Effective Treatment For Asthma Research Articles

ПЕРЕШКОДИ У ДОСЯГНЕННІ КОНТРОЛЮ БРОНХІАЛЬНОЇ АСТМИ В КЛІНІЧНІЙ ПРАКТИЦІ В УМОВАХ ПАНДЕМІЇ COVID-19)

The main goals of bronchial asthma (BA) treatment are to achieve good symptoms control and to minimize future risk of asthma-related mortality, exacerbations, persistent airflow limitation and adverse effects of therapy. Despite the availability of effective treatments for asthma the real life asthma control is lower than expected. The aim of this study was to evaluate the barriers in achieving asthma control in clinical practice during the COVID-19 pandemic according to the literature data. There are both general and COVID-19-related barriers in achieving the goals of asthma treatment. In most patients, the causes for the lack of asthma control are incorrect inhaler technique, poor adherence to treatment, overuse of short-acting bronchodilators, comorbidities, the influence of adverse environmental conditions and psychosocial factors. The COVID-19 pandemic has affected the asthma control through quarantine restrictions and the influence of post-acute COVID-19 disorders. On the one hand, quarantine restrictions had a positive effect on the asthma course: there was a decrease in the seasonal respiratory viral infections and the asthma exacerbations frequency. On the other hand, asthma patients were significantly affected by the pandemic due to a high level of anxiety, stress and limited access to routine medical care. Health disorders in post-COVID-19 period negatively affect the control of BA. After recovery from acute COVID-19 a proportion of asthma patients experienced poorer control and required increased asthma maintenance therapy. Approaches to improving asthma control include adherence to established asthma management guidelines, patient and healthcare professional education, regular asthma monitoring and assessment, review of inhaler technique, provision of a written asthma action plan, use of digital technologies. Key words: bronchial asthma, asthma control, COVID-19.

Responsiveness of Inhaled Corticosteroid Treatment in Children with Asthma: The Role of rs242941 Polymorphism of CRHR1 Gene.

Inhaled corticosteroid (ICS) is the most widely used and effective treatment of asthma. However, some patients do not respond to ICS, which might be due to various genetic factors. Hence, understanding the genetic factors involved in the ICS response could help physicians to individualize their treatment decision and action plans for given patients. This study aimed to analyze the characteristics of corticotropin-releasing hormone receptor 1 (CRHR1) genotypes in children with asthma and the correlation between rs242941 polymorphism of CRHR1 gene and ICS responsiveness. This prospective study included children with uncontrolled asthma, assessing their eosinophil count, IgE concentration, lung function, and fractional concentration of nitric oxide in exhaled breath (FENO) and performing CRHR1 polymorphism sequencing. The level of asthma control was assessed by asthma control test (ACT); the responsiveness of asthma treatment with ICS was evaluated by measuring the change of ACT and forced expiratory volume in 1s (FEV1) after treatment versus at inclusion. In total, 107 patients were analyzed for CRHR1 at rs242941. Among these, 86 (80.3%) had homozygous wild-type GG, 20 (18.7%) had heterozygous GT genotypes, and 1 (1.0%) had a homozygous variant for TT. Children with personal and family history of atopy were more likely to have GT and TT genotypes. The severity of asthma was similar between children with asthma in the three groups of GG, GT, and TT genotypes of CRHR1 at rs242941. FENO level, total IgE concentration, and eosinophilic count in children with asthma were not significantly different between GG and GT genotypes. The patient with a TT homozygous variant genotype had a higher level of FENO. There was no correlation between CRHR1 polymorphism at rs242941 and asthma control evaluated by asthma control test and lung function parameters. TT genotype of rs242941 in the CRHR1 gene is not frequent. Clinical and functional characteristics of children with asthma with rs242941 polymorphism of CRHR1 gene remain homogeneously similar. There is no correlation between rs242941 polymorphism and ACT or FEV1.

EFFECT OF SEX ON RESPONSE TO OMALIZUMAB IN PATIENTS WITH ASTHMA

<h3>Introduction</h3> There are sex-related disparities in asthma. Before puberty, males have increased prevalence and severity of asthma compared with females, and this pattern reverses after the onset of puberty. Omalizumab, an IgE antibody, is an effective treatment for allergic asthma, but sex-specific responses have not been studied in detail. <h3>Methods</h3> Post hoc analysis examined data from randomized, placebo-controlled IA05 trial of omalizumab treatment (52 weeks; 75-375 mg sc every 2-4 weeks; N=627; 6 to <12 years, ie children) and open-label, single-arm PROSPERO study (NCT01922037; 48-weeks; N=801; ≥12 years ie adolescents/adults (n=732 ≥18 years); both included patients with moderate-severe allergic asthma. <h3>Results</h3> In IA05/PROSPERO, baseline characteristics of mean age and IgE levels were similar for female and male participants (females 8.4/47.8 versus males 8.6/46.2 years; IgE levels females 463.2/560.3 versus males 472.8/615.0 IU/mL). Asthma exacerbation rates following omalizumab treatment were similar for females and males. In IA05 (children), asthma exacerbation rates were: females - placebo 0.74 versus omalizumab 0.46, males - placebo 0.55 versus omalizumab 0.43, and the interaction test of effect of sex on omalizumab response was not significant (p=0.4821). In PROSPERO (adolescents/adults), asthma exacerbation rates in females were 0.74 versus males 0.77 (p=0.787). Overall safety reported previously for IA05, Lanier JACI 2009;124;1210-6 and PROSPERO, Casale JACI:IP 2019;7(1):156-64. <h3>Conclusions</h3> Despite differences in asthma between females and males, we found no evidence that the effect of omalizumab in children was dependent on sex, and no evidence that the rate of exacerbations was dependent on sex following omalizumab initiation in adolescents/adults.

A case of bronchial asthma in a patient with long-term cough

BACKGROUND: The regulatory documents determining the phthisiatric care for population do not provide diagnostics and treatment of comorbid somatic pathology with tuberculosis in tuberculosis dispansery. If patients with diagnosed tuberculosis or suspected tuberculosis need therapeutic specialists consultation, they have to be referred to the district polyclinic working in the medical insurance system. So, timeliness of diagnostics and chronic diseases management decreases. The course of tuberculosis becomes more complicated and lengthened. At the same time tuberculosis specificities are not taken in to account complicating comorbid pathology. For effective diagnostics and treatment tuberculosis and comorbid pathology the special algorithms of patient management were develop in Tuberculosis Dispensary No. 5.&#x0D; AIM: To describe the clinical case of bronchial asthma in a 35 year old female patient as an example of effective interdisciplinary communication between general practitioner, phthisiatrician and specialists of therapeutic profile.&#x0D; MATERIALS AND METHODS: Patients with suspected tuberculosis are comprehensively examined by the phthisiatrician and therapeutic profile specialists according to special developed algorithms of diagnostic search at Tuberculosis Dispensary No. 5.&#x0D; RESULTS: The patient with long-term cough was comprehensively examined. Within a short time tuberculosis was excluded, bronchial asthma was diagnosed. The effective treatment of asthma and a plan of further patient flow-up in the district polyclinic was recommended.&#x0D; CONCLUSIONS: An experience of the interdisciplinary communication phthisiatricians and specialists of therapeutic profile who have entered the department of medical-social care and rehabilitation demonstrated the relevance and appropriateness in diagnostics of tuberculosis and concomitant chronic uninfection diseases, that let minimize risks of cross adverse effects and choose the optimal tactics of patient management.

Speech recognition can help evaluate shared decision making and predict medication adherence in primary care setting.

ObjectiveAsthma is a common chronic illness affecting 19 million US adults. Inhaled corticosteroids are a safe and effective treatment for asthma, yet, medication adherence among patients remains poor. Shared decision-making, a patient activation strategy, can improve patient adherence to inhaled corticosteroids. This study aimed to explore whether audio-recorded patient-primary care provider encounters can be used to: 1. Evaluate the level of patient-perceived shared decision-making during the encounter, and 2. Predict levels of patient’s inhaled corticosteroid adherence.Materials and methodsShared decision-making and inhaled corticosteroid adherence were assessed using the SDM Questionnaire-9 and the Medication Adherence Report Scale for Asthma (MARS-A). Speech-to-text algorithms were used to automatically transcribe 80 audio-recorded encounters between primary care providers and asthmatic patients. Machine learning algorithms (Naive Bayes, Support Vector Machines, Decision Tree) were applied to achieve the study’s predictive goals.ResultsThe accuracy of automated speech-to-text transcription was relatively high (ROUGE F-score = .9). Machine learning algorithms achieved good predictive performance for shared decision-making (the highest F-score = .88 for the Naive Bayes) and inhaled corticosteroid adherence (the highest F-score = .87 for the Support Vector Machines).DiscussionThis was the first study that trained machine learning algorithms on a dataset of audio-recorded patient-primary care provider encounters to successfully evaluate the quality of SDM and predict patient inhaled corticosteroid adherence.ConclusionMachine learning approaches can help primary care providers identify patients at risk for poor medication adherence and evaluate the quality of care by measuring levels of shared decision-making. Further work should explore the replicability of our results in larger samples and additional health domains.

Efficacy of Kantakari Avaleha and its modified dosage form of Kantakari Avaleha granules in the management of bronchial asthma – An open-label randomized controlled clinical trial

Abstract Background: Bronchial asthma is a common chronic episodic respiratory disease that resemblance to Tamaka Shwasa in Ayurveda. Kantakari Avaleha is one of the primarily recommended formulations for the management of Shwasa (bronchial asthma), Kasa (cough), and Hikka (hiccup). Although Avaleha dosage forms are better medicaments, granules have an added advantage over them such as palatability, less moisture content, and easy handling. For this purpose, Kantakari Avaleha was modified into Kantakari Avaleha granules by modifying the operational procedures of Kantakari Avaleha. Aims: To evaluate and compare the efficacy of Kantakari Avaleha and Kantakari Avaleha granules in the management of bronchial asthma. Materials and method: A total of 69 patients with mild to moderate bronchial asthma were selected randomly and divided into groups A and B. Patients of groups A were treated with Kantakari Avaleha, whereas patients of groups B received Kantakari Avaleha granules. These dosage forms of Kantakari were given in the dose of six grams with lukewarm water before breakfast and dinner for 60 days and followed up for the next 30 days. Assessments were done before and after treatment as per the scoring patterns of international asthma guidelines of the Global Initiative for Asthma (GINA), Asthma Control Questionnaire (ACQ), Asthma Control Test (ACT), and Respiratory Rate (RR), Breath-Holding Time (BHT), Peak Expiratory Flow Volume (PEFV), and laboratory investigations such as complete blood count, liver and kidney function tests, and urine routine examination were also carried out. Paired t-test and Wilcoxon signed-rank test were applied to evaluate the effect of therapy in the individual group for the above-mentioned criteria. While the comparison of results between the groups was done by applying the coefficient of variation (CV). Results: Group A showed better results in most of the cardinal symptoms, ACT, and ACQ, except for BHT, RR, and GINA control in terms of CV. In both the groups, statistically, highly significant improvement was found as per the overall assessment of bronchial asthma such as ACQ, ACT, and number of episodes and the difference between the groups was statistically insignificant. Conclusion: Both dosage forms of Kantkari were found to be effective treatments for bronchial asthma with significant relieving capacity as internal use for over 2 months. Hence, Kantakari Avaleha granules could be substituted for Kantakari Avaleha.

Morning Versus Evening Dosing of Sublingual Immunotherapy in Allergic Asthma: A Prospective Study.

BackgroundSublingual immunotherapy (SLIT) has been proved to be an effective and safe treatment for allergic asthma (AS) in children. Nonetheless, several issues regarding SLIT remain to be resolved, including the information about optimal administration timing.MethodsA total of 163 AS children aged 4-13 years were enrolled and randomized into the morning dosing (MD) group and the evening dosing (ED) group. Participants received SLIT with Dermatophagoides farinae drops between 7:00 a. m. and 9:00 a.m. (for the MD group) or between 8:00 p. m. and 10:00 p.m. (for the ED group). The total asthma symptom score (TASS), total asthma medicine score (TAMS), Asthma Control Questionnaire (ACQ), forced expiratory volume in one second (FEV1), FEV1/forced volume vital capacity (FVC), fractional exhaled nitric oxide (FeNO) and adverse events (AEs) were assessed at baseline, 0.5 and 1 year during the 1-year SLIT.ResultsAfter 1 year, 62 patients in the MD group and 63 patients in the ED group completed the entire study. The clinical efficacy, pulmonary function and FeNO in both groups improved significantly at 0.5 and 1 year (p < 0.001). Compared to the MD group, the ED group showed significant lower ACQ score at 0.5 year (p < 0.001) and lower FeNO at 1 year (p < 0.05). No significant difference between two groups was observed in AE rate (p > 0.05). All AEs occurred in the first month, with no systemic AEs reported.Conclusion1-year house dust mite (HDM) SLIT is effective and well-tolerated in AS children regardless of administration time. SLIT dosing in the evening might enhance the asthma control level and reduce FeNO level compared with SLIT dosing in the morning.

Suhuang Antitussive Capsule Ameliorates Corticosteroid Insensitivity in Cough Variant Asthma Guinea Pigs by Inhibiting p38 MAPK Signal Pathway.

Methods The CVA guinea pig model was successfully established by use of ovalbumin (OVA) sensitization and cigarette smoke (CS) exposure. The guinea pigs were divided into 6 groups: a control group, an OVA model group, an OVA + CS model group, a Suhuang treatment group, a BUD treatment group, and a combination (Suhuang and BUD) treatment group. The effects of the treatment were determined by measuring lung function (RI/Cydn) and cough symptoms (coughs number/cough latency) as outcome criteria. The levels of inflammatory cytokines in bronchoalveolar lavage fluid (BALF) were determined by ELISA. Lung tissues were stained by hematoxylin and eosin (H&E). The expressions of GR/total p38 MAPK/p-p38 MAPK were detected by Western blot. The MKP-1 mRNA levels were detected by RT-PCR. Results Combination treatment significantly decreased RI/coughs numbers and increased Cydn/cough latency. Significantly, the results indicated that combination treatment decreased injury to pulmonary tissues. Results also revealed that levels of inflammatory cytokines were reduced in all treatment groups but most markedly in the combination treatment group. Moreover, Suhuang treatment significantly ameliorated corticosteroid insensitivity by improving the expression of glucocorticoid receptors (GR). The expressions of total p38 MAPK and p-p38 MAPK in lung tissue were significantly inhibited in the Suhuang and combination treatment groups. The MKP-1 mRNA levels in Suhuang and combination treatment groups were also increased significantly. Conclusion Suhuang was effective for reversing corticosteroid insensitivity by regulating the p38 MAPK signal pathway, and combining BUD and Suhuang treatment showed synergistic interactions in CVA guinea pigs. Our findings showed that this combination therapy might be a promising therapeutic agent for CVA and also clarified its underlying mechanism of action, providing a theoretical basis for clinical combination treatment with Suhuang and BUD in CVA patients.

Herbal Nanoformulations for Asthma Treatment

In recent decades, the prevalence of asthma has substantially increased worldwide. Advances in phytochemistry and phytopharmacology have clarified the active ingredients and biological activities of medicinal plant products for treating asthma, and the role of herbal therapies in asthma treatment has become increasingly evident. However, most plant extracts have low solubility and poor stability of bioactive components, resulting in low bioavailability and loss of efficacy. Owing to these shortcomings, the clinical use of many herbal extracts is limited. To summarise and analyse the characteristics of herbal nanoformulations and their application in asthma treatment. The objective of this review article is to address the emerging trends of herbal nanoformulations for an effective treatment of asthma. Various research and review articles from reputed international journals were referred to and compiled. The nano-sized herbal formulations improve the solubility and bioavailability of herbal medicines and contribute to the sustained release of drugs, thus, increasing the therapeutic applications of herbal extracts. The review present different types of herbal nanoformulations, including micelles, nanoparticles, solid lipid nanoparticles, lipid-based liquid crystalline nanoparticles and nanoemulsions, which are potential nanodrugs for asthma treatment. Herbal nanoformulations have shown great prospects for the treatment of asthma in recent years. More safety and toxicity data are still needed to promote their development and application.

The Role of CD4+ T Cells and Microbiota in the Pathogenesis of Asthma.

Asthma, a chronic respiratory disease involving variable airflow limitations, exhibits two phenotypes: eosinophilic and neutrophilic. The asthma phenotype must be considered because the prognosis and drug responsiveness of eosinophilic and neutrophilic asthma differ. CD4+ T cells are the main determinant of asthma phenotype. Th2, Th9 and Tfh cells mediate the development of eosinophilic asthma, whereas Th1 and Th17 cells mediate the development of neutrophilic asthma. Elucidating the biological roles of CD4+ T cells is thus essential for developing effective asthma treatments and predicting a patient’s prognosis. Commensal bacteria also play a key role in the pathogenesis of asthma. Beneficial bacteria within the host act to suppress asthma, whereas harmful bacteria exacerbate asthma. Recent literature indicates that imbalances between beneficial and harmful bacteria affect the differentiation of CD4+ T cells, leading to the development of asthma. Correcting bacterial imbalances using probiotics reportedly improves asthma symptoms. In this review, we investigate the effects of crosstalk between the microbiota and CD4+ T cells on the development of asthma.

Metformin prevents airway hyperreactivity in rats with dietary obesity.

Increased insulin is associated with obesity-related airway hyperreactivity and asthma. We tested whether the use of metformin, an antidiabetic drug used to reduce insulin resistance, can reduce circulating insulin, thereby preventing airway hyperreactivity in rats with dietary obesity. Male and female rats were fed a high- or low-fat diet for 5 wk. Some male rats were simultaneously treated with metformin (100 mg/kg orally). In separate experiments, after 5 wk of a high-fat diet, some rats were switched to a low-fat diet, whereas others continued a high-fat diet for an additional 5 wk. Bronchoconstriction and bradycardia in response to bilateral electrical vagus nerve stimulation or to inhaled methacholine were measured in anesthetized and vagotomized rats. Body weight, body fat, caloric intake, fasting glucose, and insulin were measured. Vagally induced bronchoconstriction was potentiated only in male rats on a high-fat diet. Males gained more body weight, body fat, and had increased levels of fasting insulin compared with females. Metformin prevented development of vagally induced airway hyperreactivity in male rats on high-fat diet, in addition to inhibiting weight gain, fat gain, and increased insulin. In contrast, switching rats to a low-fat diet for 5 wk reduced body weight and body fat, but it did not reverse fasting glucose, fasting insulin, or potentiation of vagally induced airway hyperreactivity. These data suggest that medications that target insulin may be effective treatment for obesity-related asthma.

The role of fixed dose combinations of inhaled cortikosteroids, long acting beta-2 agonists, and long acting muscarinic antagonists (ICS/LABA/LAMA) in the treatment of asthma

The effective treatment of asthma is important in terms of improving the quality of life and decreasing the number of hospital admissions due to acute exacerbations. Parasymphatic activity is increased in patients with asthma. This is one of most important part of airway obstruction which has a great potential for reversibility. The evidence about the synergic interaction between inhaled corticosteroids (ICS), long acting beta-2 agonists (LABA), and long acting muscarinic antagonists (LAMA) encourages the use of LAMA in asthma. Tiotropium treatment was found to be successful in patients with recurrent exacerbations in whom asthma was uncontrolled despite treatment with other add on treatments that were recommended at GINA step 4. These findings triggered several clinical studies on fixed dose ICS/LABA/LAMA for asthma treatment. Three studies that have been published recently showed that fixed dose ICS/LABA/LAMA improved the lung functions and decreased the exacerbation rate without increasing the dose of ICS or LABA in asthma. In this review, the mechanisms of action of LAMA in asthma were summarized and possible role of fixed dose ICS/LABA/ LAMA in asthma treatment was discussed under the light of current literature.

Developing an ML pipeline for asthma and COPD: The case of a Dutch primary care service

A complex combination of clinical, demographic and lifestyle parameters determines the correct diagnosis and the most effective treatment for asthma and Chronic Obstructive Pulmonary Disease patients. Artificial Intelligence techniques help clinicians in devising the correct diagnosis and designing the most suitable clinical pathway accordingly, tailored to the specific patient conditions. In the case of machine learning (ML) approaches, availability of real-world patient clinical data to train and evaluate the ML pipeline deputed to assist clinicians in their daily practice is crucial. However, it is common practice to exploit either synthetic data sets or heavily preprocessed collections cleaning and merging different data sources. In this paper, we describe an automated ML pipeline designed for a real-world data set including patients from a Dutch primary care service, and provide a performance comparison of different prediction models for (i) assessing various clinical parameters, (ii) designing interventions, and (iii) defining the diagnosis.

Factors Associated with Suboptimal Control of Asthma among Adult Asthma Patients: A Cross-sectional Study.

Introduction:Asthma is a major public health problem that negatively impacts patients, families, and the community. Identifying risk factors for poor asthma control may greatly enhance the establishment of more effective treatment of asthma. The level of asthma control and risk factors for poor asthma control is relatively unknown in Ethiopia.Methods:A cross-sectional study was conducted on 150 adult asthma patients at the Outpatient Department (OPD) chest clinic of Jimma Medical Center (JMC), from February 15 –March 20, 2019. The Statistical Package for Social Science (SPSS) 21.0 was used for data analysis. Multivariate logistic regression was conducted to analyze the potential associated factors of suboptimal control of asthma.Results and Discussion:Of 150 adults diagnosed with asthma recruited in this study, 81 [54.0%] of them were females, and the mean age of the patients was 41.1 ± 12.4 years. Inhaled corticosteroid (ICS) plus short-acting beta-agonist (SABA) (64, 42.7%) was the most frequently used anti-asthmatic medication. Over one-fourth (26.0%) (95% CI, 19.2-33.8) of study participants had suboptimal asthma control. On multivariate logistic regression, being an urban dweller (AOR=3.70, p=0.025) and not applying proper inhalation technique (AOR=16.23, p=0.022) were increased the risk of suboptimal asthma control, while non-prescription anti-asthmatic drugs taking habit (AOR=0.25, p=0.010) reduces the odds of having suboptimal asthma control.Conclusion:Suboptimal asthma control is high among adult asthma patients. Being an urban dweller and not applying proper inhalation techniques were increased the likelihood of suboptimal asthma control, while non-prescription anti-asthmatic drugs taking habits had lower odds of suboptimal asthma control. The authors recommend large sample size studies on the comparative status of asthma control using prescription versus non-prescription anti-asthmatic medication.

A Case Report: The Effect of Thread Embedding Acupuncture on Partly-Controlled Asthma

Asthma is a chronic inflammatory disorder of the respiratory tract where many cells and cellular elements play a role, especially eosinophils, IgE, and other components. Uncontrolled asthma causes the quality of the patient's life to decline. Acupuncture is one of the complementary therapies that are scientifically proven to help cure asthma. Many studies have proven that acupuncture plays a role in the anti-inflammatory process. In this case report, we used the acupuncture method of thread embedding penetration from point EX-B1 to BL13, LI11, ST36, and BL23 on both sides. Acupuncture therapy is done once when the patient first arrives. The results after 3 months observations showed that patients experienced an improvement in eosinophil count, decreased level of IgE, and increased Asthma Control Test values. The improvement showed patients were fully controlled in the first month until the end of the evaluation. Therefore, thread embedding could be a good, safe, and effective treatment for asthma in adults.Keywords: asthma, thread embedding acupuncture, anti-inflammation

Real-life cost-effectiveness of benralizumab in patients with severe asthma

BackgroundAvailability of clinically effective and cost-effective treatments for severe asthma would be beneficial to patients and national healthcare systems. The aim of this study was to evaluate clinical outcomes and healthcare expenditure after incorporating benralizumab into the standard treatment of refractory eosinophilic asthma.MethodsThis was a cross-sectional multicentre study of consecutive patients with refractory eosinophilic asthma who received treatment with benralizumab during at least 12 months. Patient follow-up was performed in specialised severe asthma units. The main effectiveness parameters measured were: the avoidance of one asthma exacerbation, a 3-point increase in the asthma control test (ACT) score, and the difference in utility scores (health-related quality of life) between a 1-year baseline treatment and 1-year benralizumab treatment. The health economic evaluation included direct costs and incremental cost-effectiveness ratios (ICERs).ResultsAfter 1 year of treatment with benralizumab, patients with refractory eosinophilic asthma showed an improvement in all the effectiveness parameters analysed: improvement of asthma control and lung function, and decrease in the number of exacerbations, oral corticosteroid (both as corticosteroid courses and maintenance therapy), and inhaled corticosteroid use. The total annual cost per patient for the baseline and benralizumab treatment periods were €11,544 and €14,043, respectively, reflecting an increase in costs due to the price of the biological agent but a decrease in costs for the remaining parameters. The ICER was €602 per avoided exacerbation and €983.86 for every 3-point increase in the ACT score.ConclusionsAll the pharmacoeconomic parameters analysed show that treatment with benralizumab is a cost-effective option as an add-on therapy in patients with refractory eosinophilic asthma.

Subcutaneous Allergen Immunotherapy in Children: Real Life Compliance and Effect of COVID-19 Pandemic on Compliance

Background: Subcutaneous allergen immunotherapy (SCIT) is an effective treatment for allergic rhinitis, asthma, and venom allergy. Compliance is essential for SCIT to obtain maximal benefit as it is a long-term treatment. Objectives: This study aimed to determine the level of real-life SCIT compliance in pediatric patients and the associated factors. Additional aims were to determine how SCIT compliance was affected by the COVID-19 pandemic and why some patients dropped out SCIT. Method: Pediatric patients diagnosed with allergic rhinitis, allergic asthma, or venom allergy that received SCIT between September 2012 and July 2020 were analyzed. Results: The study included 201 children (66.7% male) with a median (interquartile range) age of 12.8 years (9.4–15.2) at the time of the first SCIT injection. The overall compliance rate before COVID-19 pandemic was 86.1%. Short SCIT follow-up time and venom anaphylaxis were found to be risk factors for drop out. The leading causes of drop outs were moving to another city/country (32.1%), symptom improvement (17.8%), treatment ineffectiveness (14.2%), and adverse reactions (14.2%). Among the 108 patients that were still receiving SCIT during the COVID-19 pandemic, 31 (28.7%) dropped out the therapy. The most frequent reasons for drop-out were fear of being infected with COVID-19 (35.4%) and thinking that the AIT practise stopped due to COVID-19 pandemic (29%). Male gender and older age were found to be the independent risk factors for drop-out of SCIT. Conclusions: Real life compliance in children was found 13.9% and it was higher than adults. Nearly one-third of children dropped out during the CO­VID-19 pandemic. Male gender and older age are associated with SCIT drop-out during the COVID-19 pandemic.

Molecular mechanisms of An-Chuan Granule for the treatment of asthma based on a network pharmacology approach and experimental validation.

An-Chuan Granule (ACG), a traditional Chinese medicine (TCM) formula, is an effective treatment for asthma but its pharmacological mechanism remains poorly understood. In the present study, network pharmacology was applied to explore the potential mechanism of ACG in the treatment of asthma. The tumor necrosis factor (TNF), Toll-like receptor (TLR), and Th17 cell differentiation-related, nucleotide-binding oligomerization domain (NOD)-like receptor, and NF-kappaB pathways were identified as the most significant signaling pathways involved in the therapeutic effect of ACG on asthma. A mouse asthma model was established using ovalbumin (OVA) to verify the effect of ACG and the underlying mechanism. The results showed that ACG treatment not only attenuated the clinical symptoms, but also reduced inflammatory cell infiltration, mucus secretion and MUC5AC production in lung tissue of asthmatic mice. In addition, ACG treatment notably decreased the inflammatory cell numbers in bronchoalveolar lavage fluid (BALF) and the levels of pro-inflammatory cytokines (including IL-6, IL-17, IL-23, TNF-alpha, IL-1beta and TGF-beta) in lung tissue of asthmatic mice. In addition, ACG treatment remarkably down-regulated the expression of TLR4, p-P65, NLRP3, Caspase-1 and adenosquamous carcinoma (ASC) in lung tissue. Further, ACG treatment decreased the expression of receptor-related orphan receptor (RORγt) in lung tissue but increased that of Forkhead box (Foxp3). In conclusion, the above results demonstrate that ACG alleviates the severity of asthma in a ´multi-compound and multi-target’ manner, which provides a basis for better understanding of the application of ACG in the treatment of asthma.

Review of Systemic Reactions to Subcutaneous Immunotherapy Based on Injection Schedule in a Single Allergy Practice

Subcutaneous allergen immunotherapy (SCIT) is an effective treatment for allergic rhinitis, asthma, and venom hypersensitivity. Although rare, severe, and potentially life-threatening systemic reactions (SR) such as anaphylaxis can occur. However, our knowledge of SR between SCIT buildup (standard and accelerated) is limited. This study aimed to compare SCIT-related reactions between standard buildup (18-shot or 30-shot) and accelerated buildup (cluster).

Efficacy and Safety of Biologic Agents in Chronic Urticaria, Asthma and Atopic Dermatitis - A Real-life Experience.

Introduction:Several biologic agents have been approved for the treatment of asthma, chronic urticaria and atopic dermatitis. These therapeutic agents are especially useful for patients with severe or refractory symptoms. We present the real-life experience of four of the commonly used biologic agents in the United Arab Emirates.Methods:In this retrospective observational study, we reviewed the demographic, clinical, laboratory and treatment parameters for all patients treated with biologic agents.Results:270 patients received biologics at our centre between May 2015 and December 2019 with a median age of 36.5 years. Omalizumab was the most prescribed agent (n=183, 67.8%) followed by dupilumab (n=54, 20%), benralizumab (n=22, 8.1%) and mepolizumab (n=11, 4.1%). Urticaria was the commonest treatment indication (n=148, 55%) followed by asthma (n=105, 39%) and atopic dermatitis (n=13, 5%). All chronic urticaria patients were treated with omalizumab and showed improvement in the mean urticaria control test score from 6.7±4.47 to 12.02±4.17, with a p-value of 0.001. Dupilumab was found to be the most commonly prescribed drug for asthma (37%), followed by omalizumab (32%), benralizumab (21%) and mepolizumab (10%). The mean Asthma control test score for all asthmatics combined increased from 17.06 ± 5.4 to 19.44 ± 5.6, with p-value 0.0012 with treatment; FeNO reduced from 60.02 ± 45.74 to 29.11 ± 27.92, with p-value 0.001 and mean FEV1 improved from 2.38L ± 0.8 to 2.67L ± 0.78, with p-value 0.045. Only 4 patients in the entire cohort reported adverse events.Conclusion:Our study demonstrated that biological agents are a safe and effective treatment for atopic asthma, chronic urticaria and atopic dermatitis.