Absence Of Asthma Symptoms Research Articles

A Real-World Study of Achievement Rate and Predictive Factors of Clinical and Deep Remission to Biologics in Patients with Severe Asthma.

Recent advances in biologics have provided new insights into the clinical course of asthma, including disease modification, clinical remission (CR), and deep remission (DR). However, the extent to which biologics achieve CR and DR in severe asthma patients is poorly understood. To assess the achievement rate and predictors of CR and DR using long-term biologics, we retrospectively evaluated 54 severe asthma patients recently started on biologics. "CR" denotes the achievement of all three criteria: (1) absence of asthma symptoms, (2) no asthma exacerbations, and (3) no use of oral corticosteroids. DR denoted CR plus (4) normalized pulmonary function and (5) suppressed type 2 inflammation. CR and DR achievement rates were 68.5% and 31.5%, respectively. Compared with the non-deep remission group, the DR group had higher adult-onset asthma rates (94.1% vs. 70.3%, p = 0.078), shorter asthma duration (5 vs. 19 years, p = 0.006), and higher FEV1 (91.5% vs. 71.5%, p < 0.001). There were no significant differences in the Asthma Control Questionnaire scores, exacerbation frequency, or type 2 inflammation at baseline between groups. Asthma duration combined with FEV1 can stratify the achievement rates of CR and DR. the early introduction of biologics in severe asthma patients may help achieve CR and DR.

The effect of the COVID-19 pandemic on long-term treatment compliance and disease control in children with persistent asthma.

No long-term data exists on asthma treatment compliances (ATC), exacerbations (AE), and control (AC) during the COVID-19 pandemic in children. This study aimed to evaluate ATC, AE, AC and the related factors among children with persistent asthma (PA) within the first year of the pandemic Methods. Children aged 6-18 years with PA who were under regular inhaled corticosteroid treatment for at least a year prior to the first COVID-19 case in Türkiye were included. Data on AE and AC were collected from medical files. Factors affecting ATC and AC as well as COVID-19 history were assessed by means of a questionnaire. The study included 247 cases. COVID-19 was detected in 14.5% of them. In the first year of the pandemic, ATC decreased to 56.7% and the most common reason was the absence of asthma symptoms. There was a significant improvement in AC (p < 0.001). The number of upper respiratory tract infections (URTI) and AE were significantly decreased during the first year of the pandemic (p < 0.001). COVID-19 infection, smoking in the household, school attendance, a family member working outside the home, house dust mite sensitization or allergic rhinitis had no significant effect on AC (p > 0.05). Regression analysis determined that children who did not have any URTI had 2.4 times better AC compared to those who had (p= 0.02; %95 CI: 1.1-5.4). Although ATC decreased significantly in the long-term in the first year of the pandemic, significant improvement was observed in AE and AC compared to the previous year, which was related only to not having URTI.

Medication adherence and quality of life among asthmatic patients in primary care in Indonesia

Background: Asthma is a chronic disease that occurs in various ages, either in developed or developing countries, causing the disturbance in daily life. The absence of asthma symptoms before an attack potentially leads to medication non-adherence behaviour. Objectives: This study aimed to assess medication adherence of asthmatic patients and analyse the relationship with quality of life. The asthmatic patients who were smokers were also identified. Methods: A cross-sectional study using the survey method was conducted. Medication Adherence Rating Scale (MARS-A) was used to measure adherence, and The Asthma Quality of Life Questionnaire (AQLQ) was used for measuring the quality of life. Results: 80 asthmatic patients from ten primary health care centers in Surabaya participated in this survey, predominantly female (56, 70.0%) and 45- 54 years of age (27, 33.8%). There were eight (10.0%) participants who were smokers. Most asthmatic patients were categorised to have intermittent asthma (41, 51.2%) and mostly received oral short-acting beta2-agonist (56, 41.0%). Fully adherence behaviour was only detected in 12 patients (15.0%). Most patients had a moderate quality of life (66, 82.5%). There was a low and positive relationship between adherence and quality of life (r = 0.296, p = 0.008). Conclusions: Because medication adherence is linked to quality of life, health care providers should encourage adherence among asthmatic patients. The quality of life of asthmatic patients in primary care should be improved by further research. Also, there were asthmatic patients who were smokers who needed more help quitting.

Medication adherence and quality of life among asthmatic patients in primary care in Indonesia

Background: Asthma is a chronic disease that occurs in various ages, either in developed or developing countries, causing the disturbance in daily life. The absence of asthma symptoms before an attack potentially leads to medication non-adherence behaviour. Objectives: This study aimed to assess medication adherence of asthmatic patients and analyse the relationship with quality of life. The asthmatic patients who were smokers were also identified. Methods: A cross-sectional study using the survey method was conducted. Medication Adherence Rating Scale (MARS-A) was used to measure adherence, and The Asthma Quality of Life Questionnaire (AQLQ) was used for measuring the quality of life. Results: 80 asthmatic patients from ten primary health care centers in Surabaya participated in this survey, predominantly female (56, 70.0%) and 45- 54 years of age (27, 33.8%). There were eight (10.0%) participants who were smokers. Most asthmatic patients were categorised to have intermittent asthma (41, 51.2%) and mostly received oral short-acting beta2-agonist (56, 41.0%). Fully adherence behaviour was only detected in 12 patients (15.0%). Most patients had a moderate quality of life (66, 82.5%). There was a low and positive relationship between adherence and quality of life (r = 0.296, p = 0.008). Conclusions: Because medication adherence is linked to quality of life, health care providers should encourage adherence among asthmatic patients. The quality of life of asthmatic patients in primary care should be improved by further research. Also, there were asthmatic patients who were smokers who needed more help quitting.

Epigenome-wide association study identifies DNA methylation markers for asthma remission in whole blood and nasal epithelium

BackgroundAsthma is a chronic respiratory disease which is not curable, yet some patients experience spontaneous remission. We hypothesized that epigenetic mechanisms may be involved in asthma remission.MethodsClinical remission (ClinR) was defined as the absence of asthma symptoms and medication for at least 12 months, and complete remission (ComR) was defined as ClinR with normal lung function and absence of airway hyperresponsiveness. We analyzed differential DNA methylation of ClinR and ComR comparing to persistent asthma (PersA) in whole blood samples (n = 72) and nasal brushing samples (n = 97) in a longitudinal cohort of well characterized asthma patients. Significant findings of whole blood DNA methylation were tested for replication in two independent cohorts, Lifelines and Epidemiological study on the Genetics and Environment of Asthma (EGEA).ResultsWe identified differentially methylated CpG sites associated with ClinR (7 CpG sites) and ComR (129 CpG sites) in whole blood. One CpG (cg13378519, Chr1) associated with ClinR was replicated and annotated to PEX11 (Peroxisomal Biogenesis Factor 11 Beta). The whole blood DNA methylation levels of this CpG were also different between ClinR and healthy subjects. One ComR-associated CpG (cg24788483, Chr10) that annotated to TCF7L2 (Transcription Factor 7 Like 2) was replicated and associated with expression of TCF7L2 gene. One out of seven ClinR-associated CpG sites and 8 out of 129 ComR-associated CpG sites identified from whole blood samples showed nominal significance (P < 0.05) and the same direction of effect in nasal brushes.ConclusionWe identified DNA methylation markers possibly associated with clinical and complete asthma remission in nasal brushes and whole blood, and two CpG sites identified from whole blood can be replicated in independent cohorts and may play a role in peroxisome proliferation and Wnt signaling pathway.

Factors influencing the response to specific immunotherapy for asthma in children aged 5–16 years

The aim of this study was to evaluate the factors predicting the response to allergen-specific immunotherapy (ASIT) in children with asthma. The case notes of children with asthma who received ASIT for 2 years were retrospectively reviewed. The cases were then divided into an effective clinical response group, defined as absence of asthma symptoms without requirement for medication for at least 6 months during follow up; and an ineffective clinical response group. At the time of initiating treatment, blood was collected for analysis of serum total IgE. Family history of atopy, history of passive smoking, onset age of wheezing and so on was obtained from each patient. Ten factors that may influence children's response were analyzed on logistic regression analysis and compared between groups. A total of 99 children with asthma received ASIT s.c. for 2 years during September 2007-February 2010. The average age was 8.66 ± 0.30 years. Good response to ASIT was found in 72 cases, while an inadequate response was found in 27 cases. Of the 10 factors tested for correlation with clinical response to ASIT, a significant correlation was found with onset age of wheezing and airway hyperresponsiveness (AHR). The odds ratio for the onset age of wheezing was 2.81 (95% confidence interval [CI]: 1.40-5.65, P = 0.004) and that for AHR was 1.33 (95%CI: 1.04-1.70, P = 0.021). Potential predictors for the response to ASIT in children with asthma were identified. Onset age of wheezing and AHR may influence response to ASIT.

Increased exhaled nitric oxide predicts new‐onset rhinitis and persistent rhinitis in adolescents without allergic symptoms

The fraction of nitric oxide in exhaled air (FE(NO)) is increased in rhinitis and asthma. We have previously suggested that elevated FE(NO) levels in the absence of asthma symptoms may be a sign of 'early asthma'. In the present study, we hypothesize that elevated exhaled NO levels may also precede rhinitis symptoms. To investigate in a cohort of adolescents whether or not increased exhaled NO levels at the age of 13-14 years predicted new-onset or persistent rhinitis within a 4-year period. A total of 959 randomly selected adolescents (13-14 years) completed a questionnaire on respiratory symptoms at baseline and follow-up, 4 years later. Exhaled NO was measured at baseline. After exclusion of subjects with asthma diagnosis or asthma symptoms at baseline, 657 participants were eligible for the present study. Higher FE(NO) levels at baseline were associated with increased risk for new-onset (P = 0.009) and persistent rhinitis (P = 0.03) within a 4-year period. The risk of new-onset rhinitis was 2.32 (1.23, 4.37) [OR (95% CI)] times higher if FE(NO) > 90th percentile of the group without rhinitis at baseline. This increased risk for new-onset rhinitis was significant [2.49 (1.24, 5.01)] after excluding subjects with allergic symptoms. The risk of persistent rhinitis was 5.11 (1.34, 19.57) times higher if FE(NO) > 90th percentile of the group without rhinitis at baseline. Elevated exhaled nitric oxide levels predicted incident and persistent rhinitis in this population-based study of adolescents. Moreover, these findings were consistent after excluding subjects with allergic symptoms. Thus, it appears that elevation of exhaled NO precedes airway symptoms and predicts development of rhinitis in subjects without allergic symptoms or family history of allergic disease.

Relationship between sensitivity to dyspnea and fluctuating peak expiratory flow rate in the absence of asthma symptoms.

BackgroundExacerbation of asthma has a negative impact on quality of life and increases the risk of fatal asthma. One of the known risk factors for patients with a history of near-fatal asthma is reduced sensitivity to dyspnea.ObjectiveWe aimed to identify patients with such risk before they experienced severe exacerbation of asthma.MethodsWe analyzed asthma symptoms and peak expiratory flow rate (PEFR) values of 53 patients recorded daily in a diary over a mean period of 274 days. Patients matched their symptoms to one of eight categories ranging in severity from 'absent' to 'severe attack'. We then analyzed the relationship between PEFR and asthma symptoms by dividing the PEFR value by the values of clinical parameters, including asthma symptom level.ResultsAverage PEFR was 75.2% (50.5-100%) in the 'absent' symptom category, 64.5% (36.6-92.6%) in 'wheeze', 57.3% (25.0-94.7%) in 'mild attack' and 43.6% (20.4-83.1%) in 'moderate attack', with the personal best reading taken as 100%. Thus, differences in PEFR in patients in the same symptom category varied widely. PEFR in wheeze, mild attack and moderate attack did not correlate significantly with duration of asthma, forced expiratory volume in one second or proportion of personal best to standard predicted PEFR values. These PEFRs showed no significant difference in groups divided by type of regular treatment, but showed a significant negative correlation with the coefficient of variation (CV) of PEFR when asthma symptoms were absent. CV for absent symptoms should be between +4.0 and -4.0% when using regression analysis to measure PEFR if the decreased PEFR is in agreement with guidelines.ConclusionTo determine which patients have reduced sensitivity to dyspnea, CV of PEFR should be considered when asthma symptoms are reported as absent. When patients present with more than 8% fluctuation in PEFR, we should intervene in their treatment, even when they claim to be stable.

Flow-Dependent and Independent Parameters of Exhaled Nitric Oxide in 9 Year-Old Children Living in Low-Income NYC Communities

RATIONALE: Fractional exhaled nitric oxide (FeNO) is elevated in asthmatic and atopic children. Collection of FeNO at multiple flow rates is used to calculate flow-independent parameters of airway NO exchange which could help distinguish between atopy and wheeze related elevated FeNO.METHODS: As part of a birth cohort study (CCCEH), nine-year old children (n = 50) of African-American and Dominican mothers living in low-income NYC neighborhoods were tested utilizing the offline NO collection method. FeNO samples were obtained at constant flows of 50, 83 and 100 mL/sec. The lowest and highest flows were collected in duplicate and the medium flow in triplicate. Current wheeze was assessed by ISAAC questionnaire. For 39 children total IgE was assessed at age 7 years. Flow rate and mean FeNO values were plotted versus total NO output to determine the flow-independent parameters, bronchial flux (JNO) and alveolar concentration (Calv). Data were analyzed using non-parametric tests.RESULTS: Children with wheeze in the last year (16%) had significantly higher FeNO at all flow rates (e.g. at 83 mL/s: 19.7 vs 10.3ppb, p = 0.021) and Calv (10.1 vs 5.4ppb, p = 0.002) when compared with children without wheeze. Log transformed total IgE concentrations were positively correlated with FeNO at all flow rates (83 mL/s: p = 0.008) and JNO (p = 0.001). However, there was no correlation between Calv and total IgE (p = 0.947).CONCLUSIONS: The multiple flow method allows partitioning of NO contributions from peripheral and distal airways. Flow independent parameters could help distinguish elevated FeNO levels related to asthma symptoms from those due to atopy in the absence of asthma symptoms. RATIONALE: Fractional exhaled nitric oxide (FeNO) is elevated in asthmatic and atopic children. Collection of FeNO at multiple flow rates is used to calculate flow-independent parameters of airway NO exchange which could help distinguish between atopy and wheeze related elevated FeNO. METHODS: As part of a birth cohort study (CCCEH), nine-year old children (n = 50) of African-American and Dominican mothers living in low-income NYC neighborhoods were tested utilizing the offline NO collection method. FeNO samples were obtained at constant flows of 50, 83 and 100 mL/sec. The lowest and highest flows were collected in duplicate and the medium flow in triplicate. Current wheeze was assessed by ISAAC questionnaire. For 39 children total IgE was assessed at age 7 years. Flow rate and mean FeNO values were plotted versus total NO output to determine the flow-independent parameters, bronchial flux (JNO) and alveolar concentration (Calv). Data were analyzed using non-parametric tests. RESULTS: Children with wheeze in the last year (16%) had significantly higher FeNO at all flow rates (e.g. at 83 mL/s: 19.7 vs 10.3ppb, p = 0.021) and Calv (10.1 vs 5.4ppb, p = 0.002) when compared with children without wheeze. Log transformed total IgE concentrations were positively correlated with FeNO at all flow rates (83 mL/s: p = 0.008) and JNO (p = 0.001). However, there was no correlation between Calv and total IgE (p = 0.947). CONCLUSIONS: The multiple flow method allows partitioning of NO contributions from peripheral and distal airways. Flow independent parameters could help distinguish elevated FeNO levels related to asthma symptoms from those due to atopy in the absence of asthma symptoms.

Significant evidence for linkage to chromosome 5q13 in a genome-wide scan for asthma in an extended pedigree resource.

Asthma is a multifactorial disease with undetermined genetic factors. We performed a genome-wide scan to identify predisposition loci for asthma. The asthma phenotype consisted of physician-confirmed presence or absence of asthma symptoms. We analyzed 81 extended Utah pedigrees ranging from three to six generations, including 742 affected individuals, ranging from 2 to 40 per pedigree. We performed parametric multipoint linkage analyses with dominant and recessive models. Our analysis revealed genome-wide significant evidence of linkage to region 5q13 (log of the odds ratio (LOD)=3.8, recessive model), and suggestive evidence for linkage to region 6p21 (LOD=2.1, dominant model). Both the 5q13 and 6p21 regions indicated in these analyses have been previously identified as regions of interest in other genome-wide scans for asthma-related phenotypes. The evidence of linkage at the 5q13 region represents the first significant evidence for linkage on a genome-wide basis for this locus. Linked pedigrees localize the region to approximately between 92.3-105.5 Mb.

Effectiveness of High Repeated Doses of Inhaled Budesonide or Fluticasone in Controlling Acute Asthma Exacerbations in Young Children

Objective. The role of inhaled corticosteroids in the treatment of acute asthma exacerbations in children is controversial. This study compared the effect of inhaled budesonide and inhaled fluticasone in controlling acute asthma exacerbations in young children at home. Methods. In a quasi-randomized crossover design, children aged 5 months to 5 years with severe recurrent asthma episodes were treated either with inhaled budesonide 200 mcg or inhaled fluticasone 125 mcg delivered with a similar spacer. At the onset of asthma exacerbations, 2 puffs of inhaled terbutaline followed by inhaled budesonide or fluticasone was administered using one of the following treatment protocols: 4-day protocol for a relatively mild exacerbation; 8-day protocol for exacerbations that were more severe or uncontrolled by the 4-day protocol; and 8-day protocol + azithromycin for exacerbations uncontrolled by the 8-day protocol or possibly associated with infection with atypical agents. Children were followed for 2 months after each exacerbation. Good response was defined as the absence of asthma symptoms for at least 2 weeks from completion of treatment. Results. One hundred children were recruited: 36 were treated with budesonide, 21 with fluticasone, and 44 with both on different occasions. The groups were similar for preliminary data. Good response was noted in 87% of the budesonide group, 85% of the fluticasone group, and 86% of the budesonide/fluticasone group. By protocol, rates of good response were 84%, 83%, and 94% for the 4-day, 8-day, and 8-day+azithromycin treatment protocols, respectively; corresponding symptom-free periods after treatment were 4.0, 4.9, and 4.3 weeks. None of the children received oral corticosteroids. Conclusion. Acute asthma exacerbations in young children can be effectively controlled at home with the use of high repetitive doses of inhaled budesonide or inhaled fluticasone, initially together with beta2-agonists, given at the beginning of the attack, for a period of 4–8 days.

Markers of platelet activation in plasma of patients suffering from persistent allergic rhinitis with or without asthma symptoms

Increased circulating levels of platelet release products are detected in various types of inflammation. It has been demonstrated that allergen challenge promotes platelet activation and leads to the release of chemokines such as platelet factor 4 (PF-4) and beta-thromboglobulin (beta-TG). The aim of this study was to determine whether or not circulating platelets get into an activated state during allergic inflammatory reactions induced by long-term natural exposure to allergens. Plasma levels of PF-4 and beta-TG (established markers of in vivo platelet activation) were determined by ELISA method in symptomatic patients with allergy to house dust mites, suffering from persistent allergic rhinitis (PAR) in the absence of asthma symptoms (12 men and 8 women; mean age 22 years) and from PAR with mild asthma (10 men and 6 women; mean age 23 years), as well as in healthy controls (10 men and 10 women; mean age 23 years). No significant differences were found between PAR patients with or without symptoms of asthma and healthy non-atopic subjects with respect to plasma levels of PF-4 and beta-TG as well as platelet count. It seems that patients undergoing continuous natural exposure to sensitizing allergens, with subsequent PAR alone or with concomitant mild asthma, have no altered platelet activity in vivo, as reflected by plasma levels of the chemokines. These findings, in conjunction with earlier data, indicate that differences may exist in platelet activity, including releasability of platelet products between patients with distinct clinical manifestation of atopy.