Asthma Classification Research Articles

Validity of Spirometry for Diagnosis of Cough Variant Asthma

Background Cough variant asthma (CVA) is a chronic or recurrent cough without wheezing accompanied by bronchial hyper-responsiveness and eosinophilic inflammation of the airways. This study aimed to evaluate the validity of spirometry in the diagnosis of CVA, as well as determining the specificity and sensitivity of spirometry parameters in CVA. Materials and Methods This descriptive observational study was conducted from March 2015 to February 2016. The subjects were 73 patients 5 to 15 years of age who referred to the pulmonology clinics of Tabriz Pediatric Center, Tabriz city, Iran. The patients were divided into two groups of classic asthma (n=37), and CVA (n=36). Basic spirometry parameters such as FEV1/FVC and FEF25-75% were measured and the spirometry findings of each individual were measured based on European Respiratory Society (ERS) criteria. After intervention (β2 (beta2) adrenergic receptor agonists as bronchodilator test), in two groups, spirometry was again performed. The FEV1/FVC and FEF 25-75% parameters were examined for intervention. Data analysis was performed using SPSS (version 16.0). Results Cut-off points for the diagnosis of CVA and classic asthma were obtained using FEV1/FVC and FEF 25-75% spirometry. The cut-off point for FEV1/FVC for the diagnosis of CVA was calculated to be 80%. When the FEV1/FVC ratio was higher than 80%, diagnosis of CVA was possible with a specificity of 94.59%, and sensitivity of 66.67%. These findings suggest a specificity and sensitivity of 94.59%, and 66.67%, respectively, for the diagnosis of classic asthma (with an FEV1/FVC ratio of below 80%). Analysis showed a positive predictive value of 100% for CVA at FEF 25-75% with a negative predictive value of 55.4%. Conclusion Spirometry can be a sensitive method for the diagnosis of CVA at a FEF 25-75% below 65%; however, it lacks the specificity for accurate diagnosis of CVA.

A composite of exhaled LTB4, LXA4, FeNO, and FEV1 as an “asthma classification ratio” characterizes childhood asthma

Aberrant generation of eicosanoids is associated with asthma, but the evidence remains incomplete and its potential utility as biomarkers is unclear. Major eicosanoids in exhaled breath condensates (EBCs) were assessed as candidate markers for childhood asthma. Ten exhaled eicosanoid species was evaluated using ELISA in the discovery phase, followed by prediction model-building and validation phases. Exhaled LTB4 , LTE4 , PGE2, and LXA4 showed significant difference between asthmatics (N=60) and controls (N=20). For validation, an expanded study population consisting of 626 subjects with asthma and 161 healthy controls was partitioned into a training subset to establish a prediction model and a test sample subset for validation. Receiver operating characteristic (ROC) analyses of the training subset revealed the level of exhaled LTB4 to be the most discriminative among all parameters, including FeNO, and a composite of exhaled LTB4 , LXA4 , together with FeNO and FEV1 , distinguishing asthma with high sensitivity and specificity. Further, the Youden index (J) indicated the cut point value of 0.598 for this composite of markers as having the strongest discriminatory ability (sensitivity = 85.2% and specificity = 83.6%). The predictive algorithm as "asthma classification ratio" was further validated in an independent test sample with sensitivity and specificity being 84.4% and 84.8%, respectively. In a pediatric study population in Taiwan, the levels of exhaled LTB4 , LTE4 , LXA4, and PGE2 in asthmatic children were significantly different from those of healthy controls, and the combination of exhaled LTB4 and LXA4 , together with FeNO and FEV1 , best characterized childhood asthma.

Bronchoprotective effect of deep inspirations in cough variant asthma: A distinguishing feature in the spectrum of airway disease?

PurposeTo assess the effect of deep inspirations (DIs) on airway behaviour in individuals with classic asthma (CA), cough variant asthma (CVA), and methacholine (MCh)-induced cough but normal airway sensitivity (COUGH) during bronchoprovocation. MethodsTwenty-five adults (18 female; 44.8 ± 12.3 years (Mean ± SD); n = 9 CA, n = 9 CVA, and n = 7 COUGH) completed two single-dose MCh challenges, with and without DIs. Bronchoprotection was assessed by comparing changes in bronchoconstriction (FEV1, FVC, FEV1/FVC, FEF50, FEF25-75), gas trapping (RV, RV/TLC) and impulse oscillometry (IOS) measurements. ResultsThe% changes in FEV1 with and without DIs were not significantly different within any group. Decreases in FEF50 and FEF25-75 were greater in CA (p = 0.041 and p = 0.029), decreases in FVC (% predicted) and FEV1/FVC(%) were less in CVA (p = 0.048 and p = 0.010), and increases in RV (L) and RV/TLC (% predicted) were less in COUGH (p = 0.007 and p = 0.028), respectively. No differences in IOS measurements were noted. ConclusionsDIs triggered bronchoconstriction in CA, bronchoprotection in CVA, and prevented gas trapping in COUGH.

Proteomic analysis of sputum reveals novel biomarkers for various presentations of asthma

BackgroundIt is now recognized that asthma can present in different forms. Typically, asthma present with symptoms of wheeze, breathlessness and cough. Atypical forms of asthma such as cough variant asthma (CVA) or chest tightness variant asthma (CTVA) do not wheeze. We hypothesize that these different forms of asthma may have distinctive cellular and molecular features.Methods30 patients with typical or classical asthma (CA), 27 patients with CVA, 30 patients with CTVA, and 30 healthy control adults were enrolled in this prospective study. We measured serum IgE, lung function, sputum eosinophils, nitric oxide in exhaled breath (FeNO). We performed proteomic analysis of induced-sputum supernatants by mass spectrometry.ResultsThere were no significant differences in atopy and FEV1 among patients with CA, CVA, and CTVA. Serum IgE, sputum eosinophil percentages, FeNO, anxiety and depression scores were significantly increased in the three presentations of asthmatic patients as compared with healthy controls but there was no difference between the asthmatic groups. Comprehensive mass spectrometric analysis revealed more than a thousand proteins in the sputum from patients with CA, CVA, and CTVA, among which 23 secreted proteins were higher in patients than that in controls.ConclusionsPatients with CA, CVA, or CTVA share common clinical characteristics of eosinophilic airway inflammation. And more importantly, their sputum samples were composed with common factors with minor distinctions. These findings support the concept that these three different presentations of asthma have similar pathogenetic mechanism in terms of an enhanced Th2 associated with eosinophilia. In addition, this study identified a pool of novel biomarkers for diagnosis of asthma and to label its subtypes.Trial registrationhttp://www.chictr.org.cn (ChiCTR-OOC-15006221)

Treating persistent asthma in rural Rwanda: characteristics, management and 24-month outcomes.

In 2007, the Rwandan Ministry of Health, with support from Partners In Health, introduced a district-level non-communicable disease programme that included asthma care. To describe the demographics, management and 24-month outcomes of asthma patients treated at three rural district hospitals in Rwanda. We retrospectively reviewed electronic medical records of asthma patients enrolled from January 2007 to December 2012, and extracted information on demographics, clinical variables and 24-month outcomes. Of the 354 patients, 66.7% were female and 41.5% were aged between 41 and 60 years. Most patients (53.1%) were enrolled with moderate persistent asthma, 40.1% had mild persistent asthma and 6.8% had severe persistent asthma. Nearly all patients (95.7%) received some type of medication, most commonly a bronchodilator. After 24 months, 272 (76.8%) patients were still alive and in care, 21.1% were lost to follow-up, 1.7% had died and 0.3% had transferred out. Of the 121 patients with an updated asthma classification at 24 months, the severity of their asthma had decreased: 17.4% had moderate and 0.8% had severe persistent asthma. Our findings show improvements in asthma severity after 24 months and reasonable rates of loss to follow-up, demonstrating that asthma can be managed effectively in rural, resource-limited settings.

Effect of anti-IgE in occupational asthma caused by exposure to low molecular weight agents.

The role of immunoglobulin (Ig)-E in occupational asthma (OA) due to low molecular weight (LMW) agents is not well established compared to classical atopic asthma. In this study, we evaluate whether anti-IgE monoclonal antibody (mAb) has an effect in a mouse model of OA, using persulfate salts. On days 1 and 8, BALB/C mice were dermally sensitized with 5% ammonium persulfate (AP) or dimethyl sulfoxide (DMSO). On days 15, 18, and 21, animals were injected intraperitoneally with anti-IgE mAb or PBS 6 hours before challenge with AP or saline. Airway hyper-responsiveness (AHR) using a methacholine test, airway inflammation in bronchoalveolar lavage (BAL) and lung tissue, and total free IgE in serum samples were analyzed 24, 48, and 96 hours after the last challenge. Anti-IgE mAb treatment almost completely neutralized free serum IgE. In AP-sensitized and challenged mice, anti-IgE mAb treatment abolished AHR 24 hour and 48 hour after the last challenge and significantly reduced the total number of eosinophils and neutrophils 48 hour and 96 hour after the last AP challenge compared with nontreated mice. Levels of interleukin (IL)-13 in BAL were also significantly decreased after anti-IgE administration 24 hour and 48 hour after the last AP challenge. Histological analysis of the lung sections from anti-IgE-treated mice revealed normal inflammatory patterns similar to control groups 48 hour after the last challenge. Anti-IgE-treated mice showed a significant improvement in asthma features related to the AHR and airway inflammation. Anti-IgE mAb has positive effects in OA induced by persulfate salts.

Assessment of asthma severity in adults with ever asthma: A continuous score.

BackgroundIn epidemiological studies, continuous measures of asthma severity should be used to catch the heterogeneity of phenotypes. This study aimed at developing and validating continuous measures of asthma severity in adult patients with ever asthma from the general population, to be used in epidemiological studies.MethodsRespiratory symptoms, anti-asthmatic treatment and lung function were measured on 520 patients with ever asthma aged 20–64 years from the general Italian population (GEIRD study; 2007/2010). The variables that represent the same dimension of asthma severity were identified through an exploratory factor analysis and were summarized through a multiple factor analysis.ResultsOnly respiratory symptoms and anti-asthmatic treatment were summarized in a continuous score (STS). STS ranges from 0 (no symptoms/treatment) to 10 (maximum symptom frequency and treatment intensity). STS was positively correlated with the Global Initiative for Asthma classification of asthma severity computed on the 137 cases with a doctor's diagnosis (Spearman’s coefficient = 0.61, p-value<0.0001) (concurrent validity). Furthermore, using a cohort of 1,097 European asthmatics (ECRHS II study; 1999/2002), increasing STS levels at baseline (1991/1993) were positively associated with long-term outcomes (hospitalization and lost workdays for breathing problems, asthma attack frequency and use of asthma controllers) (predictive validity). Finally, the STS scores computed from the GEIRD and ECRHS II data were comparable (Lin’s coefficient = 0.95, p-value<0.0001) (replication analysis).ConclusionsSTS is a valid and replicable measure of asthma severity in adults, which could be used in association studies.

Evaluation of spirometry in asthmatic children

Background:The use of spirometry in the assessment of children with asthma is taking on new importance with the realization that considerable airway obstruction may exist in the absence of clinically detectable abnormalities. Hence this study was planned to evaluate, forced expired volume in 1 second (FEV1), forced vital capacity (FVC), the forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) and Peak Expiratory Flow rates (PEFR) in asthmatic children aged 6-12 years. The objective of the study was to determine prevalence of asthma according to clinical classification and identify common trigger factors and to determine which is more sensitive between FEV1, FVC, FEV1/FVC, FEF 25-75 and PEFR in different age groups.Methods: The present study was conducted among 60 patients of age group 6 to 12 years with asthma. Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), Ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC), PEFR and Forced expiratory flow between 25-75% were recorded. Data was analyzed using chi-square test, Karl Pearson’s correlation coefficient. Level of significance was set at 5%. All p values less than 0.05 were treated as significant.Results:In Age and Sex wise correlation with classification of asthma, a male preponderance was seen in all the age groups i.e. between 6-8 years, 9-10 years and 11-12 years. Mosquito coils were the most common indoor agents to trigger an asthmatic accounting for nearly 80%. Amongst the outdoor triggers, exacerbation of symptoms during the cold weather accounted for 90 % followed by variation during festivals like Diwali, dust, pollution, exercise and insects. Comparison of Pre and Post bronchodilator FEF 25-75 values have shown a high statistical significance.Conclusions:Parents need to be educated regarding certain modifiable factors that can improve the prognosis. Pulmonary Function tests should be performed as a routine office procedure. Peak expiratory flow meter is a handy instrument. In all children above 6 years of age suspected to have asthma, this test should be performed before beginning therapy.

Benralizumab for the treatment of asthma

ABSTRACTIntroduction: The classification of asthma into phenotypes and endotoypes allows for the use of targeted therapies, including three biologics which target interleukin 5 (IL-5) signaling in eosinophilic asthma.Areas covered: As of December 2016, two monoclonal antibodies, mepolizumab and reslizumab, are approved by U.S. Food and Drug Administration and one, benralizumab, is in clinical development. Two phase 3 trials for benralizumab, SIROCCO and CALIMA, were published in September 2016. Although there are no direct comparisons among these three anti-IL-5 therapies, the goal of this review is to summarize the current data and discuss their potential similarities and differences, with a focus on benralizumab.Expert commentary: Compared to mepolizumab and reslizumab, the possible advantages of benralizumab are less frequent dosing and a potential to reduce exacerbations irrespective of the blood eosinophil count. Some improvements in asthma symptom scores and quality of life occur with all three biologics, but the clinical meaningfulness of these improvements is less clear. A more defined reference range for eosinophil levels is necessary to determine which subjects will best benefit from these medications. Until quality randomized controlled trials directly compare the three, choosing among them for the treatment of eosinophilic asthma remains difficult.

Dietary total antioxidant capacity in early school age and subsequent allergic disease.

SummaryBackgroundDietary antioxidant intake has been hypothesized to influence the development of allergic diseases; however, few prospective studies have investigated this association.ObjectiveOur aim was to study the association between total antioxidant capacity (TAC) of the diet at age 8 years and the subsequent development of asthma, rhinitis and sensitization to inhalant allergens between 8 and 16 years, and to assess potential effect modification by known risk factors.MethodsA total of 2359 children from the Swedish birth cohort BAMSE were included. Dietary TAC at age 8 years was estimated by combining information on the child's diet the past 12 months from a food frequency questionnaire with a database of common foods analysed with the oxygen radical absorbance capacity method. Classification of asthma and rhinitis was based on questionnaires, and serum IgE antibodies were measured at 8 and 16 years.ResultsA statistically significant inverse association was observed between TAC of the diet and incident sensitization to inhalant allergens (adjusted odds ratio: 0.73, 95% confidence interval: 0.55–0.97 for the third compared to the first tertile, P‐value for trend = 0.031). Effect modification by traffic‐related air pollution exposure was observed, with a stronger association between dietary TAC and sensitization among children with low traffic‐related air pollution exposure (P‐value for interaction = 0.029). There was no evidence for effect modification by GSTP1 or TNF genotypes, although these results should be interpreted with caution. No clear associations were observed between TAC and development of rhinitis or asthma, although a significant inverse association was observed for allergic asthma (OR adj 0.57, 95% CI 0.34–0.94).Conclusions and Clinical RelevanceHigher TAC of the diet in early school age may decrease the risk of developing sensitization to inhalant allergens from childhood to adolescence. These findings indicate that implementing an antioxidant‐rich diet in childhood may contribute to the prevention of allergic disease.

Asthma control and productivity loss in those with work-related asthma: A population-based study

ABSTRACTObjective: In Canada, asthma is the third leading cause of work loss, yet little is known about the associated productivity loss. The goal of this study was to look at the relationship between asthma control and productivity loss, particularly contrasting those with work-related asthma (WRA) and non-work-related asthma (NWRA). Methods: A population-based random sample of adults with asthma in British Columbia, Canada, was prospectively recruited. Asthma control was graded according to Global Initiative for Asthma classification, while productivity loss and presence of WRA was assessed using questionnaires. Ordinal regression models were then used to associate WRA with asthma control. Generalized linear models were applied to estimate the average productivity loss associated with different levels of asthma control among those with WRA and NWRA. Results: The study included 300 employed adults. Sixty (20%) had WRA. The odds of being controlled were significantly lower in those with WRA (OR = 0.23, 95% CI: 0.09, 0.56; P < 0.01). Those with WRA and uncontrolled asthma had a significant difference in productivity loss due to presenteeism ($659.1 [95% CI: 12.9, 1581.5; P = 0.04]), but not absenteeism ($88.7 [95% CI: −86.5, 279.6; P = 0.35]), when compared to those with NWRA and uncontrolled asthma. There was no significant difference when a similar comparison was made for those with controlled or partially controlled asthma. Conclusions: WRA is associated with worse asthma control and increased productivity loss. Presenteeism makes a significant contribution to productivity loss and should be considered when evaluating the overall economic burden of asthma, particularly WRA.

Prevalence, risk factors, and clinical outcomes of atopic and nonatopic asthma among rural children

BackgroundBecause of time and cost constraints, objective classification of atopic and nonatopic asthma has been limited in large epidemiologic studies. However, as we try to better understand exposure-outcome associations and ensure appropriate treatment of asthma, it is important to focus on phenotype-defined asthma classification. ObjectiveTo compare atopic and nonatopic asthma in rural children with regard to risk factors and clinical outcomes. MethodsWe conducted a cross-sectional study in rural Saskatchewan, Canada, in 2011. Parents of 6- to 14-year-old children completed a health and exposure survey. Skin prick tests were completed in a subsample of 529 children. Asthma was based physician diagnosis. Asthma status was defined as no asthma, nonatopic asthma, and atopic asthma. ResultsAsthma prevalence was 14.7% of which 32.1% of cases were atopic. After adjustment, early respiratory illness and a family history of asthma were predictors of childhood asthma, regardless of atopic status (P < .05). Being overweight and having a dog in the home were associated with an increased risk of nonatopic asthma (P < .05). A mother with a history of smoking increased the risk of atopic asthma (P = .01). Compared with those with nonatopic asthma, in the past 12 months, children with atopic asthma were more likely to report a sneezy, runny, or blocked nose or have shortness of breath (odds ratio >2), whereas those with nonatopic asthma were more likely to have parents who missed work (odd ratio >3). Those with nonatopic asthma had significantly lower forced expiratory volume in 1 second compared w2ith those with atopic asthma. ConclusionExposures may contribute differentially to atopic and nonatopic asthma and result in differential clinical presentation or burden. The study of these characteristics is important for etiologic understanding and management decisions.

Vitamin D in Pediatric Asthma and Allergic Rhinitis: Benefits beyond Skeletal Health

Deficiency of Vitamin D in the Indian subcontinent is emerging as a major noninfectious epidemic. To correlate vitamin D deficient children with the asthma and allergic rhinitis classification and pulmonary function tests. We studied 66 children with asthma and allergic rhinitis between 6 to 12 years of whom 33 cases were administered Vitamin D and 33 controls who were not given Vitamin D. The ethical committee approval was taken. It was a prospective, randomised and comparative study. Data was analysed using mean, standard deviation and pairedt test. The study revealed 42 (63.6%) males and 24 (36.4%) females. The Asthma classification depicted mild persistent in 37 (56.1%) followed by intermittent 16 (24.2%) and moderate persistent 12 (18.2%). Maximum cases of allergic rhinitis were moderate persistent 42 (63.6%). The Children who received vitamin D had significant improvement of Forced Expiratory Volume in the first second (FEV1, p-0.000), Forced Vital Capacity (FVC, p-0.005), FEV1: FVC% (p-0.002) and Peak Expiratory Flow Rate (PEFR, p-0.000). The control group showed significant improvement in the PEFR parameter (p- 0.0077). The case group showed marked improvement in the lung functions. Adherence to the duration of therapy for a period of 10 weeks with Vitamin D is mandatory.

Allergen-specific immunoglobulin E and allergic rhinitis severity.

Background:Allergic rhinitis (AR) is a common disorder. The diagnosis is based on the concordance between allergy sensitization and history. Serum allergen specific immunoglobulin E (sIgE) assessment allows characterization of the relevant sensitizing allergens. Presently, Allergic Rhinitis and its Impact on Asthma (ARIA) classification subdivides AR based on symptoms severity and duration. However, the relationship between sIgE levels and symptom severity is still a matter of debate.Objective:Therefore, this study aimed at relating sIgE levels with symptom severity assessed by ARIA classification in a group of patients with AR.Methods:We enrolled 217 patients with AR (123 women; median age, 39.5 years). The sIgE levels (expressed in kUA/L) to house-dust mite were detected by the fluorescence enzyme immunoassay in peripheral blood samples. The IgE calibrators were traceable to the second international reference preparation 75/502 of human serum IgE from the World Health Organization. Symptom severity was assessed by ARIA classification.Results:We found a significant difference in sIgE levels in patients with mild intermittent versus mild persistent symptoms (p < 0.05), mild intermittent versus moderate-to-severe persistent symptoms (p < 0.001), moderate-to-severe intermittent versus moderate-to-severe persistent symptoms (p < 0.01), and mild persistent versus moderate-to-severe persistent symptoms (p < 0.05).Conclusion:Analysis of these findings indicated that the sIgE level to house-dust mite might be a reliable biomarker for symptom severity in patients with AR. This outcome might be clinically relevant, particularly in candidates for immunotherapy.

An Approach to Non Invasive Neural Network based Diagnostics of Asthma using Gas Sensors Array

Objectives: This paper presents a neural network based non-invasive diagnostics methodology of asthma using gas sensors array working as artificial olfactory. Methods/Statistical Analysis: A series of invasive clinical trials are recommended by international bodies to justify the diagnosis of asthma. So during these tests the patient has to undergo a lot of physical trauma. To ease the suffering of the patient, in this paper, a non-invasive method for asthma detection has been proposed. Findings: In this paper, an array consisting of five semiconductor gas sensors has been developed. The sensor array along with the data acquisition system has been developed for the non-invasive detection of the asthma. Five data sets of asthma related toxic gas in different concentrations are obtained by a signal acquirement system having tin oxide gas sensor array. Obtained data are put for training and analysis on Artificial Neural Network (ANN). Proposed neural network has been trained using back propagation algorithm. From the results obtained, it can be seen that the developed model ensures the proper accuracy and consistent results. Application/Improvements: Experimental results show good classification of asthma associated exhaled toxic gas with the ambient air using only few samples and also presents the efficiency of Feed Forward Back Propagation Neural Network on the data driven from different gas sensors.

Asthma related quality of life in western Saudi subpopulation and its correlation to level of asthma control

Asthma is a chronic health problem that encompasses the patient’s entire lifetime, and causes significant mental and social problems in addition to physical symptoms. It is; therefore, considerably important to evaluate the quality of life of the patients in addition to the symptoms in order to gather full information about the health status of the patients. Aim of the workThis study objective was to assess asthma related quality of life in a group of persistent asthmatic patients and its correlation to level of asthma control, and objective measure of pulmonary function (FEV1). Patients and methods30 patients with persist asthma according to GINA classification of asthma were entrolled in the study, assessment of asthma related quality of life was done by Juniper mini-AQLQ (1999), level of asthma control by SINA-ACT questionnaire Arabic version, FEV1 by vitalograph and Laboratory measurement of total IgE. Resultstotal AQLQ was more in males than females weakly correlated with age, ACT was significantly correlated with total AQLQ and three domains (activity, symptoms, environmental) while non significant correlation with emotional domain, no significant correlation between AQLQ and FEV1, total IgE, no significant difference between patients on omalizumab and patients not on the treatment regarding total AQLQ and its four domains except environmental domain, ACT or FEV1. ConclusionAsthma quality of life is strongly correlated to level asthma control rather than the objective measures of FEV1, so it complements the results of objective assessments. Asthma related quality of life questionnaire should be implemented in the routine assessment of persistent asthmatic patients.

Inverse correlation of soluble programmed cell death-1 ligand-1 (sPD-L1) with eosinophil count and clinical severity in allergic rhinitis patients

BackgroundT-cell response outcome is determined by co-stimulatory/inhibitory signals. Programmed cell death-1 ligand-1 (PD-L1) is a member of these co-signaling molecules with known soluble form in human serum. Soluble PD-L1 (sPD-L1) is also recognized in patients with some types of malignancy or autoimmune disorders, though there are few studies on sPD-L1 roles in allergic diseases. The purpose of this survey was to evaluate the association between sPD-L1 levels with eosinophil count as well as disease severity in allergic rhinitis (AR) patients. Methods90 patients with AR were selected. Disease severity was determined by a modified Allergic Rhinitis and its Impact on Asthma (ARIA) classification as mild, moderate and severe. Whole blood samples were collected. Then eosinophil count and serum sPD-L1 were detected by a hematologic analyzer and a commercial ELISA kit. Results13 (14.44%), 31 (34.44%), and 46 (51.12%) of patients had mild, moderate and severe disease, respectively. The mean levels of sPD-L1 and eosinophil count were ascertained 18.38 ± 14.42 ng/ml and 422.43 ± 262.26 cell/μl. A significant inverse correlation was determined between sPD-L1 levels and eosinophil count (r = −0.364, P < 0.001). Moreover, we detected a significant negative association between sPD-L1 levels and disease severity (r = −0.384, P < 0.001). ConclusionsIt is deduced that sPD-L1 can be used as a helpful marker to determine the severity of AR. Furthermore, this study indicated that sPD-L1 may have an inhibitory role in AR development, and its modulation may be considered as a useful accessory therapeutic approach for reduction of AR progression.

The puzzle of immune phenotypes of childhood asthma.

Asthma represents the most common chronic childhood disease worldwide. Whereas preschool children present with wheezing triggered by different factors (multitrigger and viral wheeze), clinical asthma manifestation in school children has previously been classified as allergic and non-allergic asthma. For both, the underlying immunological mechanisms are not yet understood in depth in children. Treatment is still prescribed regardless of underlying mechanisms, and children are not always treated successfully. This review summarizes recent key findings on the complex mechanisms of the development and manifestation of childhood asthma. Whereas traditional classification of childhood asthma is primarily based on clinical symptoms like wheezing and atopy, novel approaches to specify asthma phenotypes are under way and face challenges such as including the stability of phenotypes over time and transition into adulthood. Epidemiological studies enclose more information on the patient’s disease history and environmental influences. Latest studies define endotypes based on molecular and cellular mechanisms, for example defining risk and protective single nucleotide polymorphisms (SNPs) and new immune phenotypes, showing promising results. Also, regulatory T cells and recently discovered T helper cell subtypes such as Th9 and Th17 cells were shown to be important for the development of asthma. Innate lymphoid cells (ILC) could play a critical role in asthma patients as they produce different cytokines associated with asthma. Epigenetic findings showed different acetylation and methylation patterns for children with allergic and non-allergic asthma. On a posttranscriptional level, miRNAs are regulating factors identified to differ between asthma patients and healthy controls and also indicate differences within asthma phenotypes. Metabolomics is another exciting chapter important for endotyping asthmatic children. Despite the development of new biomarkers and the discovery of new immunological molecules, the complex puzzle of childhood asthma is still far from being completed. Addressing the current challenges of distinct clinical asthma and wheeze phenotypes, including their stability and underlying endotypes, involves addressing the interplay of innate and adaptive immune regulatory mechanisms in large, interdisciplinary cohorts.

Funcionalidad Familiar en pacientes pediátricos portadores de Asma de un hospital público de Sonora, México.

Introduction: The family and psychological approaches in asthma patients are essential because a dysfunctional family can increase asthma symptoms of the sick child. Aim: To determine family functioning and classification of asthma in pediatric patients, and the condition in the areas that comprises it. Method: A cross-sectional study in asthmatic patients treated in pediatrics Regional General Hospital No. 1 between April and July 2015 was done. Asthma severity was classified in response to the GINA 2010 guide. The Dr. Emma Espejel Scale of Family Functioning was applied to the patient's family. Results: The male presented more severe asthma by 70%, especially in school age. The dysfunction of the control area of family dynamics in the Mexican family impact on the severity of asthma. Discussion and Conclusion: 50% of families with a carrier member of asthma reflect dysfunction; control area was the most affected. Family and psychological approaches in patients with asthma are basic to prevent changes in family function.

Agreement between current and active asthma classification methods, Asthma Call-back Survey, 2011–2012

Objective: Various approaches have been developed to identify persons with asthma using survey data. To assess agreement between current and active asthma classifications, 2011–2012 Asthma Call-back Survey landline telephone household data from 38 states, District of Columbia, and Puerto Rico for adults aged ≥18 years who have ever been told by a health professional they have asthma were analyzed. Methods: Respondents were classified to have current asthma if they reported still having asthma, and active asthma if they reported within the past year: 1) talking to a doctor about asthma, 2) taking asthma medication, or 3) having any symptoms of asthma. Agreement between classifications was assessed using the Kappa statistic. Results: Among adults ever told by a health professional they have asthma, an estimated 72% had current asthma and 75% had active asthma. Overall, 67% of individuals met classifications of both current and active asthma and 20% had neither current nor active asthma (Kappa = 0.68). The Kappa increased to 0.72 when talking to a doctor about asthma was removed from the active asthma classification. Conclusions: Results indicated substantial agreement between current and active asthma. Agreement was strengthened when talking to a doctor about asthma was removed from the active asthma classification.