Asthma Attacks Research Articles

Revisits to a pediatric hospital emergency department for asthma attacks

Revisits to a pediatric hospital emergency department for asthma attacks

A case study to investigate the effects of Chlorhexidine mouthwash on serum cytokines levels in children with Asthma

Asthma is an airways inflammatory disease and the most common chronic disease of childhood, which causes most hospital visits and placing a heavy financial burden on families and communities. Interleukins 4, 5 and 13, play a central role in the pathogenesis of asthma. Given the importance of oral hygiene in asthmatic patients and IL-4 and 5 are involved in the inflammatory process of periodontitis, the effect of chlorhexidine as mouthwash on asthma attacks in children on serum cytokines is necessary. In this study, 375 children with asthma were divided into two groups using or non-using chlorhexidine. Blood samples were taken and cytokines were measured by ELISA. From 375 patients, 17 patients were excluded. In this study, 171 males and 187 females participated and there were 180 patients in asthma group and 178 patients in asthma/Chlorhexidine group. The levels of IL-4, IL-5 and IL-13 had no significant difference (p > 0.05) between Asthma and Asthma/Chlorhexidine groups. Using chlorhexidine as mouthwash in children with asthma had no effect on the type 2 cytokines and may not trigger an asthma attack via allergo-inflammatory mechanism.

Emergency department discharge practices for children with acute wheeze and asthma: a survey of discharge practice and review of safety netting instructions in the UK and Ireland

ObjectiveRecovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe...

Salbutamol Easyhaler provides non-inferior relief of methacholine induced bronchoconstriction in comparison to Ventoline Evohaler with spacer: A randomized trial

BackgroundSalbutamol is a cornerstone for relieving acute asthma symptoms, typically administered through a pressurized metered-dose inhaler (pMDI). Dry powder inhalers (DPIs) offer an alternative, but concerns exist whether DPIs provide an effective relief during an obstructive event. ObjectiveWe aimed to show non-inferiority of Salbutamol Easyhaler DPI compared to pMDI with spacer in treating methacholine-induced bronchoconstriction. Applicability of Budesonide-formoterol Easyhaler DPI as a reliever was also assessed. MethodsThis was a randomized, parallel-group trial in subjects sent to methacholine challenge (MC) test for asthma diagnostics. Participants with at least 20 % decrease in forced expiratory volume in 1 s (FEV1) were randomized to receive Salbutamol Easyhaler (2 × 200 μg), Ventoline Evohaler with spacer (4 × 100 μg) or Budesonide-formoterol Easyhaler (2 × 160/4.5 μg) as a reliever. The treatment was repeated if FEV1 did not recover to at least −10 % of baseline. Results180 participants (69 % females, mean age 46 yrs [range 18–80], FEV1%pred 89.5 [62–142] %) completed the trial. Salbutamol Easyhaler was non-inferior to pMDI with spacer in acute relief of bronchoconstriction showing a −0.083 (95 % LCL -0.146) L FEV1 difference after the first dose and −0.032 (−0.071) L after the last dose. The differences in FEV1 between Budesonide-formoterol Easyhaler and Salbutamol pMDI with spacer were −0.163 (−0.225) L after the first and −0.092 (−0.131) L after the last dose. ConclusionThe study confirms non-inferiority of Salbutamol Easyhaler to Ventoline Evohaler with spacer in relieving acute bronchoconstriction, making Easyhaler a sustainable and safe reliever for MC test and supports its use during asthma attacks.

Cause of death coding in asthma

BackgroundWhile clinical coding is intended to be an objective and standardized practice, it is important to recognize that it is not entirely the case. The clinical and bureaucratic practices from event of death to a case being entered into a research dataset are important context for analysing and interpreting this data. Variation in practices can influence the accuracy of the final coded record in two different stages: the reporting of the death certificate, and the International Classification of Diseases (Version 10; ICD-10) coding of that certificate.MethodsThis study investigated 91,022 deaths recorded in the Scottish Asthma Learning Healthcare System dataset between 2000 and 2017. Asthma-related deaths were identified by the presence of any of ICD-10 codes J45 or J46, in any position. These codes were categorized either as relating to asthma attacks specifically (status asthmatic; J46) or generally to asthma diagnosis (J45).ResultsWe found that one in every 200 deaths in this were coded as being asthma related. Less than 1% of asthma-related mortality records used both J45 and J46 ICD-10 codes as causes. Infection (predominantly pneumonia) was more commonly reported as a contributing cause of death when J45 was the primary coded cause, compared to J46, which specifically denotes asthma attacks.ConclusionFurther inspection of patient history can be essential to validate deaths recorded as caused by asthma, and to identify potentially mis-recorded non-asthma deaths, particularly in those with complex comorbidities.

Levels of Galectin-7 in serum and sputum in children with asthma

Objective: To observe the expression of Galectin-7 in the serum and sputum of asthmatic children and to explore its significance in asthmatic children. Methods: The study prospectively case-control selected 183 children diagnosed with bronchial asthma at Department Ⅱ of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital of Capital Medical University. The control group consisted of 41 children with other bronchial diseases and 43 healthy children. Children in the asthma group were divided into acute and non-acute exacerbation groups. Acute exacerbation group was divided as mild acute, moderate acute and severe acute groups; non-acute exacerbation group was divided as mild persistent, moderate persistent and severe persistent groups. Children without acute exacerbation asthma in the asthma group were divided into high and low Galectin-7 groups based on median serum Galectin-7 levels. Serum and sputum were collected, Galectin-7 levels were measured using enzyme-linked immunosorbent assay. The study compared and analyzed the differences in Galectin-7 levels between children with asthma and the control groups using Mann-Whitney U test or the Kruskal-Wallis or the Chi-square test for inter-group comparisons. Results: Among 183 children, 61 cases had acute asthma exacerbation, and 122 cases had persistent asthma without acute exacerbation. The asthma group comprised 110 males and 73 females. The control group consisted of 41 children with other bronchial diseases, including 24 cases of bronchiectasis and 17 cases of obliterans bronchitis. The control group comprised 26 males and 15 females. Forty-three healthy children who underwent physical examination, including 22 males and 21 females. The levels of Galectin-7 in serum were significantly higher in children with an acute asthma exacerbation than that of healthy children (0.1 (0, 0.7) vs. 0 (0, 0.2) μg/L, Z=2.09, P=0.001). Galectin-7 levels in sputum were higher in children with an acute asthma exacerbation than that in children with other bronchial diseases (1.2 (0.1,3.7) vs. 0.4 (0.1, 1.5) μg/L, Z=2.20, P<0.001). Serum Galectin-7 levels were significantly higher in children with persistent asthma compared to children with other bronchial diseases and healthy children (0.6 (0.3, 1.2) vs. 0.1 (0, 0.5) and 0 (0, 0.2) μg/L, Z=-6.12,-7.63, both P<0.001), and the levels were significantly and positively correlated with asthma severity (r=0.77, P<0.001), disease duration (r=0.34, P=0.001), and number of previous attacks (r=0.51, P<0.001). There were 61 children in the high-Galectin-7 group and 61 children in the low-Galectin-7 group. Children with high Galectin-7 had more asthma triggers, a greater proportion with a positive family history, more previous asthma attacks, longer duration of asthma, and higher serum total IgE levels compared to those with low Galectin-7 (χ2=9.30, 22.46, Z=5.06, 3.57, 2.31, all P<0.05). Conclusion: The expression of Galectin-7 is found to be elevated in the serum and sputum of asthmatic children and correlated with asthma conditions.

Evaluation of child with asthma and her caregivers based on the Pender health promotion model, and linkages of NANDA, NIC-NOC: A case presentation.

Despite highly effective asthma treatments, the prevalence of asthma is increasing in children and adolescents. Despite easy access to asthma control, sufficient control and management are not achieved. Asthma management is crucial to prevent the development of asthma symptoms and attacks, reduce repeated hospitalizations, and prevent a decrease in the quality of life for both the child and caregivers. This case study aims to increase the utilization of theories, models, and classification systems by evaluating a child diagnosed with asthma for 6 years and their caregivers based on Pender's health promotion model (PHPM). Furthermore, the study aims to establish a connection with NANDA, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), thereby formulating a nursing care plan. This case study evaluated a child diagnosed with asthma for 6 years and their caregivers based on PHPM. A nursing care plan was developed by establishing connections with NANDA, NIC, and NOC and based on Pender's health promotion. By establishing connections with NANDA, NIC, and NOC, a nursing care plan of a total of six included nursing diagnoses has been created as five based on the PHPM. The care plan implemented improved S.B.K.'s clinical condition. Furthermore, the mother's social support increased, and her confidence in managing asthma improved. As a result of implementing the model, the mother reached the potential to develop healthy behaviors for S.B.K. and make future-oriented plans. It is recommended that NANDA-I, NIC, and NOC, along with PHPM, be used in clinical nursing care and scientific research to enhance the presentation of quality care and the individual's future health potential.

Role of Inhaled Isotonic Mgso4 in Management of Acute Asthma attacks in children

Role of Inhaled Isotonic Mgso4 in Management of Acute Asthma attacks in children

Effects of WuHuTang on the function and autophagy of dendritic cells treated with exosomes induced by RSV

Ethnopharmacological relevanceWuHuTang (WHT) is a traditional Chinese medicine compound for treating asthma, and the evidence supports that it has a good effect on acute asthma attacks in children and adults. Respiratory syncytial virus (RSV) is an important factor in the pathogenesis of acute asthma attacks, and the effect on dendritic cells is the key to its pathogenesis. Previous studies have confirmed that the pathogenesis of viruses is related to exosomes. However, there are few studies on the exosomes induced by RSV. Whether WHT can improve the changes caused by RSV-induced exosomes or not is worthy of further exploration. Aim of the studyWe aim to study the effects of RSV-induced exosomes on the function and autophagy of dendritic cells, and to observe the intervention effect of WHT serum on the above effects. MethodsThe co-culture model of exosomes derived from bone marrow mesenchymal stem cells induced by RSV (BMSCs-Exo-RSV) and dendritic cells was established, and then WHT serum was used to intervene. After 24 h of intervention, the CCK-8 method, flow cytometry, Elisa, RT-qCPR, and Western blot were used to detect the above-mentioned culture model. ResultsRSV-induced exosomes had certain effects on viability, apoptosis, and costimulatory molecules generation of dendritic cells. At the same time, the levels of IL-6, IL-12, TNF-α, and autophagy increased, while the levels of IL-4, IL-10, and TGF-β decreased, and the AKT/TSC/mTOR pathway was inhibited. WHT serum could activate this pathway and reverse the above changes in dendritic cells. ConclusionThis study reveals that the pathogenic effect of RSV is related to the exosomes induced by RSV. The exosomes induced by RSV affect the function of dendritic cells by inhibiting the AKT/TSC/mTOR pathway, which can be activated by WHT to reverse the effects caused by RSV-induced exosomes.

Type 1 Kounis syndrome: recurrent myocardial infarctions in a patient with aspirin-exacerbated respiratory disease: a case report

Introduction. We present a case of type 1 Kounis syndrome in a patient with recurrent myocardial infarction with non-obstructive coronary arteries (MINOCA) due to allergic coronary vasospasm. Awareness of doctors about this pathology will allow identifying the MINOCA causes and prescribing pathogenetic treatment.Brief description. A 51-year-old woman with aspirin-exacerbated respiratory disease (asthma, rhinosinusitis with nasal polyposis, aspirin hypersensitivity, eosinophilia) without cardiovascular risk factors developed three recurrent myocardial infarctions against the background of vasospastic angina over a 6-month period. Despite the typical clinical performance, stable ST segment elevation, unchanged coronary arteries on coronary angiography, the vasospastic MI was not immediately established. The patient received long-term treatment for type 1 MI, including beta-blockers. Recurrent MI occurred against the background of an asthma attack. During the second and third hospitalization for MI, coronary angiography revealed a spasm of the right coronary artery, which completely resolved with the nitroglycerin administration. Intracoronary ultrasound made it possible to rule out atherosclerotic involvement of the infarct-related artery. Subsequently, microvascular angina developed, which was confirmed by positron emission tomography. Vasospastic angina in combination with microvascular angina, MIBOCA with asthma attacks, were regarded as type 1 Kounis syndrome. Over the next 2 years, the patient received pathogenetic treatment, and no recurrent cardiovascular events were observed.Discussion. Lack of awareness about Kounis syndrome led to incomplete examination of the patient with MIBOCA and the prescription of pathogenetically unreasonable tehrapy, which could contribute to recurrent MI within 6 months.

Control status and follow-up of acute attacks in children with bronchial asthma with normal pulmonary ventilation function

To investigate the control status of bronchial asthma (referred to as "asthma") in school-age children with normal pulmonary ventilation function and the occurrence of acute attacks within 1 year of follow-up. A retrospective analysis was conducted on clinical data of 327 children aged 6-14 years with bronchial asthma and normal pulmonary ventilation function from April to September 2021. Based on the measured value of one second rate (FEV1/FVC), the children were divided into the ≥80% group (267 cases) and the <80% group (60 cases). The pulmonary ventilation function, asthma control level, and occurrence of acute attacks within 1 year were compared between the two groups. The baseline pulmonary ventilation function in the <80% group was lower than that in the ≥80% group, and the proportion of small airway dysfunction was higher than that in the ≥80% group (P<0.05). After standardized treatment for 1 year, the small airway function indices in the <80% group improved but remained lower than those in the ≥80% group (P<0.05). The rate of incomplete asthma control at baseline was 34.6% (113/327), and the asthma control level in the <80% group was lower than that in the ≥80% group (P<0.05). After standardized treatment for 1 year, the asthma control level in the <80% group remained lower than that in the ≥80% group, and the proportion of acute asthma attacks was higher than that in the ≥80% group (P<0.05). Approximately one-third of school-age children with asthma still have incomplete asthma control when their pulmonary ventilation function is normal. Among them, children with measured FEV1/FVC<80% have an increased risk of acute asthma attacks and require close follow-up and strengthened asthma management.

ASSOCIATING HIGHWAY DENSITY WITH ASTHMA: UNRAVELING THE LINK BETWEEN TRAFFIC-RELATED POLLUTION AND HEALTH IN U.S. NON-CALIFORNIA METROPOLITAN AREAS

This study delves into the influence of traffic-related pollution on respiratory diseases within the United States. While prior research has established a connection between air pollution and mortality or morbidity in sensitive age groups, this association has been predominantly observed in highly polluted areas, particularly in California. In this paper, we extend this line of investigation by examining adult patients with asthma symptoms across various metropolitan areas throughout the country. To address potential endogeneity concerns in our empirical framework, we adopt highway density as an instrumental variable (IV) for NO2 concentrations. This approach allows us to gain a more robust understanding of the relationship between traffic-related pollution and respiratory health outcomes. Our findings indicate that NO2 does not have a significant impact on patients with asthma symptoms in the overall sample. However, we observed that it can exacerbate asthma conditions in patients residing in warm areas. A back-of-the-envelope calculation estimates a $6.758 billion economic loss due to increasing asthma attack on adults in the selected study area. This regional disparity outside of California underscores the necessity for adjusting current regulations on vehicle emissions based on unique regional characteristics. Such adjustments could help mitigate adverse health effects associated with traffic-related pollution in different parts of the United States.

Systematic Review of Air Pollution in Morocco: Status, Impacts, and Future Directions

AbstractDespite the recognition of the importance of air pollution in Morocco, current scientific studies are predominantly descriptive and limited. This systematic review aims to provide a comprehensive overview of air pollution in Morocco, delineating the research status and identifying gaps. Searches conducted across PubMed, Google Scholar, and Scopus from 2016 to May 2023 yielded over 3200 articles. From these, 64 original studies are deemed eligible and selected, focusing on air pollution in Moroccan regions or cities. Review articles and those dealing with indoor air quality are excluded, with no restriction on specific pollutant. Research highlights road traffic as the primary contributor to air pollution in Morocco, followed by industrial activities. Exposure to air pollutants is associated with adverse health effects, including mortality, lung disease, respiratory disorders, asthma attacks, and cardiovascular disease. Pollution levels vary among cities, with Casablanca, Kenitra, and Essaouira consistently facing higher pollution levels due to transportation and industrial emissions. Altitude also influences air quality, with higher‐altitude areas generally experiencing lower pollutant concentrations. The review highlights the need for extensive research on air pollution's health and economic effects, improved air quality modeling, and broader pollutant focus beyond just regulated ones.

Advances in non-type 2 severe asthma: from molecular insights to novel treatment strategies.

Asthma is a prevalent pulmonary disease that affects more than 300 million people worldwide and imposes a substantial economic burden. While medication can effectively control symptoms in some patients, severe asthma attacks, driven by airway inflammation induced by environmental and infectious exposures, continue to be a major cause of asthma-related mortality. Heterogeneous phenotypes of asthma include type 2 (T2) and non-T2 asthma. Non-T2 asthma is often observed in patients with severe and/or steroid-resistant asthma. This review covers the molecular mechanisms, clinical phenotypes, causes and promising treatments of non-T2 severe asthma. Specifically, we discuss the signalling pathways for non-T2 asthma including the activation of inflammasomes, interferon responses and interleukin-17 pathways, and their contributions to the subtypes, progression and severity of non-T2 asthma. Understanding the molecular mechanisms and genetic determinants underlying non-T2 asthma could form the basis for precision medicine in severe asthma treatment.

DIGIPREDICT: physiological, behavioural and environmental predictors of asthma attacks—a prospective observational study using digital markers and artificial intelligence—study protocol

IntroductionAsthma attacks are a leading cause of morbidity and mortality but are preventable in most if detected and treated promptly. However, the changes that occur physiologically and behaviourally in the...

Exploring Montelukast Sodium and Calcium Chloride Interactions: A Comparative Study at Physiological and Gastric pH Levels

Montelukast, a leukotriene receptor antagonist (LTRA) is used to prevent an asthmatic attack, shortness of breath and wheezing. As intravenous therapy, Calcium chloride (fused) is used to treat hypocalcemia. Using spectrophotometry, an in vitro study of the interaction between Montelukast sodium and Calcium chloride (fused) was conducted at pH 7.4 and pH 2.4 in aqueous systems at 37 ± 0.5 °C. A reverse V-shaped curve was found from the Job’s plot indicating a strong kinetics between Montelukast sodium and Calcium chloride. The stability constant was obtained from Ardon’s plot for the complexation at both pH values (7.4 and 2.4), which indicates that Montelukast sodium and Calcium chloride relatively form a stable complex at pH 7.4. Therefore, concomitant administration of Montelukast sodium and Calcium chloride (fused) needed careful consideration since there is a possibility of forming a complex which in turn reduces the therapeutic activity.

A bronchiole-on-a-chip and a stretching system for studying human disease model of asthma attack

Asthma is an important public health issue in developed and developing countries, with a prevalence of 300 million worldwide. It is a heterogeneous disease characterized by chronic airway inflammation and hyperresponsiveness. A bronchiole-on-a-chip with a compact stretching system, which is comparable to the small-size incubator and can provide continuous cyclical scratches, is reported here for emulating the physiology of asthma and other types of lung diseases with various breathing rates. In this study, bronchial smooth muscle cells (BSMCs) are cultured on the bronchiole-on-a-chip under cyclic stretching, mimicking the respiratory rates for healthy adults and asthma patients under bronchospasm. With the cyclical cell stretching, the physiology of BSMCs is affected. In an asthma-conditioned bronchial chip, secretions of pro-inflammatory cytokines IL-6 and IL-8 increase significantly from BSMCs compared with the static or healthy condition. In on-chip treatment studies, BSMCs are treated with various concentrations of indacaterol, a long-acting bronchodilator for asthma. The secretion of IL-6 is suppressed for the indacaterol-treated group under asthma conditions. The alignment of stretched BSMCs is also affected by mechanical stretching. Bronchiole-on-a-chip demonstrates the possibility of mimicking the physiological condition of asthma in vitro and a potential drug screening system for lung diseases.

The association between waist circumference and adult asthma attack using nationally representative samples

AimsThis study aims to explore the relationship between waist circumference and asthma attack in adults.MethodsIn this cross-sectional study, we analysed data from 5,530 U.S. adults diagnosed with asthma. Participants were categorized into two groups based on their experience of asthma attacks: with or without asthma attacks. We employed adjusted weighted logistic regression models, weighted restricted cubic splines, subgroup and sensitivity analyses to assess the association between waist circumference and asthma attack.ResultsThe median age of all participants was 43 years, and the median waist circumference was 98.9 cm, with a median BMI was 28.50 kg/m2. Participants in the asthma attack group had significantly higher waist circumferences than those in the non-attack group (P < 0.001). After full adjustment for body mass index-defined obesity, age, gender, race, education levels, poverty income ratio levels, smoking status, and metabolic syndrome, every 5 cm increase in waist circumference exhibited a 1.06 times higher likelihood of asthma attack probability. The weighted restricted cubic spline analysis demonstrated an increased risk of asthma attacks with rising waist circumference. Subgroup analyses confirmed this relationship across various groups differentiated by gender, age, and smoking status. When applying a stricter definition of asthma attack, the weighted logistic regression models showed robust association between waist circumference and asthma attack.ConclusionWaist circumference is an independent predictor of asthma attacks. Our findings underscore the importance of waist circumference measurement in evaluating the risk of asthma attacks.

Ancient Indian Diet – A Balanced Diet for the Healthy Diversity of Gut Microbiota and Management of Asthma

Modernization, a stressful lifestyle, attachment to a Western diet, and the use of preserved and processed foods lead to a loss of homeostasis of intestinal microbial diversity. The use of refined flour and refined sugar, which lack of micro biota-accessible carbohydrates (MAC), means dietary fiber high salt consumption, and saturated fats in fried and packaged foods cause gut microbiota dysbiosis. Microbial dysbiosis caused by high fat, salt, and lack of fiber causes several metabolic diseases, including asthma. The objective of the study is to develop a hypothetic model that “Ancient Indian diet” which is inspired by thousands of years of Indian science, including Yoga, Ayurveda, and Naturopathy may maintain the diversity of the gut microbiota and may inhibits the asthmatic symptoms by enhancing the growth of antiasthmatic bacteria. A keyword search utilizing the phrases "western diet, beneficial microbiota, asthma, gut microbial dysbiosis, Ancient Indian diet" was conducted electronically search through the SCOPUS ,Science Direct ,PubMed, Web of Science, and PsycINFO databases. Search criteria are divided into two arms the first one includes different full-text research papers including how Indian diet altered gut microbial composition. The second one, we included the full text including how presence of certain gut microbiota can prevents the asthmatic attack. To find publications that met the eligibility requirements, the first and third authors separately reviewed each publication's title and abstract using the previously described inclusion criteria. We have included 124 research articles, which is published between 1989 to 2024. A plant-based ancient Indian diet increases the diversity of Bacteroidetes, Actinobacteria, Prevotella, Bifidobacterium, Lactobacillus, Ruminococcus, Roseburia, Lactobacillus, Lachnospira, Akkermansia and shows inhibitory effects against Clostridium, E. coli, Staphylococcus, Haemophilus, Moraxella and Neisseria. The ancient Indian diet a low-fat lacto-vegetarian diet maintains gut microbiota homeostasis, and suppresses the growth of pathogenic asthmatic bacteria and promotes the growth of beneficial asthmatic bacteria.

Interventions for pediatric asthma a literature review of efficacy and safety in pharmacological and non-pharmacological modalities

Asthma continues to be a major global health concern due to its related morbidity and healthcare utilization, especially in children. Pharmaceutical treatments are crucial for managing asthma, but non-pharmacological therapies are now increasingly recognized for their complimentary benefits in enhancing quality of life and lowering medication reliance. This review examines the many methods for managing asthma that involve both non-pharmacological and pharmacological techniques. The review underscores the significance of environmental triggers, including dust mites, pet dander, and mold, and shows practical strategies for mitigating allergy symptoms and adjusting living environments. It also covers how enhancing indoor air quality using smoke-free zones and HEPA air filters might lessen asthma attacks, particularly in kids who are exposed to secondhand smoke and urban air pollution. The objective is to maximize the care of asthma and reduce the worldwide prevalence of this chronic respiratory disorder by implementing comprehensive approaches that incorporate both non-pharmacological and pharmaceutical interventions.