Acute Asthma Patients Research Articles

Assessment of Serum Magnesium Levels In Patients With Acute Severe Bronchial Asthma Admitted in a Tertiary Care Hospital

Background: Hypomagnesaemia has been associated with diminished respiratory muscle power, which maintains the work of breathing. However, the effect of magnesium on asthma has yet to be examined in our country. Therefore, assessing the serum magnesium level in acute severe asthma patients in a tertiary-level hospital was the study’s objective. Methods: The study was a hospital-based descriptive cross-sectional study conducted at the Department of Medicine and Department of Respiratory Medicine in DMCH. Each patient performed serum magnesium ion (Mg2+) during admission with other necessary investigations. Results: Fifty-seven percent of participants had hypomagnesemia, and 43% of patients had normal magnesium levels. Mean serum magnesium was 1.57±0.22 mg/dl [range: 1.25-2.23 ng/dl]. Although a higher proportion of patients with severe attacks (64.8%) had hypomagnesemia than those who had moderate-severity attacks (47.8%), the difference is not statistically significant (p >0.05). About 23% of patients stayed at the hospital for >3 days; among them, 73.9% had hypomagnesemia. Hypomagnesaemia patients had higher odds of staying at the hospital for >3 days, but the relation is not statistically significant (OR 2.62, 95% CI 0.93 -7.36, p >0.05). Conclusion: Hypomagnesaemia is present in half of the patients with acute severe bronchial asthma and is not associated with the severity of the disease and duration of hospital stay. J Dhaka Med Coll. 2022; 31(1) : 114-119

MicroRNA-885-3p alleviates bronchial epithelial cell injury induced by lipopolysaccharide via toll-like receptor 4

ABSTRACT Airway inflammation is one of the typical pathological characteristics of asthma. MicroRNAs (miRNAs) play important roles in regulating inflammation. Nevertheless, miRNA-885-3p (miR-885-3p)’s role in asthmatic inflammation and the underlying mechanism need to be explained. In this work, miR-885-3p expression and toll-like receptor 4 (TLR4) expression in asthma patients’ plasma and lipopolysaccharide (LPS)-treated 16HBE cells were detected through quantitative real-time PCR. The interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels in 16HBE cell supernatant were examined via enzyme-linked immunosorbent assay. Cell counting kit-8 (CCK-8) assay and flow cytometry were employed to examine 16HBE cell viability and apoptosis, respectively. Western blotting was performed to examine the expression of TLR4, cleaved caspase-3, B-cell lymphoma-2 (Bcl-2), nuclear factor-kappa B (NF-κB) p65, Bcl-2-related X protein (Bax), phosphorylated (p)-NF-κB p65 and myeloid differentiation primitive-response protein 88 (MyD88) in 16HBE cells. Furthermore, the targeted relationship between TLR4 and miR-885-3p in 16HBE cells was determined through dual-luciferase reporter gene assay. Compared with healthy volunteers, miR-885-3p expression in acute asthma patients’ plasma was significantly downregulated. In 16HBE cells, the stimulation of LPS reduced miR-885-3p expression. MiR-885-3p overexpression reduced LPS-stimulated 16HBE cell injury by enhancing cell viability, and suppressing the levels of inflammatory factors and apoptosis. Furthermore, TLR4 was identified as miR-885-3p’s target gene. TLR4 overexpression weakened the impacts of miR-885-3p on LPS-stimulated cell injury and NF-κB-MyD88 signaling. In conclusion, miR-885-3p can reduce LPS-induced 16HBE cell damage, via targeting TLR4 to suppress the NF-κB-MyD88 pathway.

Effect on Airflow of a Vibrating Mesh Nebulizer Compared to a Jet Nebulizer for Delivery of Bronchodilator Therapy to Acute Severe Asthma Patients in an Emergency Department

Effect on Airflow of a Vibrating Mesh Nebulizer Compared to a Jet Nebulizer for Delivery of Bronchodilator Therapy to Acute Severe Asthma Patients in an Emergency Department

Characteristics of Acute Asthma Patients Based on Visits to The Emergency Unit and Treatment Costs in Jakarta Islamic Hospital Pondok Kopi

Proper handling of asthmatics can maintain the patient's quality of life. Visits of asthmatic patients to the Emergency Department (ER) indicate uncontrolled asthma and a marker of risk for future asthma exacerbations. Uncontrolled asthma can increase health costs, the risk of hospitalization, and can also cause death. This research at to determine the relationship of acute asthma patients who visit the emergency department with costs of treatment. Analytical descriptive research with cross-sectional study design. The population of this study was acute asthma sufferers who went to the emergency department of RSIJ Pondok Kopi in the period August 1, 2016 – August 1, 2017, and all of the population was used as a sample of 35 people. Data collection is done by studying the documentation of medical record data. The results showed 32.4% of respondents aged 41-49 years, 62.9% were female and had a high school education level (SMA), 40% of respondents were housewives (IRT), 65.7% had acute asthma. moderate, and the most precipitating factor is respiratory tract infection. Most visits to the ER were 30 patients (85.7%) with 1 visit and not accompanied by complications. The results of the highest treatment costs ranged from Rp. 300,000 – Rp. 400,000 as many as 22 patients (62.9%) with guaranteed treatment used were non-BPJS. The costs incurred by each acute asthma patient with 1 visit to the ER are lower than 2 times or more than 2 visits. It was also found that the number of acute asthma patients with complications was greater in costs than those without complications.

Particulate matter (PM2.5) and diseases: an autoregressive distributed lag (ARDL) technique.

Air pollution can be attributed to the reduction in visibility, less agricultural activity, more health issues, and long-term destruction to infrastructure. This paper aimed to examine the validity of association among the Particulate matter (PM2.5) and number of acute upper respiratory infection (ARI) and Asthma (AS) patients using an autoregressive distributed lag (ARDL) approach. This ARDL model study was conducted in Lahore, Pakistan. We used monthly data of ARI and AS patients acquired from Directorate General Health Services Punjab and PM2.5 from Air Visual-IQAir during the period January 2018-August 2019. ARDL bound testing technique was used to investigate the association between number of AS, ARI patients and PM2.5. In the short run, the PM2.5 has substantial positive impact on number of AS patients in Lahore. The values of short-run coefficient depicts that the association between PM2.5 and ARI patients is stronger than AS. The effect of PM2.5 on number of patients in short term is more than that in the long-term. For both AS and ARI, in the long run, PM2.5 has negative impact on number of patients.

WITHDRAWN: Nasal high flow oxygen for acute severe asthma patients: The best can be the enemy of the good

It was with great interest that we read the article by Ruangsomboon et al. [1] comparing nasal high-flow (NHF) oxygen and conventional oxygen therapy (COT) for the treatment of acute severe asthma patients. The usefulness of NHF in asthma does not seem obvious at first glance; indeed, asthma is a chronic inflammatory disease of the airways characterized by respiratory symptoms and airway obstruction of varying severity. Hypoxia is therefore the primary result of the physiopathology of asthmatic disease in cases of exacerbation.

Triggers of Acute Asthma in Patients Attending Emergency Centre in a Peri-urban District Hospital, Johannesburg, South Africa

Introduction: Many avoidable triggers lead to acute asthma attack and subsequent visit to the emergency centre. The aim of the study was to determine triggers of acute asthma in order to target prevention efforts in patients attending emergency centre in a district hospital, Johannesburg, South Africa. Objectives were to describe acute asthma patients, identify triggers and severity at presentation. Methods involved a prospective descriptive cross-sectional study conducted from April to August 2015, in consenting adult participants. A researcher or trained assistant completed the semi-structured questionnaire in English. Results: Overall, 239 patients enrolled (139 males, 100 females with the median age 31 years). Majority presented with moderate acute asthma (52.72%). Active cigarette smoking (p-value<0.001) and/or passive cigarette smoking (p-value=0.004) were identified potential triggers for acute asthma attack. Chi-square or Fisher Exact test analysis were used for associations between variables and severity. Bivariate logistic regression was used to ascertain triggers associated with acute asthma attack. P-value < 0.05 was statistically significant. Confidence interval was 95%. There were no significant associations between the severity of acute asthma attack and acute respiratory infection (p-value=0.818), use of medication-related asthma triggers (p-value=0.942) and knowledge of asthma allergens (p-value =0.086). Conclusion: The majority patients presented in moderate acute asthma attack which was most probably triggered by active and/ or passive cigarette smoking. Hence, frequent visits to hospital in acute asthma attack could be minimized by removing avoidable triggers from households.

Nasal High-flow Oxygen Versus Conventional Oxygen Therapy for Acute Severe Asthma Patients: A Pilot Randomized Controlled Trial.

BackgroundNasal high flow (NHF) has demonstrated efficacy in relieving dyspnea in various patients with hypoxemic and hypercapnic respiratory failure. It may also reduce dyspnea in patients with acute severe asthma in the emergency department (ED). The aim of the study was to compare the efficacy of NHF with conventional oxygen therapy (COT) in improving dyspnea in acute severe asthma patients with hypoxemia in the ED.MethodsThis pilot nonblinded randomized controlled trial was conducted involving 37 patients aged ≥ 18 years with acute severe asthma and hypoxemia in the ED of Siriraj Hospital, Bangkok, Thailand (TCTR20180926003). The participants were randomly allocated to receive either COT (n = 18) or NHF (n = 19) for 120 minutes. The primary outcome was comparing the intervention effects on the patients’ degree of dyspnea measured using the modified Borg scale (MBS). The secondary outcomes were comparing the interventions based on the numeric rating scale (NRS) of dyspnea, the dyspnea scale assessing accessory muscle use, vital signs, and blood gas results.ResultsThe intention‐to‐treat analysis included 37 patients (COT group n = 18 and NHF group n = 19). The baseline mean MBS was 7.8 in both groups. At 120 minutes, the mean (±SD) MBSs in patients receiving COT and NHF were 3.3 (±2.5) and 1.4 (±2.5), respectively (mean difference = 1.9 [95% CI = 0.2 to 3.8], p = 0.043). The trends in NRS and dyspnea score results were similar to those of MBS. Respiratory rates were lower with NHF (mean difference = 4.7 [95% CI = 1.5 to 7.8], p = 0.001). No between‐ or within‐group differences in blood gas results were found.ConclusionNasal high flow reduced the severity of dyspnea and respiratory rate in hypoxemic patients with acute severe asthma in the ED.

Written Asthma Action Plan in Emergency Department Improves Knowledge and Asthma Control among Adult Acute Asthma Patients

Self-management of asthma using the written asthma action plan (WAAP) is important in ensuring effective management of asthma as it reduces hospital visits. This study evaluates the improvement in knowledge and asthma control using WAAP among adult patients with acute asthma presenting to Emergency Department (ED). This randomized control trial was conducted over a 19-month period in an ED of a university hospital. Adult patients with acute mild to moderate asthma were included in the study. Patients were randomized into intervention and control group. A self-administered knowledge questionnaire was distributed to all patients. Both groups received asthma counselling guided by asthma flyers. The intervention group was further counselled on individualized WAAP. The control group received standard verbal advice upon discharge. Subsequently at 1 month and 3 months a follow up was conducted. Knowledge and asthma control were assessed via a telephone survey. Fifty patients were assigned randomly to intervention (WAAP) and control group. Each group received 25 patients. The knowledge score of the intervention group was significantly more than the control group (16.88+0.44 vs 13.36+3.72; p 19) at 1 month compared to control group (20.64+3.26 vs 17.72+4.17). Both groups achieved good control at 3 months follow up. Self-management with WAAP in ED improves knowledge and asthma control among acute mild to moderate asthma patients.

Risk factors for readmission of children hospitalized with acute asthma attacks in South China

Objective Asthma seriously endangers the health of children. Re-hospitalization for childhood asthma consumes a large amount of medical and health resources. The present study aimed to assess the rates and risk factors for hospital readmission of children with acute asthma attacks in south China. Methods We retrospectively enrolled 1702 acute asthma patients aged < 18 years from 1/1/2007 to 12/31/2015. Patients who were readmitted within one year after index hospital discharge were divided into a readmission group. Index hospitalization data were acquired from clinical records. Chi-square tests and multivariate logistic regression analyses were used to evaluate the risk factors. Results There were 90 (5.29%) readmitted patients from 1702 acute asthma patients. Considering the large sample differences between readmitted and single-admitted patients, 123 single-admitted patients (1.5-fold as many as the readmitted group) were randomly selected. Further univariate Chi-square tests and multivariate logistic regression analyses showed that the predictors of readmission included eczema history (odds ratio (OR) 3.122, p = 0.003) and mycoplasma pneumoniae (MP) antibody immunoglobulin M(IgM) (OR 2.386, p = 0.037). Conclusions Among the children admitted to a hospital in south China with acute asthma attacks, 5.29% were readmitted within the following year. Patients with history of eczema and positive MP antibody IgM had significantly increased the chances of one-year readmission, underlining the importance of targeted long-term postdischarge follow-up of these children.

Parametric correlation of arterial blood gas status with the duration of stay in hospital in cases of acute severe asthmatic children

Background: Asthma is one of the common causes of chronic illness in early childhood having frequent admitting diagnosis in pediatric ward. It needs proper evaluation for their treatment and management. Determination of arterial blood gas (ABG) analysis plays important role as pulmonary function test; it is important laboratory test for critically ill asthmatic patients where acid-base status interpretation is needed for their hospital admission and proper management. Aims and Objectives: The aims of the study were to assess the severity of disorders with the parameters of ABG report with their hospital stay of severe asthmatics pediatric patients during their acute exacerbations. Materials and Methods: A hospital-based prospective study conducted in forty-three severe acute bronchial asthmatic patients of 1–17 years done using automated ABG analyzer machine (COMBISYS-II), analysis of ABG report done using mean, median, and standard deviation. Results: Their comparison with the dysfunction of ABG report with their hospital stay showed positive correlation. Conclusion: Our study supported the hypothesis of enhanced hospital stay with abnormal and mixed type of ABG report.

Compliance With Asthma Guidelines and Association With Outcomes in the Emergency Department of a Tertiary Care Teaching Hospital.

Despite the existence of guidelines for treating acute asthma patients in the emergency department (ED), compliance is often poor. We aimed to examine the compliance to treatment guidelines for asthma at our tertiary care teaching hospital's ED and association with re-attendance rates. We performed a retrospective analysis of electronic patient records of patients above 16 years old who presented to our ED with a primary diagnosis of asthma over a 6 month period in 2012. Patient demographics such as age, gender, history of previous intubations and hospitalisations were reviewed, as were the treatment administered during the ED visit and on discharge. Concordance of treatment was compared with the National Asthma Education and Prevention Program's Expert Panel Report 3 (NAEPP EPR3) guidelines. Re-attendance rates to our ED within one year were then analysed. A total of 552 patients were included in the study. We found that 151 (27.4%) of patients reattended within the year, 35 (6.3%) returned more than twice. Low compliance to the EPR3 guidelines (p = 0.005), age of between 41 and 60 (p = 0.049), previous hospitalisations for asthma (p < 0.001) and non-use of recommended systemic corticosteroids (p = 0.020) in the ED predicted a higher re-attendance rate. Follow up care and medications on discharge were not signifi cant factors. Low compliance to recommended treatment by established guidelines is associated with higher re-attendance, as are middle age and previous hospitalisations. Besides managing pressures of time and resource limitations in the ED, an increased awareness of guidelines amongst doctors will improve asthma care.

Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To examine the effectiveness and safety of intramuscular (IM) versus oral corticosteroids in the treatment of acute asthma after discharge from a hospital emergency department (ED) or equivalent acute care setting.

LO80: Chest radiograph ordering for acute asthma presentations to emergency departments in Alberta: regional, site, and physician level variation

Introduction: Most acute asthma presentations to the emergency department (ED) are uncomplicated and do not require chest radiographs (CXR). Evidence suggests that the proportion of acute asthma patients receiving CXRs in the ED is high and varies substantially within and across sites and studies. This study explored CXR ordering and variation in acute asthma presentations to Alberta’s EDs. Methods: Administrative health data for Alberta was obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (&amp;gt;17 years) acute asthma (ICD-10-CA: J45) ED visits from 2011-2015. Patients with a primary or secondary diagnosis of asthma were included, provided they had a Canadian Triage and Acuity Scale score of 2-5. NACRS data were linked with Alberta Health Services’ (AHS) diagnostic imaging database. Preliminary analysis on variation in imaging at the zone, ED site, and physician level was completed using SAS (v.9.4). Physicians who saw less than an average of 10 asthma patients per year were excluded. Results: Overall, 51,511 acute asthma ED presentations occurred (~10,000/year). The average proportion of CXRs among presentations was 39.5% (2011-2015) with an average annual increase of 6.7%. From 2011-2015, CXR ordering varied across the five AHS zones (variation [V]: 25%; range: 26.0%-51.0%). Substantial variation was observed across ED sites V: 60%; range: 5.9-66.4%) and physicians (V: 89%; range: 1.4-90.6%). The mean CXR ordering among physicians was 44%. Conclusion: From 2011-2015, CXR use among acute asthma ED presentations has increased. Substantial variation in CXR use suggests that evidence-based interventions are needed to improve imaging appropriateness.

Clinical significance of serum vascular endothelial growth factor in young male asthma patients.

Background/AimsVascular endothelial growth factor (VEGF) is an important mediator of angiogenesis. However, little is known about the potential use of serum levels of VEGF as a biomarker for asthma. We investigated the differences in VEGF levels among normal controls, stable asthma patients, and those with exacerbation of acute asthma. All subjects were young males.MethodsWe measured VEGF levels in each patient group, and examined any serial changes in those with acute exacerbation.ResultsVEGF levels were significantly higher in stable asthmatic patients and even more so in acute asthmatic patients, compared to healthy controls. However, there was no correlation between VEGF levels and forced expiratory volume in 1 second in patients with stable asthma. In addition, there were no correlations between VEGF levels and asthma control test scores. In patients with acute exacerbation, VEGF levels significantly increased during the acute period; their levels decreased gradually at 7 and 14 days after treatment.ConclusionsCompared to normal control patients, the serum levels of VEGF were elevated in stable asthma patients and even more elevated in patients with acute exacerbation. However, the role of VEGF as a biomarker in stable asthma is limited. In patients with acute exacerbation, VEGF levels were associated with clinical improvements.

The Acute Asthma: It's just a Respiratory Disease? A Speckle Tracking Echocardiography Study

Objective: To determine the presence of acute myocardial dysfunction in status asthmaticus. Methodology: Prospective studies were included acute severe asthma patients admitted to intensive care from January 2008 to September 2013. We included a control group with healthy athletes subjected to stress by bench press n=20- and combat karate for 15 minutes, n=14-, SC2000-2013iƒ’ Siemens Echocardiography was available in the gym. Cardiac stress response of asthmatic patients and athletes was evaluated by echocardiography. An off-line analysis by 3D Image and hybrid speckle tracking was performed. We performed analysis by means of using ANOVA test. Results: 32 asthmatic patients (11 males) were included, with a median age of 31 (17-40 years). The age of the controls was 33.45 ± 0.9 years. The left ventricular ejection fraction was similar although septum and anterolateral segment presented segmental alterations in all acute asthmatics patients evidenced by strain and strain rate. Acute asthmatics patients had lower strain, lower velocities, less displacements, and more asynchrony versus controls. Conclusions: Acute asthmatics patients were complicated with a myocardial dysfunction detected by speckle tracking. This tool could be useful for the proper diagnosis of critically ill patients.

Roles of GITR/GITRL signal system expression at bloodstream lymphocytes in children with asthma

Objective To investigate the expression of blood CD4+CD25+Treg GITR, CD4+ T cell GITRL in children with asthma, and the role of them in asthmatic inflammation. Methods 50 cases of severe asthma were selected, and were controlled with thirty two healthy children.The venous blood was collected both in the period of acute episode and clinic remission.The mean fluorescence intensity of CD4+CD25+Treg GITR and CD4+ T cell GITRL was detected by flow cytometry. Results The expression of CD4+CD25+Treg GITR in the asthma acute period group was (24.2±8.2)MFI, which was significantly lower than (28.5±6.0)MFI in the control group(t=2.5, P 0.05). Moreover, the expression of CD4+CD25+Treg GITR in the asthma in remission group after treatment was (29.5±8.3)MFI, which was significantly higher than that in acute period group before treatment(t=-9.9, P 0.05). Furthermore, there was no significant correlation between levels of CD4+CD25+Treg GITR and CD4+ T cell GITRL. Conclusion The level of CD4+CD25+Treg GITR in acute period asthmatic patients was decreased, but it was increased in remission, but no changes of CD4+ T cell GITRL expression were observed.GITR/GITRL signal system might be involved in the asthmatic inflammation procession. Key words: Asthma; T lymphocytes; Receptor, tumor necrosis factor; Signal transduction

Hospitalization for Community-Acquired Pneumonia in Children: Effect of an Asthma Codiagnosis.

Community-acquired pneumonia (CAP) is a common and expensive cause of hospitalization among US children, many of whom receive a codiagnosis of acute asthma. The objective of this study was to describe demographic characteristics, cost, length of stay (LOS), and adherence to clinical guidelines among these groups and to compare health care utilization and guideline adherence between them. This was a multicenter retrospective cohort study using data from the Pediatric Health Information System. Children aged 2 to 18 who were hospitalized with uncomplicated CAP from July 1, 2007, to June 30, 2012 were included. Demographics, LOS, total standardized cost, and clinical guideline adherence were compared between patients with CAP only and CAP plus acute asthma. Among the 25,124 admissions, 57% were diagnosed with CAP only; 43% had a codiagnosis of acute asthma. The geometric mean for standardized cost was $4830; for LOS, it was 2.01 days. Eighty-four percent of patients had chest radiographs; CAP+acute asthma patients were less likely to have a blood culture performed (36% vs 62%, respectively) and more likely not to have a complete blood count performed (49% vs 27%, respectively). Greater guideline adherence was associated with higher cost at the patient-level but lower average cost per hospitalization at the hospital level. CAP+acute asthma patients had higher relative costs (11.8%) and LOS (5.6%) within hospitals and had more cost variation across hospitals, compared with patients with CAP only. A codiagnosis of acute asthma is common for children with CAP. This could be from misdiagnosis or co-occurrence. Diagnostic and/or management variability appears to be greater in patients with CAP+asthma, which may increase resource utilization and LOS for these patients.

High-dose of intravenous methylprednisolone versus oral in treatment of acute asthmatic patients: a cohort study

High-dose of intravenous methylprednisolone versus oral in treatment of acute asthmatic patients: a cohort study

Haploinsufficiency for Stard7 is associated with enhanced allergic responses in lung and skin.

Allergic asthma is a chronic inflammatory disorder that affects ∼20% of the population worldwide. Microarray analyses of nasal epithelial cells from acute asthmatic patients detected a 50% decrease in expression of Stard7, an intracellular phosphatidylcholine transport protein. To determine whether loss of Stard7 expression promotes allergic responses, mice were generated in which one allele of the Stard7 locus was globally disrupted (Stard7 (+/-) mice). OVA sensitization and challenge of Stard7(+/-) mice resulted in a significant increase in pulmonary inflammation, mucous cell metaplasia, airway hyperresponsiveness, and OVA-specific IgE compared with OVA-sensitized/challenged wild-type (WT) mice. This exacerbation was largely Th2-mediated with a significant increase in CD4(+)IL-13(+) T cells and IL-4, IL-5, and IL-13 cytokines. The loss of Stard7 was also associated with increased lung epithelial permeability and activation of proinflammatory dendritic cells in sensitized and/or challenged Stard7 (+/-) mice. Notably, OVA-pulsed dendritic cells from Stard7(+/-) mice were sufficient to confer an exaggerated allergic response in OVA-challenged WT mice, although airway hyperresponsiveness was greater in Stard7(+/-) recipients compared with WT recipients. Enhanced allergic responses in the lung were accompanied by age-dependent development of spontaneous atopic dermatitis. Overall, these data suggest that Stard7 is an important component of a novel protective pathway in tissues exposed to the extracellular environment.