Development Of Asthma Exacerbations Research Articles

Pharmacoeconomics analysis of using a fixed combination of budesonide/formoterol in patients with asthma in the health care system of the Russian Federation

To evaluate the budgetary impact of using budesonide + formoterol (Symbicort Turbuhaler) as maintenance therapy in real clinical practice compared with standard therapy for asthma of varying severity: for mild asthma with on-demand salbutamol; for moderate and severe asthma with the drug salmeterol + fluticasone and salbutamol on demand. A static mathematical model was built to assess the impact on the budget when introducing the drug budesonide + formoterol (Symbicort Turbuhaler) in the treatment of asthma into clinical practice from the point of view of the state. Demographic data was taken from the official data of the Federal State Statistics Service. Direct medical costs included the cost of medicines, the cost of hospitalization of patients associated with the development of asthma exacerbations, and the cost of scheduled outpatient visits. Indirect costs considered the loss of GDP due to hospitalization of patients against the background of asthma exacerbations. A one-way sensitivity analysis was performed to confirm the robustness of the study results. Assessment of direct costs in the treatment of mild, moderate and severe asthma showed that a gradual increase in the proportion of patients receiving the drug budesonide + formoterol (Symbicort Turbuhaler) over the years to 5.5, 7.7 and 9.7% accordingly, led to an increase in the cost of pharmacotherapy over 3 years by 1.7 billion rubles, while direct non-drug costs associated with the treatment of complications that developed during the treatment of asthma decreased by 8.3 billion rubles. Thus, the reduction in total direct costs amounted to RUB 6.7 billion. At the same time, indirect costs decreased by 6.0 billion rubles. The total reduction in all costs (direct and indirect) when switching patients to budesonide + formoterol (Symbicort Turbuhaler) amounted to 12.5 billion rubles. In addition, the use of the drug budesonide + formoterol (Symbicort Turbuhaler) resulted in a decrease in the number of exacerbations: in the first year by 3137, in the second by 4393 and in the third by 5534 cases. A total of 13 064 asthma exacerbations were prevented over 3 years. Increasing the proportion of patients with asthma of varying severity receiving therapy with budesonide + formoterol (Symbicort Turbuhaler) will reduce the financial burden on both the healthcare system and the budgetary system.

Respiratory viral infections and asthma exacerbations: new opportunities of omalizumab

The literature review is devoted to the discussion of the role of respiratory viral infections in the development of exacerbations of bronchial asthma. Despite significant advances in the development of new approaches and means of treating bronchial asthma, an insufficient level of control of the disease remains, one of the consequences of which is an exacerbation of asthma, which causes significant damage both to the health of patients and leads to high costs of the healthcare system for treatment. The article provides data on the leading causal role in the development of exacerbations of bronchial asthma in children, as well as adult respiratory viruses, among which rhinoviruses are most often detected during exacerbations, especially rhinovirus C. Based on the research results, the mechanisms of predisposition of patients with bronchial asthma to virus-induced exacerbations are considered in detail., including at the gene level, associated both with the suppression of the production of cytokines suppressing the replication and spread of viruses, in particular alpha-interferon, and the stimulation of the production of T2 cytokines, such as IL5. An important role in the development of asthma exacerbations in viral infections of allergic sensitization is indicated, the role of allergen-specific IgE antibodies in the pathogenesis of asthma exacerbations caused by viruses is discussed. The data on the role of plasmacytoid dendritic cells in the formation of the pathological process in virusinduced exacerbations in patients with atopic bronchial asthma are presented. The results of studies obtained both in real clinical practice and in experimental rhinovirus infection in patients with asthma, testifying to the high therapeutic efficacy of the preparation of monoclonal antibodies against IgE – omalizumab – in the prevention and treatment of exacerbations of bronchial asthma caused by respiratory viruses are presented.

Asthma Exacerbation Caused by Bacterial Infection in Two Elderly Patients

Background: The role of airway bacterial infection in the asthma exacerbation has been reported in addition to that of viral infection. However, the effect of bacterial infections on asthma exacerbation has received less attention than that of viral infections, and clinical features have not been well reported.Case presentation: Here, we describe the clinical features of two cases of asthma exacerbation that were thought to involve airway and/or lung bacterial infection and that improved with treatment including antibiotics, glucocorticoids and bronchodilators.Conclusion: The examination data suggested that neutrophilic inflammation caused by bacterial infections may have an important role in the development of asthma exacerbations.

Study on impact of air pollution on asthma among school going children residing in urban Agra

Background: Air pollution is one of the world's most serious environmental problems. Air pollution has many negative health effects on the general population, especially children, individuals with underlying chronic disease, and the elderly. The aims of this study were to evaluate the effects of traffic-related pollution on the exacerbation of asthma and development of respiratory infections in schoolgoing children in Agra, suffering from asthma compared with healthy subjects, and to estimate the association between incremental increases in principal pollutants and the incidence of respiratory symptoms. Materials and Methods: We enrolled 702 children aged 6–18 years in this prospective study. A total of 342 children with asthma and 360 healthy subjects were monitored for 6 months from September 2013 to February 2014. Clinical data were combined with the results obtained using an air pollution monitoring system of the five most common pollutants. A total of 328 children with asthma and 345 healthy subjects completed follow-up. Results: Children with asthma reported significantly more days of fever (P Conclusion: There is a significant association between traffic-related pollution and the development of asthma exacerbations and respiratory infections in children suffering from asthma. These findings suggest that environmental control may be crucial for respiratory health in children with the underlying respiratory disease.

A systematic review of the association between fish oil supplementation and the development of asthma exacerbations.

A systematic review was conducted to examine the association between fish oil supplementation and the development of asthma exacerbations. Comprehensive literature reviews of recent fish oil studies were performed to evaluate alterations in asthma surrogate markers. Additionally, the relative compositions of the fish oils used in each study were analyzed. The results of the review were inconclusive, but provide a basis for future research methods.

Effect of beta2-adrenergic agonists on eosinophil adhesion, superoxide anion generation, and degranulation

BackgroundEosinophils play important roles in the development of asthma exacerbation. Viral infection is a major cause of asthma exacerbation, and the expression of IFN-γ-inducible protein of 10 kDa (IP-10) and cysteinyl leukotrienes (cysLTs) is up-regulated in virus-induced asthma. As β2-adrenergic agonists, such as formoterol or salbutamol, are used to treat asthma exacerbation, we examined whether formoterol or salbutamol could modify eosinophil functions such as adhesiveness, particularly those activated by cysLTs or IP-10. MethodsEosinophils were isolated from the blood of healthy subjects and were pre-incubated with either formoterol or salbutamol, and subsequently stimulated with IL-5, LTD4, or IP-10. Adhesion of eosinophils to intercellular cell adhesion molecule (ICAM)-1 was measured using eosinophil peroxidase assays. The generation of eosinophil superoxide anion (O2−) was examined based on the superoxide dismutase-inhibitable reduction of cytochrome C. Eosinophil-derived neurotoxin (EDN) release was evaluated by ELISA as a marker of degranulation. ResultsNeither formoterol nor salbutamol suppressed the spontaneous adhesion of eosinophils to ICAM-1. However, when eosinophils were activated by IL-5, LTD4, or IP-10, formoterol, but not salbutamol, suppressed the adhesion to ICAM-1. Formoterol also suppressed IL-5, LTD4, or IP-10 induced eosinophil O2− generation or EDN release. ConclusionsThese findings suggest that formoterol, but not salbutamol, suppresses eosinophil functions enhanced by IL-5, LTD4, or IP-10. As these factors are involved in the development of asthma exacerbation, our results strongly support the hypothesis that administration of formoterol is a novel strategy for treating asthma exacerbation.

Impact of air pollution on respiratory diseases in children with recurrent wheezing or asthma.

BackgroundAir pollution has many negative health effects on the general population, especially children, subjects with underlying chronic disease and the elderly. The aims of this study were to evaluate the effects of traffic-related pollution on the exacerbation of asthma and development of respiratory infections in Italian children suffering from asthma or wheezing compared with healthy subjects and to estimate the association between incremental increases in principal pollutants and the incidence of respiratory symptoms.MethodsThis prospective study enrolled 777 children aged 2 to 18 years (375 with recurrent wheezing or asthma and 402 healthy subjects). Over 12 months, parents filled out a daily clinical diary to report information about respiratory symptoms, type of medication used and healthcare utilization. Clinical data were combined with the results obtained using an air pollution monitoring system of the five most common pollutants.ResultsAmong the 329 children with recurrent wheezing or asthma and 364 healthy subjects who completed follow-up, children with recurrent wheezing or asthma reported significantly more days of fever (p = 0.005) and cough (p < 0.001), episodes of rhinitis (p = 0.04) and tracheitis (p = 0.01), asthma attacks (p < 0.001), episodes of pneumonia (p < 0.001) and hospitalizations (p = 0.02). In the wheezing/asthma cohort, living close to the street with a high traffic density was a risk factor for asthma exacerbations (odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.13-2.84), whereas living near green areas was found to be protective (OR = 0.50; 95% CI, 0.31 -0.80). An increase of 10 μg/m3 of particulates less than 10 microns in diameter (PM10) and nitrogen dioxide (NO2) increased the onset of pneumonia only in wheezing/asthmatic children (continuous rate ratio [RR] = 1.08, 95% CI: 1.00-1.17 for PM10; continuous RR = 1.08, 95% CI: 1.01-1.17 for NO2).ConclusionsThere is a significant association between traffic-related pollution and the development of asthma exacerbations and respiratory infections in children born to atopic parents and in those suffering from recurrent wheezing or asthma. These findings suggest that environmental control may be crucial for respiratory health in children with underlying respiratory disease.

An Analysis of Asthma Exacerbations and Weather Conditions in Chuncheon

M O N D A Y 572 An Analysis of Asthma Exacerbations and Weather Conditions in Chuncheon Jae-Woo Kwon, Young-Ji Han, Moo Kyung Oh, Chang Ryul Lee, Seon-Sook Han, Seung-Joon Lee, Woo Jin Kim; Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, South Korea, Department of Environmental Science, Kangwon National University, Chuncheon, South Korea, Department of Health Policy and Management, Kangwon National University, Chuncheon, South Korea, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea, Division of Pulmonology, Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, South Korea. RATIONALE: In Chuncheon, located in a large basin with lakes surrounded by mountains, it has long been thought that fog triggers asthmatic episodes by local people. This study is conducted to estimate the effects of climate factors on asthma exacerbations in Chuncheon, Korea. METHODS: We enrolled patients who had visited the emergency department(ED) of 2 university hospitals in Chuncheon for asthma exacerbations from January 10th 2006 to December 31st 2012. The daily temperature, atmospheric pressure, humidity, solar radiation, and the presence of fog were retrieved from the data collected by routine monitoring for climate factors. A case-crossover analysis was performed using variables about climate factors at 1 week before and after ED visits of controls. RESULTS: There were 656 ED visits by 567 patients with asthma exacerbations. For the analysis about climate factors of one day before asthma exacerbations (lag 1), the prevalence of asthma exacerbation was lower after lag 1 day with higher mean relative humidity (%) (OR: 0.990, CI 95%: 0.982–0.998, p50.011). The prevalence of asthma exacerbation showed the tendency to be lower after lag 1 day with fog (OR: 0.782, CI 95%: 0.593–1.032, p50.083). After adjustment for lowest temperature, atmospheric pressure, and the presence of fog, mean relative humidity was still negatively correlated with the prevalence of asthma exacerbation (p50.027). CONCLUSIONS: These results suggest that low humidity might contribute to the development of asthma exacerbation and the fog may not contribute to the asthma exacerbations in Chuncheon, althoughmore largescale and well-designed studies are needed.

Severe asthma: a consequence of over exuberant repair?

Severe asthma: a consequence of over exuberant repair?

Is There Any Relationship Between Asthma and Asthma Attack in Children and Atypical Bacterial Infections; Chlamydia Pneumoniae, Mycoplasma Pneumoniae and Helicobacter Pylori

Asthma is a chronic inflammatory airway disease characterized by variable airway obstruction and bronchial hyperresponsiveness. There are many factors affecting the development and severity of childhood asthma such as genetic predisposition, atopy, environmental factors, obesity, diet, socioeconomic status, and infectious triggers. In the present study we aimed to investigate the frequency of Mycdoplasma pneumoniae, Chlamydia pneumoniae, and Helicobacter pylori infections in asthmatic children. We investigated also whether there is a relationship between these agents and asthma attacks. Seventy-nine asthmatic children (46 males, aged 5-15 years) were included in study. The study group was divided into two groups: group 1 consisted of 37 children with asthma attacks and group 2 consisted of 42 children with stable asthma. As a control group we studied 36 healthy children. Pulmonary function tests, skin prick tests for common allergens were performed; serum total IgE, phadiatop, specific IgM and IgG antibody levels (ELISA) for M. pneumoniae, C. pneumoniae and H. pylori were measured in all patients. Mycoplasma IgM and Chlamidia IgM were positive in 8.1% (3 patients) and 18.9% (7 patients) of group 1 patients, respectively. There was a statistically significant difference for Mycoplasma IgM (p = 0.031) and Chlamidia IgM (p = 0.03) between group1 and other two groups. We have not found significant difference for M. pneumoniae IgG, C. pneumoniae IgG and H. pylori IgM and IgG among groups. M. Pneumoniae and C. Pneumoniae may play a role in development of asthma exacerbations in childhood. We could not find a relationship between H. Pylori and asthma.

Mechanisms of viral impact on asthma exacerbations

Rationale Respiratory viruses are a frequent cause of wheezing in infants and children. 60 - 85% of asthma exacerbations in children and up to 50% of asthma exacerbations in adults are attributed to respiratory viruses. Previous studies investigated the role of rhinoviruses, RS-viruses and adenoviruses in development of asthma exacerbations in children hospitalized in the clinic of the Institute of Immunology (Moscow, Russia). Rhinovirus was the most frequently detected – 33 samples (24.8% of all tested samples), adenovirus – 5 samples (3.8%), RSV– 4 samples (3.0%), and mixed infections (rhinovirus and RSV) – 1 sample (0.7%). Among positive samples rhinovirus accounted for 76.7%, adenovirus - 11.6%, RSV - 9.3%, and mixed infection - 2.3%. Methods Primers for PCR diagnostics of Parainfluenza viruses of 1, 2 and 3 type and coronaviruses OC43 and 229E were developed. Investigation of HLA-alleles and genotypes was conducted in patients with virus-induced bronchial asthma to reveal HLA-associated markers of susceptibility to viral-induced asthma. Results An increased frequency of HLA-DRB1 ∗13 specificity and reduced frequencies of HLA-DRB1 ∗04 and HLA-DRB1 ∗11 specificities were noted in the viral-induced asthmatics compared to the healthy control group. A minimal increase of HLA-DRB1 homozygotes - 21% was also noted in comparison with the control group - 14%. Conclusions Investigation of HLA-haplotype in patients with viral-induced outbreaks of asthma via HLA-genotyping may reveal more evident associations between HLA-haplotypes and individual respiratory viral infections.