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Li H, Li X. Genetic relationships between high blood eosinophil count, asthma susceptibility, and asthma severity. J Asthma 2024; 61:119-131. [PMID: 37560908 DOI: 10.1080/02770903.2023.2247490] [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: 06/19/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Genetic relationships between blood eosinophil count (BEC), asthma susceptibility, and severity are unclear. We sought to identify the genetic difference between type 2 (T2) and nontype 2 (non-T2) asthma (defined by BEC) and investigate genetic relationships between high BEC, asthma susceptibility, and severity. METHODS Genome-wide association studies (GWASs) were performed for T2 (n = 9,064; BEC ≥ 300 cells/μL) versus non-T2 asthma (n = 14,379; BEC < 150 cells/μL) and asthma susceptibility (37,227 asthmatics vs. 124,132 nonasthma controls) in the UK Biobank and asthma severity (moderate-to-severe asthma [n = 2,153] vs. mild asthma [n = 5165]) in the All of Us Research Program (AoURP). Genetic causality between BEC, asthma susceptibility, and severity were dissected using Mendelian randomization (MR). RESULTS High BEC was associated with asthma and decreased pulmonary function. GWASs revealed four sets of genetic variants (p < 5 × 10-8): genes associated with only BEC or asthma and genes associated with high BEC and asthma in the same or opposite direction. The C allele of rs653178 in ATXN2 was associated with high BEC, risk for autoimmune diseases, and protection for asthma. Genetic variants associated with BEC or asthma were not associated with asthma severity. MR indicated high BEC and asthma were in bidirectional causal relationship (p < .001); however, they were not causal for asthma severity. CONCLUSIONS Genetic variants associated with asthma or BEC and asthma severity are distinctive. High BEC is a risk factor for asthma; however, it is neither necessary nor sufficient for asthma susceptibility and severity.
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Affiliation(s)
- Huashi Li
- Statistics Consulting Lab, BIO5 Institute, University of Arizona, Tucson, AZ, USA
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Xingnan Li
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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Candan O, Toptas T, Demir S, Erdenen F. There is no association between serum endotoxin levels and inflammation in asthma. J Asthma 2024:1-6. [PMID: 38289083 DOI: 10.1080/02770903.2024.2311233] [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: 11/30/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKROUND Endotoxin, in lipopolysaccharide structure (LPS), is the main component of the outer membrane of gram negative bacteria. LPS levels were associated with inflammatory disease. Asthma is a chronic inflammatory disease involving many different cell types and cellular elements. The association between LPS serum levels and the asthma is not well known. The aim of this study was to investigate the association between the LPS serum levels and the severity of asthma, demographic data and laboratory parameters. METHODOLOGY The study included 67 patients aged >18 years with a diagnosis of asthma, and 15 healthy volunteers with no history of chronic disease as a control group. The Asthma Control Test (ACT), Respiratory Function Tests (RFTs), fractional exhaled nitric oxide (FeNO), and endotoxin levels were measured and compared between the groups. The endotoxin measurements were performed using the ELISA method. RESULTS The mild-moderate asthma group included 33 patients and the severe asthma group, 34 patients. The endotoxin level was measured as 17.78 (range 3.59 to 304.55) EU/ml in the patient group and 15 (range 4.01 to 74.06) EU/ml in the control group with no statistically significant difference determined between the groups. In the subgroups, the endotoxin level was measured as 15.21 (range 3.69 to 304.55) EU/ml in the mild-moderate group and 14.46 (range 3.59 to 278.86) EU/ml in the severe asthma group with no statistically significant difference determined between the groups. CONCLUSION The results of this study showed no relationship between serum endotoxin level and asthma or asthma severity.
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Affiliation(s)
- Ozlem Candan
- Division of Hematology, Marmara Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Tayfur Toptas
- Division of Hematology, Marmara Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Semra Demir
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Fusun Erdenen
- Adult Allergy and Immunology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
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Labaeka AA, Falade AG, Addo-Yobo EOD, Mortimer K, Zurba L, Lesosky M, Ellwood P, Asher MI. Decreased prevalence and severity of asthma symptoms among adolescents in Ibadan, Nigeria, 1995-2018. Int J Tuberc Lung Dis 2023; 27:925-930. [PMID: 38042979 PMCID: PMC10719893 DOI: 10.5588/ijtld.23.0138] [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: 04/05/2023] [Accepted: 06/27/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: Phases I and III of the International Study of Asthma and Allergies in Childhood (ISAAC) documented increased asthma symptoms among Nigerian 13-14-year old adolescents. We investigated the trend further using the Global Asthma Network (GAN) surveillance.METHODS: Using ISAAC methodology, GAN Phase I data on symptoms and risk factors for asthma and asthma management were obtained from February to July 2018.RESULTS: There were 2,897 adolescents from 23 secondary schools. For current wheeze, there was an absolute prevalence fall per decade of -1.4 with -1 standard error (SE) in 16 years from 2002 (ISAAC Phase III) to 2018 (GAN Phase I). This pattern was evident for prevalence of reported asthma ever, severe asthma symptoms and night cough with ≥1 SE. During the 23-year interval between ISAAC Phase I and GAN Phase I, there was a fall (≥1 SE) in the absolute prevalence of reported asthma ever, severe asthma symptoms and night cough, except for severe asthma symptoms (-0.2 SE). Respectively 36% and 43% of symptomatic adolescents purchased and used salbutamol and prednisolone.CONCLUSION: The prevalence and severity of asthma symptoms remain high among adolescents in Ibadan. This could be mitigated by improved access to affordable and effective asthma treatments.
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Affiliation(s)
- A A Labaeka
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - A G Falade
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - E O D Addo-Yobo
- Kwame Nkrumah University of Science and Technology, Kumasi, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - K Mortimer
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, University of KwaZulu Natal, Durban
| | - L Zurba
- Spirometry Training Services Africa, Durban
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - P Ellwood
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - M I Asher
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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Çelebi Sözener Z, Özdel Öztürk B, Aydın Ö, Bavbek S, Mungan D. Overview of asthma patients followed up in a tertiary clinic. Eur Ann Allergy Clin Immunol 2023; 55:283-293. [PMID: 35670696 DOI: 10.23822/eurannaci.1764-1489.256] [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] [Indexed: 11/17/2022]
Abstract
Summary Background. Asthma is a disease that combines different biological mechanisms, inflammatory pathways, and phenotypic features. Our aim was to investigate the demographic and disease characteristics of patients with asthma and to reveal the distribution with different phenotypes according to endotype groups. Methods. Patients were identified as eosinophilic if the absolute eosinophil count was measured at least once ≥ 300/μL during the oral corticosteroid free period or ≥ 150/μL under oral corticosteroids. Patients sensitive to at least one inhalant allergen with skin prick test and/ or spIgE measurement were defined as allergic. They were categorized into four main endotypes. Results. Data of 405 asthma patients with a median age of 50.9 years were analyzed. The prominent clinical and phenotypic characteristics of the study group were being obese (43.2%) or overweight (32%), severe asthma (49.6%), adult-onset (56.1%) or late-onset asthma (35.3%). The distribution of the four main endotypes according to eosinophilic and/or allergic status, is as follows: 22.7% allergic-eosinophilic (AE), 27.9% nonallergic-eosinophilic (NAE), 22.9% allergic-noneosinophilic (ANE), 26.4% nonallergic-noneosinophilic (NANE). While most severe asthma patients were in the AE and NAE groups, those with early-onset asthma were in AE and ANE, and those with late-onset asthma were in the NAE and NANE groups. The proportion of uncontrolled patients was higher in the NAE group. Among the severe asthma patients, the rate of uncontrolled disease was higher in those with NANE asthma. Conclusions. Different phenotypes were more closely related to some endotypes. This may allow the clinicians to identify patients and predict appropriate treatment modalities and response for individualized care.
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Affiliation(s)
- Z Çelebi Sözener
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - B Özdel Öztürk
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Ö Aydın
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - S Bavbek
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - D Mungan
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
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Castillo JA, Plaza V, Rodrigo G, Juliá B, Picado C, Fernández C, Mullol J. Chronic rhinosinusitis with nasal polyps and allergic rhinitis as different multimorbid treatable traits in asthma. J Allergy Clin Immunol Glob 2023; 2:100134. [PMID: 37781668 PMCID: PMC10510007 DOI: 10.1016/j.jacig.2023.100134] [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: 11/30/2022] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 10/03/2023]
Abstract
Background Respiratory multimorbidities are linked to asthma, such as allergic rhinitis (AR) with early allergic asthma and chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) with late nonallergic asthma. Objective Our aim was to investigate the association of asthma severity and control with specific upper airway phenotypes. Method Patients with asthma were prospectively recruited from 23 pulmonology and ear, nose, and throat clinics. Asthma severity and control, as well as upper airway comorbidities (AR and non-AR [NAR], CRSwNP, and CRS without nasal polyps [CRSsNP]) were assessed according to international consensus guidelines definitions. Results A total of 492 asthmatic patients were included. Half of the asthmatic patients (49.6%) had associated rhinitis (37.0% had AR and 12.6% had NAR) and 36.2% had CRS (16.7% had CRSsNP and 19.5% had CRSwNP), whereas 14.2% had no sinonasal symptoms. Most cases of AR (78%) and NAR (84%) were present in patients with mild-to-moderate asthma, whereas CRSwNP was more frequent in patients with severe asthma (35% [P < .001]), mainly nonatopic asthma (44% [P < .001]). Patients with severe asthma with CRSwNP had worse asthma control, which was correlated (r = 0.249 [P = .034]) with sinus occupancy. Multiple logistic regression analysis showed that late-onset asthma, intolerance of aspirin and/or nonsteroidal anti-inflammatory drugs, and CRSwNP were independently associated with severe asthma. Conclusion Severe asthma is associated with CRSwNP, with sinus occupancy affecting asthma control. This study has identified 2 main different upper airway treatable traits, AR and CRSwNP, which need further evaluation to improve management and control of patients with asthma.
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Affiliation(s)
- José Antonio Castillo
- Pneumology Department, Hospital Universitari Dexeus, Barcelona, Spain
- CIBER of Respiratory Diseases, Spain
- Group of Rhinitis, Rhinosinusitis, and Nasal Polyps, Area of Asthma, SEPAR, Spain
| | - Vicente Plaza
- Pneumology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Gustavo Rodrigo
- Emergency Departament, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | | | - César Picado
- CIBER of Respiratory Diseases, Spain
- Pneumology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Fernández
- Preventive Medicine Department, Complejo Hospitalario Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria Santiago de Compostela, Fundación IMAS, Santiago de Compostela, Spain
| | - Joaquim Mullol
- CIBER of Respiratory Diseases, Spain
- Group of Rhinitis, Rhinosinusitis, and Nasal Polyps, Area of Asthma, SEPAR, Spain
- Clinical and Experimental Respiratory Immunoallergy, IDIBAPS & Rhinology Unite and Smell Clinic, ENT Department, Hospital Clínic Barcelona, Universitat de Barcelona, Spain
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Hussain M, Hassan T, Hussain G, Shah MZ, Kimbley Z. Adherence to National Asthma Guidelines in the Acute Care Setting: A Retrospective Cohort Study. Cureus 2023; 15:e48725. [PMID: 38046753 PMCID: PMC10690459 DOI: 10.7759/cureus.48725] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Peak flow is a crucial but simple test used to categorize the severity of an episode of an acute exacerbation of asthma. It should be regularly done in all the patients who present with asthma acute exacerbation in the emergency department. The British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guidelines stipulate peak flow use as one of the main tools to categorize acute asthma into moderate, severe, and life-threatening asthma. The BTS and SIGN guidelines also state peak flow is to be utilized in monitoring the disease and to guide in treating patients with acute asthma. METHODS AND MATERIALS This study aims to identify the adherence to BTS/SIGN guidelines around the use of peak expiratory flow rate (PEFR) in assessing the severity of patients presenting with acute exacerbation of asthma in a district general hospital. The retrospective cohort study involved collating data between October 2022 and February 2023 from our hospital electronic system. The data collected about the use of PEFR and whether the patients were being classified by severity in presentation following this was compared to the BTS/SIGN 158 asthma guidelines. Following this, the data analysis was done using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States). RESULTS Data from 92 patients were collated. PEFR was recorded for 29.3% (n=27) of patients and acute exacerbation of asthma severity was documented in merely 17.4% (n=16) patients. CONCLUSION The results indicate a significant proportion of the patient cohort analyzed did not have peak flow readings, there is clear room for improvement, and further intervention is needed in order for the department to adhere to the gold standard guidelines (i.e., BTS/SIGN 158), and thus improve the management and monitoring of acute asthma exacerbations. Future directions can include departmental education, posters as a reminder, and prompts on the electronic system used to alert users to check PEFR when a diagnosis of acute asthma exacerbation is documented.
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Affiliation(s)
- Muhammad Hussain
- Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
| | | | - Gulmeena Hussain
- Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
| | - Muhammad Zahir Shah
- Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
| | - Zoe Kimbley
- Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
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Kontopoulou L, Kotsiou OS, Tourlakopoulos K, Karpetas G, Paraskevadaki EV, Malli F, Pantazopoulos I, Daniil Z, Gourgoulianis KI. Physical Health-Related Quality of Life in Relation to Mediterranean Diet Adherence in a Sample of Greek Asthma Patients: A Pilot Study. J Pers Med 2023; 13:1512. [PMID: 37888123 PMCID: PMC10608726 DOI: 10.3390/jpm13101512] [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: 09/26/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
The role of nutrition in the management of asthma in obese patients is of increasing interest due to their limited response to inhaled corticosteroids. Some studies note that through diet and lifestyle, there can be an improvement in asthma control. The aim of the present study was to investigate the adherence to the Mediterranean Diet and its association with asthma severity and quality of life in patients with bronchial asthma. This is a cross-sectional study of 85 patients (70.6% female), with a mean age of 57 years, from the General University Hospital of Larissa and, more specifically, patients of the outpatient asthma clinic. Data were collected with the use of specific questionnaires. In relation to BMI, 12.9% of participants were of a normal weight, 45.9% were overweight, 25.9% were obese level I, 5.9% were obese level II, and 9.4% were in the morbidly obese range. Based on the Med Diet Score (ranging from 21 to 35), most participants (85.9%) reported moderate adherence to the Mediterranean Diet. Further analysis examined the correlations of the PCS-12 score with the frequency of consumption of each of the 11 food categories, as well as all demographic and health behavior variables. The ranked correlations indicated a significant relationship between PCS-12 score and Med Diet adherence and the consumption of alcoholic beverages (r = 0.437, p < 0.05), in accordance with the Mediterranean Diet suggestions, as well as a negative relationship with BMI score (r = -0.454, p < 0.010). Moreover, significant correlations were also present between the physical quality of life and AQLQ score and work type, as well as gender, age, and marital status. The results of our study showed a high rate of obesity in patients with asthma at the General University Hospital of Larissa and moderate adherence to the Mediterranean Diet. Increased BMI and alcoholic beverage consumption in asthma patients were significant predictors of lower physical health-related quality of life. In conclusion, personal and society-level interventions are required to effectively address obesity and poor diet in patients with asthma.
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Affiliation(s)
- Lamprini Kontopoulou
- Respiratory Disorders Lab, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece;
| | - Ourania S. Kotsiou
- Respiratory Disorders Lab, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece;
- Department of Human Pathophysiology, Faculty of Nursing, University of Thessaly, 41500 Gaiopolis, Greece
| | - Konstantinos Tourlakopoulos
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Biopolis, Greece; (K.T.); (G.K.); (I.P.); (Z.D.); (K.I.G.)
| | - Georgios Karpetas
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Biopolis, Greece; (K.T.); (G.K.); (I.P.); (Z.D.); (K.I.G.)
| | | | - Foteini Malli
- Respiratory Disorders Lab, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece;
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Biopolis, Greece; (K.T.); (G.K.); (I.P.); (Z.D.); (K.I.G.)
| | - Ioannis Pantazopoulos
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Biopolis, Greece; (K.T.); (G.K.); (I.P.); (Z.D.); (K.I.G.)
| | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Biopolis, Greece; (K.T.); (G.K.); (I.P.); (Z.D.); (K.I.G.)
| | - Konstantinos I. Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Biopolis, Greece; (K.T.); (G.K.); (I.P.); (Z.D.); (K.I.G.)
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Li X, Li H, Christenson SA, Castro M, Denlinger LC, Erzurum SC, Fahy JV, Gaston BM, Israel E, Jarjour NN, Levy BD, Mauger DT, Moore WC, Zein J, Kaminski N, Wenzel SE, Woodruff PG, Bleecker ER, Meyers DA. Genetic analyses of chr11p15.5 region identify MUC5AC- MUC5B associated with asthma-related phenotypes. J Asthma 2023; 60:1824-1835. [PMID: 36946148 PMCID: PMC10524756 DOI: 10.1080/02770903.2023.2193631] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Genome-wide association studies (GWASs) have identified single nucleotide polymorphisms (SNPs) in chr11p15.5 region associated with asthma and idiopathic interstitial pneumonias (IIPs). We sought to identify functional genes for asthma by combining SNPs and mRNA expression in bronchial epithelial cells (BEC) in the Severe Asthma Research Program (SARP). METHODS Correlation analyses of mRNA expression of six candidate genes (AP2A2, MUC6, MUC2, MUC5AC, MUC5B, and TOLLIP) and asthma phenotypes were performed in the longitudinal cohort (n = 156) with RNAseq in BEC, and replicated in the cross-sectional cohort (n = 155). eQTL (n = 114) and genetic association analysis of asthma severity (426 severe vs. 531 non-severe asthma) were performed, and compared with previously published GWASs of IIPs and asthma. RESULTS Higher expression of AP2A2 and MUC5AC and lower expression of MUC5B in BEC were correlated with asthma, asthma exacerbations, and T2 biomarkers (P < 0.01). SNPs associated with asthma and IIPs in previous GWASs were eQTL SNPs for MUC5AC, MUC5B, or TOLLIP, however, they were not in strong linkage disequilibrium. The risk alleles for asthma or protective alleles for IIPs were associated with higher expression of MUC5AC and lower expression of MUC5B. rs11603634, rs12788104, and rs28415845 associated with moderate-to-severe asthma or adult onset asthma in previous GWASs were not associated with asthma severity (P > 0.8). CONCLUSIONS SNPs associated with asthma in chr11p15.5 region are not associated with asthma severity neither with IIPs. Higher expression of MUC5AC and lower expression of MUC5B are risk for asthma but protective for IIPs.
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Affiliation(s)
- Xingnan Li
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Huashi Li
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Stephanie A. Christenson
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Loren C. Denlinger
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Serpil C. Erzurum
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John V. Fahy
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Benjamin M. Gaston
- Wells Center for Pediatric Research and Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nizar N. Jarjour
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Bruce D. Levy
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David T Mauger
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Wendy C. Moore
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joe Zein
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Naftali Kaminski
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally E. Wenzel
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Prescott G. Woodruff
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Eugene R. Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Deborah A. Meyers
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, USA
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Smolnikova MV, Kasparov EW, Malinchik MA, Kopylova KV. Genetic markers of children asthma: predisposition to disease course variants. Vavilovskii Zhurnal Genet Selektsii 2023; 27:393-400. [PMID: 37465198 PMCID: PMC10350864 DOI: 10.18699/vjgb-23-47] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/09/2022] [Accepted: 10/25/2022] [Indexed: 07/20/2023] Open
Abstract
Asthma is a heterogeneous and often difficult to treat condition that results in a disproportionate cost to healthcare systems. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. An important therapeutic focus is to achieve disease control, which is supposed to involve a personalized approach to treatment of asthma of any severity. Asthma is a multifactorial disease with a significant genetic determinant, however, the inheritance of asthma has not been fully elucidated. Polymorphic genes of inflammatory mediators, including cytokines, play an important role in developing various disease forms. In the current study, large-scale original data on the prevalence of cytokine gene genotypes (IL2, IL4, IL5, IL6, IL10, IL12, IL13, IL17A, IL31, IL33, IFNG, TNFA) among Russian children with asthma in Krasnoyarsk region have been obtained. Genotyping was carried out using real-time PCR. We identified markers predisposing to the development of different variants of the course of childhood asthma: the CT genotype and T allele of IL4 rs2243250 are associated with asthma (p < 0.05), especially in mild asthma and in controlled asthma. The TT genotype and allele T of IL13 rs1800925 are associated with severe and uncontrolled asthma (p < 0.05). The AA genotype of IL17A rs2275913, the TT genotype of IFNG rs2069705 and allelic A variants of TNFA rs1800629 are associated with mild asthma, and the TT genotype of IFNG rs2069705 is additionally associated with controlled asthma. The results obtained will supplement information on the prevalence of polymorphic variants of the cytokine genes in the Russian population and in asthma patients with different disease courses, which is likely to be used in order to shape a plan for Public Health Authority to prevent the development of severe uncontrolled asthma and to optimize personalized therapy.
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Affiliation(s)
- M V Smolnikova
- Scientific Research Institute of Medical Problems of the North - a separate division of the Federal Research Center "Krasnoyarsk Science Center" of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | - Ed W Kasparov
- Scientific Research Institute of Medical Problems of the North - a separate division of the Federal Research Center "Krasnoyarsk Science Center" of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | - M A Malinchik
- Scientific Research Institute of Medical Problems of the North - a separate division of the Federal Research Center "Krasnoyarsk Science Center" of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | - K V Kopylova
- Scientific Research Institute of Medical Problems of the North - a separate division of the Federal Research Center "Krasnoyarsk Science Center" of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
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Abstract
OBJECTIVE Asthma education has been shown to improve asthma control. Our goal was to evaluate the efficacy of asthma education on the frequency of utilization of health-care services, lung function results, degree of asthma severity, and quality of life (QOL) level in children with asthma. METHODS A single-arm prospective interventional trial was conducted in a tertiary facility. Thirty children with asthma and their parents were recruited for the research. Following an assessment of the participants' and caregivers' knowledge about asthma using an asthma knowledge questionnaire, degree of asthma control using asthma control test, inhaler technique using standardized inhaler technique checklists, and QOL using pediatric asthma QOL questionnaires, they participated in a three-month education program in the form of monthly live interactive sessions followed by weekly phone interviews. Measures taken before and after the intervention were compared. RESULTS The educational intervention improved asthma control dramatically including daytime asthma symptoms, night awakenings, and frequency of use of short-acting beta2- adrenergic receptor agonists. Furthermore, the number of emergency department visits and hospitalizations fell considerably after the intervention (p < 0.001 for all). Asthma education was also linked to better inhalation technique and lung function (p < 0.001). Furthermore, all quality-of-life measures increased (p < 0.001 for all). CONCLUSIONS Implementing an asthma education program that included both children with asthma and their parents improved asthma control levels, lung function measures, and overall quality of life. Furthermore, it increased asthma awareness, decreased the use of health-care resources, and reduced asthma severity, resulting in better asthma management.
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Affiliation(s)
- Heba A Omara
- Department of Pediatrics, Pulmonology Division, Faculty of Medicine, Ain Shams University Children's Hospital, Cairo, Egypt
| | - Mervat G Mansour
- Department of Pediatrics, Faculty of Medicine, Ain Shams University Children's Hospital, Cairo, Egypt
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11
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Li X, Guerra S, Ledford JG, Kraft M, Li H, Hastie AT, Castro M, Denlinger LC, Erzurum SC, Fahy JV, Gaston B, Israel E, Jarjour NN, Levy BD, Mauger DT, Moore WC, Zein J, Kaminski N, Wenzel SE, Woodruff PG, Meyers DA, Bleecker ER. Low CC16 mRNA Expression Levels in Bronchial Epithelial Cells Are Associated with Asthma Severity. Am J Respir Crit Care Med 2023; 207:438-451. [PMID: 36066606 PMCID: PMC9940145 DOI: 10.1164/rccm.202206-1230oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale: CC16 is a protein mainly produced by nonciliated bronchial epithelial cells (BECs) that participates in host defense. Reduced CC16 protein concentrations in BAL and serum are associated with asthma susceptibility. Objectives: Few studies have investigated the relationship between CC16 and asthma progression, and none has focused on BECs. In this study, we sought to determine if CC16 mRNA expression levels in BECs are associated with asthma severity. Methods: Association analyses between CC16 mRNA expression levels in BECs (242 asthmatics and 69 control subjects) and asthma-related phenotypes in Severe Asthma Research Program were performed using a generalized linear model. Measurements and Main Results: Low CC16 mRNA expression levels in BECs were significantly associated with asthma susceptibility and asthma severity, high systemic corticosteroids use, high retrospective and prospective asthma exacerbations, and low pulmonary function. Low CC16 mRNA expression levels were significantly associated with high T2 inflammation biomarkers (fractional exhaled nitric oxide and sputum eosinophils). CC16 mRNA expression levels were negatively correlated with expression levels of Th2 genes (IL1RL1, POSTN, SERPINB2, CLCA1, NOS2, and MUC5AC) and positively correlated with expression levels of Th1 and inflammation genes (IL12A and MUC5B). A combination of two nontraditional T2 biomarkers (CC16 and IL-6) revealed four asthma endotypes with different characteristics of T2 inflammation, obesity, and asthma severity. Conclusions: Our findings indicate that low CC16 mRNA expression levels in BECs are associated with asthma susceptibility, severity, and exacerbations, partially through immunomodulation of T2 inflammation. CC16 is a potential nontraditional T2 biomarker for asthma development and progression.
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Affiliation(s)
- Xingnan Li
- Division of Genetics, Genomics, and Precision Medicine, and
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Julie G. Ledford
- Asthma and Airway Disease Research Center, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Monica Kraft
- Asthma and Airway Disease Research Center, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Huashi Li
- Division of Genetics, Genomics, and Precision Medicine, and
| | - Annette T. Hastie
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Loren C. Denlinger
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Serpil C. Erzurum
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - John V. Fahy
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Benjamin Gaston
- Wells Center for Pediatric Research and Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nizar N. Jarjour
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Bruce D. Levy
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - David T. Mauger
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania
| | - Wendy C. Moore
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joe Zein
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Naftali Kaminski
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; and
| | - Sally E. Wenzel
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Prescott G. Woodruff
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of California at San Francisco, San Francisco, California
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12
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Rangachari P, Parvez I, LaFontaine AA, Mejias C, Thawer F, Chen J, Pathak N, Mehta R. Effect of Disease Severity, Age of Child, and Clinic No-Shows on Unscheduled Healthcare Use for Childhood Asthma at an Academic Medical Center. Int J Environ Res Public Health 2023; 20:1508. [PMID: 36674266 PMCID: PMC9864702 DOI: 10.3390/ijerph20021508] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/10/2023]
Abstract
This study examines the influence of various individual demographic and risk factors on the use of unscheduled healthcare (emergency and inpatient visits) among pediatric outpatients with asthma over three retrospective timeframes (12, 18, and 24 months) at an academic health center. Out of a total of 410 children who visited an academic medical center for asthma outpatient care between 2019 and 2020, 105 (26%) were users of unscheduled healthcare for childhood asthma over the prior 12 months, 131 (32%) over the prior 18 months, and 147 (36%) over the prior 24 months. multiple logistic regression (MLR) analysis of the effect of individual risk factors revealed that asthma severity, age of child, and clinic no-shows were statistically significant predictors of unscheduled healthcare use for childhood asthma. Children with higher levels of asthma severity were significantly more likely to use unscheduled healthcare (compared to children with lower levels of asthma severity) across all three timeframes. Likewise, children with three to four clinic no-shows were significantly more likely to use unscheduled healthcare compared to children with zero clinic no-shows in the short term (12 and 18 months). In contrast, older children were significantly less likely to use unscheduled healthcare use compared to younger children in the longer term (24 months). By virtue of its scope and design, this study provides a foundation for addressing a need identified in the literature for short- and long-term strategies for improving supported self-management and reducing unscheduled healthcare use for childhood asthma at the patient, provider, and organizational levels, e.g., (1) implementing telehealth services for asthma outpatient care to reduce clinic no-shows across all levels of asthma severity in the short term; (2) developing a provider-patient partnership to enable patient-centered asthma control among younger children with higher asthma severity in the long term; and (3) identifying hospital-community linkages to address social risk factors influencing clinic no-shows and unscheduled healthcare use among younger children with higher asthma severity in the long term.
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Affiliation(s)
- Pavani Rangachari
- Department of Population Health & Leadership, School of Health Sciences, University of New Haven, West Haven, CT 06516, USA
| | - Imran Parvez
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | | | | | - Fahim Thawer
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Jie Chen
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Niharika Pathak
- Department of Population Health & Leadership, School of Health Sciences, University of New Haven, West Haven, CT 06516, USA
| | - Renuka Mehta
- Division of Critical Care Medicine, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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13
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Birs I, Boulay ME, Bertrand M, Côté A, Boulet LP. Heterogeneity of asthma with nasal polyposis phenotypes: A cluster analysis. Clin Exp Allergy 2023; 53:52-64. [PMID: 36317421 DOI: 10.1111/cea.14247] [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: 09/09/2021] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis (CRSwNP) affects a significant number of asthmatic patients and is notably associated with a more difficult-to-control asthma and marked inflammation. We need more studies on this specific asthma phenotype and its possible subphenotypes, in order to better individualize treatments. AIM The aim of this study is to identify and characterize subphenotypes of asthma patients with CRSwNP using clinical, physiological and inflammatory variables. METHODS K-means cluster analysis was performed on 17 clinical, physiological, and inflammatory variables from 1263 patients of all asthma severity and on a subpopulation of patients with asthma and CRSwNP. Study was registered on ClinicalTrials.gov (NCT03694847). RESULTS On the overall population, three groups were identified. Cluster T1 (n = 708) are young, have a short asthma duration and a low prevalence of CRSwNP. Cluster T2 (n = 263) have the longest asthma duration and Cluster T3 (n = 292) are older with the shortest asthma duration. Patients in Clusters T2 and T3 have similar prevalences of CRSwNP. On the subpopulation of asthma with CRSwNP, three clusters were also identified. Cluster S1 (n = 83) have mild-to-moderate asthma with normal lung function. Clusters S2 (N = 53) and S3 (N = 42) include patients with severe asthma and decreased lung function, but those in Cluster S2 have a longer asthma duration, whereas those Cluster S3 have late-onset asthma. CONCLUSIONS Despite coexistence of asthma and CRSwNP, not all patients have the same evolution of their asthma. Different phenotypes of asthma with CRSwNP can be identified and exploration of the characteristics of these subgroups could lead to a better individualized, targeted management.
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Affiliation(s)
- Isabelle Birs
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Québec, Canada
| | - Marie-Eve Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Québec, Canada
| | - Mylène Bertrand
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Québec, Canada
| | - Andréanne Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Québec, Canada
| | - Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, Québec, Canada
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14
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Alcantara Galvão A, de Andrade Belitardo EMM, de Araújo Sena F, Santos JM, de Oliveira Costa GN, Feitosa CA, Fiaccone RL, Cruz ÁA, Barreto ML, Figueiredo CA, Alcantara-Neves NM. Serum 25-hydroxyvitamin D deficiency is associated with atopy, and sex may be an effect modifier of its association with asthma in teenagers from northeast Brazil. Pediatr Pulmonol 2023; 58:297-305. [PMID: 36263459 DOI: 10.1002/ppul.26200] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 09/03/2022] [Accepted: 10/08/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Sufficient vitamin D (25-hydroxyvitamin D [25(OH)D]) serum levels are associated with decreased asthma symptoms. Our aim was to investigate associations between vitamin D and atopy, asthma, asthma severity, and asthma phenotypes in Brazilian teenagers. METHODS This cross-sectional study involved 942 individuals (11-19 years old) engaged in an asthma cohort. The ISAAC questionnaire was employed to diagnosis asthma and asthma severity. Serum allergen-specific immunoglobulin E (sIgE) was measured by ImmunoCap and serum 25(OH)D was measured by ELISA. We calculated the correlation between sIgE and 25(OH)D. We used multivariate logistic regression analysis to assess associations of interest. RESULTS We found that 25(OH)D deficiency was positively associated with atopy (OR 1.45, confidence interval [CI] 1.05-2.00) and high levels of this vitamin negatively correlated with sIgE to Dermatophagoides pteronyssinus (r = -0.11, p = 0.019). The average 25(OH)D serum level was 27.0 ± 9.5 ng/ml; 366 individuals (38.8%) had a sufficient level. There was no association between 25(OH)D and asthma, asthma severity or asthma phenotypes in the population. However, sex was a possible effect modifier of the association between vitamin D and asthma: insufficiency in asthmatic women (86%) was higher than in asthmatic men (42%), and there was an association between insufficient vitamin D levels and greater asthma risk only in women (OR = 3.06, 95% CI 1.16-8.07). CONCLUSION We have shown that vitamin D deficiency was associated with greater risk of atopy in both sexes and vitamin D insufficiency was associated with asthma only in women. There was no association between vitamin D levels and asthma phenotypes or asthma severity.
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Affiliation(s)
| | | | - Flávia de Araújo Sena
- Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Juliana M Santos
- Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | | | - Caroline A Feitosa
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Brazil.,Escola Baiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Rosemeire L Fiaccone
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Brazil
| | - Álvaro A Cruz
- ProAR, Faculdade de Medicina, Universidade Federal da Bahia, (UFBA), Salvador, Brazil
| | - Maurício L Barreto
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Brazil.,Centro de Integração de Dados e Conhecimentos Para a Saúde (CIDACS), Fiocruz, Brazil
| | - Camila A Figueiredo
- Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil
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15
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Muacevic A, Adler JR, Assiri RA, Alshehri GA, Binyousef F. The Prevalence and Impact of Allergic Rhinitis on Asthma Exacerbations in Asthmatic Adult Patients in the Riyadh Region of Saudi Arabia: A Cross-Sectional Study. Cureus 2022; 14:e32324. [PMID: 36628004 PMCID: PMC9825117 DOI: 10.7759/cureus.32324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Allergic rhinitis (AR) and asthma are highly prevalent conditions known to occur concomitantly. However, observational, cross-sectional studies in Saudi Arabia assessing the frequency and severity of rhinitis in asthmatics adults using questionnaires based on guidelines are unavailable. Therefore, this study attempted to investigate this side and evaluate the role of triggers, symptoms, and family history or history of AR on asthma control levels. METHODS From April 2nd to September 18th, 2021, this observational cross-sectional study was conducted through an online self-administrated questionnaire that was distributed electronically on social media through the SurveyMonkey website (Momentive Inc., Waterford, NY). The study targeted asthmatic adult patients residing in Riyadh city in Saudi Arabia. RESULTS Overall, 187 questionnaires were analyzed. In this study, the frequency of AR in asthmatic patients was 75.5% (95% CI: 74.87-75.4%). Of those, AR was intermittent mild for 15.0%, intermittent moderate to severe for 43.9%, mild persistent for 2.14%, persistent moderate to severe for 14.4%, and 24.6% of patients were without AR. A significant association was observed between asthma control level and the severity of AR (P < 0.001). Moderate to severe persistent AR was more prevalent in patients with uncontrolled asthma (40.6%) than patients with partially controlled (25%) or controlled asthma (2.7%). CONCLUSIONS This study suggested that AR was related to more severe asthma and more difficulty in controlling asthma. The frequency significantly increased with the severity of asthma.
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16
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Shrestha Palikhe N, Mackenzie CA, Licskai C, Kim RB, Vliagoftis H, Cameron L. The CRTh2 polymorphism rs533116 G > A associates with asthma severity in older females. Front Med (Lausanne) 2022; 9:970495. [PMID: 36314028 PMCID: PMC9606418 DOI: 10.3389/fmed.2022.970495] [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: 06/16/2022] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background CRTh2 is G protein coupled receptor for prostaglandin D2 (PGD)2 expressed by immune cells that drive type 2 inflammation such as CD4+ T cells (Th2), eosinophils and group 2 innate lymphoid cells (ILC2) as well as structural cells including smooth muscle and epithelium. CRTh2-expressing cells are increased in the blood and airways of asthmatics and severe asthma is characterized by increased activity of the PGD2-CRTh2 pathway. The CRTh2 single nucleotide polymorphism (SNP) rs533116 G > A is associated with development of asthma and increased Th2 cell differentiation. Objective To examine whether CRTh2 rs533116G > A associates with asthma severity. Since severe asthma is more common in females than males, we performed a sex-stratified analysis. Methods Clinical data from asthmatics (n = 170) were obtained from clinic visits and chart review. Asthma severity was assessed according to ERS/ATS guidelines. Peripheral blood cells were characterized by flow cytometry and qRT-PCR. Genotyping was performed by TaqMan assay. Results Older females (≥45 years) homozygous for minor A allele of rs533116 were more likely to have severe asthma, lower FEV1, a higher prescribed dose of inhaled corticosteroid and more type 2 inflammation than females carrying GA or GG genotypes. Comparing females and males with the AA genotype also revealed that women had more type 2 inflammation. Conclusions and significance The polymorphism CRTh2 rs533116 G > A associates with severe asthma and type 2 inflammation in older females. This study reveals a gene-sex-aging interaction influencing the effect of CRTh2 on asthma severity.
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Affiliation(s)
- Nami Shrestha Palikhe
- Division of Pulmonary Medicine, Department of Medicine and Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada
| | - Constance A. Mackenzie
- Division of Respirology, Department of Medicine, Western University, London, ON, Canada,Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada,Division of Clinical Pharmacology and Toxicology, Ontario Poison Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christopher Licskai
- Division of Respirology, Department of Medicine, Western University, London, ON, Canada
| | - Richard B. Kim
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada
| | - Harissios Vliagoftis
- Division of Pulmonary Medicine, Department of Medicine and Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada
| | - Lisa Cameron
- Division of Pulmonary Medicine, Department of Medicine and Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada,*Correspondence: Lisa Cameron,
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17
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Tosca MA, Di Cicco ME, Leone M, Scavone M, Licari A. Controversies in the treatment of mild asthma. What novelties and practical implications? Pediatr Allergy Immunol 2022; 33 Suppl 27:11-14. [PMID: 35080294 PMCID: PMC9303533 DOI: 10.1111/pai.13618] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/17/2021] [Accepted: 08/06/2021] [Indexed: 11/27/2022]
Abstract
Mild asthma is prevalent in childhood and causes as many as 30%-40% asthma exacerbations requiring emergency visits. The management of "intermittent" and "mild persistent" asthma phenotypes is still a matter of debate, even if the role of inhaled corticosteroids, both continuous and intermittent, is a cornerstone in this field. Recent updates of the guidelines on the strategies to manage these patients are coming, since the role of inflammation in these asthma phenotypes is crucial, as well as the potential side effect and risks of short-acting beta 2 agonists overuse, prescribed as the only "as-needed" treatments. In this paper, we overview the new (r)evolution regarding intermittent and mild persistent asthma management.
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Affiliation(s)
| | - Maria Elisa Di Cicco
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | | | - Maria Scavone
- Neonatal Intensive Care Unit, San Carlo Hospital, Potenza, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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18
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Sánchez-García S, Ruiz-Hornillos J, Bernaola M, Habernau-Mena A, Lasa EM, Contreras J, Candón-Morillo R, Antón-Rodríguez C, Escudero C. Effect of the SARS-CoV-2 pandemic on the control and severity of pediatric asthma. Allergol Immunopathol (Madr) 2022; 50:99-103. [PMID: 34965644 DOI: 10.15586/aei.v50i1.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The novel disease caused by the new coronavirus SARS-CoV-2 has caused an unprecedented global pandemic. Care providers of asthmatic children are increasingly con-cerned; as viral infections are one of the primary triggers of asthma flare-up. However, the effect of SARS-CoV-2 as well as the generated worldwide lockdown on asthmatic children is unknown. OBJECTIVE The aim of this study was to analyze the effects of pandemic SARS-CoV-2 in pediat-ric asthma control. MATERIAL AND METHODS A retrospective, open, transversal study was performed at five ter-tiary hospitals. Recruited patients were aged <18 years and had physician-diagnosed asthma. Information regarding the 2019 and 2020 seasons were provided. RESULTS Data were collected from 107 children (age range: 3-18 years, mean age: 12 years). Well-controlled asthma was observed in 58 (54.2%) patients in 2020 versus 30 (28%) in 2019, and 15 (14%) patients had poorly controlled asthma in 2020 versus 28 (26.2%) in 2019. In 2020, a decrease in exacerbations caused by allergies to pollen, dust mites, molds, and through other causes not related to SARS-CoV-2 infection was observed. An increase in exacerbations was observed due to animal dander, stress, physical exercise, and SARSCoV-2 infection. Children had a reduced need for asthma-controlling medication, made fewer visits to healthcare providers and had lesser need of treatment with oral corticosteroids if compared with the same season of 2019. CONCLUSION Pediatric asthma control improved, the need for controller medication declined, and fewer visits to healthcare providers were made during the pandemic if compared with the 2019 season.
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19
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Abstract
BACKGROUNDS The development of asthma is highly affected by exposure to exogenous and endogenous oxidative molecules, but the impact of this exposure on the pathophysiology of asthma has received little attention. OBJECTIVES Evaluating group of selective oxidative stress markers as a tool in the management of asthma disease. METHODS In comparison with matched healthy controls, levels of the oxidant and antioxidant markers: lipid peroxidation malondialdehyde (MDA), Total glutathione (tGSH), Uric acid (UA), Glutathione peroxidase (GPx), Catalase (CAT) superoxide dismutase (SOD), and Total antioxidant capacity (TAC) were assessed in serum and saliva of different asthma groups. RESULTS All oxidative markers in serum and saliva of asthma patients showed significant alterations from normal healthy controls (P < 0.05), except the salivary SOD (P = 0.441). Their levels in serum were significantly correlated with asthma severity (P < 0.05), and the distinguishing between childhood and adult asthma was significantly accomplished by GPx, SOD, TAC markers (P < 0.05). However, in patients with childhood asthma no significant differences were detected between the levels of GPx, CAT, UA, MDA in serum and saliva samples (P > 0.05). CONCLUSION Determination of the oxidative markers GPx, CAT, UA in serum or saliva can distinguish asthma from healthy states. The serum levels of UA and TAC are highly effective in monitoring asthma severity, while the salivary GPx, CAT, UA, MDA are beneficial in the management of childhood asthma. Discrimination of the age factor between asthma groups can be achieved by testing GPx, SOD, TAC in serum.
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Affiliation(s)
- Muayad M Abboud
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zerga, Jordan
| | - Futoon A Al-Rawashde
- School of Biomedicine, Faculty of Health Sciences, University Sultan Zainal Abidin (UniSZA), Terengganu, Malaysia
| | - Enas M Al-Zayadneh
- Department of Pediatrics, School of Biomedicine, University of Jordan, Amman, Jordan
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20
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Kuo CH, Tsai ML, Li CH, Hsiao HP, Chao MC, Lee MS, Lin YC, Hung CH. Altered Pattern of Macrophage Polarization as a Biomarker for Severity of Childhood Asthma. J Inflamm Res 2021; 14:6011-6023. [PMID: 34819741 PMCID: PMC8608023 DOI: 10.2147/jir.s319754] [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: 05/18/2021] [Accepted: 11/12/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Asthma causes a substantial morbidity and mortality burden in children and the pathogenesis of childhood asthma is not completely understood. Macrophages are heterogeneous with divergent M1/M2 polarization phenotypes in response to various stimulations during the inflammatory process. We aimed to investigate the pattern of macrophage polarization and its association with severity and exacerbation in asthmatic children. Patients and Methods Normal and asthmatic children aged 4–18 years were enrolled for 12 months. Children with asthma were further subgrouped according to their severity and the requirement for hospitalization during exacerbations. Clinical data were obtained from medical records. Peripheral blood samples were collected to analyze macrophage polarization, including M1, M2, and subsets, by flow cytometry. Results Fifty-one asthmatic cases and 27 normal controls were included in this study. The level of PM-2K+CD14+ but not PM-2K+CD14− was decreased in asthmatic children. The levels of M2a (CCR7−CXCR1+), M2b (CCR7−CD86+), and M2c (CCR7−CCR2+) subsets, but not M1 (CCR7+CD86+), were increased in asthmatic children. The levels of M1 were decreased, but the levels of M2c were increased, in children with moderate asthma compared to those with mild asthma. The levels of PM-2K+CD14+ cells and M1 subsets were decreased, but the M2c subset cells were increased in asthmatic children requiring hospitalization during exacerbations. Conclusion Macrophage polarization may be involved in the pathogenesis of childhood asthma and is a potential biomarker of childhood asthma disease severity.
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Affiliation(s)
- Chang-Hung Kuo
- Ta-Kuo Clinic, Kaohsiung, Taiwan.,Department of Pediatrics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Mei-Lan Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hsiang Li
- Department of Pediatrics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Pin Hsiao
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chyn Chao
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Sheng Lee
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Lin
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Laboratory Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Ph.D. Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Substance and Behavior Addiction Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Hsing Hung
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
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21
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Zhu T, Zhang X, Chen X, Brown AP, Weirauch MT, Guilbert TW, Khurana Hershey GK, Biagini JM, Ji H. Nasal DNA methylation differentiates severe from non-severe asthma in African-American children. Allergy 2021; 76:1836-1845. [PMID: 33175399 PMCID: PMC8110596 DOI: 10.1111/all.14655] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Asthma is highly heterogeneous, and severity evaluation is key to asthma management. DNA methylation (DNAm) contributes to asthma pathogenesis. This study aimed to identify nasal epithelial DNAm differences between severe and nonsevere asthmatic children and evaluate the impact of environmental exposures. METHODS Thirty-three nonsevere and 22 severe asthmatic African American children were included in an epigenome-wide association study. Genome-wide nasal epithelial DNAm and gene expression were measured. CpG sites associated with asthma severity and environmental exposures and predictive of severe asthma were identified. DNAm was correlated with gene expression. Enrichment for transcription factor (TF) binding sites or histone modifications surrounding DNAm differences were determined. RESULTS We identified 816 differentially methylated CpG positions (DMPs) and 10 differentially methylated regions (DMRs) associated with asthma severity. Three DMPs exhibited discriminatory ability for severe asthma. Intriguingly, six DMPs were simultaneously associated with asthma, allergic asthma, total IgE, environmental IgE, and FeNO in an independent cohort of children. Twenty-seven DMPs were associated with traffic-related air pollution or secondhand smoke. DNAm at 22 DMPs was altered by diesel particles or allergen in human bronchial epithelial cells. DNAm levels at 39 DMPs were correlated with mRNA expression. Proximal to 816 DMPs, three histone marks and several TFs involved in asthma pathogenesis were enriched. CONCLUSIONS Significant differences in nasal epithelial DNAm were observed between nonsevere and severe asthma in African American children, a subset of which may be useful to predict disease severity. These CpG sites are subjected to the influences of environmental exposures and may regulate gene expression.
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Affiliation(s)
- Tao Zhu
- California National Primate Research Center, Davis, CA
| | - Xue Zhang
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Xiaoting Chen
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Matthew T. Weirauch
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Divisions of Biomedical Informatics and Developmental Biology, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Theresa W. Guilbert
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gurjit K. Khurana Hershey
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Divison of Asthma Research, Cincinnati Children’s Hospital Medical Center, Davis, CA
| | - Jocelyn M. Biagini
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Divison of Asthma Research, Cincinnati Children’s Hospital Medical Center, Davis, CA
| | - Hong Ji
- California National Primate Research Center, Davis, CA
- Department of Anatomy, Physiology and Cell biology, School of Veterinary Medicine, University of California, Davis, CA
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22
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Nakwan N. Impact of asthma severity as risk factor to future exacerbations in patients admitted for asthma exacerbation. Multidiscip Respir Med 2021; 16:780. [PMID: 34557299 PMCID: PMC8419716 DOI: 10.4081/mrm.2021.780] [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: 05/10/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background To investigate the impact of disease severity on exacerbation patterns and identify its potential as a risk factor for future exacerbations in patients admitted for asthma exacerbations. Methods We analyzed frequency and time to next exacerbation over a period of three years in 532 patients admitted for exacerbation. Disease severity was selected as a potential risk factor for the events. Kaplan-Meier analysis was used to identify the probability of future exacerbations. A Cox-proportional hazards model was used to assess independent relative risks. Results Out of 532 patients analyzed, the frequency of exacerbations rose as the severity of the asthma increased. The exacerbation rates in the following year were 1.66 per person for patients with mild asthma and 3.98 for patients with severe asthma. The median time to the next exacerbation in patients with mild asthma was 61.4 weeks (95% CI, 40.1-82.6) compared to 15.0 weeks (95% CI, 11.3-18.6) in patients with severe asthma (p<0.001). Multivariate analysis showed that asthma severity (severe vs mild asthma, HR=1.42, 95% CI, 1.07-1.89), a history of 1-2 exacerbations (HR=1.95, 95% CI, 1.45-2.63) or > 2 exacerbations (HR=2.32, 95% CI, 1.56-3.44) in the previous 12 months, and a high number of comorbidities (≥5 vs none, HR=2.5, 95% CI, 1.41-4.45) were independent predictors of the probability of future exacerbations. Conclusion Asthma severity is a strong independent risk factor for future exacerbations, and exacerbation rates also become more frequent as the severity of the asthma increases. These findings help in better understanding of the natural course of exacerbations across the spectrum of asthma disease severity.
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Affiliation(s)
- Narongwit Nakwan
- Division of Pulmonology, Department of Medicine, Hat Yai Medical Education Center, Hat Yai Hospital, Songkhla, Thailand
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23
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Parlar-Chun R, Truong G, Isbell T, Delgado Y, Arca M. Association of obesity with severity outcomes in hospitalized pediatric asthma exacerbations. J Asthma 2020; 59:54-58. [PMID: 32962448 DOI: 10.1080/02770903.2020.1827422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION While there seems to be an association between obesity and asthma, the exact nature of the relationship remains unknown. It is unclear if there is increased severity of exacerbation for those that require hospitalization. We examine the association between obesity and severity outcomes such as hospital length of stay, intensive care admissions, and need for continuous albuterol or magnesium administration. METHODS Patients 4 to 17 years old admitted between 1/1/2012-1/1/2016 with asthma identified by discharge codes were reviewed. Obesity was defined as BMI ≥95%. Clinical data such as age, gender, family history of asthma, use of controller medication along with outcome data such as length of stay, ICU admission, use of continuous albuterol, and use of magnesium were collected. Binary outcomes were analyzed with multivariate logistic regression while length of stay was analyzed with negative binomial regression. RESULTS Overall, 995 patients met inclusion criteria. The median age was 7 years old with 170 (17%) patients categorized as obese. We find no difference in length of stay (IRR 0.99 [0.91, 1.09], p = 0.9), PICU admission (OR 0.72 [0.43, 1.21], p = 0.22), or magnesium administration (OR 1.34 [0.95, 1.88], p = 0.09) between obese and non-obese patients. There were increased odds of continuous albuterol use (OR 1.47 [1.02, 2.11]) for obese patients. CONCLUSION We find no association between obesity and outcomes of length of stay, ICU admission, or magnesium administration. While growing evidence links obesity with asthma, our study suggests it may not be associated with the severity of exacerbation.
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Affiliation(s)
- Raymond Parlar-Chun
- Children's Memorial Hermann, Houston, TX, USA.,Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Grace Truong
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Tasia Isbell
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Yesenia Delgado
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Makenna Arca
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
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24
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Li X, Christenson SA, Modena B, Li H, Busse WW, Castro M, Denlinger LC, Erzurum SC, Fahy JV, Gaston B, Hastie AT, Israel E, Jarjour NN, Levy BD, Moore WC, Woodruff PG, Kaminski N, Wenzel SE, Bleecker ER, Meyers DA; NHLBI Severe Asthma Research Program (SARP). Genetic analyses identify GSDMB associated with asthma severity, exacerbations, and antiviral pathways. J Allergy Clin Immunol 2021; 147:894-909. [PMID: 32795586 DOI: 10.1016/j.jaci.2020.07.030] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Chr17q12-21.2 region is the strongest and most consistently associated region with asthma susceptibility. The functional genes or single nucleotide polymorphisms (SNPs) are not obvious due to linkage disequilibrium. OBJECTIVES We sought to comprehensively investigate whole-genome sequence and RNA sequence from human bronchial epithelial cells to dissect functional genes/SNPs for asthma severity in the Severe Asthma Research Program. METHODS Expression quantitative trait loci analysis (n = 114), correlation analysis (n = 156) of gene expression and asthma phenotypes, and pathway analysis were performed in bronchial epithelial cells and replicated. Genetic association for asthma severity (426 severe vs 531 nonsevere asthma) and longitudinal asthma exacerbations (n = 273) was performed. RESULTS Multiple SNPs in gasdermin B (GSDMB) associated with asthma severity (odds ratio, >1.25) and longitudinal asthma exacerbations (P < .05). Expression quantitative trait loci analyses identified multiple SNPs associated with expression levels of post-GPI attachment to proteins 3, GSDMB, or gasdermin A (3.1 × 10-9 <P < 1.8 × 10-4). Higher expression levels of GSDMB correlated with asthma and greater number of exacerbations (P < .05). Expression levels of GSDMB correlated with genes involved in IFN signaling, MHC class I antigen presentation, and immune system pathways (false-discovery rate-adjusted P < .05). rs1031458 and rs3902920 in GSDMB colocalized with IFN regulatory factor binding sites and associated with GSDMB expression, asthma severity, and asthma exacerbations (P < .05). CONCLUSIONS By using a unique set of gene expression data from lung cells obtained using bronchoscopy from comprehensively characterized subjects with asthma, we show that SNPs in GSDMB associated with asthma severity, exacerbations, and GSDMB expression levels. Furthermore, its expression levels correlated with asthma exacerbations and antiviral pathways. Thus, GSDMB is a functional gene for both asthma susceptibility and severity.
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25
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Alem K, Gebeyehu S, Arega Y. Risk Factors and Treatment Types for Asthma Severity Among Adult Patients. J Asthma Allergy 2020; 13:167-177. [PMID: 32440162 PMCID: PMC7217635 DOI: 10.2147/jaa.s246464] [Citation(s) in RCA: 2] [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: 01/17/2020] [Accepted: 04/23/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the risk factors and treatment types for asthma severity among adult patients by applying a retrospective study design. MATERIALS AND METHODS The symptoms of asthma and corresponding medication prescription were addressed by descriptive statistics, and an ordinal logistic regression model was applied to identify the risk factors of asthma severity based on the data obtained from chronic follow-up of 422 adult asthma patients from September 11, 2012, to July 8, 2016, at the University of Gondar Teaching Hospital (UOGTH). RESULTS From 422 study units, the more commonly presenting asthma symptoms were coughing and wheezing expressed by 52.13% and 50.9%, respectively. For the treatment type given to the patients, oxygen and prednisolone were highly distributed drugs to the patients in chronic illness, medication and follow-up clinic of the University of Gondar Teaching Hospital (UOGTH) which were expressed by 73.5% and 35.5%, respectively. The proportional odd logit model was used to analyse asthma severity in patients; patients who were female (OR=1.68), a rural resident (OR=1.56), regular physical exercise (OR=2.39), allergen to pet (OR=3.17), had asthma in childhood (OR=2.27), had a family history (OR=1.89), and had depression (OR=2.31) were more likely to increase asthma severity than others, and patients who were in case with regular cooker, dry season was less likely to increase asthma severity. CONCLUSION Generally, the study presented the most common asthma symptoms and treatment types correspondingly. The study also showed that demographic, environmental, genetic, and health-related factors have a significant effect on asthma severity.
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Affiliation(s)
- Kidanemariam Alem
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Sefinew Gebeyehu
- Department of Statistics, College of Natural and Computational Sciences, Adigrat University, Adigrat, Ethiopia
| | - Yibeltal Arega
- Department of Statistics, College of Natural and Computational Sciences, University of Gondar, Gondar, Ethiopia
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26
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Li X, Hastie AT, Peters MC, Hawkins GA, Phipatanakul W, Li H, Moore WC, Busse WW, Castro M, Erzurum SC, Gaston B, Israel E, Jarjour NN, Levy BD, Wenzel SE, Meyers DA, Fahy JV, Bleecker ER. Investigation of the relationship between IL-6 and type 2 biomarkers in patients with severe asthma. J Allergy Clin Immunol 2020; 145:430-433. [PMID: 31513878 PMCID: PMC7469890 DOI: 10.1016/j.jaci.2019.08.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 01/06/2023]
Abstract
Combination of IL-6 (non-Type 2 asthma) and FeNO or blood eosinophil count (Type 2 asthma) identified asthma endotypes related to asthma severity, exacerbations, and responsiveness to corticosteroids and potential for response to anti-Type 2 and anti-IL-6 treatment.
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Affiliation(s)
- Xingnan Li
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Ariz.
| | - Annette T Hastie
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael C Peters
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California at San Francisco, San Francisco, Calif
| | - Gregory A Hawkins
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| | - Wanda Phipatanakul
- Boston Children's Hospital, Boston, Mass; Division of Allergy and Immunology, Harvard Medical School, Boston, Mass
| | - Huashi Li
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Ariz
| | - Wendy C Moore
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine, Madison, Wis
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Mo
| | | | - Benjamin Gaston
- Division of Pediatric Pulmonology, Rainbow Babies and Children's Hospital and Cleveland Medical Center, Cleveland, Ohio
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine, Madison, Wis
| | - Bruce D Levy
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Sally E Wenzel
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pa
| | - Deborah A Meyers
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Ariz
| | - John V Fahy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California at San Francisco, San Francisco, Calif
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Ariz
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27
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Sobeih AA, Behairy OG, Abd Almonaem ER, Mohammad OI, Mn Abdelrahman A. Clusterin in atopic and non-atopic childhood asthma. Scand J Clin Lab Invest 2019; 79:368-371. [PMID: 31161800 DOI: 10.1080/00365513.2019.1624976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Several biomarkers have been studied to diagnose or to detect the phenotype of asthma. Clusterin is a sensitive cellular biosensor of oxidative stress and has been studied as a biomarker for inflammatory diseases. We aimed to study serum clusterin level in atopic versus non-atopic childhood asthma and its relation to disease severity. This case-control study included 160 children; 120 stable asthmatic children and 40 apparently healthy children. Asthmatic children were further subdivided into atopic and non-atopic. All children were subjected to medical history taking, clinical examination, and laboratory investigations including complete blood count, serum IgE, serum clusterin level and spirometry before and after bronchodilator therapy. In comparison to controls, patients had significantly higher eosinophils count which was higher in atopic than non-atopic group, also serum IgE level was higher in the atopic asthmatics (118.1 ± 16.2 U/ml) than in both the non-atopic asthmatics (81.2 ± 6.1 U/ml) and the controls (76.3 ± 11.6 U/ml). There was statistical significant difference in serum levels of Clusterin which were highest in the atopic group (182.5 ± 33.5 ng/l), followed by the non-atopic patients (127.5 ± 32.5 ng/l) and lowest in the controls (46.09 ± 7.01 ng/l). Moreover, the higher the severity of asthma, the higher was the level of serum clusterin. In conclusion serum level of clusterin was higher in atopic than non-atopic asthmatic children and it increases significantly with increased severity of the disease.
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Affiliation(s)
- Ahmad Ata Sobeih
- Department of Pediatrics, Faculty of Medicine, Benha University , Benha , Egypt
| | - Ola Galal Behairy
- Department of Pediatrics, Faculty of Medicine, Benha University , Benha , Egypt
| | | | | | - Amira Mn Abdelrahman
- Department of Clinical Pathology, Faculty of Medicine, Benha University , Benha , Egypt
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28
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Whalen OM, Campbell LE, Murphy VE, Lane AE, Gibson PG, Mattes J, Collison A, Mallise CA, Woolard A, Karayanidis F. Observational study of mental health in asthmatic women during the prenatal and postnatal periods. J Asthma 2019; 57:829-841. [PMID: 31148493 DOI: 10.1080/02770903.2019.1621888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: We aimed to examine the prevalence and severity of psychological distress of women with asthma in both the prenatal and postnatal periods, and to determine whether asthmatic women with and without mental health problems differ in self-management, medications knowledge, and asthma symptoms.Methods: We assessed spirometry performance and asthma symptoms in 120 women (mean age 29.8 years) before 23 weeks gestation, as part of the Breathing for Life Trial (Trial ID: ACTRN12613000202763). Prenatal depression data was obtained from medical records. At 6 weeks postpartum, we assessed general health, self-reported asthma control, depression symptoms (with the Edinburgh Postnatal Depression Scale) and adaptive functioning (with the Achenbach System of Empirically Based Assessment scales).Results: Twenty percent of our sample reported having a current mental health diagnosis, 14% reported currently receiving mental health care, while 47% reported having received mental health care in the past (and may/may not have received a diagnosis). The sample scored high on the Aggressive Behavior, Avoidant Personality, and Attention Deficit/Hyperactivity scales. Poorer self-reported postnatal asthma control was strongly correlated with elevated somatic complaints, externalizing problems, antisocial personality problems, and greater withdrawal. Prenatal spirometry or asthma severity and control were largely not associated with measures of psychopathology.Conclusions: These findings indicate that pregnant women with asthma frequently report issues with psychopathology during the prenatal and postnatal periods, and that the subjective perception of asthma control may be more related to psychopathology than objective asthma measures. However, due to sample bias, these findings are likely to be understated.
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Affiliation(s)
- Olivia M Whalen
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Linda E Campbell
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alison E Lane
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Gibson
- Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia.,Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Adam Collison
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Carly A Mallise
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Alix Woolard
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Frini Karayanidis
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
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29
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Abstract
Objectives: Asthma is a multifactorial, heterogeneous, complex and common chronic respiratory disease driven by diverse mechanisms. Although asthma presents various clinical forms with different levels of severity, it is unclear whether asthma severities are a consequence of disease management or varied etiologies. We sought to investigate this question.Methods: This article presents a cross-sectional study of 113,671 Israeli adolescents. Univariate and multivariable logistic regression models were performed to analyze the independent associations between mild asthma and moderate-to-severe asthma phenotypes and coexistent medical conditions within each gender separately. Hierarchical clustering of the odds ratios of the diverse statistically significant medical conditions associated with asthma severity-gender groups was also performed. We focused on the allergic and neurological-cognitive-mental disorders.Results: Among males, two associations were common to both asthma groups (atopic dermatitis and allergic rhinitis), five unique to mild asthma (urticaria/angioedema, Hymenoptera/bee allergies, allergic conjunctivitis, epilepsy and migraine) and two unique to moderate-to-severe asthma (learning disabilities and ADD/ADHD (Attention-deficit disorder/Attention-deficit/hyperactivity disorder)). Among females, two associations were common to both clinical asthma groups (allergic rhinitis and urticaria/angioedema), and five unique to moderate-to-severe asthma (atopic dermatitis, learning disabilities, ADD/ADHD, anxiety/mood disorders and migraine). Allergic rhinitis was the only condition to be associated with all four groups. Learning disabilities and ADD/ADHD were only associated with moderate-to-severe asthma (but not with mild asthma), in both males and females. Hierarchical clustering analysis uncovered two prominent clusters, separating mild from moderate-to-severe asthma.Conclusions: The differences between mild and moderate-to-severe asthma enhance asthma phenotype characterization, with respect to comorbidities, and indicate varied etiologies.
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Affiliation(s)
- Yossy Machluf
- Medical Corps, IDF, Israel.,Shamir Research Institute, University of Haifa, Kazerin, Israel
| | | | - Ron Rotkopf
- Department of Life Sciences Core Facilities, Faculty of Biochemistry, Weizmann Institute of Science, Rehovot, Israel
| | - Daniel Fink
- Shaarei Zedek Medical Center, Jerusalem, Israel
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30
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Machluf Y, Farkash R, Rotkopf R, Fink D, Chaiter Y. Asthma phenotypes and associated comorbidities in a large cohort of adolescents in Israel. J Asthma 2019; 57:722-735. [PMID: 31017024 DOI: 10.1080/02770903.2019.1604743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: Asthma is a multifactorial, heterogeneous, complex and common chronic respiratory disease driven by diverse mechanisms. Although asthma presents various clinical forms with different levels of severity, it is unclear whether asthma severities are a consequence of disease management or varied etiologies. We sought to investigate this question.Methods: This article presents a cross-sectional study of 113,671 Israeli adolescents. Univariate and multivariable logistic regression models were performed to analyze the independent associations between mild asthma and moderate-to-severe asthma phenotypes and coexistent medical conditions within each gender separately. Hierarchical clustering of the odds ratios of the diverse statistically significant medical conditions associated with asthma severity-gender groups was also performed. We focused on the allergic and neurological-cognitive-mental disorders.Results: Among males, two associations were common to both asthma groups (atopic dermatitis and allergic rhinitis), five unique to mild asthma (urticaria/angioedema, Hymenoptera/bee allergies, allergic conjunctivitis, epilepsy and migraine) and two unique to moderate-to-severe asthma (learning disabilities and ADD/ADHD (Attention-deficit disorder/Attention-deficit/hyperactivity disorder)). Among females, two associations were common to both clinical asthma groups (allergic rhinitis and urticaria/angioedema), and five unique to moderate-to-severe asthma (atopic dermatitis, learning disabilities, ADD/ADHD, anxiety/mood disorders and migraine). Allergic rhinitis was the only condition to be associated with all four groups. Learning disabilities and ADD/ADHD were only associated with moderate-to-severe asthma (but not with mild asthma), in both males and females. Hierarchical clustering analysis uncovered two prominent clusters, separating mild from moderate-to-severe asthma.Conclusions: The differences between mild and moderate-to-severe asthma enhance asthma phenotype characterization, with respect to comorbidities, and indicate varied etiologies.
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Affiliation(s)
- Yossy Machluf
- Medical Corps, IDF, Israel.,Shamir Research Institute, University of Haifa, Kazerin, Israel
| | | | - Ron Rotkopf
- Department of Life Sciences Core Facilities, Faculty of Biochemistry, Weizmann Institute of Science, Rehovot, Israel
| | - Daniel Fink
- Shaarei Zedek Medical Center, Jerusalem, Israel
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31
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Rege S, Kavati A, Ortiz B, Mosnaim G, Cabana MD, Murphy K, Aparasu RR. Documentation of asthma control and severity in pediatrics: analysis of national office-based visits. J Asthma 2019; 57:205-216. [PMID: 30657001 DOI: 10.1080/02770903.2018.1554069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the extent of documentation of asthma control and severity and associated characteristics among pediatric asthma patients in office-based settings. Methods: This cross-sectional study utilized data from the 2012-2015 National Ambulatory Medical Care Survey (NAMCS). Patients aged 6-17 years with a diagnosis of asthma were included. Weighted descriptive analysis examined the extent of documentation and uncontrolled asthma; while logistic regression evaluated associated characteristics. Results: Overall, there were 2.47 million (95% confidence interval, 95% CI: 2.04-2.90) average annual visits with asthma as a primary diagnosis. Asthma control and severity was documented in only 36.1% and 33.8% of the visits, respectively. An established patient (odds ratio, OR = 3.81), Hispanic ethnicity (OR = 2.10), chronic sinusitis (OR = 5.59), and visits in the Northeast (OR = 2.12) and Midwest (OR = 2.25) regions had higher odds of documented asthma control status, whereas undocumented asthma severity (OR = 0.02), and visits in spring (OR = 0.34), had lower odds. Osteopathic doctors (OR = 0.18), visits in the Northeast region (OR = 0.23), chronic sinusitis (OR = 0.08), and undocumented asthma control status (OR = 0.03) had lower odds of documented asthma severity, whereas visits in spring (OR = 3.88) and autumn (OR = 3.32) had higher odds. Moderate/severe persistent asthma (OR = 15.35) had higher odds of uncontrolled asthma (as compared to intermittent asthma), while visits in the summer (OR = 0.14) had lower odds. Conclusion: The findings of this study suggest a critical need to increase the documentation of asthma severity and control to improve quality of asthma care in children.
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Affiliation(s)
- Sanika Rege
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
| | - Abhishek Kavati
- US Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Benjamin Ortiz
- US Clinical Development and Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Michael D Cabana
- Department of Pediatrics, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Kevin Murphy
- Boys Town National Research Hospital, Boys Town, NE, USA
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
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Harvey MW, Farrell AK, Imami L, Carré JM, Slatcher RB. Maternal attachment avoidance is linked to youth diurnal cortisol slopes in children with asthma. Attach Hum Dev 2018; 21:23-37. [PMID: 30406724 DOI: 10.1080/14616734.2018.1541514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prior evidence suggests that an individual's attachment orientation is linked to the health and health-related biology of his/her romantic relationship partners. The current study examined whether this effect extends to parent-child relationships. Specifically, we investigated the association between maternal attachment anxiety and avoidance and diurnal cortisol of offspring. In a sample of 138 youth with asthma and their primary caregivers, caregivers reported their attachment orientations, and their children (aged 10-17) supplied four saliva samples per day over four days to assess diurnal cortisol patterns. Growth curve analyses revealed no links to caregiver attachment anxiety, but caregiver attachment avoidance was significantly associated with children's diurnal cortisol slopes, such that greater attachment avoidance predicted flatter diurnal cortisol slopes. Maternal warmth did not mediate this link. These results support the possibility that an individual's adult attachment orientation may "get under the skin" of family members to influence their health-related biology. Future research should seek to determine the causal direction of this association and mechanisms of this effect.
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Affiliation(s)
- Michael W Harvey
- a Department of Phsychology , Wayne State University , Detroit , USA
| | - Allison K Farrell
- a Department of Phsychology , Wayne State University , Detroit , USA
| | - Ledina Imami
- a Department of Phsychology , Wayne State University , Detroit , USA
| | - Justin M Carré
- b Departmnt of Psychology , Nipissing University , North Bay , Ontario , Canada
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Havan M, Razi CH, Bulus AD, Köksal AO, Andıran N. Effects of 25 hydroxy vitamin D levels on the severity and asthma control in school age asthma patients. ARCH ARGENT PEDIATR 2018; 115:336-342. [PMID: 28737861 DOI: 10.5546/aap.2017.eng.336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/23/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective was to determine vitamin D levels in patients between the ages 6 and 18 years, followed for asthma, and the relation between vitamin D levels and asthma control and severity. MATERIALS AND METHODS Patients with asthma and healthy volunteers between the ages 6 and 18 years were enrolled into the study as patient and control groups, respectively. Patient demographic information and clinical findings were recorded; a respiratory function test was performed. Body mass index (BMI), 25(OH) D,calcium, phosphorus, alkaline phosphatase, total IgE and eosinophil levels were determined for all patients. Asthma severity and control conditions were established based on GINA (Global Initiative for Asthma) criteria. RESULTS Seventy two patients with asthma and 66 healthy children were included. Compared to the control group, decreased serum vitamin D levels were detected in patient group. Thirty eight (52.8%) patients in asthma patient group had vitamin D defficiency; in this group, asthma control was poor and asthma severity was significantly higher. No significant correlation was found between vitamin D levels and gender, obesity, respiratory functions, skin test, serum eosinophil and total IgE levels. CONCLUSION The frequency of vitamin D deficiency and insufficiency was higher in children with asthma, compared to the controls. Lower levels of vitamin D are associated with poor asthma control and increased asthma severity.
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Affiliation(s)
- Merve Havan
- Pediatrics, Keçiören Research and Educational Hospital, Ankara, Turkey
| | - Cem H Razi
- Pediatric Allergy and Immunoloy, Keçiören Research and Educational Hospital, Ankara, Turkey
| | - Ayse D Bulus
- Pediatric Endocrinology, Keçiören Research and Educational Hospital, Ankara, Turkey
| | - Ali O Köksal
- Pediatrics, Keçiören Research and Educational Hospital, Ankara, Turkey.
| | - Nesibe Andıran
- Pediatrics, Keçiören Research and Educational Hospital, Ankara, Turkey
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Ahmadizar F, Vijverberg SJH, Arets HGM, de Boer A, Garssen J, Kraneveld AD, Maitland-van der Zee AH. Breastfeeding is associated with a decreased risk of childhood asthma exacerbations later in life. Pediatr Allergy Immunol 2017; 28:649-654. [PMID: 28755494 DOI: 10.1111/pai.12760] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Accepted: 07/25/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Breastfeeding has been suggested to influence the risk of asthma and asthma severity in children. However, the conclusions from epidemiologic studies are inconsistent. METHODS We used data from 960 children (aged 4-12 years) using regular asthma medication who participated in the PACMAN study. Breastfeeding exposure was based on questionnaire data and stratified into (i) ever vs never, and (ii) ≥6 vs <6 months duration of breastfeeding. Asthma severity was based on the occurrence of asthma exacerbations in the preceding year and/or poorly controlled asthma symptoms during the last week of study visit. Odds ratios (ORs) were derived from univariate and multivariable logistic regression analyses. RESULTS Breastfeeding was associated with a decreased risk of asthma exacerbations; adjusted (adj.) OR: 0.55 (95% confidence interval [CI]: 0.35-0.87). After stratification for duration of breastfeeding, the adj. ORs were 0.48 (95% CI: 0.27-0.84) for duration <6 months and 0.71 (95% CI: 0.43-1.20) for duration ≥6 months breastfeeding. When we stratified the analysis by family history of asthma, the association between breastfeeding and asthma exacerbations was strong and statistically significant only in children with a positive family history of asthma; adj. OR: 0.34 (95% CI: 0.18-0.66). There was no association between breastfeeding and risk of poor asthma control; adj. OR: 1.04 (95% CI: 0.76-1.41). CONCLUSION In a pediatric population with asthma, children who had been breastfed had a statistically significantly lower risk of asthma exacerbations later in life compared to asthmatic children who had not been breastfed.
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Affiliation(s)
- Fariba Ahmadizar
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Susanne J H Vijverberg
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Hubertus G M Arets
- Department of Pediatric Pulmonology and Allergology, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Department of Immunology, Nutricia Research, Utrecht, the Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Machluf Y, Farkash R, Fink D, Chaiter Y. Asthma severity and heterogeneity: Insights from prevalence trends and associated demographic variables and anthropometric indices among Israeli adolescents. J Asthma 2017; 55:826-836. [PMID: 28872935 DOI: 10.1080/02770903.2017.1373809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES While asthma presents various clinical forms with different levels of severity, it is unclear whether asthma severities are a consequence of disease management or varied etiologies. We sought to investigate this question. METHODS This paper presents a cross-sectional study of 113,671 Israeli adolescents. Prevalence rates of mild and moderate-to-severe asthma over a 24-year period were calculated and multivariate regression models (outcomes: different asthma severity, reference: subjects without asthma) were performed to analyze associations with anthropometric indices and socio-demographic variables, in males and females separately. RESULTS The prevalence of mild asthma increased until birth years 1976-1980 and then steadily decreased. In contrast, the prevalence of moderate-to-severe asthma was relatively stable until birth years 1976-1980, then rose steeply until 1986-1990 and subsequently plateaued in the early 1990s. Obesity was positively associated with both mild and moderate-to-severe asthma in males (Odds Ratio (OR) [95%CIs]: 1.61 [1.37-1.89] and 1.63 [1.34-1.98], respectively) and females (1.54 [1.10-2.16] and 1.54 [1.20-1.98], respectively). Family size greater than three siblings was negatively associated with both mild and moderate-to-severe asthma in males (0.62 [0.56-0.68] and 0.59 [0.52-0.68]) and females (0.71 [0.60-0.83] and 0.73 [0.63-0.83]). In contrast, in males, underweight was only associated with mild asthma (1.54 [1.22-1.94]) but not with moderate-to-severe asthma. In females, overweight was only associated with moderate-to-severe asthma (1.21 [1.00-1.46]) and rural residence was only associated with mild asthma (1.26 [1.09-1.47]). CONCLUSIONS The differences between mild and moderate-to-severe asthma enhance asthma phenotype characterization, with respect to secular trends and associated variables, and indicate varied etiologies.
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Affiliation(s)
| | | | - Daniel Fink
- b Shaarei Zedek Medical Center , Jerusalem , Israel
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El-Alameey IR, Fathy GA, Shady MMA, Ali A, Fathy HA, Youness ER, Nasr SA. Relationship of Oxidant and Antioxidant Markers to Asthma Severity in Egyptian Asthmatic Children. Open Access Maced J Med Sci 2017; 5:645-650. [PMID: 28932307 PMCID: PMC5591596 DOI: 10.3889/oamjms.2017.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/18/2017] [Accepted: 06/20/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND: Asthma is a chronic airway disease which is characterized by oxidant antioxidant imbalance with the generation of oxidative stress related mediators. AIM: The study aimed to evaluate the role of asymmetric dimethylarginine, and malondialdehyde as oxidant markers and serum paraoxonase activity as an antioxidant marker in asthma, and to determine their relationship to the asthma severity and lung function among asthmatic children in Egypt. PATIENTS AND METHODS: This case control study was conducted on sixty patients with asthma compared with sixty apparently healthy children of matched age and sex. RESULTS: Serum concentrations of oxidant markers as asymmetric dimethylarginine and malondialdehyde were significantly increased in asthmatic patients while anti-oxidant marker as paraoxonase activity was significantly decreased compared to healthy controls (P < 0.05). ANOVA test revealed highly significant elevation of the serum concentrations of oxidant markers while anti-oxidant marker was significantly decreased in severe asthmatic patients (P < 0.001) compared to the patients with moderate and mild asthma respectively. Serum malondialdehyde concentration was a strong predictor of asthma severity by multiple regression analysis (P < 0.05). CONCLUSION: The study revealed an imbalance between oxidative and antioxidant defence systems in asthmatic children. Serum concentration of malondialdehyde was the most predictive biomarker having a significant association with asthma severity.
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Affiliation(s)
| | - Gihan A Fathy
- National Research Centre, Child Health Department, Egypt
| | | | - Alaa Ali
- National Research Centre, Child Health Department, Egypt
| | - Hanan A Fathy
- National Center for Radiation Research and Technology, Pediatric Department, Egypt
| | | | - Soha A Nasr
- National Research Centre, Clinical Pathology, Egypt
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Zoratti EM, Krouse RZ, Babineau DC, Pongracic JA, O'Connor GT, Wood RA, Khurana Hershey GK, Kercsmar CM, Gruchalla RS, Kattan M, Teach SJ, Sigelman SM, Gergen PJ, Togias A, Visness CM, Busse WW, Liu AH. Asthma phenotypes in inner-city children. J Allergy Clin Immunol 2017; 138:1016-1029. [PMID: 27720016 DOI: 10.1016/j.jaci.2016.06.061] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children with asthma in low-income urban areas have high morbidity. Phenotypic analysis in these children is lacking, but may identify characteristics to inform successful tailored management approaches. OBJECTIVE We sought to identify distinct asthma phenotypes among inner-city children receiving guidelines-based management. METHODS Nine inner-city asthma consortium centers enrolled 717 children aged 6 to 17 years. Data were collected at baseline and prospectively every 2 months for 1 year. Participants' asthma and rhinitis were optimally managed by study physicians on the basis of guidelines. Cluster analysis using 50 baseline and 12 longitudinal variables was performed in 616 participants completing 4 or more follow-up visits. RESULTS Five clusters (designated A through E) were distinguished by indicators of asthma and rhinitis severity, pulmonary physiology, allergy (sensitization and total serum IgE), and allergic inflammation. In comparison to other clusters, cluster A was distinguished by lower allergy/inflammation, minimally symptomatic asthma and rhinitis, and normal pulmonary physiology. Cluster B had highly symptomatic asthma despite high step-level treatment, lower allergy and inflammation, and mildly altered pulmonary physiology. Cluster C had minimally symptomatic asthma and rhinitis, intermediate allergy and inflammation, and mildly impaired pulmonary physiology. Clusters D and E exhibited progressively higher asthma and rhinitis symptoms and allergy/inflammation. Cluster E had the most symptomatic asthma while receiving high step-level treatment and had the highest total serum IgE level (median, 733 kU/L), blood eosinophil count (median, 400 cells/mm3), and allergen sensitizations (15 of 22 tested). CONCLUSIONS Allergy distinguishes asthma phenotypes in urban children. Severe asthma often coclusters with highly allergic children. However, a symptomatic phenotype with little allergy or allergic inflammation was identified.
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Affiliation(s)
- Edward M Zoratti
- Henry Ford Health System and Wayne State University School of Medicine, Detroit, Mich.
| | | | | | | | | | - Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | | | - Meyer Kattan
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Stephen J Teach
- Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Steven M Sigelman
- National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Peter J Gergen
- National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Alkis Togias
- National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | | | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Andrew H Liu
- National Jewish Health, Denver, Colo; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
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Pongracic JA, Krouse RZ, Babineau DC, Zoratti EM, Cohen RT, Wood RA, Khurana Hershey GK, Kercsmar CM, Gruchalla RS, Kattan M, Teach SJ, Johnson CC, Bacharier LB, Gern JE, Sigelman SM, Gergen PJ, Togias A, Visness CM, Busse WW, Liu AH. Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents. J Allergy Clin Immunol 2017; 138:1030-1041. [PMID: 27720017 DOI: 10.1016/j.jaci.2016.06.059] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Treatment levels required to control asthma vary greatly across a population with asthma. The factors that contribute to variability in treatment requirements of inner-city children have not been fully elucidated. OBJECTIVE We sought to identify the clinical characteristics that distinguish difficult-to-control asthma from easy-to-control asthma. METHODS Asthmatic children aged 6 to 17 years underwent baseline assessment and bimonthly guideline-based management visits over 1 year. Difficult-to-control and easy-to-control asthma were defined as daily therapy with 500 μg of fluticasone or greater with or without a long-acting β-agonist versus 100 μg or less assigned on at least 4 visits. Forty-four baseline variables were used to compare the 2 groups by using univariate analyses and to identify the most relevant features of difficult-to-control asthma by using a variable selection algorithm. Nonlinear seasonal variation in longitudinal measures (symptoms, pulmonary physiology, and exacerbations) was examined by using generalized additive mixed-effects models. RESULTS Among 619 recruited participants, 40.9% had difficult-to-control asthma, 37.5% had easy-to-control asthma, and 21.6% fell into neither group. At baseline, FEV1 bronchodilator responsiveness was the most important characteristic distinguishing difficult-to-control asthma from easy-to-control asthma. Markers of rhinitis severity and atopy were among the other major discriminating features. Over time, difficult-to-control asthma was characterized by high exacerbation rates, particularly in spring and fall; greater daytime and nighttime symptoms, especially in fall and winter; and compromised pulmonary physiology despite ongoing high-dose controller therapy. CONCLUSIONS Despite good adherence, difficult-to-control asthma showed little improvement in symptoms, exacerbations, or pulmonary physiology over the year. In addition to pulmonary physiology measures, rhinitis severity and atopy were associated with high-dose asthma controller therapy requirement.
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Affiliation(s)
| | | | | | | | | | - Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | | | - Meyer Kattan
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Stephen J Teach
- Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | | | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Andrew H Liu
- National Jewish Health, Denver, and Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
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Stridsman C, Backman H, Eklund BM, Rönmark E, Hedman L. Adolescent girls with asthma have worse asthma control and health-related quality of life than boys-A population based study. Pediatr Pulmonol 2017; 52:866-872. [PMID: 28444980 DOI: 10.1002/ppul.23723] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 12/23/2016] [Accepted: 04/07/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Population-based studies investigating health-related quality of life (HRQoL) among asthmatic adolescents are rare. Further, among subjects with asthma, HRQoL may be affected by asthma control and severity. AIM To investigate HRQoL in relation to asthma control and asthma severity among adolescents. METHOD As a part of the population-based OLIN pediatric study, 266 adolescents with current asthma (14-15 yr) were identified. N = 247 completed the DISABKIDS HRQoL asthma module, including the domains impact and worry. The Asthma Control Test (ACT) was used and a disease severity score was calculated based on symptoms and medicine use. RESULTS The prevalence of current asthma was 11%. Well-controlled asthma was reported by 15% of the adolescents, and 53% had partly controlled asthma. The prevalence of uncontrolled asthma was significantly higher among girls than boys (38% vs 25%), and girls also reported lower HRQoL scores. There was a fairly strong correlation between the ACT and DISABKIDS scores. Independent risk factors for low HRQoL impact (a score <67) were female sex (OR 4.66, 95%CI 1.82-9.54) and decreased ACT scores (1.38, 1.18-1.62). Risk factors for low HRQoL worry (a score <70) were female sex (3.33, 1.41-7.86), decreased ACT scores (1.35, 1.16-1.57), severe asthma (6.23, 1.46-16.50), and having current eczema (2.68, 1.00-7.24). CONCLUSION Only a minority of the asthmatic adolescents reported well-controlled asthma, and poor asthma control and female sex were risk factors for low HRQoL. Our results demonstrate that evaluation of asthma control is of great importance for asthma management.
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Affiliation(s)
- Caroline Stridsman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.,The OLIN Studies, Norrbotten County Council, Luleå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | | | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.,Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
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Navanandan N, Federico M, Mistry RD. Positive Expiratory Pressure for the Treatment of Acute Asthma Exacerbations: A Randomized Controlled Trial. J Pediatr 2017; 185:149-154.e2. [PMID: 28284473 DOI: 10.1016/j.jpeds.2017.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/06/2016] [Revised: 01/30/2017] [Accepted: 02/09/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the efficacy of brief, single administration of positive expiratory pressure (PEP) therapy in reducing clinical severity and need for additional second-line therapies and hospitalization in children presenting to the emergency department (ED) with acute asthma. STUDY DESIGN This was a prospective randomized controlled trial of children 2-18 years of age presenting to a tertiary-care academic pediatric ED with moderate-to-severe asthma exacerbations from December 2014 to June 2016. Children who continued to have moderate asthma severity after completion of initial therapies (albuterol/ipratropium bromide and corticosteroids) were randomized to receive PEP therapy or standard of care. The primary outcome was change in pulmonary asthma score before and after intervention, as assessed by a blinded physician. Secondary outcomes included need for additional therapies, ED length of stay, and disposition. RESULTS A total of 52 patients were randomized to receive either PEP (n?=?26) or standard therapy (n?=?26). Study groups were similar in demographics and baseline characteristics. There was no significant difference in primary outcome between groups with a mean change in Pulmonary Asthma Score of 0.92 (±1.2) in the PEP group and 0.40 (±1.2) in the standard group (P?=?.12). There also was no significant difference in need for additional therapies, ED length of stay, and disposition. Mild, self-resolving side effects were observed in 3 subjects receiving PEP therapy. CONCLUSION Single, brief, administration of PEP therapy after completion of first-line therapies does not improve clinical severity in children presenting to the ED with acute asthma. TRIAL REGISTRATION ClinicalTrials.gov: NCT02494076.
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Zandieh SO, Cespedes A, Ciarleglio A, Bourgeois W, Rapoport DM, Bruzzese JM. Asthma and subjective sleep disordered breathing in a large cohort of urban adolescents. J Asthma 2016; 54:62-68. [PMID: 27740900 DOI: 10.1080/02770903.2016.1188942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Sleep disordered breathing (SDB) has not been well studied in urban adolescents with asthma in community settings. Nor has the association of SDB symptoms and asthma severity been studied. We characterized self-reported symptoms suggesting SDB and investigated the association of SDB symptoms, probable asthma, and asthma severity. METHODS 9,565 adolescents from 21 inner-city high schools were screened for an asthma intervention study. Students reported on symptoms suggesting SDB using questions from the 2007 NHANES, if they were ever diagnosed with asthma, and on asthma symptoms. Using generalized linear mixed models with logit link with school as a random intercept and adjusting for age, gender, and race/ethnicity, we examined associations of SDB symptoms, and demographic characteristics, probable asthma, and asthma severity. RESULTS 12% reported SDB symptoms. Older and bi-racial participants (compared to Caucasian) had higher odds of symptoms suggesting SDB (p <.001). Compared to those without probable asthma, adolescents with probable asthma had 2.63 greater odds of reporting SDB symptoms (p <.001). Among those with probable asthma, the odds of reporting SDB symptoms increased with asthma severity. When exploring daytime severity and severity due to night wakening separately, results were similar. All results remained significant when controlling for age, gender, and ethnicity. CONCLUSIONS In a large urban community cohort of predominately ethnic minority adolescents, self-reported SDB symptoms were associated with probable asthma and increased asthma severity. This study highlights the importance of SDB as a modifiable co-morbidity of asthma.
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Affiliation(s)
- Stephanie O Zandieh
- a Department of Pediatrics , Weill Cornell Medical College , New York , NY , USA
| | - Amarilis Cespedes
- b New York University College of Global Public Health , New York , NY , USA
| | - Adam Ciarleglio
- c Department of Child and Adolescent Psychiatry , New York University School of Medicine , New York , NY , USA
| | - Wallace Bourgeois
- d Department of Pediatrics , Columbia University College of Physicians and Surgeons , New York , NY , USA
| | - David M Rapoport
- e Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Jean-Marie Bruzzese
- f Department of Scholarship and Research , Columbia University School of Nursing , New York , NY , USA
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Bandaru S, Akka J, Marri VK, Alvala M, Ponnala D, Mundluru HP. Analysis of ADRB2 (Arg16Gly) Gene Variant with Susceptibility, Pharmacogenetic Response and Disease Severity in South Indian Asthmatics. Inflammation 2016; 38:2146-55. [PMID: 26071206 DOI: 10.1007/s10753-015-0197-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
β2-Adrenergic receptor (β2-AR) plays a crucial role in asthma pathophysiology by regulating, processes of the lung function, and clinical response to bronchodilators. The +46G>A- Gly16Arg polymorphism in the gene encoding β2 adrenergic receptor (ADRB2) has been associated with receptor non-responsiveness after β2-agonist exposure. In the present study, we sought to evaluate the possible association of Gly16Arg polymorphism with asthma susceptibility, pharmacogenetic response to Salbutamol, and varying degrees of disease severity. Three hundred ninety-eight clinically diagnosed patients and 456 healthy controls were enrolled for the study. Patients were classified into severity classes according to Global Initiative for Asthma guidelines. To assess bronchodilator response, spirometry was performed before and 15 min after Salbutamol (200 μg) delivery. Responders to Salbutamol were categorized if percentage reversibility was greater than or equal to 12% in them, while those showing reversibility less than 12% were classified as non-responders. Genotyping was carried out by ARMS-PCR technique. Statistical methods were applied to test for the significance of the results. In the present study, there was lack of significant association of polymorphism with disease susceptibility as well as with bronchodilator response. The polymorphism was not associated with mild and moderate asthma subtypes; however, there was a notable association with severe asthma subtype. In addition, the polymorphism was associated with severe asthma compared to subtypes of mild and moderate asthma combined. In a South Indian population, the ADRB2 Arg/Gly may not form a susceptible variant to develop asthma nor can be a standard predictive marker to bronchodilator response; nevertheless, the patterns in asthma severity can be predicted by analyzing this variant.
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Affiliation(s)
- Srinivas Bandaru
- National Institute of Pharmaceutical Education and Research, Hyderabad, 500 037, India.
- Department of Toxicology, Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, 500 016, India.
| | - Jyothy Akka
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, 500 016, India
| | - Vijaya Kumar Marri
- Government General and Chest Hospital, Gandhi Medical College and Osmania Medical College, Hyderabad, 500 038, India
| | - Mallika Alvala
- National Institute of Pharmaceutical Education and Research, Hyderabad, 500 037, India
| | - Deepika Ponnala
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, 500 016, India
| | - Hema Prasad Mundluru
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, 500 016, India
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Abstract
BACKGROUND Allergic and nonallergic asthma severity in children can be affected by microbial exposures. OBJECTIVE We sought to examine associations between exposures to household microbes and childhood asthma severity stratified by atopic status. METHODS Participants (n = 196) were selected from a cohort of asthmatic children in Connecticut and Massachusetts. Children were grouped according to asthma severity (mild with no or minimal symptoms and medication or moderate to severe persistent) and atopic status (determined by serum IgE levels). Microbial community structure and concentrations in house dust were determined by using next-generation DNA sequencing and quantitative PCR. Logistic regression was used to explore associations between asthma severity and exposure metrics, including richness, taxa identification and quantification, community composition, and concentration of total fungi and bacteria. RESULTS Among all children, increased asthma severity was significantly associated with an increased concentration of summed allergenic fungal species, high total fungal concentrations, and high bacterial richness by using logistic regression in addition to microbial community composition by using the distance comparison t test. Asthma severity in atopic children was associated with fungal community composition (P = .001). By using logistic regression, asthma severity in nonatopic children was associated with total fungal concentration (odds ratio, 2.40; 95% CI, 1.06-5.44). The fungal genus Volutella was associated with increased asthma severity in atopic children (P = .0001, q = 0.04). The yeast genera Kondoa might be protective; Cryptococcus species might also affect asthma severity. CONCLUSION Asthma severity among this cohort of children was associated with microbial exposure, and associations differed based on atopic status.
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Affiliation(s)
- Karen C Dannemiller
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Conn
| | - Janneane F Gent
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Conn
| | - Brian P Leaderer
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Conn
| | - Jordan Peccia
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Conn.
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Perzanowski MS, Ronmark E, James HR, Hedman L, Schuyler AJ, Bjerg A, Lundback B, Platts-Mills TAE. Relevance of specific IgE antibody titer to the prevalence, severity, and persistence of asthma among 19-year-olds in northern Sweden. J Allergy Clin Immunol 2016; 138:1582-1590. [PMID: 27430609 DOI: 10.1016/j.jaci.2016.05.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 04/27/2016] [Accepted: 05/11/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Although sensitization to indoor allergens is strongly associated with asthma, there are questions as to how this relates to asthma symptoms. OBJECTIVE We sought to study the relevance of IgE antibodies to cat and dog allergens in an area in which (1) the climate discourages cockroach, fungal, and mite growth and (2) dander allergens are known to be present in schools and houses without animals. METHODS IgE to 8 allergens was tested in 963 sera from a population-based study on 19-year-olds, and associations with asthma symptoms, diagnosis, and treatment were examined. In positive sera IgE to specific cat and dog allergens was also assayed. RESULTS IgE specific for animal dander had the highest prevalence and strongest relationship to asthma diagnosis. Furthermore, asthma severity, as judged by the frequency of symptoms and use of treatment, was directly associated with the titer of IgE antibodies to animal dander. Among the 103 subjects who had current asthma at age 19 years, 50 had asthma before age 12 years. Among those 50, the odds ratios for asthma related to any IgE antibodies to animal dander or high-titer IgE antibodies (≥17.5 IU/mL) were 9.2 (95% CI, 4.9-17) and 13 (95% CI, 6.9-25), respectively. In multivariable analysis IgE antibodies to Fel d 1 and Can f 5 were each associated with current asthma. CONCLUSION High-titer IgE antibodies to cat and dog allergens were strongly associated with the diagnosis, severity, and persistence of asthma; however, a large proportion of patients with current asthma did not live in a house with a cat or dog.
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Affiliation(s)
| | - Eva Ronmark
- Department of Public Health and Clinical Medicine, OLIN Unit, Umea University, Umea, Sweden
| | - Hayley R James
- Division of Allergy and Immunology, University of Virginia, Charlottesville, Va
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, OLIN Unit, Umea University, Umea, Sweden
| | | | - Anders Bjerg
- Department of Medicine/Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bo Lundback
- Department of Medicine/Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kidd CDA, Thompson PJ, Barrett L, Baltic S. Histone Modifications and Asthma. The Interface of the Epigenetic and Genetic Landscapes. Am J Respir Cell Mol Biol 2016; 54:3-12. [PMID: 26397168 DOI: 10.1165/rcmb.2015-0050tr] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Complex lung diseases, such as asthma, are influenced by both genetic predisposition and environmental stimuli. The epigenetic landscape of such diseases is attracting increasing interest and research. Epigenetics broadly covers the transient and the inheritable changes to gene expression that are not directly due to changes in nucleotide sequences. Epigenetic mechanisms could have significant impact on asthma-related allergic, immune, and regulatory pathways, as well as on the generation of biomarkers and the heritable transmission of asthma phenotypes. Recent technological advances have allowed mapping of the epigenome and analysis of genome-wide epigenetic contributors to disease. As a result, ground-breaking observations regarding histone post-translational modifications in a number of immunological diseases have emerged. In this review, we look beyond the biological information coded by DNA and review the epigenetic modifications made to histones, with evidence suggesting a role for their modification in asthma.
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Affiliation(s)
- Courtney D A Kidd
- 1 Institute for Respiratory Health, Perth, Western Australia, Australia.,2 Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; and
| | - Philip J Thompson
- 1 Institute for Respiratory Health, Perth, Western Australia, Australia.,2 Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; and.,3 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Western Australia, Perth, Western Australia, Australia
| | - Lucy Barrett
- 1 Institute for Respiratory Health, Perth, Western Australia, Australia.,2 Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; and
| | - Svetlana Baltic
- 1 Institute for Respiratory Health, Perth, Western Australia, Australia.,2 Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; and
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46
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Abstract
Asthma is a heterogeneous condition and approximately 5-10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway remodeling) that may develop over time or shortly after onset of disease. Quantitative computed tomography (QCT) imaging of the tracheobronchial tree and lung parenchyma has improved during the last 10 years, and has enabled investigators to study the large airway architecture in detail and assess indirectly the small airway structure. In severe asthmatics, morphologic changes in large airways, quantitatively assessed using 2D-3D airway registration and recent algorithms, are characterized by airway wall thickening, luminal narrowing and bronchial stenoses. Extent of expiratory gas trapping, quantitatively assessed using lung densitometry, may be used to assess indirectly small airway remodeling. Investigators have used these quantitative imaging techniques in order to attempt severity grading of asthma, and to identify clusters of asthmatic patients that differ in morphologic and functional characteristics. Although standardization of image analysis procedures needs to be improved, the identification of remodeling pattern in various phenotypes of severe asthma and the ability to relate airway structures to important clinical outcomes should help target treatment more effectively.
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Affiliation(s)
- Philippe A Grenier
- 1 Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France ; 2 Department of ARTEMIS, Telecom SudParis, Institut Mines-Telecom, CNRS UMR 8145 - UMR 5157, Evry, France ; 3 Service de Radiologie, APHP, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, UPRESS EA 2363, France
| | - Catalin I Fetita
- 1 Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France ; 2 Department of ARTEMIS, Telecom SudParis, Institut Mines-Telecom, CNRS UMR 8145 - UMR 5157, Evry, France ; 3 Service de Radiologie, APHP, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, UPRESS EA 2363, France
| | - Pierre-Yves Brillet
- 1 Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France ; 2 Department of ARTEMIS, Telecom SudParis, Institut Mines-Telecom, CNRS UMR 8145 - UMR 5157, Evry, France ; 3 Service de Radiologie, APHP, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, UPRESS EA 2363, France
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47
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Dannemiller KC, Gent JF, Leaderer BP, Peccia J. Indoor microbial communities: Influence on asthma severity in atopic and nonatopic children. J Allergy Clin Immunol 2016; 138:76-83.e1. [PMID: 26851966 DOI: 10.1016/j.jaci.2015.11.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 11/12/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allergic and nonallergic asthma severity in children can be affected by microbial exposures. OBJECTIVE We sought to examine associations between exposures to household microbes and childhood asthma severity stratified by atopic status. METHODS Participants (n = 196) were selected from a cohort of asthmatic children in Connecticut and Massachusetts. Children were grouped according to asthma severity (mild with no or minimal symptoms and medication or moderate to severe persistent) and atopic status (determined by serum IgE levels). Microbial community structure and concentrations in house dust were determined by using next-generation DNA sequencing and quantitative PCR. Logistic regression was used to explore associations between asthma severity and exposure metrics, including richness, taxa identification and quantification, community composition, and concentration of total fungi and bacteria. RESULTS Among all children, increased asthma severity was significantly associated with an increased concentration of summed allergenic fungal species, high total fungal concentrations, and high bacterial richness by using logistic regression in addition to microbial community composition by using the distance comparison t test. Asthma severity in atopic children was associated with fungal community composition (P = .001). By using logistic regression, asthma severity in nonatopic children was associated with total fungal concentration (odds ratio, 2.40; 95% CI, 1.06-5.44). The fungal genus Volutella was associated with increased asthma severity in atopic children (P = .0001, q = 0.04). The yeast genera Kondoa might be protective; Cryptococcus species might also affect asthma severity. CONCLUSION Asthma severity among this cohort of children was associated with microbial exposure, and associations differed based on atopic status.
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Affiliation(s)
- Karen C Dannemiller
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Conn
| | - Janneane F Gent
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Conn
| | - Brian P Leaderer
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Conn
| | - Jordan Peccia
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Conn.
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48
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Shipe R, Burdick MD, Strieter BA, Liu L, Shim YM, Sung SS, Teague WG, Mehrad B, Strieter RM, Rose CE. Number, activation, and differentiation of circulating fibrocytes correlate with asthma severity. J Allergy Clin Immunol 2015; 137:750-7.e3. [PMID: 26371837 DOI: 10.1016/j.jaci.2015.07.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/25/2015] [Accepted: 07/08/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND A biomarker that predicts poor asthma control would be clinically useful. Fibrocytes are bone marrow-derived circulating progenitor cells that have been implicated in tissue fibrosis and T(H)2 responses in asthmatic patients. OBJECTIVE We sought to test the hypothesis that the concentration and activation state of peripheral blood fibrocytes correlates with asthma severity. METHODS By using fluorescence-activated cell sorting analysis, fibrocytes (CD45(+) and collagen 1 [Col1](+)) were enumerated and characterized in the buffy coats of fresh peripheral blood samples from 15 control subjects and 40 asthmatic patients. RESULTS Concentrations of peripheral blood total (CD45(+)Col1(+)), activated (the TGF-β transducing protein phosphorylated SMAD2/3 [p-SMAD2/3](+) or phosphorylated AKT [p-AKT](+)), and differentiated (α-smooth muscle actin [α-SMA](+)) fibrocytes were increased in asthmatic patients compared with control subjects. The increase in total and CD45(+)Col1(+)CXCR4(+) fibrocytes was primarily seen in patients with severe asthma (Global Initiative for Asthma steps 4-5) as opposed to those with milder asthma (Global Initiative for Asthma steps 1-3). In addition, numbers of circulating α-SMA(+) and α-SMA(+)CXCR4(+) fibrocytes were increased in asthmatic patients experiencing an asthma exacerbation in the preceding 12 months. A significant correlation (P < .05) was observed between CD45(+)Col1(+)CXCR4(+) fibrocytes and the activation phenotypes CD45(+)Col1(+)p-SMAD2/3(+) and CD45(+)Col1(+)p-AKT(+). CONCLUSION There was correlation between circulating fibrocyte subsets and asthma severity, and there was an increased number of activated/differentiated fibrocytes in circulating blood of asthmatic patients experiencing an exacerbation in the preceding 12 months.
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Affiliation(s)
- Ryan Shipe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Marie D Burdick
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Brett A Strieter
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Ling Liu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Yun Michael Shim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Sun-sang Sung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - W Gerald Teague
- Pulmonary Division, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Borna Mehrad
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Robert M Strieter
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - C Edward Rose
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va.
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49
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Zhou T, Wang T, Garcia JGN. A nonmuscle myosin light chain kinase-dependent gene signature in peripheral blood mononuclear cells is linked to human asthma severity and exacerbation status. Pulm Circ 2015; 5:335-8. [PMID: 26064459 DOI: 10.1086/680357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/13/2014] [Indexed: 12/12/2022] Open
Abstract
Asthma is increasingly recognized as a heterogeneous disease influenced by complex genetic and environmental contributions. Myosin light chain kinase (MLCK; gene symbol, MYLK), especially the nonmuscle isoform nmMLCK, is a cytoskeleton protein known to be related to human asthma susceptibility and severity, findings confirmed in preclinical models of asthmatic inflammation. In this study, we define the central capacity for a nmMLCK-influenced gene signature in human peripheral blood mononuclear cells to predict human asthma severity and exacerbation status. We refined this signature from a list of nmMLCK-influenced genes identified in lung tissues of nmMLCK knockout mice exposed to inflammatory stimuli (ventilator-induced lung injury), with subsequent identification of nmMLCK-influenced genes in a list of human asthma severity-related genes expressed in blood. The enriched nmMLCK-influenced gene signature successfully predicted human asthma severity and exacerbation status in both discovery and validation human asthma cohorts. These findings validate the central role played by nmMLCK in asthma susceptibility, severity, and exacerbation and further provide novel gene signatures as effective asthma biomarkers for severity, exacerbation, and prognosis.
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Affiliation(s)
- Tong Zhou
- Arizona Respiratory Center and Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Ting Wang
- TW and JGNG contributed equally as senior authors
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50
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Franzese C. Management of acute asthma exacerbations. Int Forum Allergy Rhinol 2015; 5 Suppl 1:S51-6. [PMID: 26034013 DOI: 10.1002/alr.21554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/17/2015] [Accepted: 04/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acute asthma exacerbations are common events in the lives of asthmatics, and even the best-managed asthma patients will have acute asthma exacerbations. There are different levels of severity of exacerbations with corresponding management strategies the physician can use to treat acute events. These strategies, including some adjunctive therapies, are reviewed in this article. METHODS A review of the English-language scientific literature was performed regarding management of acute asthma exacerbations, focusing of published guidelines, meta-analyses, and database reviews. RESULTS Symptoms of exacerbations are reviewed with attention to determining the severity of the exacerbation and the place of management, either at home or in a more acute care setting. Medical therapies for the treatment of each severity level are reviewed as to their effectiveness. Post-exacerbation care is also discussed. CONCLUSION Asthma exacerbations will happen and both the provider and patient need to be educated on how to manage these occurrences. Whether the patient is managed at home or in a hospital setting will be determined by the level of severity. Regardless of the medical therapies employed, continued focus should be on further prevention of additional exacerbations.
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Affiliation(s)
- Christine Franzese
- Department of Otolaryngology, Eastern Virginia School of Medicine, Norfolk, VA
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