Asthma Classification Research Articles

Therapeutic Response of Patients with Chest Tightness Variant Asthma: A One-Year Multicenter, Prospective Real-Life Study

Background: Although asthmatic patients with chest tightness as their only presenting symptom (chest tightness variant asthma, CTVA) have clinical characteristics of eosinophilic airway inflammation similar to those of classic asthma (CA), the response of CTVA to treatment regimens used for CA is unclear. Methods: To explore the clinical course and response of 96 CTVA patients to standard asthma treatments with inhaled corticosteroids with long-acting beta-agonists in a 52-week multicenter, prospective, real-life study. Findings: After 52 weeks of treatment with therapy regimens used for CA, the 5-point Asthma Control Questionnaire (ACQ-5) scores decreased markedly from 1·34±0·88(before treatment; V0) to 0·97±0·70 (4 weeks, V1), 0·83±0·72 (13 weeks, V2), 0·73±0·76 (26 weeks, V3), and 0·76±0·79(52 weeks, V4) ( P <0·01), while the Asthma Quality of Life Questionnaire (AQLQ) scores increased from 5·76±0·76 (V0) to 6·24±0·60(V3) and 6·14±0·60(V4) ( P <0·01). The Self-rating Anxiety Scale(SAS) score improved as evidenced by a decrease from 41·44±10·24 (V0) to 37·61±11·41 (V2) and 37·67±8·07 (V4) ( P <0·01). Diurnal variation in peak expiratory flow (PEF) and the bronchial provocation test were improved at one year. However, forced expiratory volume (FEV1) andnitric oxide levels in exhaled breath (FeNO) showed no improvement. Interpretation CTVA patients showed a good clinical response to anti-asthma treatments, and the treatment effects may be related to theseverity of CTVA. Interpretation: CTVA patients showed a good clinical response to antiasthma treatments, and the treatment effects may be related to the severity of CTVA. Trial Registration: ClinicalTrials.gov identifier: NCT 03237221 Funding: 1.This study was supported by the Zhejiang Medical and Health Science and Technology program from Health Commission of Zhejiang Province (WKJ2014-ZJ-01412). 2.This work was funded by the Precision Medicine Research of The National Key Research and Development Plan of China (2016YFC0905800). 3.This study was supported by the program for the Key Site of National Clinical Research Center for Respiratory Disease, the Key ScienceTechnology Innovation Team of Zhejiang Province (2011R50016). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the Institutional Review Board for Human Studies of Second Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China).

The cough variant asthma

Cough variant asthma (CVA) was first described by W. Corrao. CVA was described as the isolated chronic cough as the only presenting symptom responsive to bronchodilator therapy.This phenotype of asthma is present with airway hyperresponsiveness, eosinophilic inflammation airways and bronchodilator responsive coughing without typical manifestation of asthma such as wheezing or dyspnea. CVA shares common features with classic asthma such as eosinophilic inflammation and airway remodeling. Because of that, CVA is clinically considered as a variant type of asthma.

Polymorphism -509C/T in TGFB1 Promoter Is Associated With Increased Risk and Severity of Persistent Allergic Rhinitis in a Chinese Population.

Polymorphism -509C/T in the promoter of transforming growth factor beta1 (TGFB1) gene is implicated in the pathogenesis of asthma. This polymorphism might also act to regulate the development of allergic rhinitis (AR). To investigate whether -509C/T is associated with AR susceptibility and severity in a Han Chinese population. The study enrolled 263 patients with persistent AR and 249 healthy controls. AR patients were classified as mild or moderate/severe AR groups according to the Allergic Rhinitis and its Impact on Asthma classification. TGFB1 gene polymorphism -509C/T was genotyped with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Serum total Immunoglobulin E (IgE) and specific IgE levels were determined using an ImmunoCAP. Significant difference was found in the allele frequency of TGFB1 -509C/T between AR patients and healthy controls (P = .027) but not in the genotype frequency (P =.051). However, the genotype frequency of TGFB1 -509C/T showed significant difference between the mild AR group, the moderate/severe AR group, and the control group (P = .012); between the moderate/severe AR group and the control group (P =.036); between the mild AR group and the moderate/severe AR group (P = .038); but not between the mild AR group and the control group (P =.075). TGFB1 promoter polymorphism -509C/T may be associated with the susceptibility and the severity of persistent AR of Han Chinese, but the functional relationship still needs clarification.

A cross sectional observational study of severity of allergic rhinitis and its impact on asthma

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Allergic rhinitis (AR) and asthma are chronic diseases that often coexist and whose prevalence is increasing day by day. Uncontrolled allergic rhinitis may be associated with worsening of asthma and hence optimal treatment of AR may improve the coexisting asthma. The objective of the study was to study the severity of allergic rhinitis and its impact on asthma.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross sectional study was conducted on 60 patients, at our Institute from November 2017 to June 2019 who were clinically diagnosed to have AR and asthma. Patients were evaluated by proper history taking, in detailed clinical examination and diagnostic nasal endoscopy and spirometry. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study out of 60 patients, majority fell in 20 to 40 age group. According to allergic rhinitis and its impact on asthma (ARIA) classification 10 (17%) had mild intermittent AR, 12 (20%) had mild persistent AR, 5 (8%) had moderate/severe intermittent AR and 33 (55%) had moderate or severe persistent AR. In case of moderate/severe persistent AR: 4 had intermittent, 9 had mild persistent, 10 had moderate persistent and 10 severe persistent asthma. Spearman’s rank correlation was done between severity of AR and severity of asthma, spearman’s rho: 0.365, p&amp;lt;0.004 was significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We noted that as the severity of allergic rhinitis increased, severity of asthma also increased, which was a linear correlation.&lt;/p&gt;

Prevalence of asthma at a school-based health clinic in Nicaragua.

Worldwide, it is estimated that 235-334 million people have been diagnosed with asthma. In Nicaragua, the current asthma rate for children 13-14 years of age was 15.2%. The purpose of this study was to determine the prevalence of asthma at this school-based health clinic in Managua, Nicaragua, associated symptoms or diseases, determine asthma classification, medications, and hospitalization rates. A retrospective chart review was performed on all pediatric patient's medical records seen in the clinic during a 5-day period (n = 105). A total of 23 patients (21.9%) had asthma documented in the medical chart and were included in the analysis. Of the 23 patients, 3 (13%) patients were classified with intermittent asthma while the rest of the patients (87%) were not classified. Albuterol was prescribed for 19 (86%) of the patients with two patients who had both albuterol and QVAR® prescribed. Six (26%) patients had a family history of asthma. This study demonstrated the prevalence of asthma in school-aged children in Nicaragua is significant and higher than previously reported. The lack of a classification of asthma prevents patients from potentially being treated appropriately.

Abstracts From the 31st Pediatric Exercise Physiology Meeting: Children-Exercise-Physical Activity &amp; Sport Performance (September 2019, Umeå, Sweden)

The prevalence of asthma is high in winter endurance athletes with onset typically occurring during adolescence; later than classical asthma. It is well accepted that cold and dry air is involved i ...

Spirometry In Classification and Management of Childhood Asthma

Asthma is the most common chronic illness of childhood. Measurement of lung function provides a better view in diagnosis and management of asthma. Considering scarcity of literature and usefulness of spirometry, this study done to assess role of spirometry on childhood asthma. Prospective study was conducted on children (n=52, age 6 to 12 years) attending asthma clinic in P.D.U. Medical College and Civil Hospital, Rajkot over a period of 2 years (oct-2016 to sep-2018). Diagnosis and management of asthma was done clinically and by spirometry according to GINA – 2015 guidelines. Spirometry is done for minimum 3 times with gap of 3 month each. High positive correlation between clinical and spirometry diagnosis with milder form of asthma. While severe form of asthma is more likely to under diagnosed and under treated (Intermittent, mild persistent and moderate persistent asthma positive correlation 71.5%, 77.3% and 32% respectively). Improvement in FEV1 and FEF25-75 values observes on subsequent spirometry ((FEV1)1 to (FEV1)2 p value=0.000, (FEV1)1 to (FEV1)3 p value=0.001, (FEF25-75)1 to (FEF25-75)2 p value=0.000, (FEF25-75)1 to (FEF25-75)3 p value=0.00). Significant decrease in amount of drug (inhalation steroid – budesonide, mcg/day) required (spirometry-1 mean 357.69, spirometry-2 mean 350.00, spirommetry-3 mean 273.07, p value=0.009). Spirometry is to be done in all children at the time of initial diagnosis of asthma and then once or twice every year. FEV1 and FEF25-75 is important tool for monitoring and assessing treatment response in asthma. Spirometry based treatment implementation leads to better asthma control, optimum dose adjustment.

The Asthma Control Test (ACT) as Predictor of Asthma Exacerbation among Indonesian Hajj Pilgrims in 2018

Objective: Every year, millions of Muslims from around the world gather in Saudi Arabia to perform Hajj. Before leaving for pilgrimage, Indonesian pilgrims go through various health examinations in Regional Primary Health Center (Pusat Kesehatan Masyarakat/ Puskesmas). Since there was no existing research on Asthma Control Test (ACT) assessment for pilgrims with bronchial asthma to predict asthma exacerbations during Hajj pilgrimage period, this cohort study was conducted to fill this gap.Methods: Pilgrims who suffered from asthma were recruited in Daerah Khusus Ibukota (DKI) Jakarta Province region in 2018. The degree classification of asthma in the ACT group was determined as uncontrolled, partially controlled, and fully controlled. ACT scores were calculated in Puskesmas and embarkation. Observation of asthma exacerbations in pilgrims while performing Hajj was performed by doctors. Data were analyzed with SPSS for Windows.Results: A total of 68 participants were included (46 female [67.6%]; 45 aged &lt;60 years [66.2%]). At embarkation, the asthma classification based on the ACT was as follows: 36 (52.9%) and 13 (19.1%) pilgrims had partially controlled and uncontrolled asthma, and 17 (47.2%) and 8 (61.5%) of each group experienced exacerbation, respectively, with p = 0.006 for the ACT values at embarkation. The area under the curve value was 0.717 (95% CI; 0.596-0.838).Conclusion: There was increased asthma exacerbation incidence in the uncontrolled and partially controlled ACT groups at embarkation compared to the fully controlled ACT group. The ACT score was able to predict the occurrence of acute asthma exacerbation during Hajj period.International Journal of Human and Health Sciences Vol. 04 No. 02 April’20 Page : 128-135

A COMPREHENSIVE COMPARISON OF MACHINE LEARNING ALGORITHMS ON DIAGNOSING ASTHMA DISEASE AND COPD

Ponte Academic JournalMar 2020, Volume 76, Issue 3 A COMPREHENSIVE COMPARISON OF MACHINE LEARNING ALGORITHMS ON DIAGNOSING ASTHMA DISEASE AND COPDAuthor(s): Erkut Bolat ,Hasan Yildirim, Sedat Altin, Eray YurtsevenJ. Ponte - Mar 2020 - Volume 76 - Issue 3 doi: 10.21506/j.ponte.2020.3.17 Abstract:The diagnosis and classification of asthma and COPD, which are the most common respiratory diseases, have been vital importance. Recently, machine learning has been great interest for processing health data due to this importance. The focus of previous studies has been to obtain the most predictive algorithm for diagnosing aforementioned diseases. However, variable importance has received little attention. The principal objective of this study is to investigate machine learning algorithms both predictivity and variable importance evaluation abilities. A comprehensive comparison has been carried out by considering different performance criteria including accuracy, precision, recall, Kappa statistics, F-measure, ROC curve and AUC value. The findings have been indicated that Random forest (with CART learner), C5.0 for asthma and SVM (with non-linear kernel) and GBM for COPD are the best algorithms. While the most important variable for asthma is FEV3, MEF50 for COPD. FEV1 and FVC have been common variables among the top five variables. The rank of variables has been supported by statistical significance tests. Additionally, ROC curves and AUC values have provided similar and supportive results as visually. Consequently, this study should be of value to practitioners and researchers studying on expert systems on health sciences and machine learning applications. Download full text:Check if you have access through your login credentials or your institution Username Password

Risk Factors and Comorbidities Associated With the Allergic Rhinitis Phenotype in Children According to the ARIA Classification.

PurposeData are lacking on the association between the allergic rhinitis (AR) phenotype and sensitization to specific allergens or bronchial hyperresponsiveness (BHR) in children. We here investigated risk factors and comorbidities, including sensitization to specific allergens and BHR, for the AR phenotype by AR and its Impact on Asthma (ARIA) classification in a general population-based birth cohort study.MethodsWe enrolled 606 children aged 7 years from the Panel Study of Korean Children. The AR phenotype was assigned in accordance with the ARIA classification in children. Skin prick tests and Provocholine provocation test were performed. Risk factors and comorbidities for AR phenotypes were then analyzed.ResultsThe prevalence of mild and moderate to severe AR in our study cohort was 37.2% and 8.8%, respectively. Recent use of analgesics or antipyretics and current cat ownership were associated with the risk of mild persistent AR. Sensitizations to Dermatophagoides Pteronyssinus (Der p), Japanese hop and cat were associated with moderate to severe persistent AR. Children with moderate to severe AR had a higher risk of current asthma and BHR compared to mild AR cases (adjusted odds ratio [aOR], 5.26; 95% confidence interval [CI], 1.77–15.62). Moderate to severe AR with allergic sensitization was associated with the highest risk of BHR (aOR, 11.77; 95% CI, 3.40–40.74).ConclusionsModerate to severe-persistent AR is more closely related to respiratory comorbidities and sensitizations than mild AR. Stratifying the AR phenotype by ARIA classification may assist in disease management.

Phenotypic classification of asthma based on a new Type 2–high and Type 2–low endotypic classification: It all began with Rackemann

Background: Asthma is now recognized as a heterogeneous collection of disease entities associated with different clinical phenotypic presentations and diverse endotypic mechanisms. Recently, a new system of nomenclature of asthma has evolved by using a type 2 (T2) high and T2-low endotypic classification that has proven useful for diagnosis and for choosing the right biologic for patients with asthma.Aim: The purpose of this report was to provide an overview of molecular endotypes, asthma phenotypes, and existing biomarkers,with a focus on the new classification system of T2 and non-T2 pathways in the historical context of the contributionsof Francis M. Rackemann, M.D., that set the stage both for our current understanding of the spectrum of disease entities of asthma and for the basis for the use of emerging biologics for the treatment of these disorders.Methods: This article was based on literature review of PubMed and the author’s own research and clinical experiences.Results: Currently, the therapy for asthma is being directed to a treatment strategy based on patient-specific phenotypic characteristics and underlying endotypic mechanisms of tissue injury that focus on a T2-high and T2-low airway inflammation classification. Based on this classification, the clinician is provided with a useful treatment stratagem for choosing the right biologic for personalized care of patients with asthma. Although not perfect in its total applicability, it affords a guide in helping to choose among the currently available biologics, the most appropriate one, as well as those that inevitably will become available.Conclusion: The phenotypic classification of asthma described in this report began with the clinical observations that weremade by of an astute clinician long before the supernova emergence of information related to T2-high and T2-low immunefunction. Rackemann’s legacy to clinical allergy practice once again illustrates that science and technology can best progressthrough the energizing force of clinical observation.

G Protein-Coupled Receptors in Asthma Therapy: Pharmacology and Drug Action.

Asthma is a heterogeneous inflammatory disease of the airways that is associated with airway hyperresponsiveness and airflow limitation. Although asthma was once simply categorized as atopic or nonatopic, emerging analyses over the last few decades have revealed a variety of asthma endotypes that are attributed to numerous pathophysiological mechanisms. The classification of asthma by endotype is primarily routed in different profiles of airway inflammation that contribute to bronchoconstriction. Many asthma therapeutics target G protein–coupled receptors (GPCRs), which either enhance bronchodilation or prevent bronchoconstriction. Short-acting and long-acting β2-agonists are widely used bronchodilators that signal through the activation of the β2-adrenergic receptor. Short-acting and long-acting antagonists of muscarinic acetylcholine receptors are used to reduce bronchoconstriction by blocking the action of acetylcholine. Leukotriene antagonists that block the signaling of cysteinyl leukotriene receptor 1 are used as an add-on therapy to reduce bronchoconstriction and inflammation induced by cysteinyl leukotrienes. A number of GPCR-targeting asthma drug candidates are also in different stages of development. Among them, antagonists of prostaglandin D2 receptor 2 have advanced into phase III clinical trials. Others, including antagonists of the adenosine A2B receptor and the histamine H4 receptor, are in early stages of clinical investigation. In the past decade, significant research advancements in pharmacology, cell biology, structural biology, and molecular physiology have greatly deepened our understanding of the therapeutic roles of GPCRs in asthma and drug action on these GPCRs. This review summarizes our current understanding of GPCR signaling and pharmacology in the context of asthma treatment.SIGNIFICANCE STATEMENTAlthough current treatment methods for asthma are effective for a majority of asthma patients, there are still a large number of patients with poorly controlled asthma who may experience asthma exacerbations. This review summarizes current asthma treatment methods and our understanding of signaling and pharmacology of G protein–coupled receptors (GPCRs) in asthma therapy, and discusses controversies regarding the use of GPCR drugs and new opportunities in developing GPCR-targeting therapeutics for the treatment of asthma.

Classification of asthma.

Asthma is a chronic inflammatory disorder of the airways that results, physiologically, in hyperreactivity and, clinically, in recurrent episodes of wheezing, chest tightness, or coughing. Airway inflammation, smooth-muscle contraction, epithelial sloughing, mucous hypersecretion, bronchial hyperresponsiveness, and mucosal edema contribute to the underlying pathophysiology of asthma. Diagnostic tests such as methacholine or mannitol challenges or spirometry (pre- and postbronchodilator responses) help to identify such underlying pathophysiology via assessments of bronchial hyperreactivity and lung mechanics but are imperfect and, ultimately, must be viewed in the context of a patient's clinical presentation, including response to pharmacotherapy. Asthma can be classified into either intermittent or persistent, and the latter is either mild, moderate, or severe. Some patients change, in either direction, from intermittent to persistent asthma. In addition, patients with asthma may be classified as allergic (immunoglobulin E mediated), nonallergic (often triggered by viral upper respiratory tract infections or no apparent cause), occupational, aspirin-exacerbated respiratory disease, potentially fatal, exercise-induced, and cough variant asthma. In the latter, the patients have a nonproductive cough that responds to treatment for asthma but not with antibiotics, expectorants, mucolytics, antitussives, or beta₂-adrenergic agonists, and to treatment for acid reflux and rhinosinusitis. Thus, cough variant asthma is in the differential diagnosis of chronic cough.

Computer-aided classification of small airways dysfunction using impulse oscillometric features: a children-focused review.

Background and objective Spirometry, which is the most commonly used technique for asthma diagnosis, is often unsuitable for small children as it requires them to follow exact instructions and perform extreme inspiration and expiration maneuvers. In contrast, impulse oscillometry (IOS) is a child-friendly technique that could serve as an alternative pulmonary function test (PFT) for asthma diagnosis and control in children as it offers several advantages over spirometry. However, the complex test results of IOS may be difficult to be understood by practitioners due to its reliance on mechanical and electrical models of the human pulmonary system. Recognizing this reality, computer-aided decision systems could help to improve the utility of IOS. The main objective of this paper is to understand the current computer-aided classification research works on this topic. Methods This paper presents a methodological review of research works related to the computer-aided classification of peripheral airway obstruction using the IOS technique, which is focused on, but not limited to, asthmatic children. Publications that focused on computer-aided classification of asthma, peripheral dysfunction and/or small airway impairment (SAI) based on impulse oscillometric features were selected for this review. Results Out of the 34 articles that were identified using the selected scientific web databases and topic-related parameters, only eight met the eligibility criteria. The most relevant results of the articles reviewed are related to the performance of the different classifiers using static features which are solely based on the first pulmonary function testing measurements (IOS and spirometry). These results included an overall classifiers' accuracy performance ranging from 42.24% to 98.61%. Conclusion There is still a great opportunity to improve the utility of IOS by developing more computer-aided robust classifiers, specifically for the asthmatic children population as the classification studies performed to date (1) are limited in number, (2) include features derived from tests that are not optimally suitable for children, (3) are solely bi-class (mostly asthma and non-asthma) and therefore fail to include different degrees of peripheral obstruction for disease prevention and control and (4) lack of validation in cases that focus on multi-class classification of the different degrees of peripheral airway obstruction.

Allergic Rhinitis and OSA in Children Residing at a High Altitude

OSA affects 2%to 4 %of the pediatric population; allergic rhinitis (AR) has been identified as a risk factor in sleep-disordered breathing, but no studies evaluating such an association have been conducted in high-altitude environments. The goal of this study was to assess whether the severity of AR is associated with the severity of OSA in children undergoing polysomnography (PSG) in the high-altitude city of Bogotá, Colombia. A cross-sectional observational study of children with AR was conducted. Severity of AR was evaluated by using the AR health-related quality of life questionnaire for children (ESPRINT-15) and the Allergic Rhinitis and its Impact on Asthma (ARIA) classification. Diagnosis and severity of OSA were established by using PSG. Potential associations between AR severity and OSA severity were assessed by using binary logistic regression and the Spearman correlation coefficient (ρ). A total of 99 children (mean age, 7.9 years; 45%female) were included; 53%had OSA. An ESPRINT-15 score was associated with severe OSA (OR, 2.0; 95%CI, 1.12-6.04; P=.01). Patients with moderate/severe persistent rhinitis according to ARIA exhibited a 10.1-fold greater risk of severe OSA (OR, 10.15; 95%CI, 1.15-89.0). Furthermore, the apnea-hypopnea index was associated with the ESPRINT-15 score (ρ= 0.215; P= .03) and with the ARIA severity scale (P= .04; ρ= 0.203). In symptomatic children with AR residing at a high altitude, increasing AR severity is associated with more severe OSA.

Evaluating direct costs and productivity losses of patients with asthma receiving GINA 4/5 therapy in the United States

BackgroundDespite the low prevalence for all patients with asthma, those with severe disease account for a disproportionately large economic burden. ObjectiveTo evaluate current direct health care and productivity loss costs associated with patients with asthma receiving Global Initiative for Asthma Step 4/5 therapy (“G4/5 asthma”) in the United States. MethodsAsthma patients aged 12 years or older were identified in the IBM MarketScan Research Databases between January 1, 2012 and December 31, 2015. Patients were indexed on their earliest medical claim for asthma and were required to have at last 2 years of continuous eligibility. The G4/5 asthma classification required 1 or more medium- or high-dosage inhaled corticosteroids (ICS)/long-acting beta-agonist (LABA) claims, 1 or more omalizumab claims, or systemic corticosteroids covering at least 50% of the 12-month baseline period. The European Respiratory Society/American Thoracic Society criteria for severe uncontrolled asthma were modified for claims data and used to identify patients with exacerbations or high rescue medication use (“Ex/R″). Direct health care costs and productivity loss costs attributable to workplace absence or short-term or long-term disability were measured during the 12-month post-index period. ResultsA total of 605,614 patients with asthma were identified. Annual health care costs were $4,384 greater for G4/5 asthma vs non-G4/5 patients with asthma; asthma-related costs contributed $2,183 of this difference (P < .001). Differences were primarily driven by G4/5 patients with asthma with Ex/R, whose costs were $5,019 greater than G4/5 patients without Ex/R (P < .001). For patients with 1 or more absences or short-term disability claims, G4/5 patients missed 7.2 more work hours for absence and had 3.9 more days of work lost for short-term disability than non-G4/5 patients with asthma, respectively (P < .05). ConclusionG4/5 patients with asthma incurred significantly greater direct and indirect costs than non-G4/5 patients with asthma. Differences were largely driven by those with Ex/R.

Quantitative computed tomography measurement of cross-sectional area of small pulmonary vessels in asthmatic patients.

Background:Cross-sectional area (CSA) for small pulmonary vessels is considered a parameter of pulmonary vessel alterations in patients with chronic obstructive pulmonary disease. This study was to evaluate the correlation of CSA with airflow obstruction parameters in asthma. Furthermore, we aimed to measure the difference in vascular alteration between asthma phenotypes and evaluate its relation with cytokine levels.Methods:We consecutively enrolled 20 adult asthmatic patients (13 women: age range, 26–80 years) and 20 healthy controls (8 women: age range, 23–61 years) from Peking University Third Hospital. Total CSA <5 mm2 (CSA<5) was measured with 64-slice spiral computed tomography, and the percentage CSA <5 for the lung area (%CSA<5) was calculated. Data were corrected for body surface area to obtain sixth-generation airway luminal diameter (LDcor), luminal area (Aicor), and airway wall thickness, and airway wall area percentage (WA%) was calculated. Enzyme-linked immunosorbent assay was used to detect the expression of leptin, total immunoglobulin E, periostin, and transforming growth factor β1 in serum and matrix metalloproteinase 9 in induced sputum supernatant of asthmatic patients. The differences in %CSA<5 between subgroups were assessed by independent samples Student's t test, and Spearman correlation analysis was used to analyze the correlation of %CSA<5 with clinical indexes and inflammatory cytokine levels.Results:Patients with asthma and controls did not differ in %CSA<5. In asthma patients, %CSA<5 was lower with initial onset age ≤12 years old, airflow restriction and uncontrolled Global Initiative for Asthma classification (all P < 0.05). Moreover, it was positively correlated with forced vital capacity ratio in 1 s (FEV1)/forced expiratory volume ratio, FEV1%, LDcor, Aicor, and serum leptin level (all P < 0.05) and negatively with total lung WA% (P = 0.007).Conclusions:%CSA<5 of pulmonary small vessels was well correlated with airflow limitation indexes and sixth-generation airway parameters. It has certain significance in predicting the clinical control of asthma.

HMM Based Cough Sound Scrutiny for Classification of Asthma and Pneumonia in Paediatry

Isolating pediatric asthma from pediatric pneumonia is one of the serious issues in remote territories. These sicknesses have covering side effects, however require radically extraordinary medicines. Existing rules for pneumonia order in asset poor areas from The World Health Organization require the utilization of bronchodilator test to isolate asthma from pneumonia. In any case, bronchodilator is a costly test to direct and not effectively accessible in remote regions. In this investigation, we star represent an imaginative and novel system utilizing hack sound examination to isolate pneumonia cases from asthma. In crafted by this paper we dissected hack sound information from 20 subjects (10 pneumonia and 10 asthma patients). Utilizing scientific highlights of hack sounds, a HMM classifier was prepared to distinguish pneumonic hack and asthmatic hack. At that point by registering Pneumonic Cough Index every patient was delegated either into pneumonia or asthma. Proposed strategy accomplished a precision of 90% (affectability = 100% and explicitness = 80%) in arranging pneumonia and asthma patients. Our outcomes demonstrate that hack sound convey basic data which can be utilized to isolate asthma patients from pneumonia. Proposed strategy in this paper indicates potential to turn into an option for bronchodilator test in the asset poor zones of the world

Severe asthma: Comparison of different classifications of severity and control.

Criteria of asthma severity and control lack standardization. to compare classifications of asthma severity and control, applied to patients from a severe asthma clinic. Cross-sectional study of 473 patients followed up for ≥6 months, reclassified using three criteria: 1) the World Health Organization (WHO) 2010, 2) the American Thoracic Society (ATS) 2000, and 3) the European Respiratory Society (ERS)/ATS 2014. In order to evaluate disease control, the 2012 and 2014 Global Initiative for Asthma (GINA) classifications were compared. According to the definition of WHO 2010, 429 had Difficult-to-treat severe asthma and only 12 presented Treatment-resistant severe asthma. 114 patients had Refractory asthma by ATS 2000 and 88 had Severe asthma by ERS/ATS 2014. Considering the definitions of WHO 2010, only 9 out of 12 with Treatment-resistant and 64 out of 429 with Difficult-to-treat severe asthma met the criteria of ATS 2000 and ERS/ATS 2014. As for GINA classification of control, 208 (44%) of the 473 subjects were classified as having asthma controlled by the 2014 criteria, whereas only 45 (10%) patients had controlled asthma by the GINA 2012 criteria. The Kappa statistic indicates the highest agreement of the severity classification occurred between the criteria of ATS 2000 and ERS/ATS 2014 (0.64). Good agreement was found between Refractory asthma ATS 2000 and Severe asthma ERS/ATS 2014 classifications. However, poor agreement was observed between the severity rating proposed by the WHO and other classifications. The GINA control classifications of 2012 and 2014 also agreed poorly.

Bariatric surgery: a potential cure for asthma?

Asthma incidence and severity are increased in obese populations. Systematic reviews have shown benefit from weight-loss interventions on asthma outcomes, but the role of bariatric surgery is still unclear. In this review, cohorts of obese asthmatic patients undergoing bariatric surgery were examined regarding different asthma outcomes. The available data on patients who were followed up showed improvements in asthma control, exacerbation risk, asthma-related hospitalisation, medication use and airway hyperresponsiveness, with some patients not requiring further treatment for asthma. Follow-up duration was variable, being mostly of 1 year, with some studies reporting long-term outcomes after 5 years. The studies reviewed had many limitations, including small numbers of patients, lack of control arm in some studies and lack of standardisation of asthma diagnosis, classification and outcome measures, in addition to possible reporting bias. Data on small numbers of patients also show the possibility of benefit exclusively in nonallergic asthma. Larger, more stringent clinical trials are needed before recommending bariatric surgery for treatment of asthma.