Keim SA. Infant Feeding Practices During the First Postnatal Year and Risk of Asthma and Allergic Disease During the First 6 Years of Life. Breastfeed Med 2021; 16:539-546. [PMID: 33733866 PMCID: PMC8290294 DOI: 10.1089/bfm.2020.0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Breastfeeding may protect against childhood asthma and allergic diseases. Studies have not focused on the mode of feeding human milk and followed children to school age although feeding human milk from a bottle rather than the breast may alter the risk of disease. Materials and Methods: At 12 months' postpartum, women in the Moms2Moms study (Columbus, OH) completed a survey assessing sociodemographic and infant feeding behaviors. At 6 years' postpartum, they completed a survey and pediatric medical records were abstracted to assess asthma and allergic disease diagnoses. Logistic regression models were used to estimate associations between infant feeding behaviors and asthma or allergic disease. Results: Of 285 children, 16% had asthma and 44% ever had ≥1 allergy diagnosis. Longer durations of each infant feeding behavior were not clearly associated with increased odds of asthma or allergic disease by age 6. Results suggested that longer durations of breast milk feeding (regardless of the mode of feeding) may be related to a lower risk of food allergy (e.g., odds ratio [OR]1-month, adjusted = 0.96, 95% confidence interval [CI] = 0.87-1.05; OR12-month, adjusted = 0.57, 95% CI = 0.19-1.74), but that the mode of feeding (regardless of the substance fed) may be more meaningful for environmental allergies (e.g., exclusive direct breast milk feeding OR12-month, adjusted = 0.32, 95% CI = 0.06-1.81). However, effect estimates were imprecise and CIs included the null. Conclusions: Although no clear associations between mode of breast milk feeding (breast versus expressed) and asthma and allergy outcomes were observed, future research with larger samples should further evaluate these associations.
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Affiliation(s)
- Grace Pelak
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Anna M. Wiese
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Whitney L. Phillips
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sarah A. Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Turner PJ, d'Art YM, Duca B, Chastell SA, Marco-Martin G, Vera-Berrios RN, Alvarez O, Bazire R, Rodríguez Del Río P, Vazquez-Ortiz M, Baumert JL, van Ree R, Mills CEN, Fernandez-Rivas M, Hourihane JO. Single-dose oral challenges to validate eliciting doses in children with cow's milk allergy. Pediatr Allergy Immunol 2021; 32:1056-1065. [PMID: 33608940 DOI: 10.1111/pai.13482] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/28/2021] [Accepted: 02/17/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is increasing interest in the use of eliciting doses (EDs) to inform allergen risk management. The ED can be estimated from the distribution of threshold doses for allergic subjects undergoing food challenges within a specified population. Estimated ED05 values for cow's milk (the dose expected to cause objective allergic symptoms in 5% of the milk-allergic population) range from 0.5 mg to 13.9 mg cow's milk protein. We undertook a single-dose challenge study to validate a predicted ED05 for cow's milk of 0.5 mg protein. METHODS Participants were recruited from 4 clinical centres. Predetermined criteria were used to identify patients reacting to 0.5 mg cow's milk protein (approximately 0.015 mL of fresh cow's milk). Children over 1 year underwent formal challenge to cow's milk to confirm clinical reactivity. RESULTS 172 children (median age 6.0 (IQR 0.7-11) years, 57% male) were included in this analysis. Twelve (7.0%, 95% CI 3.7%-11.9%) children experienced objective symptoms that met the predetermined criteria. One participant had mild anaphylaxis that responded to a single dose of adrenaline, the remainder experienced only mild symptoms with no treatment required. We did not identify any baseline predictors of sensitization that were associated with objective reactivity to the single-dose challenge using 0.5 mg cow's milk protein. CONCLUSIONS These data support an estimated ED05 for cow's milk of 0.5 mg protein. Values for ED05 above 0.5 mg for cow's milk protein proposed for allergen risk management need to be reviewed.
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Affiliation(s)
- Paul J Turner
- Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK
| | - Yvonne M d'Art
- Paediatrics and Child Health, University College Cork, Ireland
| | - Bettina Duca
- Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK
| | - Sophia A Chastell
- Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK
| | - Guadalupe Marco-Martin
- Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.,ARADyAL Research Network, Madrid, Spain
| | - Rosialzira N Vera-Berrios
- Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.,ARADyAL Research Network, Madrid, Spain
| | - Olaya Alvarez
- ARADyAL Research Network, Madrid, Spain.,Department of Allergy, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.,Health Research Institute Princesa, Madrid, Spain
| | - Raphaëlle Bazire
- ARADyAL Research Network, Madrid, Spain.,Department of Allergy, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.,Health Research Institute Princesa, Madrid, Spain
| | - Pablo Rodríguez Del Río
- ARADyAL Research Network, Madrid, Spain.,Department of Allergy, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.,Health Research Institute Princesa, Madrid, Spain
| | - Marta Vazquez-Ortiz
- Section of Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK
| | - Joseph L Baumert
- Food Allergy Research and Resource Program, University of Nebraska, Lincoln, USA
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Clare E N Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Montserrat Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.,ARADyAL Research Network, Madrid, Spain
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, University College Cork, Ireland.,Paediatrics and Child Health, Royal College of Surgeons in Ireland, Children's Health Ireland, Dublin, Ireland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Xu-De Z, Bei-Bei G, Xi-Juan W, Hai-Bo L, Li-Li Z, Feng-Xia L. Serum IgE Predicts Difference of Population and Allergens in Allergic Diseases: Data from Weifang City, China. Mediators Inflamm 2021; 2021:6627087. [PMID: 34257517 DOI: 10.1155/2021/6627087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/08/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Immunoglobulin E (IgE) is the most important promoter of allergic inflammation. However, there are few systematic studies on IgE in age range, genders, disease spectrum, and time regularity. Aim To screen the common allergens, allergen spectrum, and IgE difference between type 2 inflammatory allergic diseases and other allergic diseases in Weifang, China. Methods A retrospective study was performed by estimating patients' clinical data suffering from allergic diseases (urticaria, pollinosis, allergic rhinitis, atopic dermatitis, and bronchial asthma) between May 2019 and April 2020 using an allergen detection kit of Macro-Union Pharmaceutical. Results 732 of the 1367 patients showed different antigen positive, and the positive rate was 53.5%. The most common allergens were dust mites, mixed fungi, Artemisia pollen, cat/dog dander, and cockroaches. There were 27.0% (369/1367) of the patients with single positive allergen-specific IgE (sIgE), 26.5% (363/1367) with multiple-positive IgE. The total immunoglobulin E (tIgE) levels varied with gender, age, and type of disease. There was a difference in the distribution of allergens between children and adults. A positive correlation between the serum-specific IgE and the corresponding local inhaled allergen density was observed. Conclusions In this study, we found that type 2 inflammatory allergic diseases have higher serum IgE and a higher probability of inhaled sIgE positive. According to age, gender, and condition, serological IgE detection of allergens provides new insight into the early diagnosis and prevention of allergic diseases.
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Abstract
Background Asthma is the most common chronic disease of childhood and a major source of childhood health burden worldwide. These burdens are particularly marked when children experience characteristic ‘symptom flare-ups’ or acute asthma exacerbations (AAEs). AAE are associated with significant health and economic impacts, including acute Emergency Department visits, occasional hospitalizations, and rarely, death. To treat children with AAE, several medications have been studied and used. Methods We conducted a narrative review of the literature with the primary objective of understanding the evidence of their efficacy. We present this efficacy evidence in the context of a general stepwise management pathway for paediatric AAEs. This framework is developed from the combined recommendations of eight established (inter)national paediatric guidelines. Discussion Management of paediatric AAE centres around four major care goals: (1) immediate and objective assessment of AAE severity; (2) prompt and effective medical interventions to decrease respiratory distress and improve oxygenation; (3) appropriate disposition of patient; and (4) safe discharge plans. Several medications are currently recommended with varying efficacies, including heliox, systemic corticosteroids, first-line bronchodilators (salbutamol/albuterol), adjunctive bronchodilators (ipratropium bromide, magnesium sulfate) and second-line bronchodilators (aminophylline, i.v. salbutamol, i.v. terbutaline, epinephrine, ketamine). Care of children with AAE is further enhanced using clinical severity scoring, pathway-driven care and after-event discharge planning. Conclusions AAEs in children are primarily managed by medications supported by a growing body of literature. Continued efforts to study the efficacy of second-line bronchodilators, integrate AAE management with long-term asthma control and provide fair/equitable care are required.
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Affiliation(s)
- James S Leung
- McMaster University, Faculty of Health Sciences, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
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Akar-Ghibril N, Casale T, Custovic A, Phipatanakul W. Allergic Endotypes and Phenotypes of Asthma. J Allergy Clin Immunol Pract 2021; 8:429-440. [PMID: 32037107 DOI: 10.1016/j.jaip.2019.11.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/30/2019] [Accepted: 11/16/2019] [Indexed: 12/12/2022]
Abstract
Allergic asthma is defined as asthma associated with sensitization to aeroallergens, which leads to asthma symptoms and airway inflammation. Allergic asthma is the most common asthma phenotype. The onset of allergic asthma is most often in childhood and is usually accompanied by other comorbidities including atopic dermatitis and allergic rhinitis. It is often persistent although there is a wide variation in disease severity. It is a TH2-driven process. Biomarkers have been identified to distinguish patients with allergic asthma, particularly serum IgE levels, tests to indicate sensitization to aeroallergens such as specific IgE or skin prick test positivity, blood and sputum eosinophil levels, fraction of exhaled nitric oxide, and periostin. Treatments for allergic asthma include environmental control measures, allergen immunotherapy, and glucocorticoids. Biologics, targeting the TH2 pathway, have been shown to be effective in the treatment of allergic asthma.
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Affiliation(s)
- Nicole Akar-Ghibril
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Thomas Casale
- Division of Allergy and Immunology, University of South Florida Health Morsani College of Medicine, Tampa, Fla
| | - Adnan Custovic
- Respiratory Division, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Wanda Phipatanakul
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
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Papadopoulos NG, Aggelides X, Stamataki S, Prokopakis E, Katotomichelakis M, Xepapadaki P. New concepts in pediatric rhinitis. Pediatr Allergy Immunol 2021; 32:635-646. [PMID: 33475171 DOI: 10.1111/pai.13454] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Rhinitis-and especially allergic rhinitis (AR)-remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Xenophon Aggelides
- Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Stamataki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, University of Crete, School of Medicine, Heraklion, Greece
| | | | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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Choi H, Dostal M, Pastorkova A, Rossner P, Sram RJ. Airborne Benzo[a]Pyrene may contribute to divergent Pheno-Endotypes in children. Environ Health 2021; 20:40. [PMID: 33836759 PMCID: PMC8035778 DOI: 10.1186/s12940-021-00711-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Asthma represents a syndrome for which our understanding of the molecular processes underlying discrete sub-diseases (i.e., endotypes), beyond atopic asthma, is limited. The public health needs to characterize etiology-associated endotype risks is becoming urgent. In particular, the roles of polyaromatic hydrocarbon (PAH), globally distributed combustion by-products, toward the two known endotypes - T helper 2 cell high (Th2) or T helper 2 cell low (non-Th2) - warrants clarification. OBJECTIVES To explain ambient B[a]P association with non-atopic asthma (i.e., a proxy of non-Th2 endotype) is markedly different from that with atopic asthma (i.e., a proxy for Th2-high endotype). METHODS In a case-control study, we compare the non-atopic as well as atopic asthmatic boys and girls against their respective controls in terms of the ambient Benzo[a]pyrene concentration nearest to their home, plasma 15-Ft2-isoprostane (15-Ft2-isoP), urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), and lung function deficit. We repeated the analysis for i) dichotomous asthma outcome and ii) multinomial asthma-overweight/obese (OV/OB) combined outcomes. RESULTS The non-atopic asthma cases are associated with a significantly higher median B[a]P (11.16 ng/m3) compared to that in the non-atopic controls (3.83 ng/m3; P-value < 0.001). In asthma-OV/OB stratified analysis, the non-atopic girls with lean and OV/OB asthma are associated with a step-wisely elevated B[a]P (median,11.16 and 18.00 ng/m3, respectively), compared to the non-atopic lean control girls (median, 4.28 ng/m3, P-value < 0.001). In contrast, atopic asthmatic children (2.73 ng/m3) are not associated with a significantly elevated median B[a]P, compared to the atopic control children (2.60 ng/m3; P-value > 0.05). Based on the logistic regression model, on ln-unit increate in B[a]P is associated with 4.7-times greater odds (95% CI, 1.9-11.5, P = 0.001) of asthma among the non-atopic boys. The same unit increase in B[a]P is associated with 44.8-times greater odds (95% CI, 4.7-428.2, P = 0.001) among the non-atopic girls after adjusting for urinary Cotinine, lung function deficit, 15-Ft2-isoP, and 8-oxodG. CONCLUSIONS Ambient B[a]P is robustly associated with non-atopic asthma, while it has no clear associations with atopic asthma among lean children. Furthermore, lung function deficit, 15-Ft2-isoP, and 8-oxodG are associated with profound alteration of B[a]P-asthma associations among the non-atopic children.
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Affiliation(s)
- Hyunok Choi
- College of Health, Lehigh University, Bethlehem, PA USA
| | - Miroslav Dostal
- Department of Genetic Toxicology and Nanotoxicology, Institute of Experimental Medicine, Czech Academy of Sciences, Prague, Czech Republic
| | - Anna Pastorkova
- Department of Genetic Toxicology and Nanotoxicology, Institute of Experimental Medicine, Czech Academy of Sciences, Prague, Czech Republic
| | - Pavel Rossner
- Department of Genetic Toxicology and Nanotoxicology, Institute of Experimental Medicine, Czech Academy of Sciences, Prague, Czech Republic
| | - Radim J. Sram
- Department of Genetic Toxicology and Nanotoxicology, Institute of Experimental Medicine, Czech Academy of Sciences, Prague, Czech Republic
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Papamichael MM, Katsardis C, Tsoukalas D, Lambert K, Erbas B, Itsiopoulos C. Potential role of folate status on pulmonary function in pediatric asthma. Nutrition 2021; 90:111267. [PMID: 33979761 DOI: 10.1016/j.nut.2021.111267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to explore the relationship between plasma folate status and measures of airway disease (as reflected by spirometry) in children with asthma on a traditional Mediterranean diet. We hypothesized that folate deficiency is associated with lung function impairment in this group of children. METHODS This cross-sectional study included 64 children with mild asthma (52% boys, mean age 8 ± 2 y) residing in Athens, Greece. Clinical assessments included spirometry and fractional exhaled nitric oxide (FeNO). Plasma 5-methyltetrahydrofolate (5-MTHF) was analyzed using high performance-liquid chromatography assay and examined in participants using quartiles (Q1-Q4). RESULTS Of the 64 children, 45.3% were folate deficient (5-MTHF <10 nmol/L). A positive relationship was observed between 5-MTHF and forced vital capacity (FVC; β = 0.79, 95% confidence interval (CI), 0.14-1.44; adjusted P = 0.019), forced expiratory volume in 1s (FEV1) (β = 0.78; 95% CI, 0.01-1.55; adjusted P = 0.046), and peak expiratory flow (PEF; β = 1.64; 95% CI, 0.14-3.15; adjusted P = 0.033) in girls only, adjusting for body mass index and regular exercise. Girls with low plasma folate concentrations (Q1), compared with girls with high concentrations (Q4) had 8.64% lower FVC (β = -8.64; 95% CI, -16.18 to -1.09; adjusted P = 0.027), 10.35% FEV1 (β = -10.35; 95% CI, -18.82 to -1.89; adjusted P = 0.019), and 18.72% PEF (β = -18.72; 95% CI, -36.30 to -1.14; adjusted P = 0.038). CONCLUSION The findings of this study highlighted the potential negative effects of folate deficiency on pulmonary function in girls with asthma, the importance of monitoring folate status in children with asthma, and early prevention strategies.
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Affiliation(s)
- Maria Michelle Papamichael
- La Trobe University, School of Allied Health, Department of Dietetics, Nutrition & Sport, Melbourne, Australia; European Institute of Nutritional Medicine, Rome, Italy.
| | | | | | - Katrina Lambert
- La Trobe University, School of Psychology & Public Health, Department of Public Health, Melbourne, Australia
| | - Bircan Erbas
- La Trobe University, School of Psychology & Public Health, Department of Public Health, Melbourne, Australia; Universitas Airlangga, Faculty of Public Health, Surabaya, Indonesia
| | - Catherine Itsiopoulos
- La Trobe University, School of Allied Health, Department of Dietetics, Nutrition & Sport, Melbourne, Australia; RMIT University, School of Health and Biomedical Sciences, Melbourne, Australia
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Li CY, Liu Z. Effect of budesonide on hospitalization rates among children with acute asthma attending paediatric emergency department: a systematic review and meta-analysis. World J Pediatr 2021; 17:152-63. [PMID: 33829387 DOI: 10.1007/s12519-020-00403-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/03/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The efficacy of inhaled budesonide for managing moderate-to-severe acute exacerbations in children is not clear. Therefore, this study aimed to evaluate hospital admission rates, need for use of systemic corticosteroids, length of hospital stay and adverse events when inhaled budesonide is added to standard pediatric emergency department management of moderate-to-severe acute exacerbations of asthma. METHODS A systematic search was conducted in PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar databases. Randomized controlled trials that evaluated the effect of nebulized budesonide in moderate-to-severe acute exacerbations of asthma in pediatric patients were included for this meta-analysis. Statistical analysis was done using STATA version 13.0. RESULTS A total of 16 RCTs were included. Children receiving nebulized budesonide had 43% lower risk of being hospitalized (RR 0.57; 95% CI, 0.39; 0.85) and 66% lower risk of requiring systemic corticosteroids (RR 0.34; 95 % CI, 0.21; 0.55) compared with those receiving placebo. There were no differences in the length of hospital stay (Hedges's g standardized mean difference - 1.53; 95% CI, - 3.64; 0.58) and risk of adverse events (RR 0.87, 95% CI; 0.65; 1.17) between the two groups. There was no evidence of publication bias for any of the outcomes considered. CONCLUSION The findings of this meta-analysis support the use of inhaled budesonide in reducing risk of hospitalization and the need for systemic corticosteroids among children with acute moderate-to-severe asthma exacerbation.
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刘 欣, 冯 雍, 尚 云. [Correlation between bronchial dilation test and asthma control level in children with asthma]. Zhongguo Dang Dai Er Ke Za Zhi 2021; 23:265-270. [PMID: 33691920 PMCID: PMC7969182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To study the correlation between the bronchial dilation test (BDT) and asthma control level in children with asthma. METHODS A total of 153 children with asthma, aged 5-14 years, who attended the outpatient service from March 2016 to March 2018 were enrolled. According to the presence or absence of atopic constitution, they were divided into an allergic group with 79 children and a non-allergic group with 74 children. The correlation between BDT and Childhood Asthma Control Test (C-ACT) scores was analyzed for both groups. RESULTS All basic pulmonary function parameters were positively correlated with C-ACT scores in the non-allergic group (P < 0.05). Except the forced vital capacity, peak expiratory flow and maximal expiratory flow at 25% vital capacity in percent predicted values, the other pulmonary function parameters were positively correlated with C-ACT scores in the allergic group (P < 0.05). The improvement rates of all BDT parameters (except maximal expiratory flow at 25% vital capacity in the allergic group and maximal expiratory flow at 50% vital capacity in the non-allergic group) were negatively correlated with C-ACT scores in the two groups (P < 0.05). CONCLUSIONS The improvement rate of BDT is well correlated with C-ACT scores in children with asthma, suggesting that BDT can be used as an index for predicting asthma control level.
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Affiliation(s)
- 欣 刘
- />中国医科大学附属盛京医院小儿呼吸内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - 雍 冯
- />中国医科大学附属盛京医院小儿呼吸内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - 云晓 尚
- />中国医科大学附属盛京医院小儿呼吸内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
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刘 欣, 冯 雍, 尚 云. [Correlation between bronchial dilation test and asthma control level in children with asthma]. Zhongguo Dang Dai Er Ke Za Zhi 2021; 23:265-270. [PMID: 33691920 PMCID: PMC7969182 DOI: 10.7499/j.issn.1008-8830.2012029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the correlation between the bronchial dilation test (BDT) and asthma control level in children with asthma. METHODS A total of 153 children with asthma, aged 5-14 years, who attended the outpatient service from March 2016 to March 2018 were enrolled. According to the presence or absence of atopic constitution, they were divided into an allergic group with 79 children and a non-allergic group with 74 children. The correlation between BDT and Childhood Asthma Control Test (C-ACT) scores was analyzed for both groups. RESULTS All basic pulmonary function parameters were positively correlated with C-ACT scores in the non-allergic group (P < 0.05). Except the forced vital capacity, peak expiratory flow and maximal expiratory flow at 25% vital capacity in percent predicted values, the other pulmonary function parameters were positively correlated with C-ACT scores in the allergic group (P < 0.05). The improvement rates of all BDT parameters (except maximal expiratory flow at 25% vital capacity in the allergic group and maximal expiratory flow at 50% vital capacity in the non-allergic group) were negatively correlated with C-ACT scores in the two groups (P < 0.05). CONCLUSIONS The improvement rate of BDT is well correlated with C-ACT scores in children with asthma, suggesting that BDT can be used as an index for predicting asthma control level.
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Affiliation(s)
- 欣 刘
- />中国医科大学附属盛京医院小儿呼吸内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - 雍 冯
- />中国医科大学附属盛京医院小儿呼吸内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - 云晓 尚
- />中国医科大学附属盛京医院小儿呼吸内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Gashi V, Ahmetaj L. The Prevalence of Self-reported Respiratory Symptoms, Asthma and use of Asthma Medication Among Young Adolescents from Southeast Kosovo. Med Arch 2021; 74:19-23. [PMID: 32317829 PMCID: PMC7164728 DOI: 10.5455/medarh.2020.74.19-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: Asthma is a chronic inflammatory airway disease characterized by episodes of airway narrowing leading to manifestations of symptoms such as wheeze, shortness of breath, chest tightness and cough, that may resolve spontaneously or following treatment. Aim: The aim of this paper was to present the collected data related to the prevalence of self-reported respiratory symptoms, asthma, and use of asthma medication among school children aged 13-14 years from the city of Gjilan, a municipality located in southeast Kosovo. Methods: This was a cross-sectional study realized during the year 2018 as a part of the Project of Global Asthma Network (GAN) Phase I. The study elaborated randomly selected sample of 1200 school children from the city of Gjilan, in the southeast of Kosovo. The mean age was 13.4±0.51 with median IQR=13 (13-14). About 618 (51.5%) were male and 582 (48.5%) were female with the relation between the genders of 1:1.1. The percentage difference between the genders was not statistically significant (Difference test: Difference 3% [(-0.99-6.99) CI 95%]; Chi-square=2.159; df=1 p=0.1417). The prevalence of wheezing/ whistling in the chest EVER and the last 12 months was 12.7% vs. 6.4% respectively with no significant association between gender and symptoms (p>0.05) (Table 1). About 1132 (94.3%) had no attacks of wheezing in the last 12 MONTHS, 59 (4.9%) had 1-3 attacks, 7 (0.6%) had 4-12 attacks and 2 (0.2%) had>12 attacks. The analysis did not indicate a significant association between gender and the frequency of wheezing attacks (none / 1-3 / ≥ 4) for Pearson Chi-square: 2.5501; df=2; p=0.2801. Conclusion: This study has found moderately low asthma prevalence among adolescents in the southeast region of Kosovo, with no significant association between genders. Although, should be considered as an urgent need the proper examination, because asthma seems to be under-diagnosed and also untreated. It’s possible that doctors in our country hesitate to diagnose asthma or the parents themselves and the children deny it.
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Affiliation(s)
- Valbona Gashi
- Department of Allergology and Clinical Immunology, School of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Luljeta Ahmetaj
- Department of Allergology and Clinical Immunology, University of Prishtina, University of Prishtina, Prishtina, Kosovo
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Lee S, Lasky-Su JA, Lange C, Kim W, Kumar PL, McDonald MLN, Vaz Fragoso CA, Laurie C, Raby BA, Celedón JC, Cho MH, Won S, Weiss ST, Hecker J. A novel locus for exertional dyspnoea in childhood asthma. Eur Respir J 2021; 57:13993003.01224-2020. [PMID: 32855217 DOI: 10.1183/13993003.01224-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
Abstract
Most children diagnosed with asthma have respiratory symptoms such as cough, dyspnoea and wheezing, which are also important markers of overall respiratory function. A decade of genome-wide association studies (GWAS) have investigated genetic susceptibility to asthma itself, but few have focused on important respiratory symptoms that characterise childhood asthma.Using whole-genome sequencing (WGS) data for 894 asthmatic trios from a Costa Rican cohort, we performed family-based association tests (FBATs) to assess the association between genetic variants and multiple asthma-relevant respiratory phenotypes: cough, phlegm, wheezing, exertional dyspnoea and exertional chest tightness. We tested whether genome-wide significant associations were replicated in two additional studies: 1) 286 asthmatic trios from the Childhood Asthma Management Program (CAMP), and 2) 2691 African American current or former smokers from the COPDGene study.In the 894 Costa Rican trios, we identified a genome-wide significant association (p=2.16×10-9) between exertional dyspnoea and the single nucleotide polymorphism (SNP) rs10165869, located on chromosome 2q37.3, that was replicated in the CAMP cohort (p=0.023) with the same direction of association (combined p=3.28×10-10). This association was not found in the African American participants from COPDGene. We also found suggestive evidence for an association between SNP rs10165869 and the atypical chemokine receptor 3 (ACKR3).Our finding encourages the secondary association analysis of a wider range of phenotypes that characterise respiratory symptoms in other airway diseases/studies.
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Affiliation(s)
- Sanghun Lee
- Dept of Medical Consilience, Division of Medicine, Graduate School, Dankook University, Yongin, South Korea.,Dept of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jessica Ann Lasky-Su
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Christoph Lange
- Dept of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wonji Kim
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Preeti Lakshman Kumar
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Merry-Lynn N McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Cecelia Laurie
- Dept of Biostatistics, University of Washington, Seattle, WA, USA
| | - Benjamin A Raby
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sungho Won
- Dept of Public Health Science, Seoul National University, Seoul, South Korea
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Julian Hecker
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
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