Asthmatic Patients Research Articles

Adherence to Mediterranean diet and asthma control. Results from a small study among asthmatic patients in Greece

Objectives Current variations in asthma prevalence and clinical characteristics suggest that lifestyle choices including dietary habits, may affect the pathogenesis and/or clinical expression of the disease. The purpose of this study is to evaluate the association between adherence to Mediterranean diet (MD) and asthma control, considering disease severity. Methods Adherence to MD was assessed through a questionnaire, the MD Adherence Screener (MEDAS), previously validated in Mediterranean populations. Each participant received a score ranging from 0 to 14. A score higher than 10 indicates high MD adherence. The level of asthma control was assessed by the Asthma Control Test and two groups were formed (controlled vs. partly controlled/uncontrolled). Results The study sample included 105 participants (34% males). About 45% of participants were severe asthmatics. Adherence to MD was associated with 14% higher, though not statistically significant, probability of controlled asthma in the overall study sample (OR = 1.14; 95% CI = 0.46–2.81) and 60% higher probability of controlled asthma among severe asthmatics (OR = 1.60, 95% CI = 0.46–5.59). Conclusions These results indicate a possible association between adherence to MD and asthma control, but findings are restricted by the study’s small sample size which does not allow asserting the inference.

Improvement in health-related quality of life questionnaires with biologic treatment in severe asthma and comorbid chronic rhinosinusitis with or without nasal polyposis: a real-life experience.

Patients with severe asthma frequently have comorbid chronic rhinosinusitis (CRS) with or without nasal polyps, that can increase the symptom burden and complicate treatment. Real-life clinical data on the impact of biologic treatments on CRS-specific quality-of-life questionnaires are still lacking. In this retrospective real-life study, we collected data from patients with severe asthma with comorbid CRS with/without nasal polyposis at baseline, and after 3, 6 and 12 months of treatment with omalizumab, mepolizumab, benralizumab or dupilumab. In particular, we evaluated improvements in HRQoL as measured by SinoNasal Outcome Test-22 (SNOT-22, 0 - 110), Visual Analog Scale symptom scores (VAS, 0-10), and Asthma Control Test (ACT, 5-25) and the proportion of patients meeting the minimal clinically important difference (MCID). Disease-specific HRQoL, as measured by SNOT 22 and VAS score improved in all patients at 3, 6, and 12 months of treatment compared with baseline (SNOT-22: 14, IQR: 0-52 vs 10, IQR:0-30 vs 0, IQR:0-15 vs 0, IQR:0-12, p < 0.001, VAS score: 1, IQR: 0-5 vs 0, IQR:0-3 vs 0, IQR:0-2 vs 0, IQR 0-1, p < 0.001). After 3 months of treatment >80% of patients reached the MCID for ACT, while only patients on dupilumab showed to reach a MCID in 100% of cases. The effect size depended upon the symptom burden at baseline. The study confirms the efficacy of omalizumab, mepolizumab, benralizumab, and dupilumab in a real-life setting, with a rapid improvement in CRS-specific HRQoL and general health status. These data highlight the importance of targeting type 2 inflammation in asthmatic patients with co-existing upper and lower airways disease.The Authors disclose that preliminary data and analysis of the present study have been presented in abstract form during the "X International Workshop on Lung Health - Respiratory Disease and Immune Response", held in Nice on 19-21 January 2023.

Significant association between asthma and a lower risk of mortality among COVID-19 patients in Spain: A meta-analysis.

Various prevalences of asthma in coronavirus disease 2019 (COVID-19) have been reported in different regions, and the association between asthma and COVID-19 subsequent mortality has been in debate. Thus, this study aimed to investigate whether there was a significant association between asthma and COVID-19 mortality in Spain through a meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were strictly complied with conducting this study. The pooled odds ratio (OR) with a corresponding 95% confidence interval (CI) was calculated by a random-effects model. The I 2 statistics for heterogeneity, sensitivity analysis for robustness, Begg's test, and Egger's test for publication bias, along with subgroup analyses for confounding bias, were also performed to support the foundation of this study. The meta-analysis revealed that asthma was significantly associated with a lower risk of mortality among COVID-19 patients in Spain with a random-effects model (pooled OR = 0.78, 95% CI = 0.69-0.88, I 2 = 35%). Further subgroup analyses by male proportion and sample size also indicated that a statistically significant negative correlation did exist between asthma and COVID-19 mortality. Robustness and no publication on-bias were evidenced by sensitivity analysis, Egger's test, and Begg's test, respectively. In conclusion, patients with asthma were found to have a lower risk of mortality from COVID-19 in Spain, especially among elderly patients. In addition, asthmatic patients infected with COVID-19 may be at risk of death compared to non-asthmatic patients, which is not a cause for undue concern, thereby reducing the burden of medication.

Combination treatment with monoclonal antibodies for the management of severe asthma and immune-mediated inflammatory diseases: a comprehensive review.

Biological drugs have revolutionized the management of severe asthma, and a tailored treatment approach made it possible to consider remission as an achievable treatment target. The incidence of autoimmune diseases is increasing in many parts of the world. Patients suffering from severe asthma, eligible or already treated with an asthma-approved biologic agent, may suffer from another immune-mediated inflammatory disease (IMID) that could require the simultaneous use of a second monoclonal antibody. The real-life studies available in the literature describing the concurrent administration of an asthma-approved biologic agent with another biologic for a different immune disease, obtained through a systematic search on online databases based on monoclonal antibodies, were collected and analyzed. 26 articles were included in this review according to the prespecified inclusion and exclusion criteria. All included papers were retrospective in nature. Study designs were case reports (n=18), case series (n=3), retrospective chart reviews (n=3), retrospective observational studies (n=1), and cohort studies (n=1). The study is intended to present, within the current literature, all the administered combinations of severe asthma-approved biologics with monoclonal antibodies for a different indication. Those were grouped according to the IMID for whom the second biologic agent, with a different mechanism of action, was prescribed. The combinations prescribed to the cohort of patients specifically treating uncontrolled severe asthma were deeper evaluated in the discussion section, since an analysis of these therapeutic combinations deriving from real-life experiences may be useful to optimize the management of patients with severe asthma, ultimately leading to improved patient care and outcomes. Prospective registries and future studies are required to assess the safety and efficacy of combination therapies for severe asthmatic patients who suffer from an IMID.

Association between asthma and visceral adipose tissue in adults, a cross-sectional study from NHANES 2011-2018.

Asthma is a chronic inflammatory disease that affects millions of people worldwide. Obesity, particularly visceral adipose tissue (VAT), is known to secrete adipokines and pro-inflammatory factors, which are closely associated with various metabolic and cardiovascular diseases. Research indicates that these metabolic disturbances can exacerbate inflammatory conditions, contributing to both cardiovascular and respiratory diseases, including asthma. Despite these associations, studies on the specific relationship between VAT and asthma remain limited and warrant further investigation. Utilizing the NHANES database from 2011 to 2018, we included a total of 11,137 participants. Multivariable regression analysis was performed, stratifying subjects based on VAT levels and adjusting for various confounders. Subgroup interaction analysis and nonlinear analysis were conducted to explore potential effect modifiers and nonlinear associations. In this study, 11,137 participants were included, with 49.74% being female. Among the 509 asthma patients, 69.35% were female. The number of asthma patients among Non-Hispanic Whites was 212, representing 41.65% of the total, the highest proportion among the studied groups. The VAT for asthma patients was 529g, significantly higher than the 455g in the non-asthma group (P < 0.001). Multivariable regression analysis showed that for every 200g increase in VAT, the risk of asthma increased by 10.4% (P = 0.032), 20.8% (P < 0.001), and 20.3% (P = 0.004) across three models (unadjusted, adjusted for demographic factors, and fully adjusted). Subgroup analysis indicated a stronger association between VAT and asthma risk in females and individuals over 40 years old. Nonlinear analysis uncovers a J-shaped relationship between VAT and asthma, with the lowest risk observed at 464.57g (P < 0.001). The study findings suggest that increased VAT is associated with elevated asthma risk, particularly among females and older individuals. These results underscore the importance of considering VAT in asthma risk assessment and highlight potential targeted interventions to reduce asthma risk associated with excess visceral adiposity.

Comparative Risk of Neuropsychiatric Adverse Events Associated With Leukotriene-Receptor Antagonists Versus Inhaled Corticosteroids

Leukotriene-receptor antagonists (LTRA) and inhaled corticosteroids (ICS) are common controller medications for asthma, but limited studies examine their comparative risks on neuropsychiatric adverse events (NAEs) in asthma patients. To investigate the comparative risks of LTRA versus ICS on seven distinct categories of NAEs in asthma patients at a nationwide level. We conducted a nationwide cohort study during 2010-2021. Incident NAEs and its clinical subgroups (e.g., psychotic disorders, anxiety disorders, movement disorders, behavioral and emotional disorders, mood disorders, sleep-related disorders, and personality disorders) were assessed. Cox proportional hazards regressions were employed to quantify the comparative risks. There were 1,249,897 asthma patients aged 6-64 years. Incidence rates for NAEs were 25.10 per 1000 person-years among patients treated with LTRA, and 23.46 per 1000 person-years among those treated with ICS. The incidence rate difference was 1.64 [95%CI: 0.30-2.98] per 1000 person-years. Positive associations of NAEs and three clinical subgroups were found in patients treated with LTRA compared to ICS (hazard ratios (HR): 1.06 [95%CI: 1.00-1.12] for NAEs; HR: 1.88 [95%CI: 1.24-2.84] for psychotic disorders; HR: 1.10 [95%CI: 1.01-1.20] for anxiety disorders; and HR: 1.27 [95%CI: 1.02-1.58] for behavioral and emotional disorders), but not for movement disorders, mood disorders, sleep-related disorders, and personality disorders. This nationwide cohort study identified heightened risks, ranging from 6% to 88%, of NAEs and three clinical subgroups in asthma patients treated with LTRA compared to ICS. These findings underscore the necessity for clinicians to communicate with patients regarding potential neuropsychiatric harms when prescribing LTRA.

Allergen Immunotherapy for the Prevention and Treatment of Asthma.

Allergic asthma is the predominant phenotype among asthmatics. Although conventional pharmacotherapy is a central component in the management of asthma, it does not enable control of asthma symptoms in all patients. In recent decades, some uncontrolled asthmatic patients, especially those with allergic asthma, have benefited from biological therapies. However, biologics do not address all the unmet needs left by conventional pharmacotherapy. Furthermore, it is noteworthy that neither conventional pharmacotherapy nor biological therapies have disease-modifying properties. In this context, allergen immunotherapy (AIT) represents an indispensable component of the therapeutic arsenal against allergic asthma, due to its disease-modifying immunological effects. In this review article, funded by an AIT manufacturer, we find clinical trials support AIT as the only treatment option able both to improve allergic asthma symptoms and to prevent the onset and worsening of the condition. For patients with severe asthma or other safety concerns, the combination of AIT and biologics offers very promising new treatment modalities for the management of allergic asthma. Trial Registration: clinicaltrials.gov identifier: NCT06027073.

Distinctive CD39+CD9+ lung interstitial macrophages suppress IL-23/Th17-mediated neutrophilic asthma by inhibiting NETosis.

The IL-23-Th17 axis is responsible for neutrophilic inflammation in various inflammatory diseases. Here, we discover a potential pathway to inhibit neutrophilic asthma. In our neutrophil-dominant asthma (NDA) model, single-cell RNA-seq analysis identifies a subpopulation of CD39+CD9+ interstitial macrophages (IMs) suppressed by IL-23 in NDA conditions but increased by an IL-23 inhibitor αIL-23p19. Adoptively transferred CD39+CD9+ IMs suppress neutrophil extracellular trap formation (NETosis), a representative phenotype of NDA, and also Th17 cell activation and neutrophilic inflammation. CD39+CD9+ IMs first attach to neutrophils in a CD9-dependent manner, and then remove ATP near neutrophils that contribute to NETosis in a CD39-dependent manner. Transcriptomic data from asthmatic patients finally show decreased CD39+CD9+ IMs in severe asthma than mild/moderate asthma. Our results suggest that CD39+CD9+ IMs function as a potent negative regulator of neutrophilic inflammation by suppressing NETosis in the IL-23-Th17 axis and can thus serve as a potential therapeutic target for IL-23-Th17-mediated neutrophilic asthma.

Association of metformin use with asthma development and adverse outcomes: A systematic review and meta-analysis.

Asthma and diabetes are prevalent chronic diseases affecting a significant population globally. Research has suggested that metformin, a commonly used medication for diabetes management, may also have beneficial effects in enhancing asthma outcomes. Considering the comorbidity of asthma and diabetes, a comprehensive analysis was performed to investigate the efficacy of metformin in reducing adverse outcomes of asthma patients with diabetes. To gather relevant data, we conducted a systematic search of the PubMed, Embase, and CENTRAL databases for observational studies published prior to September 2023. We specifically looked for studies involving individuals diagnosed with both asthma and diabetes, comparing the incidence and severity of asthma exacerbations in metformin users versus nonusers. The inclusion criteria encompassed studies that recruited participants aged 18 years and older. The primary outcome of interest was the risk of newly developing asthma, while secondary outcomes included the adjusted risk of asthma-induced exacerbations, emergency room visits, and hospitalizations. All data analyses and visualizations were performed using the R programming language. We identified and included 7 studies involving a total of 1,176,398 patients in our analysis. The pooled effect size indicated a potential reduction in the incidence of newly developed asthma among patients with type 2 diabetes who used metformin, although this finding did not reach statistical significance. Similar conclusions have also been observed in other outcomes, such as exacerbation, asthma-related emergency department visits, risk of systemic corticosteroid prescription. The only positive outcome is that the use of metformin can reduce the chance of patients being hospitalized due to asthma. In most outcome indicators, it cannot be assumed that the use of metformin can reduce asthma-related adverse events. However, the conclusion is not so certain, and longer observation and more evidence are still required. Metformin still shows some potential in the intervention of respiratory diseases.

Prevalence and predictors of annual asthma reviews in Scottish primary care data.

People with asthma are recommended to have regular reviews in primary care, with assessment of symptoms, adjustment of treatment and self-management processes, and the delivery of a written action plan for emergencies. Our study aimed to investigate the incidence and factors associated with attendance of annual reviews. electronic health records for approximately 50 000 Scottish asthma patients, between 2008 and 2016. Multivariable logistic regression using linked primary care prescription data and primary care registration demographic data. There was a median of 381 days between subsequent reviews. Reviews in the index year were strongly associated with reviews in the following year (odds ratio 1.76 [1.68-1.84]). In contrast, asthma consultations (excluding reviews) in the index year were associated with a lower odds of having a review in the following year (0.48 [0.46-0.51]). Those aged 18-35 in the index year, or with missing address in the practice registration data, were the least likely age group to have an asthma review in the following year. Reviewing the delivery of asthma care identifies patients who may be slipping through the gaps by receiving only reactive asthma care rather than the structured, preventative care which can be delivered through annual reviews. Understanding the risk factors for not receiving an annual review can be leveraged to create more effective review invitations, such as explaining the specific content of reviews, introducing new contact methods to improve health equity, and reviewing the algorithm used to determine who is invited.

Factors associated with therapeutic non-adherence in asthmatic patients: A multicenter study in Algeria

Effective medication adherence, is a real global challenge that emerges as a pivotal factor influencing asthma control, exacerbation frequency, hospitalization rates and ultimately, mortality, morbidity and health care costs. In light of this, our study aimed to assess therapeutic adherence levels among asthmatic patients and identify factors contributing to non-adherence. We conducted a descriptive, cross-sectional multicenter study, among asthmatic patients receiving outpatient or inpatient care across seven asthma centers located in two Algerian cities: Algiers (University Hospital Center of Benimessous, University Hospital Center of Bab el oued, EPSP of Zeralda, EPSP of Beraki and EPSP of Rouiba) and Constantine (Constantine University Hospital Center (CHU), EPSP of Constantine), between July and December 2023. We evaluated therapeutic adherence using the Morisky 8-item questionnaire, while a 12-item questionnaire assessed patients' knowledge levels. Logistic regression analysis enabled us to identify factors associated with non-adherence. Our study, involved 390 patients, with a median age of 34 years and a sex ratio of 1.5. Notably, 38.2% of asthmatic patients exhibited poor adherence to treatment. Multivariate analysis revealed several factors potentially linked to non-adherence, including, age, place of residence, employment status, access to social insurance, treatment type and complexity, auto-medication, occurrence of adverse effects, limited level of education and inadequate knowledge about asthma management. Furthermore, there was a significant correlation between non-adherence and a higher rate of asthma exacerbations, with a reported occurrence of 68%. our findings emphasize concerning levels of therapeutic adherence, given its impact on disease control and the quality of life of asthmatic patients. This underscores the importance of implementing a therapeutic education program aimed at improving treatment adherence by addressing the factors identified as barriers in clinical patient management.

Local receptor-interacting protein kinase 2 inhibition mitigates house dust mite-induced asthma.

House dust mite is the most frequent trigger of allergic asthma, with innate and adaptive immune mechanisms playing critical roles in outcomes. We recently identified the nucleotide-binding oligomerisation domain 1 (NOD1)/receptor-interacting serine/threonine protein kinase 2 (RIPK2) signalling pathway as a relevant contributor to murine house dust mite-induced asthma. This study aimed to evaluate the effectiveness of a pharmacological RIPK2 inhibitor administered locally as a preventive and therapeutic approach using a house dust mite-induced asthma model in wild-type and humanised NOD1 mice harbouring an asthma-associated risk allele, and its relevance using air-liquid interface epithelial cultures from asthma patients. A RIPK2 inhibitor was administered intranasally either preventively or therapeutically in a murine house dust mite-induced asthma model. Airway hyperresponsiveness, bronchoalveolar lavage composition, cytokine/chemokine expression and mucus production were evaluated, as well as the effect of the inhibitor on precision-cut lung slices. Furthermore, the inhibitor was tested on air-liquid interface epithelial cultures from asthma patients and controls. While local preventive administration of the RIPK2 inhibitor reduced airway hyperresponsiveness, eosinophilia, mucus production, T-helper type 2 cytokines and interleukin 33 (IL-33) in wild-type mice, its therapeutic administration failed to reduce the above parameters, except IL-33. By contrast, therapeutic RIPK2 inhibition mitigated all asthma features in humanised NOD1 mice. Results in precision-cut lung slices emphasised an early role of thymic stromal lymphopoietin and IL-33 in the NOD1-dependent response to house dust mite, and a late effect of NOD1 signalling on IL-13 effector response. RIPK2 inhibitor downregulated thymic stromal lymphopoietin and chemokines in house dust mite-stimulated epithelial cultures from asthma patients. These data support that local interference of the NOD1 signalling pathway through RIPK2 inhibition may represent a new therapeutic approach in house dust mite-induced asthma.

A Comparative Observational Study of the Diagnostic Utility of Impulse Oscillometry Versus Spirometry in Obstructive Airway Diseases.

Background Obstructive airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), significantly impact respiratory function, making accurate diagnosis and differentiation essential for proper management. While spirometry is the gold standard for assessing lung function, impulse oscillometry (IOS) has emerged as a complementary tool, especially when spirometry results are inconclusive. This study aimed to compare the diagnostic utility of IOS with spirometry in patients with obstructive airway diseases and evaluate the correlation between these two methods. Methods A comparative observational study was conducted over 18 months at a tertiary care hospital in central India, including 130 patients (65 with asthma and 65 with COPD). Diagnostic evaluations using spirometry and IOS were performed before and after bronchodilator administration. Spirometry parameters assessed were forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio, while IOS parameters evaluated included resistance at 5 Hz (R5), resistance at20Hz (R20), resonant frequency(Fres), reactance at 5 Hz (X5), and the area under the reactance curve (AX). Statistical analysis was conducted using IBM SPSS version 27.0 (IBM Corp., Armonk, USA) and GraphPad Prism version 7.0 (Dotmatics, Boston, USA). Results Significant differences were observed in spirometry parameters between asthma and COPD groups, with asthma patients showing better lung function (FEV1, FVC, and FEV1/FVC; p<0.05). No significant differences were found in IOS parameters between the groupsexcept for a correlation between FEV1 (%) and IOS measurements in the asthma group. Spirometry demonstrated superior sensitivity in identifying airway obstruction compared to IOS. However, IOS was more effective in detecting peripheral airway obstruction in asthma patients, with 22 out of 65 (33.85%) asthma patients showing peripheral airway obstruction compared to six out of 65 (9.23%) COPD patients (p=0.001). Conclusion While spirometry remains the primary diagnostic tool for assessing obstructive airway diseases, IOS is a valuable adjunct, particularly for detecting peripheral airway involvement in asthma patients. Combining spirometry and IOS enhances diagnostic accuracy and provides a more comprehensive assessment of lung function in patients with asthma and COPD.

Uncovering Factors Contributing to Poor Asthma Control among Asthmatic Patients in Erbil City - Kurdistan Region

الكشف عن العوامل التي تساهم في ضعف السيطرة على الربو: مجموعة مستقبلية خلاصة الخلفية: الربو هو مرض غير متجانس، ويتميز عادة بالتهاب مجرى الهواء المزمن وتقييد تدفق الهواء الزفير المتغير الهدف: كان الهدف من هذه الدراسة هو الكشف عن العوامل التي تساهم في ضعف السيطرة على الربو في مدينة أربيل في العراق. طُرق: تم إجراء هذه الدراسة الرصدية المقطعية على 200 مريض مصاب بالربو في الفترة من 1 يونيو 2023 إلى 31 ديسمبر 2023 لتقييم السيطرة على الربو في مدينة أربيل. الخصائص الديموغرافية والسريرية والمحفزات والأمراض المصاحبة ومشاكل الاستنشاق وأسباب الزيارة وحالة السيطرة على الربو باستخدام استبيان أداة تقييم .GINA 2023 ينقسم مستوى التحكم في الربو إلى ثلاثة مستويات يمكن التحكم فيها، ومستوى يمكن التحكم فيه جزئيًا، وغير يمكن التحكم فيه. نتائج: تمت في هذه الدراسة دراسة 200 مريض مصاب بالربو (108 إناث و 92 ذكر(كان متوسط العمر ± SD للمرضى 35.61 ± 17.182 سنة (يتراوح من 15 إلى 81 سنة)، ونسبة الإناث إلى الذكور هي 1.17:1. السيطرة على الربو سيئة للغاية وتم التحكم في 24 مريضًا فقط (12٪.( ليس للجنس ولا للفئة العمرية علاقة ذات دلالة إحصائية مع السيطرة على الربو. تشمل العوامل ذات الأهمية الإحصائية المرتبطة بالسيطرة على الربو تقنية الاستنشاق غير الصحيحة (45.5%)، والخوف من الإدمان (29%)، ووصفات الاستنشاق غير الصحيحة (27.5%)، والساحل (23%)، ونوع الجهاز (22.5%)، والالتهابات (21 ( % ، والتعرض الداخلي والخارجي (18%)، ودخان التبغ (17%)، والتهاب الأنف التحسسي ((%28.5)، والارتجاع المعدي المريئي (21.5(% علاج SABA وحده 104 (52%)، في حين أن العوامل الأخرى المرتبطة بالسيطرة على الربو ولكنها ليست ذات دلالة إحصائية مثل الإجهاد العاطفي (9.5%) وحساسية الطعام (8.5%)، والسمنة (15%)، والتهاب الجلد التأتبي (6(% ، انقطاع التنفس الانسدادي أثناء النوم (15%)، والحمل (5.5 .(% خاتمة: من العوامل ذات الأهمية الإحصائية المرتبطة بسوء التحكم في الربو هي أن الربو الذي يتم التحكم فيه بشكل سيئ مرتبط بأجهزة الاستنشاق (تقنية الاستنشاق غير المناسبة، وصفة الاستنشاق غير المناسبة، وعدم الالتزام بجهاز الاستنشاق) والمحفزات (العدوى، والحساسية، والدخان، والتلوث) والأمراض المصاحبة (التهاب الجيوب الأنفية، والارتجاع المعدي المريئي.( الكلمات المفتاحية: ، المثيرات الربو، السيطرة، الاستنشاق ، الأمراض المصاحبة.

Knowledge of self-management and asthma control among asthma patients attending a polyclinic in Western part of Singapore

BACKGROUND: Self-management is important for asthma control, yet it is unclear whether asthmatic patients have sufficient knowledge to optimally manage their disease. We examined the associations between the knowledge of self-management in adult patients attending a polyclinic in Singapore, sociodemographic factors, and asthma control. MATERIALS AND METHODS: A cross-sectional survey was conducted among adult asthmatic patients in a public primary care clinic (polyclinic) using convenience sampling. A a structured and validated self-administered questionnaire solicited the responses of study participants. Questionnaire comprised three sections: (1) Sociodemographic and asthma-related variables, (2) Modified Asthma Self-Management Questionnaire (ASMQ), and (3) The GINA assessment of asthma control. Participants completed the questionnaire in the clinic waiting area and returned them into a sealed box in the same area. Data were analyzed using SPSS version 29.0. Summary statistics were used to describe the study sample; t-test or analysis of variance (ANOVA), as appropriate, tested the differences in self-management knowledge by sociodemographic characteristics. Logistic regression was used to determine the association between asthma control and self-management knowledge controlling for sociodemographic characteristics. RESULTS: The sample comprised 141 asthma patients; Out of a total of 100 points, the mean ASMQ score was 46.8 (standard deviation 21.7). The scores for the knowledge of self-management of Asthma differed by age, level of education, and having been taught about asthma on bivariate analyses (P &lt; 0.05). Linear regression showed a significant association of asthma self-management knowledge with educational level only. No association was observed between ASMQ scores and asthma control. CONCLUSION: There were gaps in patients’ knowledge about asthma self-management, although they were generally knowledgeable about the inhaler technique. Higher education levels were associated with higher levels of knowledge beyond the effect of age and having been instructed about asthma, suggest that it is crucial that educational programs on asthma are made accessible to patients with lower levels of education. Further research needs to determine whether asthma educational programs targeting the knowledge gaps found in this study can improve knowledge of self-management and asthma control.

NFATc1 in CD4+ T cells and CD11c+ dendritic cells drives TH2-mediated eosinophilic inflammation in allergic asthma

BackgroundAsthma, a chronic lung disease, is a significant public health problem worldwide. It is marked by increased Th2 response resulting in eosinophil accumulation. The pathophysiology of asthma involves various cell types, including epithelial cells, dendritic cells (DCs), innate lymphoid cells (ILCs), B cells, and effector cells. Nuclear factor of activated T-cells, cytoplasmic 1 (NFATc1), a critical transcription factor for immune regulation, is known for its role in T cells and, more recently, in myeloid cells. However, the specific contributions of NFATc1 in T cells and DCs in the context of asthma are not well understood. ObjectiveExplore NFATc1’s role in T cells and dendritic cells in modulating Th2 immune responses within the pathophysiology of allergic asthma. MethodsMice lacking Nfatc1 in CD4+T cells or CD11c+ dendritic cells, were induced with asthma using house dust mite (HDM), enabling investigation into NFATc1's role in both cell types in experimental allergic asthma. Additionally, the study examined NFATc1 expression in these cells and its correlation with blood eosinophil levels in an adult asthma cohort. ResultsIn HDM-induced asthma model, we found that Nfatc1 deficiency either in CD4+ T cells or CD11c+ dendritic cells resulted in reduced Th2-driven eosinophilic inflammation, immunoglobulin E (IgE) levels, and mast cell presence in the lung of asthmatic mice. Nfatc1's absence in CD4+ T cells directly hampered Th2 cell polarization and functionality, whereas in CD11c+ dendritic cells, it affected DC differentiation and maturation, thereby weakening T cell priming, proliferation and subsequent Th2 differentiation. Correspondingly, translational research indicated significant correlations between CD4+NFATc1+ and CD11c+NFATc1+ cell populations and eosinophil levels in asthmatic patients, but not in healthy controls. ConclusionNFATc1 in T cells and dendritic cells modulate Th2-mediated eosinophilic inflammation in allergic asthma, which offering insights into asthma pathogenesis and identifying NFATc1 as a potential target for therapeutic intervention.

Transcriptional profiles of peripheral eosinophils in chronic obstructive pulmonary disease and asthma-An exploratory study.

The role of eosinophilic inflammation in the pathogenesis of chronic obstructive pulmonary disease (COPD) remains ambiguous and likely differs from its role in asthma. The molecular processes underlying the differences between eosinophils from asthma and COPD have not been sufficiently studied. The objective of this study was to compare the transcriptomic profiles of blood eosinophils in COPD and asthma. Eosinophils were isolated from peripheral blood drawn from stable mild-to-moderate COPD and asthma patients. RNA was isolated from eosinophils and sequenced using an NGSelect RNA. The prepared libraries were sequenced on an Illumina platform. The study group included five patients with asthma and four patients with COPD. The RNA-Seq data analysis identified 26 differentially expressed genes between COPD and asthma (according to adjusted p-value). In total, 6 genes were upregulated (e.g. CCL3L1, CCL4L2, GPR82) and 20 were downregulated (e.g. JUN, IFITM3, DUSP1, GNG7) in peripheral eosinophils of COPD patients compared to asthma. The genes associated with signalling of IL-4 and IL-13 pathways were downregulated in COPD eosinophils compared to asthma. In conclusion, blood eosinophils from COPD and asthma patients present different transcriptomic profiles suggesting their different function in pathobiology of both obstructive airway diseases. These differences might indicate the direction of the search of targeted therapy in COPD.

The Impact of Wildfire Smoke on Asthma Control in California: A Microsimulation Approach.

Wildfire smoke exposure leads to poorer health among those with pre-existing conditions such as asthma. Particulate matter in wildfire smoke can worsen asthma control, cause acute exacerbations, and increase health resource utilization (HRU) and costs. Research to date has been retrospective with few opportunities to project changes in underlying asthma control and HRU given exposure to wildfire smoke. Using a microsimulation of 5,000 Californians with asthma, we calculated changes in asthma control distribution, risk of exacerbation, and HRU and cost outcomes in the 16weeks during and after a wildfire. The model was calibrated against empirical values on asthma control distribution and increased HRU after exposure to wildfire smoke. Without smoke exposure, 48% of the cohort exhibited complete or well control of asthma, and 8% required acute healthcare per cycle. Following two consecutive weeks of wildfire smoke, complete or well control of asthma fell to 27%, with an additional 4% HRU. This corresponds to total additional $601,250 in all-cause medical costs and eight fewer quality-adjusted life years over 16weeks of model time. Our model found increased asthma health and cost burden due to wildfire smoke that were aligned with empirical evidence from a historic wildfire event. This study establishes a framework for a more nuanced understanding of asthma impacts from wildfire smoke that can help inform the development of public health policies to mitigate harm and promote resilience among asthma patients in the face of climate change.

Remote asthma monitoring: How and why?

Background: The coronavirus disease 2019 pandemic contributed to substantial advancement in digital technologies in health care. Health-care professionals involved in respiratory care can now tailor their therapy for their patients with asthma, who still account for &gt;1 million emergency department visits annually, with remote monitoring services. Remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) are both ways to help patients with chronic asthma and other patients who need respiratory monitoring in pulmonary and in allergy and immunology clinics. RPM and RTM allow clinicians to gain further understanding as to what is going on in the patient’s home on a regular basis. Objectives: To ensure that the populations to monitor are correctly identified, privacy and security measures are in place, staffing resources are sufficient, and billing practices are understood before initiating RPM and RTM. Methods: A review of the current literature (2019‐2023) for RPM and RTM from PubMed, National Center of Biotechnical Information, American College of Allergy, Asthma and Immunology and the U.S. Centers for Disease Control and Prevention as well as practical experiences are outlined to provide an easy-to-follow guide for implementation in practice. Results: RPM and RTM services help identify and address gaps in care for patients such as patients with uncontrolled asthma and to assist with populations of need such as the underserved, the elderly, and rural populations. Conclusion: As artificial intelligence and other technologies continue to grow in the healthcare space, remote monitoring services are expected to transform health-care delivery to new heights yet to be seen.

Factors Associated with Health-related Quality of Life in Moroccan Adults with Asthma

Introduction: The assessment of asthmatics’ health-related quality of life (HRQOL) has become an important outcome measure of the disease’s effects from the patient’s perspective. This study aims to assess the asthmatics’ QOL and determine the factors affecting it. Methods: A cross-sectional study was conducted among 220 adult people with asthma attending the Pneumology Department of Hassan II University Hospital in Fez from March to May 2022. Patients were questioned by a face-to-face questionnaire, an asthma control test, an observance questionnaire, a knowledge questionnaire, and a specific asthma QOL questionnaire. The influence of the variables was evaluated by bivariate analysis and multiple linear regression. Results: The mean age was 48.4 ± 15.4. 71.8% were women, half were not attending school, and 77.7% lived in urban areas. 67.7% were nonsmokers, and 72.73% were passive workers. Only 42.27% complied well with treatment, and 41.82% have well-controlled asthma. The majority of people had insufficient knowledge. The QOL was considered good for 20% of the participants, poor for 11.8%, and average for 68.2% of the patients. The mean of the global QOL score was 5.1 ± 0.9. The most significant factors associated with a higher QOL were good asthma control (ß = 0.70; P ≤ 0.001), good knowledge score (ß = 0.125; P = 0.013), insurance coverage (ß = 0.144; P = 0.005), and work activity (ß = 0.133; P = 0.007). Conclusion: Our study found multiple factors affecting asthma patients’ QOL, including asthma control, knowledge, and socioeconomic status. We can take some measures to improve the situation through patient education.