Chronic Persistent Asthma Research Articles

The specificity of body surface temperature of relevant back-shu points in patients with chronic persistent asthma based on infrared thermal imaging technology

To detect the body surface temperature of the relevant back-shu points in patients with chronic persistent asthma by infrared thermal imaging technology, and observe the specific changes of the body surface temperature of the relevant back-shu points under the condition of lung disease. Forty-five patients with chronic persistent asthma (observation group) and 45 healthy subjects (control group) were selected. The body surface temperature of bilateral Feishu (BL 13), Geshu (BL 17), Pishu (BL 20) and Shenshu (BL 23) were measured by BK-MT02A medical infrared thermography. The body surface temperature of bilateral Feishu (BL 13), Geshu (BL 17), Pishu (BL 20) and Shenshu (BL 23) in the observation group was higher than that in the control group (P<0.01, P<0.05). The body surface temperature of bilateral Feishu (BL 13) and Geshu (BL 17) was higher than that of ipsilateral Pishu (BL 20) and Shenshu (BL 23) in the two groups (P<0.01, P<0.05). There was no statistically significant difference in body surface temperature between ipsilateral Feishu (BL 13) and Geshu (BL 17), between ipsilateral Pishu (BL 20) and Shenshu (BL 23) (P>0.05). The pathological increase of body surface temperature of Feishu (BL 13), Geshu (BL 17), Pishu (BL 20) and Shenshu (BL 23) in patients with chronic persistent asthma indicates that above acupoints have specificity in reflecting lung diseases. The Feishu (BL 13) and Geshu (BL 17), which have significantly increased body surface temperature, not only provide objective basis for the pathological pathogenesis of "deficiency in origin and excess in symptom" in patients with chronic persistent asthma, but also reflect the different expressions of different acupoints on the same meridian for the lung diseases.

Chronic Obstructive Pulmonary Disease among non-Smokers

Since tobacco use has been linked to COPD for more than 50 years, this population has served as the foundation for almost all of our knowledge regarding the clinical, physiological, pathological, and radiological aspects of the disease as well as the rates of lung function loss and the effectiveness of various treatments. We stated in 1990 that 25 to 45% of COPD cases among never smokers. According to the 2017 Global Burden of Disease report, smoking is only responsible for 35% of the burden of COPD worldwide, with the majority of cases occurring in high-income nations. Most of the world's remaining 65% of nonsmokers with COPD live in low- and middle-income nations. Other non-smoking risk factors for COPD include exposure to biomass smoke while cooking in poorly ventilated homes, high ambient air pollution levels, occupational exposures to dust and gases, ambient ozone exposure, poverty, recurrent respiratory tract infections in childhood, poorly controlled chronic persistent asthma, and prior tubercular lung disease. Worldwide, non-tobacco-related risk factors, which vary by geographic region, are to blame for around half of all instances of COPD. Inflammation, oxidative stress, airway remodelling, and accelerated lung ageing are potential factors for the development of COPD in never-smokers. Never-smokers with COPD had less severe chronic respiratory symptoms, little to no emphysema, less airflow limitation, and fewer comorbidities than smokers who acquire COPD; however, exacerbations can still happen often. More research- including epidemiological, translational, clinical, and implementation studies- is required to fill in knowledge gaps and promote viable solutions to lessen the burden of COPD in never-smokers. Clinical history and spirometry can be used to diagnose Chronic Obstructive Pulmonary Disease (COPD), but identifying its risk factors is time-consuming and crucial because doing so can stop the disease's progression. Contrary to popular belief, smoking cigarettes is only one of the numerous risk factors for COPD. We have examined the etiology of nonsmoker COPD through this review in an effort to identify the causative risk factor and reduce the disease's morbidity and mortality.

Stepping Down in Asthma

Beta-2-agonists continue to find a dominant role in all the current guidelines on the management of chronic persistent bronchial asthma. However, the safety of the drugs remains doubtful. Thus, there is a case for review of the "Step up-Step down" approach in the management of chronic persistent bronchial asthma. Based on the currently available experimental and clinical data on bronchial asthma, the authors are of the opinion that chronic persistent bronchial asthma is best managed by a modified "Step I-Step II" approach.

Guidelines for the management of asthma in adults and adolescents: Position statement of the South African Thoracic Society - 2021 update.

Asthma prevalence is increasing worldwide, and surveys indicate that most patients in developed and developing countries, including South Africa, do not receive optimal care and are therefore not well controlled. Standard management guidelines adapted to in-country realities are important to support optimal care. The South African Thoracic Society (SATS) first published a guideline for the management of chronic persistent asthma in 1992, which has subsequently been revised several times. The main aim of the present document was to revise and update SATS' statement on the suggested management of chronic asthma, based on the need to promote optimal care and control of asthma, together with the incorporation of new concepts and drug developments. This revised document reinforces optimal care and incorporates the following primary objectives to achieve the recent advances in asthma care: continued emphasis on the use of inhaled corticosteroids (ICS) as the foundation of asthma treatmentto reduce the reliance on short-acting beta-2 agonist (SABA) monotherapy for asthma symptomsto incorporate the evidence and strategy for the use of the combination of an ICS and formoterol for acute symptom relief (instead of a SABA)to incorporate the evidence and strategy for the use of as-needed ICS-long-acting beta agonists (LABA) for patients with infrequent symptoms or 'mild' asthmato incorporate the evidence and strategy for the use of a long-acting muscarinic antagonist (LAMA) in combination with ICS-LABA; andto incorporate the evidence and strategy for the use of and management with a biologic therapy in severe asthma.

The efficacy and safety of azithromycin in treatment for childhood asthma: A systematic review and meta-analysis.

Azithromycin (AZI) is increasingly used for childhood asthma despite limited and inconsistent data. We aimed to evaluate the efficacy and safety of AZI in childhood asthma. We searched seven databases to include randomized controlled trials (RCTs) of AZI in the treatment of childhood asthma. Four reviewers independently screened the records. Risk of Bias 2 was used to assess the quality of RCTs. Risk ratioswith 95% confidence interval (CI) from dichotomous outcomes, and mean difference (MD) with 95% CI from continuous outcomes were pooled. We included 19 eligible reports from 17 studies. The prevalence of exacerbations in AZI + budesonide (BUD) + β2 agonist (BA) group was lower than BUD + BA group (four [13%] vs. 19 [63%], p < 0.05) in 6- 14 years old children with chronic persistent asthma. AZI plus antiasthma drugs (AADs) could improve the posttreatment childhood asthma control test score (MD = 2.97; 95% CI, 2.39-3.54) compared to AADs alone in children with chronic persistent asthma. AZI plus AADs could improve posttreatmentforced expiratory volume in 1 s of predicted value/forced vital capacity % (MD = 10.24%; 95% CI, 6.44%-14.03%) and posttreatment peak expiratory flow % of predicted value (MD = 7.00%; 95% CI, 2.53%-11.47%) compared to AADs alone in children with chronic persistent asthma. The most common adverse reactions of AZI combined with other drugs were gastrointestinal reactions. AZI may be beneficial in improving some clinical symptoms and lung functions in older asthma children (over 6 years old) with persistent asthma. But it still requires further research.

Acupoint thread-embedding as adjuvant therapy for bronchial asthma in children and its effect on pulmonary function, serum IgA and IgE levels

To observe the efficacy of acupoint thread-embedding combined with fluticasone propionate aerosol for chronic persistent bronchial asthma of lung-spleen qi deficiency and spleen-kidney yang deficiency in children and its effect on pulmonary function and serum levels of IgA and IgE. A total of 120 children with chronic persistent bronchial asthma were randomly divided into an observation group (60 cases, 9 cases dropped off) and a control group (60 cases, 7 cases dropped off). The control group was treated with fluticasone propionate aerosol (125 μg per inhalation), twice a day; based on the control group treatment, the observation group was treated with acupoint thread-embedding at Dingchuan (EX-B 1), Feishu (BL 13), Zusanli (ST 36) and Danzhong (CV 17), once half a month. Both groups were treated for 3 months. The pulmonary function, serum IgA, IgE levels and TCM symptom score were compared between the two groups before and after treatment, and the clinical efficacy was evaluated. After treatment, the large airway function (peak expiratory flow [PEF], forced expiratory volume at the first second [FEV1]) and small airway function (maximal expiratory flow at 25% of the forced capacity [MEF25%], maximal expiratory flow at 50% of the forced capacity [MEF50%], maximal expiratory flow at 75% of the forced capacity [MEF75%] and midexpiratory flow 25%-75% [MEF25%-75%]) were higher than those before treatment (P<0.05), and the pulmonary function in the observation group was higher than that in the control group (P<0.05). After treatment, the serum IgA levels in the two groups were higher than those before treatment (P<0.05), and the serum IgE levels and TCM symptom scores were lower than those before treatment (P<0.05); the serum IgA level in the observation group was higher than that in the control group (P<0.05), and the serum IgE level and TCM symptom score in the observation group were lower than those in the control group (P<0.05). The total effective rate was 94.1% (48/51) in the observation group, which was higher than 88.7% (47/53) in the control group (P<0.05). Acupoint thread-embedding combined with fluticasone propionate aerosol could improve the pulmonary function, TCM symptoms and serum IgA and IgE levels in children with chronic persistent bronchial asthma of lung-spleen qi deficiency and spleen-kidney yang deficiency. The curative effect is better than fluticasone propionate aerosol alone.

Dysregulated Arginine Metabolism in Young Patients with Chronic Persistent Asthma and in Human Bronchial Epithelial Cells.

Background: Recent metabolomics studies have found circulatory metabolism alterations in patients with asthma, indicating that altered metabolites played a significant role in asthma. However, the regulatory mechanisms in asthma, especially in young chronic persistent asthma remain underexplored. Methods: In this study, a prospective cohort of 162 patients diagnosed of asthma admitted to the First Affiliated Hospital of Xi’an Jiaotong University from January 2018 to December 2019 was used to perform a nested case-control study. Among them, we included 30 patients with chronic persistent asthma between 20 to 35 years old; 30 health control with evenly distributed age and sex were then recruited. Nontargeted metabolomics was applied to identify serum metabolic profiles and altered metabolic pathways. Results: In vitro, human bronchial epithelial cells (HBECs) line BEAS-2B with the addition of L-citrulline and/or asymmetric dimethylarginine (ADMA) model was utilized and the concentrations of nitric oxide (NO) metabolites were tested to evaluate the therapeutic potential of L-citrulline. The young patients with chronic persistent asthma displayed dysregulated serum metabolic profiles, especially enriched in arginine metabolism. The ratio of L-citrulline to ornithine is associated with blood eosinophil count. In vitro, adding L-citrulline could reverse ADMA-mediated reduction of NOx at lower L-arginine concentration (25 μM), but was ineffective in the higher L-arginine concentration (100 μM) media. Conclusions: The arginine metabolism balance is of vital importance during the pathogenesis and progression of chronic asthma. L-citrulline could be a powerful approach to restore airway NO production, potentially exhibiting therapeutic benefits among young patients with chronic asthma.

Activity and Safety of Daratumumab Monotheray in Patients with Relapsed and Refractory Multiple Myeloma Requiring Dialysis: Preliminary Results of Spanish, Retrospective, Multicenter Trial

Introduction:Daratumumab (DARA) is a first-in-class, fully human IgG1 kappa MoAb that targets to a unique CD38 epitope in plasma cells and has been recently approved for patients with relapsed and refractory myeloma multiple (RRMM) that have received ≥3 prior lines of therapy including proteasome (IP) inhibitor and an immunomodulatory agent (IMiD). Based on pharmacokinetic analysis it is not necessary to adjust the dosage of DARA in patients with creatinine clearance 30-60 mL/min. However there are no published data available in patients with RRMM requiring dialysis.Aims:The objective of this retrospective, multicenter, open-label study is to report the safety and efficacy of DARA in patients with RRMM with end-stage renal failure requiring dialysis.Methods:The eligibility criteria to participate in this study included patients ≥18 years, documented progression of MM by IMWG criteria following the most recent therapy including a PI and an IMID or double-refractory to a PI and an IMID, ECOG performance status score 0-2, absence of chronic obstructive pulmonary disease or persistent asthma, and no prior exposure to anti-CD38 antibody therapy. Patients received DARA at the standard dose (16 mg/kg IV weekly for 8 weeks, then every 2 weeks for 16 weeks, and then every 4 weeks) until disease progression or unacceptable toxicity. Pre-medications with antihistamines, antipyretics and corticosteroids and post-infusion medications with corticosteroids were administered including the use of montelukast. Anti-viral prophylaxis was considered. Data on anti-MM activity and adverse events (AEs) including grade 3-4 AEs and infusion related reactions (IRRs) were collected.Results:The study, including eight Spanish centers is ongoing and we report here the preliminary results of the first eight patients included from January 2017 to July, 2017. There were 4 male and 4 female with a median age at the time of the beginning of DARA therapy of 63 years (range, 52 -71) and with a median time from diagnosis to initiation of DARA of 4.61 years (range, 1 - 6). MM was Bence Jones in 3 patients, IgA type in 2, IgD in 2, and IgG in 1 patient. Distribution of disease according to the International Stage System was: 5 patients were in stage II, 2 patients were in stage I, and the remaining patient was in stage III. The median number (range) of prior lines of therapy was 4 (2 -7); 37% of patients received >3 prior lines. All patients were double refractory to both a PI and IMiD, 2 patients were also refractory to carfilzomib, and 1 patient was triple refractory including pomalidomide. Four patients had received previous stem-cell transplant (3 autologous and 1 allogeneic).At the time of diagnosis, 2 out of the 8 patients had high-risk cytogenetics [1 patient with add(1q) and 1 with del(17p)]. Detailed patient characteristics with respect to baseline clinical features and laboratory parameters are provided in Table 1. In 6 patients, end-stage renal failure was myeloma-related (2 patients with acute renal injury at time of diagnosis), while the remaining 2 patients were already on dialysis at the time of MM diagnosis. The median time from the diagnosis of MM and the beginning of the dialysis was 5 years (range, 1-6). The median time on dialysis at study entry was 24 months (range, 8-97).The median (range) number of cycles of DARA administered was 4 (1-7). The overall response rate and the clinical benefit rate (stable disease or better) was 37.5% (1 VGPR and 2 PR) and 62.5%, respectively. No patient has become dialysis independent.With a median follow-up of 4 months, 2 patients have died because of disease progression (1 patient) and due to myeloma-related causes (1 patient) and one patient suffered disease progression. The remaining 5 patients are still alive with ongoing DARA treatment. Regarding safety, no patient discontinued treatment due to AEs and the most common non-hematological AEs included grade 1 or 2 IRRs observed only during the first cycle, (4 patients). Anemia (n=2, grade 2 and 3), thrombocytopenia (n=2, grade 1 and 2), and neutropenia (n=2, grade 1 and 4), were the hematological AEs most frequently observed.Conclusions:Although still preliminary, our data suggest that DARA monotherapy is an efficacious and safe therapeutic option for patients with RRMM and end-stage renal failure including dialysis. AE profile seems to be similar to that previously observed in patients with normal or moderately impaired renal function. [Display omitted] Disclosuresde la Rubia:Celgene: Other: Honoraria; Janssen: Other: Honoraria; Amgen: Other: Honoraria.

Gu-Ben-Fang-Xiao decoction modulates lipid metabolism by activating the AMPK pathway in asthma remission

Gu-Ben-Fang-Xiao decoction (GBFXD), derived from the traditional Chinese medicine Yu-Ping-Feng-San, is widely used in clinical settings and has obvious curative effects in respiratory diseases. GBFXD regulates cholesterol transport and lipid metabolism in chronic persistent asthma. There is evidence for its beneficial effects in the remission stage of asthma; however, its metabolic regulatory effects and underlying mechanisms during asthma remission are unclear. In the present study, we used liquid chromatography-mass spectrometry (LC-MS) to analyse the metabolic profile of mouse serum during asthma remission. The acquired LC–MS data were subjected to a multivariate analysis for identification of significantly altered metabolites. In total, 42 metabolites were significantly differentially expressed among the control, model, and GBFXD groups. In particular, levels of fatty acids, acylcarnitines, phosphatidylcholines, phosphatidylethanolamines, phosphatidylinositols, triglycerides, and diacylglycerols were altered during asthma remission. GBFXD may maintain lipid homeostasis on the lung surface by modulating lipid metabolism and may thereby alleviate asthma. We further quantified hypogeic acid (FA 16:1) based on targeted metabolomics and found that GBFXD may regulate fatty acid metabolism by activating the AMP-activated protein kinase (AMPK) pathway. These results support the use of GBFXD in patients with asthma remission.

Acupuncture for chronic persistent asthma based on the theory of Meridian-viscera Association: study protocol for a multi-center randomized controlled trial in China

BackgroundAcupuncture is effective in symptom and quality of life improvement of chronic asthma, but the efficacy differences between different acupoints are uncertain. In terms of the theory of Meridian-viscera Association, the study aims to investigate the different effectiveness between acupoints in Lung meridian and the acupoints in Heart meridian, so as to provide the evidence to develop a better prescription of the acupuncture treatment of chronic persistent asthma.MethodsThis study is a multicentral randomized controlled trial. A total of 68 chronic persistent asthma patients will be randomly allocated into two groups: the Lung meridian group and the Heart meridian group. This trial will include a 2-week baseline period, a 4-week treatment period with 12 sessions’ acupuncture, and an 8-week follow-up period. The primary outcome is the Asthma Quality of Life Questionnaire (AQLQ). Secondary outcomes are the Asthma Control Test (ACT), Peak Expiratory Flow (PEF), and Forced Expiratory Volume in 1 s (FEV1). The AQLQ and ACT will be collected at baseline, week 4, week 8, and week 12 after randomization. PEF, FEV1, the Self-rating Anxiety Scale (SAS), and the Self-rating Depression Scale (SDS) will be assessed at baseline and week 4.DiscussionThe results will provide evidence for acupuncture prescription selection and the clinical efficacy improvement. The results of this trial will also be used to determine whether or not a full definitive trial will go ahead, which will further confirm the theory of Meridian-viscera Association.Trial registrationChinese Clinical Trial Registry (http://www.chictr.org.cn/showproj.aspx?proj=43803) ChiCTR1900027284. Registered on 7 November 2019

IL-1 signaling pathway molecules as key markers in childhood asthma.

The prevalence of childhood asthma has been increasing in recent years. This study aims to investigate the involvement of the key molecules of IL-1 (interleukin-1) signaling pathways in pediatric patients with asthma. Differentially expressed genes (DEGs) associated with IL-1 signaling pathways were identified with RNA-seq from peripheral blood samples collected from asthmatic or healthy children and were further verified in clinical peripheral blood samples. Cellular models and asthmatic mice were subsequently developed to validate the identified asthmatic markers. Among the DEGs identified by RNA-seq, eight signal transducers associated with the IL-1 signaling network, namely IL-1RN, IL-1β, IL-1RAP, IRAK3, IL-1R1, MYD88, IRAK2, and PELI1, were found to be substantially upregulated in children with asthma. Interestingly, a significant serially increased expression of four genes (IL-1RN, IL-1RAP, IRAK3, and PELI1) was observed in healthy subjects, patients with chronic persistent asthma and patients with acute exacerbation asthma. In particular, these four genes were continuously overexpressed in recurrent patients. A significant induction of the above four genes was then observed in house dust mite (HDM)-stimulated peripheral blood mononuclear cells (PBMCs) and ovalbumin (OVA)-induced asthmatic mice. In addition, a time-dependent induction of IL-1RAP and PELI1 was also detected in HDM-treated THP-1 cells, an acute monocytic leukemia cell line. These results demonstrate that IL-1RN, IL-1RAP, IRAK3, and PELI1, which are signal transducers of the IL-1 signaling pathway, could serve as biomarkers for the pathogenesis of childhood asthma and for potential therapeutic targets of asthma.

UNMASKING CHRONIC COUGH AND ASTHMA: THE SILENT BODY

SESSION TITLE: Fellows Allergy and Airway Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Foreign body aspiration is an emergency situation which requires early bronchoscopy. Most of the patients will recall the event, however it could be a surprising finding in bronchoscopy procedures. Symptoms include shortness of breath, fever, and hemoptysis. In this case, it presents as chronic cough with uncontrolled asthma for several years despite optimized therapy. CASE PRESENTATION: Case of a 52-year-old man with past medical history of GERD, partly controlled severe asthma and chronic persistent cough who presented with bloody sputum without shortness of breath, chest pain or palpitation. Initial evaluation at ER with evidence of right lower lobe infiltrate and was admitted for treatment of pneumonia. He also recognized recurrent episodes of bronchitis, and fever episodes in the last 48 hours. He presented 3 months prior to admission to the emergency department with cough and subjective fever, by which had a chest x ray showing linear and patchy densities at the right lung base, azithromycin was prescribed and discharge home respectively. On examination, vital signs were stable. Chest auscultation revealed mildly decreased breath sounds and rhonchi in the right lower lung field. Chest transverse axial computer tomography with a right basilar lung consolidation with air bronchograms and hyperdense filling defect in the right lower lobe bronchus. Chest computer tomography 3 year prior to admission had evidence of right sided infiltrate believe to be secondary to pneumonia that was treated at that time. In view of hemoptysis and persistent right lower lobe infiltrate a flexible bronchoscopy was performed that revealed significant erythema with a foreign body visualized in the right lower lobe with associated granulation tissue . Subsequent evaluation visits with improved chronic cough and asthma respectively after the successful retrieval. DISCUSSION: Foreign bodies may result in serious complications if left unrecognized. This complication includes recurrent pneumonia, lung abscess, bronchopleuralcutaneus fistulas, atelectasis, and bronchiectasis with mucus impaction . However, in the case of chronic aspiration, bronchoscopy may show features of tissue reaction to the foreign body, by which object could be found incarcerated and difficult to be seen. Granulation reactions could eventually lead to airway strictures, and subsequently airway distortion, by which could present with unilateral wheezes in physical examination. Its important to note that bronchoscopy is present in chronic cough management algorithm. CONCLUSIONS: Chronic cough and persistent asthma that does not respond to standard therapy is the key to suggest a foreign body aspiration. Chronic cough is the most common symptom and is present in two-thirds of patients with foreign body aspiration. For that purpose, it’s important an early suspicion for a successful detection and a subsequent improvement of symptoms. Reference #1: Irwin RS, Madison JM. The diagnosis and treatment of cough. N Engl J Med. 2000;343:1715–21. Reference #2: Irwin RS, Boulet LP, Cloutier MM, Fuller R, Gold PM, Hoffstein, et al. Managing cough as a defense mechanism and as a symptom. A consensus panel report to the American College of Chest Physicians. Chest. 1998;114(2 suppl):133–81S. Reference #3: Al-Majed SA, Ashour M, Al-Mobeireek AF, Al-Hajjaj MS, Alzeer AH, Al-Kattan K. Overlooked inhaled foreign bodies: late sequelae and the likelihood of recovery. Respiratory Medicine. 1997;91(5):293–296. DISCLOSURES: No relevant relationships by Christian Castillo Latorre, source=Web Response No relevant relationships by Ilean Lamboy, source=Web Response No relevant relationships by Mariana Mercader-Pérez, source=Web Response No relevant relationships by William Rodriguez-Cintron, source=Web Response No relevant relationships by Jose Torres-Palacios, source=Web Response

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A Physician Suffering from COVID-19 with Multiple Co-Morbidities Have Delayed Viral Clearance: A Case Report from Bangladesh

Background: Novel corona virus (SARS-Coronavirus-2 SARS-CoV-2) which emerged in China has spread to multiple countries rapidly. Little information is known about delayed viral clearance in mild to moderate COVID-19 pa-tients. As it is highly contagious, health care workers including physicians are high risk of being infected in hospital care. Case Report: A 37 years old Bangladeshi physician working in a paediatric unit of a medical college hos-pital with multiple co-morbidities, hypertension, diagnosed axial spondy-loarthropathy (ankylosing spondylitis) taking disease modifying anti rheu-matic drugs— DMARDs (Salfasalazine) from 2016 till now, chronic persis-tent bronchial asthma on medication developed sore throat, increasing breathlessness and cough admitted to his own hospital on 22 April, 2020. He had a history of contact with a relapse nephrotic syndrome (glomerulone-phritis) patient admitted with severe respiratory distress later confirmed as COVID-19 following RT PCR test on 14 April, 2020. After 3 days of contact with the patient, the physician also developed the symptoms mentioned above. The RT PCR test result of the physician came positive on 18 April, 2020. The physician primarily taken only azithromycin 500 mg once daily along with other regular drugs. On 5, 12 and 18 May, 2020, his sample was taken for re-test and came positive subsequently. After that he started Iver-mectin (0.15 mg/kg) once daily for 3 days and doxycycline 100 mg BD for 7 days. He gave samples again on 27 and 29 May, 2020 which were came nega-tive after 39 days. On full recovery he was discharged from hospital on day 40. We choose the patient because presence of co-morbidities may be asso-ciated with delayed viral clearance and physicians with co-morbidities working in a hospital have high risk of being infected.

Budesonide/Fomoterol in combination with Montelukast in the treatment of Bronchial Asthma.

Objective:To analyze the clinical effect of budesonide/fomoterol combined with montelukast in the treatment of chronic persistent asthma.Methods:Ninety-four patients with asthma who came to our hospital for treatment from April 2017 to April 2019 were randomly divided into control group and observation group, with 47 patients in each group. The control group was treated with budesonide/formoterol, and the observation group was treated with montelukast on the basis of the control group. The treatment effect of the two groups was observed and compared.Results:The total efficacy rate of the observation group was significantly higher than that of the control group (P<0.05); the daytime symptom score and nighttime symptom score of the observation group were significantly higher than those of the control group (P<0.05). The pulmonary function indexes of the two groups after treatment were significantly higher than that before treatment, and the improvement of the observation group was more significant (P<0.05); the FeNO and EO levels of the observation group after treatment were superior to those of the control group, and the difference was statistically significant (P<0.05).Conclusion:Budesonide/formoterol powder inhalation combined with montelukast can effectively improve the lung function, reduce the level of inflammatory factors, and accelerate the regression of symptoms in the treatment of chronic persistent asthma. It is worth clinical application.

The Reliability of Adjusting Stepped Care Based on FeNO Monitoring for Patients with Chronic Persistent Asthma.

ObjectiveTo examine the feasibility of fractional exhaled nitrous oxide (FeNO) guided stepped care in patients with chronic persistent asthma.Methods160 patients with asthma were enrolled and randomly divided into study and control groups, and were given standardized treatment according to GINA 2014. All patients were evaluated every 3 months and their medication was adjusted according to the results of evaluation. The control group was adjusted according to the recommended protocol from GINA, while the study group was adjusted on the basis of the control group and combined with the results of FeNO. The complete control rate, failure rate of stepwise treatment, ACQ score, lung function, and peripheral blood eosinophil count were compared between the two groups.ResultsIn both study and control groups, the patient condition was effectively controlled. Strikingly, the failure rate of step therapy in study group was lower than that of control group (P<0.05), although there were no significant differences between the two groups on total control rate, ACQ score, lung function, and peripheral blood eosinophil count (P>0.05). Furthermore, the levels of FeNO positively correlated with ACQ scores and eosinophil counts or negatively with lung function.ConclusionsThe dynamic monitoring of FeNO could effectively guide the medication and reduce the rate of treatment failure, which could be used to inform standardized management of asthma.

Is there a benefit to adding a long-acting beta-agonist to an inhaled corticosteroid versus increasing the dose of inhaled corticosteroid in children with chronic persistent asthma?

Is there a benefit to adding a long-acting beta-agonist to an inhaled corticosteroid versus increasing the dose of inhaled corticosteroid in children with chronic persistent asthma?

Observation of the Improvement in Nocturnal Asthma Symptoms with Administration of Once Daily Sustained Released Theophylline

Objective: The aims and objective of this study to observe the improvement in Nocturnal Asthma symptoms and Quality of Life (QoL) with administration of once daily sustained release theophylline preparation.Background: Nocturnal symptoms are a common part of the asthma. Nocturnal asthma is defined by a drop in forced expiratory volume in 1 second (FEV1) of at least 15% between bedtime and awakening in patients with clinical and physiologic evidence of asthma, which may include improvement in QoL.Methodology: The patient with Chronic Persistent Asthma, both sex, age &gt;18 to 50 years of age and preferably patients with nocturnal exacerbations were included in the study. All patients were diagnosed on the basis of clinical history, physical examination, chest X-ray and pulmonary function tests, in accordance with the clinical criteria for the diagnosis by the GINA. The recruitment period was between March 2017 and August 2017 Shaheed Suhrawardy Medical College Hospital, Dhaka.Results: It was observed that 65(92.85%) was found exacerbation free night and 5(7.15%) patients were found exacerbation with sustained release Theophylline. There are significantly improved qualities of life between 1st follow up to 2nd follow up, 3rd follow up and 4th follow up p&lt;0.001 which was statistically significant. Spirometry test was gradually improved between 1st visit of FEV1 to 2nd, 3rd and 4th visit of FEV1, (p&lt;0.001) that was statistically significant.Conclusion: Most of the patients were found exacerbation free night. There are significantly improved quality of life between 1st follow up to 2nd follow up, 3rd follow up and 4th follow up in Spirometry test. The value of FEV1 was gradually improve in the lst visit, 2nd, 3rd and 4th visit with sustained release Theophylline.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 74-77

Clinical Roles of Lung Volumes Detected by Body Plethysmography and Helium Dilution in Asthmatic Patients: A Correlation and Diagnosis Analysis

Roles of lung volumes in asthma remain controversial. We aimed to evaluate the efficacy of lung volumes in differentiating asthma severity levels. Consecutive outpatients with chronic persistent asthma were enrolled, and body plethysmography (BP) and helium dilution (HD) were performed simultaneously to extract RV%pred, TLC%pred, and RV/TLC. Significant negative correlations were found between FEV1%pred and RV%pred (r = −0.557, P < 0.001), TLC%pred (r = −0.387, P < 0.001), and RV/TLC (r = −0.485, P < 0.001) measured by BP, as well as difference in volumes between these two techniques (ΔRV%pred, ΔTLC%pred and ΔRV/TLC). In mild and moderate asthma, AUC of RV%pred detected by BP and ΔTLC%pred was 0.723 (95%CI 0.571–0.874, P = 0.005) and 0.739 (95%CI 0.607–0.872, P = 0.002) with sensitivity and specificity being 79.41% and 88.24%, and 65.22% and 56.52% at cut-off of 145.40% and 14.23%, respectively. In moderate and severe asthma, AUC of RV%pred detected by BP and ΔTLC%pred was 0.782 (95%CI 0.671–0.893, P < 0.001) and 0.788 (95%CI 0.681–0.894, P < 0.002) with sensitivity and specificity being 77.78% and 97.22%, and 73.53% and 52.94% at cut-off of 179.85% and 20.22%, respectively. In conclusion, lung volumes are reliable complement of FEV1 in identifying asthma severity levels.

Use of Montelukast to Reduce Infusion Reactions in an Early Access Treatment Protocol of Daratumumab in United States Patients with Relapsed or Refractory Multiple Myeloma

Use of Montelukast to Reduce Infusion Reactions in an Early Access Treatment Protocol of Daratumumab in United States Patients with Relapsed or Refractory Multiple Myeloma