Duration Of Asthma Research Articles

Thymic stromal lymphopoietin (TSLP) is a master regulator of type 2 immune responses; however, the associations between serum TSLP and the characteristics of adult asthma have not been fully clarified. The aim of this study was to determine the characteristics of adult asthma with high serum TSLP and explore TSLP's association with the late-onset eosinophilic asthma phenotype. Baseline data of the TNH-Azma study (a real-world observational cohort study conducted in Japan on 1344 patients with asthma from 30 hospitals) was used and serum cytokines were measured. Patients were stratified into quartile groups based on the baseline serum TSLP levels, and their clinical characteristics were compared. Multivariable regression analyses were used to determine clinical variables associated with serum TSLP and cytokines associated with the late-onset eosinophilic asthma phenotype. Patients with TSLP-high asthma were older, late-onset, eosinophilic, and less atopic; had a higher BMI; more smoking history; and more asthma-COPD overlap, sleep apnea syndrome (SAS), hypertension, and heart disease. They also exhibited lower lung function with worse asthma symptoms and were more frequently on oral corticosteroids. Multivariable regression analyses adjusted for age and sex demonstrated that a high TSLP level was positively associated with later asthma onset, longer asthma duration, hypertension, higher blood eosinophils, BMI, smoking history, use of biologics, SAS, and high Fres, and was negatively associated with pollinosis. Among the serum cytokines, TSLP exhibited the strongest association with late-onset, eosinophilic asthma. High serum TSLP is a distinctive feature of late-onset, long-duration, eosinophilic asthma. Patients with asthma with this feature may be a unique target population for specific asthma therapy.

Background: Severe asthma is associated with an increased risk of osteoporosis, largely due to chronic corticosteroid exposure and persistent systemic inflammation. Data from different international registries indicate a significant prevalence of osteoporosis among patients with severe asthma, with large variations attributed to differences in treatment strategies and optimization of care. Aims and Methods: This study aims to assess the prevalence of osteoporosis among patients with severe asthma enrolled in the Severe Asthma Network Italy (SANI) registry who are receiving treatment with monoclonal antibodies (mAbs) and/or long-acting muscarinic antagonists (LAMAs) and compare the characteristics of patients with and without osteoporosis to identify key risk factors contributing to osteoporosis. Results: A total of 1813 patients receiving Step 5 GINA (mAbs, LAMAs) treatment were included in the final analysis, of whom 282 (15.5%) had osteoporosis. Osteoporosis prevalence was significantly higher in women (20.3%) compared to men (8.0%). The prevalence also increased with age (p < 0.001) and with asthma duration (p = 0.008). Patients with osteoporosis exhibited poorer asthma control, lower lung function (FEV1 and FVC), a higher rate of exacerbations, and more frequent chronic oral corticosteroid (OCS) use compared to those without osteoporosis. Nasal polyposis was not significantly associated with osteoporosis in this cohort. Conclusions: Osteoporosis is highly prevalent in individuals with severe asthma, mainly due to chronic corticosteroid exposure and persistent inflammation, and is associated with asthma duration, sex, age, frequent exacerbations, cumulative exposure to OCS, and reduced lung function. Early recognition of osteoporosis risk is essential, and biologic therapies offer a promising strategy to reduce OCS dependence, mitigate adverse effects, and improve long-term outcomes.

Analysis of airway inflammation demonstrates a mechanism for T2-biologic failure in asthma.

Asthma has been associated with the development and progression of various cardiovascular diseases but its relationship with degenerative valvular heart disease (VHD) remains unclear. This study investigated the association between asthma and incident degenerative VHD, including aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR) and pulmonary regurgitation (PR). We analysed 483 735 participants from the UK Biobank (median age 56.5 years; 45.2% male) who were free of VHD at baseline. Asthma status was self-reported at recruitment. Incident VHD was ascertained through hospital admission and mortality records using International Classification of Diseases, Tenth Revision codes. Cox proportional hazards models were used to estimate HRs and 95% CIs for each VHD subtype, adjusting for demographic, lifestyle and clinical covariates. Sensitivity analyses accounted for asthma medications, duration of asthma and competing risks. Over a median follow-up of 13.8 years, 5388 participants developed AS, 2650 AR, 6088 MR and 821 PR. Asthma was associated with increased risk of AS (HR 1.31; 95% CI 1.21 to 1.41), AR (HR 1.24; 95% CI 1.11 to 1.39), MR (HR 1.19; 95% CI 1.10 to 1.28) and PR (HR 1.34; 95% CI 1.10 to 1.62). The association with AR was attenuated after adjusting for asthma medications (HR 1.12; 95% CI 0.97 to 1.30). Results were robust across multiple sensitivity analyses, including adjustment for asthma duration and exclusion of participants with pre-existing cardiovascular disease. Asthma is independently associated with a modestly increased risk of several degenerative VHDs, particularly aortic and mitral valve diseases. These findings suggest a potential shared inflammatory pathway and highlight the need for heightened cardiovascular surveillance in individuals with asthma.

Determinants of airway morphology in asthma: Inflammatory and noninflammatory factors

Abstract Introduction: This cross-sectional study investigates the prevalence of psychiatric morbidity among patients with bronchial asthma (BA), emphasizing the interplay between psychological factors and asthma management. Materials and Methods: The study included 50 patients aged 18–65 years with a clinical diagnosis of BA, excluding those with a history of psychiatric illness or other medical disorders. Data were collected using the MINI International Neuropsychiatric Interview. Observations and Results: The study found a significant psychiatric morbidity rate of 54%, with major depressive disorder (18%) and generalized anxiety disorder (12%) being the most prevalent diagnoses. Males exhibited higher rates of nicotine and alcohol dependence, while females showed increased prevalence of anxiety disorders. The duration of asthma did not significantly correlate with psychiatric morbidity. Discussion: These findings align with previous research indicating a high prevalence of psychiatric disorders in asthma patients. The study emphasizes the need for comprehensive screening and integrated management strategies. Conclusion: Early identification and treatment of psychiatric conditions in asthma patients are crucial. Collaborative care between pulmonologists and psychiatrists is essential to improve the patient outcomes and address potential psychiatric emergencies, highlighting the intricate relationship between BA and psychiatric morbidity.

Introduction: Asthma in adolescents presents unique challenges due to developmental, behavioral, and environmental factors. Objective: To assess the effectiveness of Nigella sativa (black seed) supplementation in improving asthma control among adolescents. Methodology: This randomized controlled trial was conducted from September 2023 to August 2024 at the International Islamic University, Islamabad, in collaboration with the Department of Pulmonology at Shifa International Hospitals, Islamabad. A total of 96 adolescents aged 12–18 years with partially controlled or uncontrolled asthma were enrolled. Participants were divided into two equal groups (n = 48 each). The intervention group received 500 mg Nigella sativa capsules twice daily for 12 weeks alongside standard asthma therapy, while the control group continued standard therapy alone. Forced Expiratory Volume in 1 second (FEV₁) and Forced Vital Capacity (FVC), Asthma Control Test (ACT) scores, adherence, and adverse events were measured. Allocation concealment was maintained using sealed opaque envelopes. Statistical analysis was conducted using SPSS 26, with p &lt; 0.05 considered significant. Results: At baseline, both groups were comparable in age, gender, asthma duration, ACT scores, FEV₁, and FVC (p &gt; 0.05). By Week 12, the Nigella sativa group showed a significant improvement in ACT scores from 16.3 ± 2.9 to 22.5 ± 2.2, compared to 16.5 ± 3.1 to 18.1 ± 3.0 in controls (mean difference: 4.4; 95% CI: 3.14–5.63; p &lt; 0.001; Cohen’s d = 1.58). Similarly, FEV₁ increased from 71.85 ± 9.4% to 82.19 ± 8.1% in the intervention group versus 72.43 ± 8.7% to 74.02 ± 8.5% in controls (95% CI: 5.78–11.49; p &lt; 0.001; d = 1.00). FVC also improved, rising from 78.26 ± 7.6% to 86.43 ± 6.9% in the Nigella group, versus 77.91 ± 7.9% to 79.16 ± 7.2% in controls (Δ = 7.27%; 95% CI: 5.27–9.48; p &lt; 0.001; d = 1.08). Adherence was high (91.67%), and adverse effects were minimal and mild (6.25% gastrointestinal discomfort, 2.08% headache), comparable between groups (0.05). By Week 12, the Nigella sativa group showed a significant improvement in ACT scores from 16.3 ± 2.9 to 22.5 ± 2.2, compared to 16.5 ± 3.1 to 18.1 ± 3.0 in controls (mean difference: 4.4; 95% CI: 3.14–5.63; p &lt; 0.001; Cohen’s d = 1.58). Similarly, FEV₁ increased from 71.85 ± 9.4% to 82.19 ± 8.1% in the intervention group versus 72.43 ± 8.7% to 74.02 ± 8.5% in controls (95% CI: 5.78–11.49; p &lt; 0.001; d = 1.00). FVC also improved, rising from 78.26 ± 7.6% to 86.43 ± 6.9% in the Nigella group, versus 77.91 ± 7.9% to 79.16 ± 7.2% in controls (Δ = 7.27%; 95% CI: 5.27–9.48; p &lt; 0.001; d = 1.08). Adherence was high (91.67%), and adverse effects were minimal and mild (6.25% gastrointestinal discomfort, 2.08% headache), comparable between groups. Conclusion: Nigella sativa supplementation significantly improved asthma control and lung function in adolescents with minimal side effects and high adherence.

Background: Gastroesophageal reflux disease is increasingly recognized as a comorbidity in asthma patients, and may be involved in the modulation of disease severity and control of symptoms. Estimation of prevalence and risk factors is therefore of fundamental importance in the optimization of asthma management, most importantly in resource-poor settings. Objective: To determine the frequency of gastroesophageal reflux disease among patients presenting with bronchial asthma. Study Design: Descriptive cross-sectional study. Duration and Place of Study: This study was conducted from February to May 2025 at the Pulmonology Department, Mardan Medical Complex Mardan. Methodology: A total of 167 patients aged 18–65 years with confirmed bronchial asthma were enrolled. Diagnosis was based on clinical symptoms and spirometric criteria (≥12% and 200 mL increase in FEV₁ post-bronchodilator). Individuals with other chronic respiratory diseases were excluded. Symptom-based diagnosis of GERD required heartburn, regurgitation, dysphagia, and persistent throat discomfort. Results: The mean age was 41.22 ± 11.80 years; 53.3% were female. GERD was present in 46.1% of patients. Statistically significant associations with GERD included age &gt;40 years (p&lt;0.001), BMI &gt;25 (p&lt;0.001), asthma duration &gt;5 years (p&lt;0.001), smoking (p&lt;0.001), diabetes mellitus (p&lt;0.001), hypertension (p&lt;0.001), and cardiac disease (p&lt;0.001). Conclusion: GERD is prevalent among asthmatic patients and is significantly associated with age, obesity, smoking, chronic asthma, and comorbidities, underscoring the need for routine GERD screening in asthma care.

Peripheral eosinophil count as a biomarker for asthma exacerbation severity in acute care settings.

Background and objectiveThis study aimed to assess the nutritional status of individuals with severe asthma and to determine how dietary antioxidant (AO) intake influences the disease prognosis and plasma total antioxidant status (TAS).MethodsThe study included 44 patients with severe asthma and 45 healthy participants. Anthropometric measurements, asthma control levels, scores from a validated antioxidant food consumption frequency questionnaire, 3-day food records, and demographic information were gathered from each participant. Blood samples obtained after overnight fasting were analyzed for plasma TAS and total oxidant status (TOS).ResultsThe mean antioxidant intake measured by the FFQ and food records, as well as plasma TAS levels, were significantly lower in the asthma group compared to the control group (p < 0.05). In the asthma group, negative correlations were found between the duration of asthma and both plasma TAS and antioxidant intake from the FFQ and food records, indicating that longer asthma duration was associated with lower antioxidant status (p < 0.05). Additionally, a positive correlation was observed between the asthma control level and the antioxidant intake from the FFQ in the case group, suggesting that better asthma control was associated with higher antioxidant intake (p < 0.05).ConclusionPlasma TAS levels in patients with severe asthma were significantly lower than in healthy individuals. Higher dietary antioxidant intake was positively associated with plasma TAS and may contribute to improved asthma control. These findings suggest that increasing dietary antioxidant intake could be beneficial in the management of severe asthma.Clinical trial numberNot applicable.

The influence of respiratory syncytial virus immunoprophylaxis on allergic sensitisation in children with respiratory allergy.

To assess the magnitude of clinical inertia and its associated factors among adult patients with asthma on chronic follow-up at Jimma Medical Center, Ethiopia, from December 2021 to May 2022. A hospital-based prospective observational study was conducted in Jimma Medical Center from 1 December 2021 to 30 May 2022. 135 patients with asthma who fulfilled the inclusion criteria were enrolled in the study consecutively and followed for 3 months. Of 148 patients, 135 patients' data were analysed. The mean (SD) age of the patients was 52.03 (±15.75) years. More than half (54.1%) of the study participants were men. Most of the study participants (68.9%) at the first and (70.4%) at the second visit, which is 3 months after the first visit, had clinical inertia, respectively. Comorbidity (adjusted OR (AOR) 3.35, 95% CI (1.15, 9.81), p<0.027), asthma duration of 5-10 years (AOR 7.58, 95% CI (1.51, 38.05), p<0.014), moderate persistent asthma (AOR 6.91, 95% CI (2.46, 19.42), p<0.00) and severe persistent asthma (AOR 10.84, 95% CI (1.1, 107.0), p<0.041) were contributing factors for clinical inertia. The burden of clinical inertia in this study was high at both visits. Comorbidity, duration of asthma of 5-10 years, moderate persistent and severe persistent asthma were identified as contributing factors to clinical inertia. Policymaker intervention to avoid clinical inertia is necessary to improve asthma treatment outcomes.

Dupilumab Reduces Exacerbations and Improves Asthma Control in Children Regardless of Asthma Duration

Clinical remission of mild-to-moderate asthma: Rates, contributing factors, and stability.

Objective Age of asthma onset is critical for determining heterogeneous asthma phenotypes. How onset and duration affect therapeutic response is not well understood. Phase 3 QUEST (NCT02414854) and open-label extension TRAVERSE (NCT02134028) studies demonstrated dupilumab’s efficacy up to three years in patients ≥12 years with uncontrolled, moderate-to-severe asthma. We assessed how age of asthma onset and asthma duration affect clinical efficacy of dupilumab in patients with moderate-to-severe type 2 inflammatory asthma. Methods This post hoc analysis included patients with type 2 asthma from QUEST who enrolled in TRAVERSE. Annualized severe exacerbation rates (AER), change from parent study baseline (PSBL) in pre-bronchodilator forced expiratory volume in 1 s (FEV1), and five-item Asthma Control Questionnaire (ACQ-5) score were assessed according to asthma age of onset (<18 years, 18–40 years, >40 years) and duration (<20 years, ≥20 years). Results In all subgroups, treatment with dupilumab through QUEST and TRAVERSE progressively reduced AER (TRAVERSE Week 48–96 range, 0.160–0.333), increased pre-bronchodilator FEV1 (TRAVERSE Week 96 change from PSBL range, 0.20–0.44 L), and reduced ACQ-5 scores (TRAVERSE Week 48 change from PSBL range, −1.63 to −1.84). In patients who received placebo during QUEST, treatment with dupilumab in TRAVERSE improved AER, FEV1, and ACQ-5 in all subgroups. Conclusions In patients with uncontrolled, moderate-to-severe type 2 asthma, treatment with dupilumab provides sustained, long-term exacerbation rate reductions and improvements in lung function and asthma control, across all subgroups, with higher reductions in AER and improvements in pre-bronchodilator FEV1 seen in patients with later onset or longer duration.

Introduction: Recent data indicate that approximately 10–20% of patients with severe asthma (SA) receiving benralizumab (BENRA) do not achieve the desired outcomes. Emerging evidence suggests that clinical remission (CRem) is possible with biologics, warranting investigations into predictive factors. Methods: In this retrospective, single-center study, we analyzed 103 SA patients treated with BENRA for 12 months. CRem was defined as meeting four criteria: no exacerbations requiring oral corticosteroids (OCSs), discontinuation of chronic OCS therapy, improvement in FEV1 ≥100 mL, and an ACQ score < 1.5. Logistic regression identified predictors of remission. Results: After 12 months, 33% of patients achieved CRem, while 10% discontinued treatment due to lack of improvement. BENRA reduced the annual exacerbation rate from a median of 2 to 0 (p < 0.0001) and eliminated OCS use in 80% of patients. Lung function improved significantly, with a +13.5% predicted increase in FEV1 (p < 0.0001). Asthma control also improved, with ACQ scores decreasing from 3.2 to 1.5 (p < 0.0001) and mini-AQLQ scores increasing from 3.4 to 5.0 (p < 0.0001). Key predictors of remission included baseline eosinophil count ≥740 × 103/μL (OR = 3.91, p = 0.02), SA duration (OR = 0.90, p = 0.02), baseline quality of life (OR = 2.18, p = 0.04), and pre-treatment FEV1 (OR = 1.07, p = 0.005). The logistic regression model for these parameters showed strong predictive accuracy (AUC = 0.855, 95% CI 0.78–0.93). Importantly, the SA phase, rather than total asthma duration, was the critical factor, with each additional year reducing the odds of remission by ~10%. Conclusion: Clinical remission is a realistic goal in severe asthma, and early initiation of biologic therapy is vital for improving remission rates and long-term outcomes.

Introduction:We aimed to investigate clinical and laboratory parameters that can predict clinical response in patients who completed subcutaneous immunotherapy (SCIT) against house dust mites (HDM) and to determine parameters associated with systemic adverse effects (SAE).Methods:In total, 108 patients who had complete medical data were evaluated.Results:Around 54.6% of patients were male; mean age was 11.7 ± 3.1 years. All patients had allergic rhinitis, 86% had asthma, and 22% had atopic dermatitis. After SCIT, mean symptom score (SS) for allergic rhinitis had decreased in 86% of patients, asthma severity had decreased in 35.5% of asthma patients. After SCIT, median eosinophil count and HDM skin prick test (SPT) diameters decreased, there was not statistically significant change in total IgE (P = 0.001, 0.001, and 0.824, respectively). No statistically significant difference was detected between the SS change groups (decreased, same, or increased) in terms of age, gender, disease duration, presence and severity of asthma, presence of atopic dermatitis, duration of SCIT, time after SCIT, initial sensitization status, total IgE, eosinophil and basophil counts, and SPT diameter for HDM. However, in the group with decreasing SS, total IgE change (in direction of decrease) was found to be statistically significantly higher (P = 0.008). SAEs were observed in 15.7% of patients, 0.41% of injections. SAEs were more common in girls (P = 0.023). Initial eosinophil count, basophil count, and dermatophagoides farina SPT diameter were statistically significantly higher in group with SAE (P = 0.007, 0.008, and 0.036, respectively).Conclusion:HDM-specific SCIT is a treatment that provides reduction in allergic rhinitis symptoms and asthma severity in children. However, we could not identify any clinical or laboratory findings that could predict clinical success before treatment. Girls and patients with high eosinophil and basophil counts should be monitored more carefully for the development of SAE.

Aberrant immune response is a hallmark of asthma, with 5%-10% of patients suffering from severe disease exhibiting poor response to standard treatment. A better understanding of the immune responses contributing to disease heterogeneity is critical for improving asthma management. T cells are major players in the orchestration of asthma, in both mild and severe disease, but it is unclear whether specific T cell subsets influence asthma symptom duration. Here we show a significant association of airway CD8+ effector memory T cells re-expressing CD45RA (TEMRAs), but not CD8+CD45RO+ or tissue-resident memory T cells, with asthma duration in patients with severe asthma (SA) but not mild to moderate asthma (MMA). Higher frequencies of IFN-γ+CD8+ TEMRAs compared with IFN-γ+CD45RO+ T cells were detected in SA airways, and the TEMRAs from patients with SA but not MMA proliferated ex vivo, although both expressed cellular senescence-associated biomarkers. Prompted by the transcriptomic profile of SA CD8+ TEMRAs and proliferative response to IL-15, airway IL15 expression was higher in patients with SA compared with MMA. Additionally, IL15 expression in asthmatic airways negatively correlated with lung function. Our findings add what we believe is a new dimension to understanding asthma heterogeneity, identifying IL-15 as a potential target for treatment.

Asthma is a common respiratory disease in pregnancy, with approximately 18% of cases worsening. Small airway disease (SAD) with a reported prevalence of up to 70% is now recognised as a principal indicator of poor asthma control. Impulse oscillometry (IOS) is a non-invasive, technically easier, and patient-friendly tool for detecting SAD. We aimed to assess the prevalence of SAD in pregnant women with asthma and the acceptance of the IOS across different trimesters of pregnancy. This cross-sectional study was conducted among pregnant women aged ≥18 years with clinically diagnosed asthma. All patients underwent IOS following manufacturer and European Respiratory Society guidelines. A questionnaire was used to assess their satisfaction with the technique. Out of 78 patients who underwent IOS, SAD was present in 55.1% (95% CI = 43.4 to 66.4%). Post-bronchodilator reversibility was observed in 37.2% of patients. Abnormal total (R5) and larger (R20) airway resistance were found in 79.5% and 64.1% of patients, respectively. Other IOS parameters (Fres, AX, and X5) were abnormal in 58.9%, 30.7%, and 39.7% of patients, respectively. Bivariate and multivariate logistic regression analyses indicated longer duration of asthma (OR = 1.1; 95% CI = 1.05-1.18; P < 0.001) and passive smoking (OR = 4.2; 95% CI = 1.58-11.1; P = 0.004) were significantly associated with SAD. All participants tolerated the IOS well, with a satisfaction score of 4.75 ± 0.72. The IOS is a helpful tool for the evaluation of SAD, a significant comorbidity in pregnant women with asthma. Factors such as longer disease duration and exposure to passive smoking, akin to risk factors for chronic airflow obstruction, are significantly associated with SAD. Future research should explore SAD's impact on clinical management and overall asthma outcomes.

Objectives Cardiovascular disease (CVD) is a major cause of death in Korea, and studies have reported that asthma can have a negative impact on CVD. This study aimed to identify the association between asthma and CVD, including the current status, treatment status, and duration of asthma in Korean adults. Methods The Korea National Health and Nutrition Examination Survey (2016–2021) was used, and 34,384 adults aged 19 years or older were included. Exposures were asthma-related characteristics, and outcomes were hypertension, ischemic heart disease, and stroke. The association between asthma characteristics and CVD was analyzed using the chi-square test and multiple logistic regression analysis. Results The asthma diagnosis experience rate of the population was 3.1%; 1.6% were currently suffering from asthma, 1.0% were receiving asthma treatment, 0.6% were receiving regular medication, and 1.5% had a disease duration of 11 years or more. The CVD diagnosis rates in the population were 20.2% for hypertension, 2.3% for ischemic heart disease, and 1.8% for stroke. Compared to those who had no asthma diagnosis, those who had been diagnosed with asthma (OR = 2.06, 95% CI = 1.47–2.87), received asthma treatment (OR = 1.93, 95% CI = 1.22–3.04), and had a long duration of asthma (OR = 3.54, 95% CI = 1.71–7.33) had a significantly higher risk of ischemic heart disease. However, hypertension and stroke were not significantly correlated with asthma-related characteristics. Conclusions Asthma diagnosis and asthma-related characteristics were associated with an increased risk of ischemic heart disease. Our study suggests that research on risk assessment and management of CVD in patients with asthma would be needed.