Asthma Symptom Burden Research Articles

Adverse Childhood Experiences and Related Events are Associated with Asthma Symptoms in Children

ObjectiveTo examine the association between adverse childhood experiences (ACEs) and related events and asthma symptom burden in children. MethodsThis is a cross-sectional study of baseline data from 147 participants with asthma from a cohort of children enrolled in the Pediatric ACEs Screening and Resiliency Study. Participants completed the PEdiatric ACEs and Related Life Events Screener (PEARLS) tool, a 17-item questionnaire, capturing 3 domains of childhood adversity—child maltreatment, household challenges, and social context. Asthma symptom burden was assessed using the International Study of Asthma and Allergies in Childhood core questionnaire, which asks participants to identify the presence and frequency of severe wheezing that limits speech, wheezing with exercise, nocturnal wheezing, and nocturnal cough in the last 12 months. Using multivariable logistical regression models, we examined the relationship between reported PEARLS and asthma symptoms. ResultsOf children with asthma, 86% reported at least 1 adversity, with 48% reporting 4 or more. The odds of severe wheeze limiting speech increased by 19% with each additional reported adversity captured by the PEARLS tool (95% confidence intervals (CI) 1.01–1.41). Increasing PEARLS scores were also associated with 16% increased odds of reporting wheeze with exercise (95% CI 1.03–1.31). Wheezing with exercise was associated with the household challenges domain (odds ratio (OR) 1.34; 95% CI 1.05–1.72), while severe wheeze limiting speech was associated with the social context domain (OR 1.75; 95%CI 1.02–3.02). ConclusionsChildhood adversities are associated with increased asthma symptom burden, suggesting the tool may be helpful in identifying children at risk for poorly controlled asthma.

Small airway dysfunction measured by impulse oscillometry is associated with exacerbations and poor symptom control in patients with asthma treated in a tertiary hospital subspecialist airways disease clinic.

Small airways dysfunction contributes to asthma pathophysiology and clinical outcomes including exacerbations and asthma control. Respiratory oscillometry is a simple, non-invasive and effort independent lung function test that provides vital information about small airway function. However, interpretation and clinical utility of respiratory oscillometry has been in part limited by lack of agreed parameters and the respective cutoffs. The aim of this study was to determine the prevalence of small airways dysfunction based on published impulse oscillometry (IOS) definition in patients with asthma referred to a tertiary asthma clinic and the extent to which it correlates with asthma clinical outcomes. We retrospectively reviewed the medical records of all patients with asthma managed in the severe asthma clinic between January 2019 and December 2022 who underwent routine lung function tests with oscillometry and spirometry. Small airways dysfunction was determined from various published IOS parameter cutoffs, and the data were analysed to determine correlations between IOS parameters and asthma outcomes. Amongst the 148 patients, the prevalence of small airways dysfunction ranged from 53% to 78% depending on the defining oscillometry parameter. All oscillometry parameters correlated with the severity of airflow obstruction (FEV1% predicted, p < 0.001). Several oscillometry parameters correlated with asthma symptom burden, the strongest correlation was seen for frequency dependent resistance (R5-R20) with scores of Asthma Control Questionnaire (ACQ6) (Spearman's rank coefficient 0.213, p = 0.028) and Asthma Control Test (ACT) (Spearman's rank coefficient -0.248, p = 0.012). R5-R20 was predictive of poor asthma control defined by ACQ6 >1.5 (OR 2.97, p = 0.022) or ACT <20 (OR 2.44, p = 0.055). Small airways dysfunction defined by R5-R20 and area under the reactance curve (AX) also significantly increases asthma exacerbation risk (OR 2.60, p = 0.02 and OR 2.31, p = 0.03 respectively). Respiratory oscillometry is a sensitive measure of small airways dysfunction that should complement spirometry in the routine assessment of asthma. Small airways dysfunction is highly prevalent in patients with asthma referred to a tertiary asthma clinic. R5-R20 was the metric most predictive in identifying patients at risk of asthma exacerbations and poor asthma control.

Relationship Between Asthma Control Status and Health-Related Quality of Life in Japan: A Cross-Sectional Mixed-Methods Study.

There is limited information regarding multidimensional relationships between asthma control and health-related quality of life (HRQoL), work productivity, and asthma symptom burden in Japan. Furthermore, systematic qualitative investigations about asthma burden have not been performed. This cross-sectional, mixed-methods study included Japanese patients (≥ 20years) with asthma adherent to inhaled corticosteroids/long-acting β2-agonists (ICS/LABA). The primary endpoint was impact of asthma on HRQoL, measured using the Asthma Health Questionnaire-33 (AHQ-33). Secondary endpoints were cough burden (Japanese-adapted Leicester Cough Questionnaire [J-LCQ]) and impact of asthma on work/activities (asthma-specific Work Productivity and Activity Impairment Questionnaire [WPAI:Asthma]). Quantitative data were assessed for the overall population and for well-controlled (WC) and not well-controlled (NWC) asthma subgroups. Qualitative verbal interviews further assessed the impact of NWC asthma on patients' HRQoL; emergent themes were extracted using thematic analyses. Of 454 patients, 45.2% (n = 205) had NWC asthma. Patients with NWC asthma had significantly worse asthma- and cough-related HRQoL across all AHQ-33 and J-LCQ domains and significantly greater work and activity impairment versus patients with WC asthma, across all assessed WPAI:Asthma domains. AHQ-33 total score was highly correlated with J-LCQ total and domain scores (r = -0.8132 to r = -0.7407). Nine themes emerged from qualitative interviews and confirmed that patients with NWC asthma had considerable HRQoL impairment due to asthma symptoms. Patients with NWC asthma had higher symptom burden and worse HRQoL than patients with WC asthma, despite ICS/LABA adherence. Cough burden correlated with HRQoL, suggesting cough may be one of the key markers to inform treatment strategy for patients with asthma.

Bronchodilator response does not associate with asthma control or symptom burden among patients with poorly controlled asthma

PurposeThe purpose of this study was to determine how four different definitions of bronchodilator response (BDR) relate to asthma control and asthma symptom burden in a large population of participants with poorly controlled asthma. ProceduresWe examined the baseline change in FEV1 and FVC in response to albuterol among 931 participants with poorly controlled asthma pooled from three clinical trials conducted by the American Lung Association - Airways Clinical Research Centers. We defined BDR based on four definitions and analyzed the association of each with asthma control as measured by the Asthma Control Test or Asthma Control Questionnaire, and asthma symptom burden as measured by the Asthma Symptom Utility Index. Main findingsA BDR was seen in 31–42% of all participants, depending on the definition used. There was good agreement among responses (kappa coefficient 0.73 to 0.87), but only 56% of participants met all four definitions for BDR. A BDR was more common in men than women, in Blacks compared to Whites, in non-smokers compared to smokers, and in non-obese compared to obese participants. Among those with poorly controlled asthma, 35% had a BDR compared to 25% of those with well controlled asthma, and among those with a high symptom burden, 34% had a BDR compared to 28% of those with a low symptom burden. After adjusting for age, sex, height, race, obesity and baseline lung function, none of the four definitions was associated with asthma control or symptom burden. ConclusionA BDR is not associated with asthma control or symptoms in people with poorly controlled asthma, regardless of the definition of BDR used. These findings question the clinical utility of a BDR in assessing asthma control and symptoms.

HSD85 The Impact of a Virtual Home Environmental Assessment and Modification Project on Pediatric Asthma Symptom Burden and Control

To assess the impact of virtual Environmental Improvements for Children with Asthma (EICA) on asthma symptom burden and control from baseline to 12-month post-intervention. EICA is an American Lung Association assessment and modification program designed to reduce asthma symptom burden in the home setting by reducing exposure to environmental asthma triggers. Pre-pandemic EICA was an in-home visit program; COVID-19 required adoption of virtual visits.

Psychological distress and symptom-related burnout in asthma during the COVID-19 pandemic.

People with asthma may be particularly vulnerable to pandemic-related psychological distress, and research is needed to understand the impact of the coronavirus disease 19 (COVID-19) pandemic on their health and well-being. We sought to study the well-being of people with asthma relative to non-asthmatic controls during the COVID-19 pandemic. We also investigated asthma symptoms and COVID-19-related anxiety as potential mediators of distress. Participants completed self-report measures of psychological functioning, including anxiety, depression, stress, and burnout. Controlling for potential confounds, multiple-regression analyses examined differences in psychological health between people with and without asthma. Mediator analyses investigated the role of asthma symptoms and COVID-19-related anxiety in this relationship. 234 adults (111 with asthma, 123 without) participated in an online survey from July to November 2020. During this time, people with asthma reported higher levels of anxiety, perceived stress, and burnout symptoms compared to controls. Elevations in burnout symptoms were found beyond general anxiety and depression (sr2 = .03, p < .001). Reported symptoms typical in both asthma and COVID-19 partially mediated this relationship (Pm = .42, p < .05). People with asthma reported unique psychological challenges during the COVID-19 pandemic including elevated burnout symptoms. Experience of asthma symptoms played a key role in vulnerability to emotional exhaustion. Clinical implications include increased attention to asthma symptom burden within the context of heightened environmental stress and restricted healthcare access.

Worldwide Trends in the Burden of Asthma Symptoms in School-aged Children: Global Asthma Network Phase I Cross-sectional Study

Worldwide Trends in the Burden of Asthma Symptoms in School-aged Children: Global Asthma Network Phase I Cross-sectional Study

Age at asthma diagnosis is related to prevalence and characteristics of asthma symptoms

BackgroundAlthough asthma may begin at any age, knowledge about relationship between asthma age of onset and the prevalence and character of different symptoms is scarce. ObjectivesThe aim of this study was to investigate if adult-diagnosed asthma is associated with more symptoms and different symptom profiles than child-diagnosed asthma. MethodsA FinEsS postal survey was conducted in a random sample of 16 000 20-69-year-old Finnish adults in 2016. Those reporting physician-diagnosed asthma and age at asthma diagnosis were included. Age 18 years was chosen to delineate child- and adult-diagnosed asthma. ResultsOf responders (N = 8199, 51.5%), 842 (10.3%) reported asthma diagnosis. Adult-diagnosed asthma was reported by 499 (59.3%) and child-diagnosed by 343 (40.7%). Of responders with adult-diagnosed and child-diagnosed asthma, 81.8% versus 60.6% used asthma medication (p < 0.001), respectively. Current asthma was also more prevalent in adult-diagnosed asthma (89.2% versus 72.0%, p < 0.001). Risk factors of attacks of breathlessness during the last 12 months were adult-diagnosis (OR = 2.41, 95% CI 1.64–3.54, p < 0.001), female gender (OR = 1.49, 1.07–2.08, p = 0.018), family history of asthma (OR = 1.48, 1.07–2.04, p = 0.018) and allergic rhinitis (OR = 1.49, 1.07–2.09, p = 0.019). All the analysed asthma symptoms, except dyspnea in exercise, were more prevalent in adult-diagnosed asthma in age- and gender-adjusted analyses (p = 0.032-<0.001) which was also more often associated with 5 or more asthma symptoms (p < 0.001) and less often with non-symptomatic appearance (p < 0.001) than child-diagnosed asthma. ConclusionResponders with adult-diagnosed asthma had more often current asthma and a higher and multiform asthma symptom burden, although they used asthma medication more often compared to responders with child-diagnosed asthma.

Maternal body composition and gestational weight gain in relation to asthma control during pregnancy.

Poor asthma control is common during pregnancy and contributes to adverse pregnancy outcomes. Identification of risk factors for poor gestational asthma control is crucial. Examine associations of body composition and gestational weight gain with asthma control in a prospective pregnancy cohort (n = 299). Exposures included pre-pregnancy body mass index (BMI), first trimester skinfolds, and trimester-specific gestational weight gain. Outcomes included percent predicted forced expiratory volumes (FEV1, FEV6), forced vital capacity (FVC), peak expiratory flow (PEF), FEV1/FVC, symptoms (activity limitation, nighttime symptoms, inhaler use, and respiratory symptoms), and exacerbations (asthma attacks, medical encounters). Linear and Poisson models examined associations with lung function (β (95% confidence interval (CI)), asthma symptom burden (relative rate ratio (RR (95%CI)), and exacerbations (RR (95%CI)). Women with a BMI ≥ 30 had lower percent predicted FVC across pregnancy (βThirdTrimester: -5.20 (-8.61, -1.78)) and more frequent night symptoms in the first trimester (RR: 1.66 (1.08, 2.56)). Higher first trimester skinfolds were associated with lower FEV1, FEV6, and FVC, and more frequent night symptoms and inhaler use across pregnancy. Excessive first trimester gestational weight gain was associated with more frequent activity limitation in the first trimester (RR: 3.36 (1.15, 9.80)) and inhaler use across pregnancy (RRThirdTrimester: 3.49 (1.21, 10.02)). Higher adiposity and first trimester excessive gestational weight gain were associated with restrictive changes in lung function and symptomology during pregnancy.

Rising and falling prevalence of asthma symptoms

Asthma is the leading chronic disease in children, affecting 5·1 million children in the USA. 1 Asthma and Allergy Foundation of AmericaAsthma facts and figures. https://www.aafa.org/asthma-factsDate: 2021 Date accessed: July 13, 2021 Google Scholar However, worldwide important variations have been reported in asthma prevalence. In The Lancet, Innes Asher and colleagues report findings from the Global Asthma Network (GAN), assessing global changes in asthma prevalence over the past three decades, with use of similar, standardised methods as the International Study of Asthma and Allergies in Childhood (ISAAC). 2 Asher MI Rutter CE Bissell K et al. Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study. Lancet. 2021; 398: 1569-1580 Google Scholar Using centres that completed GAN Phase I and ISAAC Phase I (1993–95), ISAAC Phase III (2001–03), or both, the authors assessed the global prevalence and the 10-yearly change in prevalence of current wheeze, severe asthma symptoms, asthma ever, exercise wheeze, and night cough (defined by four core questions in a questionnaire). The study included data from questionnaires filled by almost 120 000 adolescents (aged 13–14 years) and school-aged children (aged 6–7 years) from 27 centres in 14 countries. Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional studyTrends in prevalence and severity of asthma symptoms over the past three decades varied by age group, country income, region, and centre. The high worldwide burden of severe asthma symptoms would be mitigated by enabling access to effective therapies for asthma. Full-Text PDF Open Access

Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study

SummaryBackgroundAsthma is the most common chronic disease in children globally. The Global Asthma Network (GAN) Phase I study aimed to determine if the worldwide burden of asthma symptoms is changing.MethodsThis updated cross-sectional study used the same methods as the International study of Asthma and Allergies in Childhood (ISAAC) Phase III. Asthma symptoms were assessed from centres that completed GAN Phase I and ISAAC Phase I (1993–95), ISAAC Phase III (2001–03), or both. We included individuals from two age groups (children aged 6–7 years and adolescents aged 13–14 years) who self-completed written questionnaires at school. We estimated the 10-year rate of change in prevalence of current wheeze, severe asthma symptoms, ever having asthma, exercise wheeze, and night cough (defined by core questions in the questionnaire) for each centre, and we estimated trends across world regions and income levels using mixed-effects linear regression models with region and country income level as confounders.FindingsOverall, 119 795 participants from 27 centres in 14 countries were included: 74 361 adolescents (response rate 90%) and 45 434 children (response rate 79%). About one in ten individuals of both age groups had wheeze in the preceding year, of whom almost half had severe symptoms. Most centres showed a change in prevalence of 2 SE or more between ISAAC Phase III to GAN Phase I. Over the 27-year period (1993–2020), adolescents showed a significant decrease in percentage point prevalence per decade in severe asthma symptoms (–0·37, 95% CI –0·69 to –0·04) and an increase in ever having asthma (1·25, 0·67 to 1·83) and night cough (4·25, 3·06 to 5·44), which was also found in children (3·21, 1·80 to 4·62). The prevalence of current wheeze decreased in low-income countries (–1·37, –2·47 to –0·27], in children and –1·67, –2·70 to –0·64, in adolescents) and increased in lower-middle-income countries (1·99, 0·33 to 3·66, in children and 1·69, 0·13 to 3·25, in adolescents), but it was stable in upper-middle-income and high-income countries.InterpretationTrends in prevalence and severity of asthma symptoms over the past three decades varied by age group, country income, region, and centre. The high worldwide burden of severe asthma symptoms would be mitigated by enabling access to effective therapies for asthma.FundingInternational Union Against Tuberculosis and Lung Disease, Boehringer Ingelheim New Zealand, AstraZeneca Educational Grant, National Institute for Health Research, UK Medical Research Council, European Research Council, and Instituto de Salud Carlos III.

Associations of Snoring and Asthma Morbidity in the School Inner-City Asthma Study

Inner-city children are disproportionately affected by asthma and sleep-disordered breathing (SDB). However, little is known about the association of SDB symptoms with asthma morbidity in this vulnerable population. Assess the relationship between snoring frequency and asthma morbidity. This study was part of the School Inner-City Asthma Study, a longitudinal prospective cohort study of children with persistent asthma who attended schools in the Northeast United States from 2008 to 2013. Participants had baseline assessments of asthma symptoms, snoring, and allergy status. Caregivers completed quarterly surveys for 12 months on symptoms of asthma, snoring, and health care outcomes. Snoring frequency (non-, rare-, sometimes-, habitual-snoring) and its relationship with asthma symptoms and asthma morbidity were assessed by mixed-effects models. There were 1186 observations from 339 subjects. Mean age was 7.9 years; roughly half were male, and most were of minority race. Half were overweight or obese, and 65.5% had atopy. At initial snoring assessment, 24.8% reported habitual snoring, but report of snoring frequency varied over the study period. Multivariate analyses revealed increased odds of maximum asthma symptom days for habitual snoring compared with nonsnoring (1.58; 95% CI, 1.19-2.10; P < .002) and all other snoring categories. Habitual snoring was associated with greater odds of health care utilization (incidence rate ratio, 1.72; 95% CI, 1.10-2.69; P= .02) and worse asthma control (odds ratio, 1.49; 95% CI, 1.05-2.11; P= .03) compared with nonsnoring. Snoring is common among inner-city school-age children with asthma, and habitual snoring is associated with increased asthma symptom burden and health care utilization.

ASTHMA SYMPTOMS AND LUNG FUNCTION AMONG RECENT GRADUATES IN NIGERIA: A PRELIMINARY REPORT

SESSION TITLE: Allergy and Airway Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Asthma is an important cause of morbidity and mortality among young adults especially in developing countries. We, therefore, aim to investigate the burden of asthma symptoms and lung function among recent graduates in Nigeria. METHODS: In a cross-sectional study, 55 (34 females, mean age 26.7±2.1) national youth corps member completed the European Community Respiratory Health Study (ERCHS) screening questionnaire. Spirometry was performed according to the ERS/ATS protocol. Mann -Whitney U test was used to test the difference of spirometric value between those with asthma symptoms and those without the symptoms RESULTS: Fifteen (27%) of the participants had possible asthma as defined by the ERCHS questionnaire. Current wheeze was documented in 10(18%) of the participants. Six (11%) was woken up by an attack of breathlessness in the last 12 months, however, only 3 (5.5%) has had an attack of asthma or currently taken anti-asthma medications. The participants median (IQR) pre-bronchodilator FEVI, FVC and FEVI/FVC were 2.7(2.1-3.2)L; 3.2(2.5-3.7)L; 0.85(0.81-0.87) respectively, while the post-bronchodilator values were 2.8(2.2-3.3); 3.1(2.4-3.7)L; 0.88(0.85-0.90). There were no significant differences in the spirometric values of those with asthma symptoms and those without asthma symptoms CONCLUSIONS: Asthma symptoms are moderately prevalent among these young adults although there are no spirometric abnormality CLINICAL IMPLICATIONS: Asthma remains under-diagnosed in Nigeria and a large scale study needs to be done to ensure proper diagnosis and management of people with asthma. DISCLOSURES: no disclosure on file for OLUFEMI ADEWOLE; No relevant relationships by Adenike Arawomo, source=Web Response no disclosure on file for Olayemi Awopeju; No relevant relationships by Gregory Erhabor, source=Web Response No relevant relationships by John Erhabor, source=Web Response no disclosure on file for AWONIYI FRANCIS

Asthma management and control in Nigeria: the asthma insight and reality Nigeria (AIRNIG) study

ABSTRACTBackground: The state of asthma management and asthma control at the population level in Nigeria is unknown. We aimed to determine the level of asthma control and asthma management practices in Nigeria.Methods: A cross-sectional population-based study of 405 participants with current asthma (physician-diagnosed with use of asthma medication or asthma symptoms in the preceding 12 months). We determined the level of asthma control, self-perception of asthma control, health-care use, missed work/school, and medication use.Results: Asthma was controlled in 6.2% of the participants. Night-time awakening and limitation in activity in the preceding 4 weeks were reported by 77.5% and 78.3%, respectively, 56.3% and 14.1% missed work/school and had emergency room visits, respectively, and 11.6% and 38.8% used inhaled corticosteroid and short-acting beta-2 agonist, respectively, in the preceding year. About a third (34.3%) had spirometry ever performed and 46.7% had training on inhaler technique. Nearly 90% with uncontrolled asthma had self-perception of asthma control between somewhat and completely controlled.Conclusion: The level of asthma control in Nigeria is poor with a high burden of asthma symptoms and limitation in activities. This calls for a broad-based approach for the improvement in asthma care that encompasses education and access to medications.

How patient participation was used to develop a questionnaire that is fit for purpose for assessing quality of life in severe asthma

BackgroundPrevious research shows that existing asthma quality of life questionnaires fail to measure the burden of oral corticosteroids that can be used to treat severe asthma, and are therefore not fit for purpose for severe asthma according to the USA’s Food and Drug Administration (FDA) criteria for content validity. Patient input and documentation of that input is key to achieving content validity according to FDA guidelines. This paper describes the process of constructing a new questionnaire to measure the burden of asthma symptoms and burden of treatment in severe asthma, using criteria specified by the FDA.MethodsA draft severe asthma questionnaire (SAQ) was constructed using qualitative input from severe asthma patients who took part in an earlier study. The aim of this study was to improve that draft questionnaire using a further group of patients. In four iterative focus groups, 16 people with severe asthma completed the draft questionnaire, discussed the wording and structure and suggested changes that were incorporated into the final version.ResultsThe original intention to ask patients to identify whether problems were caused by asthma symptoms or side effects of medication was abandoned as the attribution of cause was found to be difficult and inconsistent. The recall period of 2 weeks was acceptable but fails to reflect the patients’ desire to express the variability of severe asthma. Patients suggested improvements to the wording of the draft questionnaire, including splitting some items in two, combining two items in one, and changes to some of the words in individual items and the response scale.ConclusionsThe final version of the questionnaire was substantially different from one constructed using only qualitative reports from patients about the quality of life deficits of severe asthma. Patients make a valuable contribution to the questionnaire if they are asked to comment and improve an initial draft and where patients are treated as partners in the process of questionnaire construction, rather than only as a source of information to experts who construct the questionnaire.

"This illness diminishes me. What it does is like theft": Aqualitative meta-synthesis of people's experiences of livingwith asthma.

BackgroundWhat matters to people in their everyday experiences of living with asthma is influenced by a diverse range of personal, social, medical and environmental factors. Previous reviews of the asthma literature have largely focused on medical aspects of asthma or specific population groups with particular needs.ObjectiveTo identify, describe and synthesize from the available qualitative literature the views and experiences of adults living with asthma.MethodWe systematically searched for qualitative studies reporting on the personal experience of living with asthma. A meta‐synthesis approach was used to analyse and interpret the data. Key themes relating to personal perspectives on asthma were identified and grouped into overarching concepts.ResultsWe identified 26 studies. There was a paucity of literature on the physical burden of asthma symptoms and the role of social support. Our synthesis generated a central concept of the “work” associated with living with asthma: work was of a personal nature, and at times an intensely emotional experience. Individuals tailored their behaviour in response to demands of the physical and social environment, including interactions with health‐care professionals.ConclusionThis is the first systematic review of the qualitative literature reporting on people's own perspectives of living with asthma. Our findings draw attention to the nuances and sensitivities surrounding patient experiences of self‐management. Medical care is a central plank of managing chronic conditions, but our health‐care systems are now expected to deliver patient‐centred care. Considering the broader aspects of asthma management, beyond that of symptoms and treatment, will help to facilitate comprehensive care.

Regional cerebral glucose metabolism in the insula during acute stress predicts increased post-stress pulmonary inflammation in asthma

Although psychological factors contribute to the frequency, severity, and burden of asthma symptoms, the role of the brain in the pathophysiology and treatment of this disease is largely unknown. To examine the neural mechanisms which may regulate airway inflammation in asthma, we used [18F]fluoro-deoxyglucose positron emission tomography (FDG-PET) to identify neural circuits that are active during performance of a social stress task or a matched control condition. Asthmatic subjects with either high or low levels of chronic life stress underwent both stress and control conditions. Fractional exhaled nitric oxide (FeNO) was collected at baseline, as well as hourly post-challenge, and provided a measure of airway inflammation. These data reveal that, in those with high levels of chronic stress, an acute stressor leads to elevated post-stress FeNO levels relative to those with low chronic stress. In addition, increased regional glucose metabolism in the insular cortex predicts overall FeNO levels. This region of the insula is nearly identical to a region we identified in a previous study where activation following challenge with inhaled allergen predicted the increase in percentage of eosinophils in lung tissue 24 h later. These data corroborate previous evidence indicating a role for the insula in the interaction of emotion and inflammation in asthma and may lead to novel targets for future treatment.

78. Increased glucose metabolism during acute stress in emotional neural circuitry, assessed with FDG-PET, predicts airway inflammation and psychological symptoms in asthma

Although psychological stress contributes to frequency, severity, and burden of asthma symptoms, the role of the brain in the pathophysiology and treatment of this disease is unknown. To examine the neural mechanisms through which stress contributes to airway inflammation, asthmatic subjects high or low in chronic life stress underwent an acute stressor. [18F]Fluoro-deoxyglucose positron emission tomography (FDG-PET) was used to identify neural circuits active during performance of a social stress task or a matched control condition. Sputum was collected to assess markers of airway inflammation, including expression of genes in the IL-17 pathway, products of which can contribute to both inflammation and depression. Preliminary results indicate that, during an acute stressor, activation in the anterior and mid-cingulate cortex, as well as the inferior frontal gyrus is greater in those with high vs. low chronic stress. These increases in regional glucose metabolism also predicted increased gene expression in the IL-17 pathway, as well as symptoms of anxiety and depression. Moreover, those subjects high in chronic stress showed increased gene expression in the IL-17 pathway following an acute stressor, as well as increased symptoms of anxiety and depression, relative to those with low chronic stress levels. These data suggest potential neural pathways through which psychological stress may influence airway inflammation, thus leading to an increase in asthma symptoms, disease severity, and uncovering novel targets for future treatment.

What’s Next for Somatic Symptom Disorder?

What’s Next for Somatic Symptom Disorder?

Prevalence of respiratory symptoms at two time points in a population of children in Manchester—a cohort study

ObjectiveAlthough the prevalence of asthma and atopy has been noted to have increased in recent decades, patterns of asthma prevalence have, traditionally, been difficult to track. Most reports on trends...