Different Degrees Of Asthma Severity Research Articles

The Value of RDW, PDW, and Immunoglobulin E in the Clinical Diagnosis of Pediatric Asthma

Objective: To observe and explore the value of the combined application of red blood cell distribution width (RDW), platelet distribution width (PDW), and immunoglobulin E (IgE) in the process of clinical diagnosis of children with asthma. Methods: Fifty-five children with suspected asthma were admitted to the hospital from July 2021 to July 2023. They underwent a bronchodilator test upon admission and their RDW, PDW, and IgE were detected. The efficacy of diagnosis with a single indicator (RDW/PDW/IgE) and combined parameters (PDW + PDW + IgE) were compared with the results of the bronchodilator test. Results: 49 cases of pediatric asthma were diagnosed by the bronchodilator test. RDW and PDW of asthmatic children were lower than those of non-asthmatic children, while the IgE of asthmatic children was higher than that of non-asthmatic children, and there was a significant difference in the RDW, PDW, and IgE among children with different degrees of asthma severity (P < 0.05). The positive rate of the three combined diagnostic tests of RDW, PDW, and IgE was significantly higher than the positive rate of a single-parameter diagnosis (P < 0.05). Conclusion: The combination of RDW, PDW, and IgE plays a crucial role in the clinical diagnosis of asthmatic children. These tests further improve the efficiency of clinical diagnosis and help identify the severity of the disease.

Interleukin-18 −607C/A Gene Polymorphism in Egyptian Asthmatic Children

Asthma is a multifactorial respiratory disease determined by interactions of multiple disease susceptibility genes and environmental factors. Interleukin (IL)-18 is an important cytokine for initiating and perpetuating the catabolic and inflammatory response in allergic asthma. A number of single nucleotide polymorphisms that influence IL-18 production are found in the gene promoter region. The aim of this study was to investigate the association of IL-18 -607C/A promoter polymorphism with asthma and whether this polymorphism influenced the severity of asthma in affected children. The influence of this promoter gene polymorphism on total serum IgE level in studied subjects was also investigated. This study was carried out at the Allergy Clinic of Abu El Reesh Children's Hospital at Cairo University, Egypt. This study included 40 asthmatic children, subdivided into four groups according to different degrees of asthma severity, and 20 apparently healthy subjects as the control group. All cases were subjected to history taking, clinical examination, and the following laboratory investigations: complete blood count, total serum IgE level assay by ELISA and genomic DNA extraction, and analysis for IL-18 -607C/A promoter gene polymorphism using the PCR-RFLP (restriction fragment length polymorphism) technique. In the present study the IL-18 -607AA genotype frequency was higher in cases (22.5 %) than in the control group (15 %); however, the difference was not statistically significant (p = 0.773). No statistically significant difference between the degree of asthma severity and IL-18 -607C/A polymorphism was found (p = 0.489). No significant association could be detected upon comparing the frequencies of C and A alleles among the two studied groups (p = 0.366). Also, no significant differences were demonstrated for the allele frequencies when the intermittent with mild [odds ratio (OR) = 2.72, 95 % CI 1.03-2.33, p = 0.067], intermittent with moderate, and severe (OR = 2.8, 95 % CI 1.01-8.5, p = 0.066) asthma groups were compared. The median value of the total serum IgE level in asthmatic cases with the mutant genotype (AA) was significantly higher [360 IU/L (96.6-1,340 IU/L)] than in the control group [119 IU/L (70.6-158.9 IU/L)] (p = 0.033). No significant statistical difference was encountered regarding the distribution of IL-18 -607C/A genotypes and allele frequencies in asthma patients and healthy controls. Also, there were no significant associations between asthma severity and different genotypes or alleles. The median value of the total serum IgE level in asthmatic cases with the mutant genotype (AA) was significantly higher than in the control group. Thus, IL-18 -607AA genotype frequency might be related to higher total serum IgE.

Bronchial reactivity indices are determinants of health-related quality of life in patients with stable asthma

BackgroundA very weak relationship has been reported between the health-related quality of life (HRQL) of patients with asthma and their degree of airway hyper-responsiveness (AHR), evaluated in terms of sensitivity....

Eotaxin-1 in exhaled breath condensate of stable and unstable asthma patients.

BackgroundAirway eosinophilia is considered a central event in the pathogenesis of asthma. Eotaxin plays a key role in selective eosinophil accumulation in the airways and, subsequently, their activation and degranulation. The study was undertaken to evaluate eotaxin-1 levels in the exhaled breath condensate (EBC) of asthmatics with different degrees of asthma severity and to establish the possible correlation of these measurements with other recognized parameters of airway inflammation.MethodsEBC was collected from 46 patients with allergic asthma (14 with steroid-naïve asthma, 16 with ICS-treated, stable asthma, 16 with ICS-treated unstable asthma) and 12 healthy volunteers. Concentrations of eotaxin-1 were measured by ELISA.ResultsIn the three groups of asthmatics, eotaxin-1 concentrations in EBC were significantly higher compared with healthy volunteers (steroid-naïve asthma: 9.70 pg/ml ± 1.70, stable ICS-treated asthma: 10.45 ± 2.00, unstable ICS-treated asthma: 17.97 ± 3.60, healthy volunteers: 6.24 ± 0.70). Eotaxin-1 levels were significantly higher in patients with unstable asthma than in the two groups with stable disease. We observed statistically significant correlations between the concentrations of eotaxin-1 in EBC and exhaled nitric oxide (FENO) or serum eosinophil cationic protein (ECP) in the three studied groups of asthmatics. We also discovered a significantly positive correlation between eotaxin-1 in EBC and blood eosinophil count in the groups of patients with unstable asthma and steroid-naïve asthma.ConclusionsMeasurements of eotaxin-1 in the EBC of asthma patients may provide another useful diagnostic tool for detecting and monitoring airway inflammation and disease severity.

Rescue Treatment in Asthma: More Than As-Needed Bronchodilation

International guidelines recommend the use of rapid-onset inhaled beta(2)-agonists alone for symptom relief in all asthmatic patients. However, recent clinical trials have shown that the "as-required," or PRN, use of inhaled combinations of a corticosteroid and a rapid-onset beta(2)-agonist provides clinical advantages over the traditional PRN inhaled rapid-onset beta(2)-agonists alone in patients with different degrees of asthma severity. Asthma symptoms are associated not only with bronchoconstriction but also with increased airway inflammation. Inhaled beta(2)-agonists have a rapid onset of bronchodilator action that is mainly mediated by a relaxing effect on airway smooth muscle. Inhaled corticosteroids also have rapid clinical effects that can suppress lower airway inflammation, and there is a rapid synergistic potentiation of the antiinflammatory effect of corticosteroids and of the bronchodilatory action of beta(2)-agonists when the two drugs are given simultaneously. On the basis of this emerging evidence, we propose that the current rescue use of rapid-onset inhaled beta(2)-agonists alone should now be replaced by an inhaled rapid-acting beta(2)-agonist combined with a corticosteroid as preferred PRN strategy. We conclude with a call for clinical trials aimed to test the superiority of this approach in all degrees of asthma severity in a real-world setting in addition to any of the regular treatments recommended by international guidelines. In the future it might even be possible to control asthma entirely with PRN combination inhalers without maintenance therapy, at least in patients with less severe disease.

High-sensitivity C-reactive protein in the exhaled breath condensate and serum in stable and unstable asthma

Asthma is a chronic airway inflammatory disease. Measurement of serum high- sensitivity C-reactive protein (hs-CRP) levels has suggested the involvement of low-grade systemic inflammation in several disorders, such as cardiovascular disease and diabetes mellitus. In recent years, there have been some reports concerning hs-CRP assessment as a useful tool for detecting systemic inflammation in asthma. The study was undertaken to evaluate hs-CRP levels in the exhaled breath condensate (EBC) of asthmatics with different degrees of asthma severity and their relationship to hs-CRP levels in serum, clinical characteristics, and the intensification of airway inflammation. The study group was 62 patients with allergic asthma (20 with steroid-naïve mild asthma, 19 with ICS-treated, stable mild-to-moderate asthma, 23 with ICS-treated unstable, severe asthma) and 15 healthy volunteers. In the three groups of asthmatics hs-CRP concentrations in EBC and serum were significantly higher than in healthy volunteers. hs-CRP levels both in EBC and serum were significantly higher in patients with unstable asthma than in the two groups with stable disease. hs-CRP concentrations in EBC strongly correlated with those measured in serum. There was a significant correlation between hs-CRP levels both in EBC and serum and exhaled nitric oxide (F(ENO)) in the three groups of asthmatics or serum ECP in the group of patients with steroid-naïve mild asthma and unstable, severe asthma. The levels of hs-CRP in EBC are correlated with those measured in serum and may provide another useful diagnostic tool for detecting and monitoring low-grade inflammation in patients with asthma.

RANTES in exhaled breath condensate of stable and unstable asthma patients

RANTES has been implicated in the allergic inflammation of asthma by promoting the migration and activation of the inflammatory cells, including eosinophils. The study was undertaken to evaluate RANTES levels in the exhaled breath condensate (EBC) of asthmatics with different degrees of asthma severity. EBC was collected from 33 patients with allergic asthma (11 with steroid-naïve mild asthma, 10 with ICS-treated, stable mild-to-moderate asthma, 12 with ICS-treated unstable, severe asthma) and seven healthy volunteers. In the three groups of asthmatics, RANTES concentrations in EBC were significantly higher compared with healthy volunteers. RANTES levels were significantly higher in patients with unstable asthma than in the two groups with stable disease. We observed statistically significant correlations between the concentrations of RANTES in EBC and F(ENO) in the three studied groups of asthmatics; notably, the correlation between the parameters described above was strong positive in the group of unstable and steroid-naïve stable asthmatics. We also discovered a significantly positive correlation between RANTES in EBC and the serum ECP or blood eosinophil count in the groups of asthmatics with severe, unstable asthma and between RANTES and serum ECP in the group of steroid-naïve stable asthmatics. Measurements of RANTES in EBC may provide another useful diagnostic tool for detecting and monitoring inflammation in patients with asthma.

Severity, control, and responsiveness in asthma

Guidelines for asthma management have proposed that initial treatment should be based on assessment of asthma severity. The treatments proposed for different degrees of asthma severity are essentially estimates of the intensity of treatment needed to achieve asthma control. Responsiveness to treatment is heterogeneous, however, even among asthmatic patients with asthma of similar severity. This heterogeneity calls attention to the importance of assessing asthma control and adjusting treatment accordingly. Application of a guidelines-based approach to asthma management thus requires general agreement on what is meant by severity, control, and responsiveness and requires further an awareness of asthma as causing symptoms and functional impairment in the present and also as causing risk of adverse events in the future.

Asthma-Related Costs Relative to Severity and Control in General Practice

Limited data are available about costs of asthma care by general practitioners (GPs) in France. This study evaluated asthma care costs of children treated by GPs, and the relationship between cost and asthma control across different degrees of asthma severity. We conducted a retrospective longitudinal observational study based on a computerized prescription database of GPs supplemented with a cross-sectional survey of children aged 6–16 with persistent asthma (GINA step ≥2). Retrospective data on asthma-related medical resource utilization (MRU) were collected for a 12-month study period. MRU included antiasthma medications, visits to GPs, visits to emergency rooms, and hospitalizations. Asthma control was evaluated from recent asthma symptoms, whereas severity was defined by the average dose of inhaled corticosteroids prescribed during a preindex period. Univariate and multivariate analyses were used to evaluate relationships between MRU and other variables of interest. Among 261 children with completed surveys, the proportion of total MRU cost due to GP visits, medications, and emergency room visits was 20%, 30%, and 2%, respectively. Although hospitalizations accounted for almost 50% of total costs, only 17 children (6.5%) were hospitalized during the study period. In children with severe asthma, total MRU cost was significantly higher when control of asthma was poor, compared with moderate and good levels of asthma control (p = 0.004). However, no similar association emerged in children with low and moderate severity. A minority of children with high-cost medical use accounted for a significant part of total expenditures. Total MRU costs varied according to level of control in children with high disease severity. (Pediatr Asthma Allergy Immunol 2005; 18[1]:36–45.)

Leukotrienes and 8-isoprostane in exhaled breath condensate of children with stable and unstable asthma

Background Cysteinyl-leukotrienes (cys-LTs) and 8-isoprostane are biomarkers of airway inflammation and oxidative stress. Objective The aim of this study was to evaluate cys-LT and 8-isoprostane levels in exhaled breath condensate (EBC) of children with different degrees of asthma severity. Methods EBC was collected from 14 steroid-naive children with mild persistent asthma, 13 children with stable mild- to-moderate persistent asthma treated with inhaled corticosteroids (ICS), 9 ICS-treated children with unstable asthma, and 19 healthy children. Results In the three groups of asthmatic children, EBC concentrations of cys-LTs and 8-isoprostane were significantly higher than in control children (steroid-naive asthmatic children: cys-LTs median, 10.8 pg/mL, P < .001, 8-isoprostane, 16.2 pg/mL, P < .001; ICS-treated stable asthmatic children: cys-LTs, 12.7 pg/mL, P < .001, 8-isoprostane, 18.1 pg/mL, P < .001; children with unstable asthma: cys-LTs, 106.0 pg/mL, P < .01, 8-isoprostane, 29.7 pg/mL, P < .01; control children: cys-LTs, 4.3 pg/mL, 8-isoprostane, 3.5 pg/mL). Cys-LT levels were higher in children with unstable asthma than in the other two asthmatic groups ( P < .05). FE NO levels were significantly higher in steroid-naive and in children with unstable asthma compared with ICS-treated children with stable asthma ( P < .01). Conclusions Our study shows that EBC cys-LTs and 8-isoprostane concentrations are higher in asthmatic children than in healthy control children, with scattered values in patients with unstable asthma. These findings suggest that EBC eicosanoid measurement may have useful clinical implications for investigating phenotype differences among asthmatic patients.