Increased Asthma Severity Research Articles

Perturbations in the airway microbiome are associated with type 2 asthma phenotype and severity

BackgroundAirway microbiome has been linked to asthma heterogeneity, yet little is known about the associations between airway microbiota and type 2 (T2) asthma phenotype and severity. ObjectiveTo determine the relationship of nasopharyngeal (NP) and induced sputum (IS) microbiota to the phenotypic features of T2 asthma. MethodsNP and IS samples from subjects with T2 mild-to-moderate asthma (n = 23), subjects with severe asthma (n = 21), and healthy controls (n = 16) were analyzed. Bacterial microbiota and functional profiles were compared. The correlation between microbial communities and clinical and inflammatory features was evaluated in individuals with asthma of 2 statuses. ResultsDifferences in NP and IS microbiota were associated with T2 asthma phenotype. Alterations in NP microbiota were more reflective of T2 inflammation and severity, with additional stratification of a subgroup characterized by significant elevations in T2 inflammatory biomarkers and reductions in bacterial richness and diversity (P < .05). Burkholderia-Caballeronia-Paraburkholderia, Ralstonia, and Rhodococcus were identified as hub taxa within NP microbial network in T2 severe asthma, which were prevalent in the entire airway and involved in bacterial functions including inflammatory and steroid responses (P < .05). The composition and diversity of IS microbiota were complex, with Veillonella as the most altered genus, having an increase with increasing asthma severity. ConclusionOur work revealed the significant associations of microbiota perturbations throughout the entire respiratory tract to the extent of T2 inflammation, phenotype and severity in T2 asthma. The specific taxa identified invite further mechanistic investigations to unravel their possibility as biomarkers and therapeutic targets for T2 severe asthma.

Epidemiology of Childhood Asthma in the UK.

Global prevalence of pediatric asthma and associated morbidity and mortality has continuously increased. Asthma is the most common chronic illness in children in the UK; however, recent epidemiology data are lacking. This analysis describes the overall prevalence and burden of illness of asthma in children. This was a retrospective, longitudinal, database analysis using the Clinical Practice Research Datalink database. Primary care records of 19,330 patients (6-11 years) between January 1 and December 31, 2017, were analyzed. Asthma prevalence was assessed by severity (as described by Global Initiative for Asthma 2017 guidelines), and symptoms, comorbidities, and treatments were compared between asthma patients and matched non-asthmatic controls. Results are presented descriptively; logistic regression analyses were performed for asthma symptoms. The estimated prevalence of pediatric asthma was 6.5% (95% CI: 6.4-6.5) in the UK (mild: 74.2%; moderate: 15.0%; severe: 10.8%). All patients with moderate or severe asthma and 72.5% of patients with mild asthma were prescribed drug therapy. Most patients with moderate or severe asthma were prescribed a short-acting β2-agonist (94.9% and 96.0%, respectively), compared with 69.2% of mild asthma patients. Daytime symptoms were reported by 78.1% in those with severe asthma; 34.9% reported night-time symptoms and 30.8% reported an impact on usual activities. Asthma patients had a higher baseline prevalence of comorbidities compared with non-asthmatic controls, notably atopic dermatitis (47.8% in severe asthma versus 20.8% in controls) and allergic rhinitis (13.3% in severe asthma versus 2.0% in controls). This analysis confirmed that asthma remains a common morbidity among children in the UK. Increasing asthma severity was associated with worsening symptoms, and asthma patients had significantly more comorbidities compared with non-asthmatic controls.

Ciliary Function, Antigen Stasis and Asthma.

The prevalence of asthma exceeds 3% of the population. Asthma is observed to be more common in children following severe viral lower respiratory illnesses that affect ciliary function, but mechanisms linking ciliary function to asthma pathogenesis have been obscure. Recent data regarding primary ciliary dyskinesia (PCD) may help us to understand the association. Here, I will review what is known about the relationship between ciliary function and asthma. PCD is caused by pathologic variants in over 50 different genes that affect the structure and function of motile cilia. At the cellular level, a characteristic feature shared by most PCD patients is that antigens and other particles are not cleared from the epithelial surface. Poor antigen clearance results in pro-oxidant pathway activation and airway epithelial damage and may predispose PCD patients to DUOX1- and IL33-mediated asthma. Secondary ciliary dysfunction, such as that caused by viruses or by smoking, can also contribute to asthma development. Moreover, variants in genes that affect the function of cilia can be associated with poor lung function, even in the absence of PCD, and with increased asthma severity. The role of antigen stasis on the surface of dysfunctional airway cilia in the pathophysiology of asthma is a novel area for research, because specific airway clearance techniques and other therapeutic interventions, such as antioxidants, could be of value in preventing the development of asthma.

Correlation of Vitamin D Levels with Severity of Asthma in Children Between 6 to 12 Years

Background: Millions of children worldwide suffer from chronic asthma, a serious respiratory disease that has a major influence on everyday living and health outcomes. There are significant public health concerns regarding the estimated 10-15% frequency of asthma in children in India. Vitamin D, which is recognized for its immunomodulatory qualities, according to recent studies reduces the severity. In this study, children aged 6 to 12 years old's vitamin D levels and the severity of their asthma were examined. Materials and Methods: At a tertiary care teaching hospital, 100 children between the ages of 6 and 12 who were presenting with acute exacerbations of bronchial asthma were the subjects of a prospective cohort study from August 2021 to August 2022. ELISA was used to evaluate serum 25-hydroxyvitamin D levels, and the GINA recommendations were used to determine the severity of asthma. Based on their levels of vitamin D, the kids were divided into three groups: sufficient (&gt;30 ng/mL), insufficient (20–30 ng/mL), and deficient (&lt;20 ng/mL). Children who were deficient in vitamin D were given supplements and monitored for three months. With SPSS 27, statistical analysis was carried out. Findings: The results of the study showed a strong correlation between increased asthma severity and inadequate asthma control and reduced vitamin D levels. Children with the most acute and uncontrollably asthmatic episodes were those with low vitamin D levels (&lt;20 ng/mL). Significant improvements in asthma control, decreased activity limits, and decreased need for rescue medication were noted after three months of vitamin D administration. Conclusion: This study shows a clear link between children's asthma control issues and higher asthma severity when there is a vitamin D Deficiency. Supplementing with vitamin D significantly improved asthma outcomes, indicating a possible therapeutic role for this nutrient. Future studies with larger sample sizes and longer follow-up periods are recommended to validate these findings and further elucidate the underlying mechanisms.

Vitamin D deficiency and level of asthma control and severity in an adult population in Morocco

Vitamin D plays a critical role in immune modulation, with implications for the severity and control of asthma. The study included 174 asthmatic patients aged 18-65 whose serum 25(OH)D3 levels and their relationship with asthma severity, control, and lung function were assessed. The prevalence of hypovitaminosis D was 64%, with 36.3% of patients having normal levels, 29.8% insufficient, and 33.9% deficient. Lower vitamin D levels were significantly associated with increased asthma severity (p=0.04) and poorer asthma control (p=0.03). Patients with severe asthma had mean 25(OH)D3 levels of 24.1±11.8 ng/mL, compared to 32.5±13.1 ng/mL in patients with non-severe asthma. Controlled asthma was linked with higher vitamin D levels (28.3±12.5 ng/mL) compared to partially controlled (24.7±10.8 ng/mL) and uncontrolled asthma (23.3±12.1 ng/mL). A non-significant trend was observed toward reduced Forced Expiratory Volume in One Second (FEV1) in vitamin D-deficient patients. Vitamin D deficiency is significantly associated with asthma control level and severity, underscoring the need for further research on the therapeutic potential of vitamin D in asthma management.

Impact of obesity on airway remodeling in asthma: pathophysiological insights and clinical implications.

The prevalence of obesity among asthma patients has surged in recent years, posing a significant risk factor for uncontrolled asthma. Beyond its impact on asthma severity and patients' quality of life, obesity is associated with reduced lung function, increased asthma exacerbations, hospitalizations, heightened airway hyperresponsiveness, and elevated asthma-related mortality. Obesity may lead to metabolic dysfunction and immune dysregulation, fostering chronic inflammation characterized by increased pro-inflammatory mediators and adipocytokines, elevated reactive oxygen species, and reduced antioxidant activity. This chronic inflammation holds the potential to induce airway remodeling in individuals with asthma and obesity. Airway remodeling encompasses structural and pathological changes, involving alterations in the airway's epithelial and subepithelial layers, hyperplasia and hypertrophy of airway smooth muscle, and changes in airway vascularity. In individuals with asthma and obesity, airway remodeling may underlie heightened airway hyperresponsiveness and increased asthma severity, ultimately contributing to the development of persistent airflow limitation, declining lung function, and a potential increase in asthma-related mortality. Despite efforts to address the impact of obesity on asthma outcomes, the intricate mechanisms linking obesity to asthma pathophysiology, particularly concerning airway remodeling, remain incompletely understood. This comprehensive review discusses current research investigating the influence of obesity on airway remodeling, to enhance our understanding of obesity's role in the context of asthma airway remodeling.

Allergic Rhinitis.

Allergic rhinitis (AR) affects more than 400 million people worldwide, making it 1 of the most prevalent chronic diseases. Childhood AR is increasing, and almost half of patients with AR develop symptoms before age 6 years. Although a diagnosis of AR is associated with higher socioeconomic status, underserved and urban populations have more indoor aeroallergen sensitizations and are likely underdiagnosed with AR, further exacerbating health-care disparities. AR negatively impacts quality of life, school performance, and overall health outcomes. Untreated AR in children increases the risk for poor asthma control, increased asthma severity, and exacerbations. Many patients believe that they have seasonal allergies only but in reality have both perennial and seasonal AR, which may change the approach to allergen avoidance measures and treatment recommendations. Pharmacotherapy of AR has expanded, with many intranasal corticosteroids, intranasal antihistamines, and second-generation oral antihistamines approved for pediatric use. Allergen immunotherapy, including both subcutaneous and sublingual forms, are approved for children and are disease modifying, potentially reducing further allergen sensitization and progression to asthma. Many of the currently available biological therapies indicated for pediatric asthma and/or atopic diseases reduce AR symptoms as well. Children with moderate to severe or refractory AR or those with comorbidities should be referred to allergists for diagnostic testing and expanded management options, including immunotherapy and potential biological treatment.

Ciliary dyskinesia in severe asthma is not affected by chronic mucus hypersecretion.

Chronic mucus hypersecretion (CMH) is linked to increased asthma severity. Ciliary dyskinesia is present in severe asthma but CMH was not associated with a worse ciliary dysfunction, suggesting another mechanism to explain chronic cough and phlegm. https://bit.ly/3JNUgGr.

A Study on The Levels of Serum Vitamin D and Magnesium in Asthma Severity

Serum magnesium levels influence the concentration of circulating vitamin D in blood, which in turn influence immunity; thus, it plays an important role in the asthma pathogenesis. Adult asthma is less studied, hypomagnesemia along with the vitamin D deficiency and insufficiency, is common in asthmatic patients, causing frequent attacks of asthma, infections of respiratory tract, severe exacerbations, and poor bronchodilator response. AIMS AND OBJECTIVES: To measure vitamin D insufficiency and deficiency levels, as well as levels of serum magnesium in asthmatic patients, and correlate them with asthma severity. MATERIAL AND METHODS: This is a cross-sectional case-control study with 60 chronic stable asthma patients and 60 healthy controls. A pulmonary function test was performed following the clinical history and systemic examination. All subjects had their serum levels of magnesium, 25-hydroxycholecalciferol [25(OH)D] measured. RESULTS: A significant relationship was observed between vitamin D deficiency, hypomagnesemia, and asthma severity. CONCLUSION: Vitamin D and serum magnesium deficiency are frequent in asthma patients. Lower levels of one or both are associated with increased asthma severity, frequency of attacks, and exacerbation. Serum 25(OH)D and magnesium levels may be useful indicators of asthma severity.

Wheezy and Cough Asthma Phenotypes in a cohort of Egyptian Children: Clinical features and CCR3 T51C Gene Polymorphism

Background: Asthma is a heterogenous disease with variable characteristic phenotypes. Correlating clinical asthma phenotypes with the underlying genotypes could pave the way for development of tailored asthma medications. Objective: The purpose of this study was to describe the clinical features of wheezy and cough asthma phenotypes and to assess the frequency of CCR3T51C gene polymorphism among Egyptian asthmatic children. Methods: A group of 60 Egyptian asthmatic children (40 wheezy phenotype and 20 cough phenotype) together with 100 controls were enrolled and analyzed for the genotypes of CCR3 T51C polymorphisms using PCR-RFLP. Serum IgE levels were determined by ELISA technique. Results: Regarding the clinical characteristics, associated allergic rhinitis and atopic dermatitis were found to be significantly higher among wheezy phenotype compared to cough phenotype. Also, most of the patients with wheezy phenotype had moderate to severe asthma while most of the patients with cough phenotype had mild asthma. Regarding the frequency of CCR3 T51C genotypes, the TT homozygote genotype was the most frequent genotype among cases and controls. However, no statistically significant differences were found between the two clinical phenotypes. Conclusion: In our studied population, wheezy asthma phenotype was characterized by higher frequency of associated allergic march and increased asthma severity. Yet, our results deny the value of CCR3T51C genetic polymorphism as a genetic marker for differentiating between wheezy and cough asthma phenotypes.

IL-33 Induces an Antiviral Signature in Mast Cells but Enhances Their Permissiveness for Human Rhinovirus Infection.

Mast cells (MCs) are classically associated with allergic asthma but their role in antiviral immunity is unclear. Human rhinoviruses (HRVs) are a major cause of asthma exacerbations and can infect and replicate within MCs. The primary site of HRV infection is the airway epithelium and MCs localise to this site with increasing asthma severity. The asthma susceptibility gene, IL-33, encodes an epithelial-derived cytokine released following HRV infection but its impact on MC antiviral responses has yet to be determined. In this study we investigated the global response of LAD2 MCs to IL-33 stimulation using RNA sequencing and identified genes involved in antiviral immunity. In spite of this, IL-33 treatment increased permissiveness of MCs to HRV16 infection which, from the RNA-Seq data, we attributed to upregulation of ICAM1. Flow cytometric analysis confirmed an IL-33-dependent increase in ICAM1 surface expression as well as LDLR, the receptors used by major and minor group HRVs for cellular entry. Neutralisation of ICAM1 reduced the IL-33-dependent enhancement in HRV16 replication and release in both LAD2 MCs and cord blood derived MCs. These findings demonstrate that although IL-33 induces an antiviral signature in MCs, it also upregulates the receptors for HRV entry to enhance infection. This highlights the potential for a gene-environment interaction involving IL33 and HRV in MCs to contribute to virus-induced asthma exacerbations.

Expression of microRNA-378 in children with bronchial asthma

Background and aim Many studies have been conducted on microRNAs (miR) to better understand the mechanisms underlying asthma development and to identify possible biomarkers for asthma. The purpose of this study was to determine the expression and role of miR-378 in children with asthma. Patients and methods A total of 90 children with bronchial asthma and 30 healthy controls were included. Medical histories, clinical evaluations, and laboratory investigations including miR-378 by RT-PCR were performed on all children. Results Patients had statistically significantly greater eosinophils count, serum immunoglobulin E levels, and miR-378 than controls, being statistically higher in the bronchial asthma group (1.8 ± 1.6, 289.8 ± 57.5, and 8.16 ± 8.8, respectively) than the control group (0.8 ± 0.1, 17.4 ± 9.7, and 0.96 ± 0.22, respectively), with P value less than 0.001. Moreover, miR-378 expression in patients with asthma was statistically significantly increased with increasing asthma severity (mild was 1.67 ± 0.66, moderate was 6.6 ± 1.56, and severe was 21.49 ± 7.65), with P value less than 0.001. Conclusion In children with bronchial asthma, the expression of miR-378 is high, and it rises with the severity of the disease. Therefore, miR-378 could be a valuable biomarker for bronchial asthma diagnosis.

Biologic therapies for asthma in underserved populations

Black and Hispanic children living in disadvantaged urban environments in the USA face a disproportionate burden of asthma, experiencing the highest rates of morbidity and mortality in the country. 1 Altman MC Calatroni A Ramratnam S et al. Endotype of allergic asthma with airway obstruction in urban children. J Allergy Clin Immunol. 2021; 148: 1198-1209 Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar The repeated exacerbations that accompany severe eosinophilic asthma in these populations can lead to loss of lung function, increased asthma severity, and progression to a pattern of fixed obstructive lung disease by early adulthood. 2 O'Brian AL Lemanske Jr, RF Evans MD Gangnon RE Gern JE Jackson DJ Recurrent severe exacerbations in early life and reduced lung function at school age. J Allergy Clin Immunol. 2012; 129: 1162-1164 Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar , 3 McGeachie MJ Yates KP Zhou X et al. Patterns of growth and decline in lung function in persistent childhood asthma. N Engl J Med. 2016; 374: 1842-1852 Crossref PubMed Scopus (350) Google Scholar Worryingly, in a substantial proportion of these children, conventional guideline-directed therapies, such as corticosteroids and long-acting β agonists, do not improve asthma control. Consequently, the identification of novel therapeutic strategies represents an important unmet need for underserved Black and Hispanic children living in urban areas. 4 Gonzalez Burchard E Borrell LN Need for racial and ethnic diversity in asthma precision medicine. N Engl J Med. 2021; 385: 2297-2298 Crossref PubMed Scopus (5) Google Scholar Mepolizumab for urban children with exacerbation-prone eosinophilic asthma in the USA (MUPPITS-2): a randomised, double-blind, placebo-controlled, parallel-group trialPhenotype-directed therapy with mepolizumab in urban children with exacerbation-prone eosinophilic asthma reduced the number of exacerbations. Full-Text PDF

Overview of Spirometry and the Use of Its Parameters for Asthma Monitoring in Children

Asthma is the most common chronic pulmonary disease in the world, affecting more than three hundred million people from different races and age groups. Childhood asthma is considered one of the main causes of increased healthcare expenditures, particularly in developing countries. Spirometry is the most essential and commonly used lung function test. It is used mainly for the evaluation of lung function to obtain reliable data used for the detection of lung diseases, such as asthma, as well as for monitoring lung health. The two spirometry parameters, peak expiratory flow rate (PEFR) and forced expiratory volume in one second (FEV1), are effective in the diagnosis and management of patients with asthma. However, FEV1 is preferred as it is a more accurate parameter compared to PEFR for the evaluation and recognition of bronchoconstriction. In children with asthma, the most commonly used lung function parameter for asthma monitoring is FEV1. It was discovered that a decrease in FEV1 is associated with an increase in asthma severity.

Predictive characteristics to discriminate the longitudinal outcomes of childhood asthma: a retrospective program-based study.

Childhood asthma is an inflammatory disease with heterogeneous outcomes. We sought to determine the impact of total IgE, blood eosinophil, allergen sensitization, and inhaled corticosteroid (ICS) on longitudinal outcomes and to identify characteristics for discriminating different outcomes. We conducted a retrospective study in 383 childhood asthma patients and another 313 patients with blood eosinophil data only receiving regular program-based visits from September 1, 2004, to December 31, 2018. Peak expiratory flow (PEF) variability, PEF predicted %, asthma severity, and asthma control at each visit were assessed as clinical outcomes. Our data show that the percentage of blood eosinophils was significantly associated with increased asthma severity (OR: 1.043, 95% CI: 1.002-1.086, P = 0.0392). Mold sensitization was significantly associated with asthma severity (OR: 2.2485, 95% CI: 1.3253-3.8150, P = 0.0027). Characteristics including sensitization status plus ICS dosage had the best area under the receiver operating characteristic curve (AUC) value for predicting longitudinal PEF predicted % (0.6609), PEF variability (0.6885), asthma severity (0.5918), and asthma control (0.6441), respectively. We showed that the risk for adverse clinical outcomes at follow-up differed between serum IgE, blood eosinophil, and allergen sensitization identified at baseline. Sensitization and ICS dosage were predictive characteristics of long-term clinical outcomes. The unique aspects of the study are its longitudinal assessment of patients receiving guideline-based asthma management program to help characterize the stability of the clinical outcomes over time. Characteristics including allergen sensitization and ICS dosage demonstrated an improved capability for distinguishing between better and worse clinical outcomes. Through longitudinal serial assessment, this study indicates the risk for adverse clinical outcomes differed between children with serum IgE/blood eosinophil/allergen sensitization characterized at baseline.

Quality of life and asthma control in pregnant women with asthma

BackgroundAsthma is the most commonly occurring respiratory illness during pregnancy. Associations with complications of pregnancy and adverse perinatal outcome have been established. However, little is known about quality of life (QoL) in pregnant women with asthma and how it relates to asthma control particularly for Iran.ObjectiveTo determine the relationship between asthma related QoL and asthma control and severity.MethodsWe conducted a prospective study in pregnant women with asthma. We used the Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire (AQLQ) and the guidelines of the Global Initiative for Asthma for assessment of asthma severity.ResultsAmong 1603 pregnant women, 34 were diagnosed with asthma. Of these 13 had intermittent, 10 mild, 8 moderate and 3 severe persistent asthma. There was a significant decrease of QoL with poorer asthma control (p = 0.014). This decline could be due to limitations of activity in those with poorer asthma control, which is underlined by the significant decline of QoL with increasing asthma severity (p = 0.024).ConclusionAlthough the majority of pregnant women with asthma had a favorable score in AQLQ, reduced QoL was related to increased asthma severity and poor asthma control. This underlines the importance of controlling asthma during pregnancy not only for the prevention of adverse pregnancy outcomes but also for the preservation of QoL.

Clinical Correlates of Rhinovirus Infection in Preschool Asthma

Asthma is a common chronic disease of childhood in developed countries causing significant burden on public health. Rhinovirus is one of the most commonly identified triggers for wheezing episodes in preschool-aged children. In this study, researchers identified characteristics of children with preschool asthma associated with susceptibility to rhinovirus infections. The authors also investigated whether rhinovirus infections were associated with a more acute clinical course of asthma exacerbation and if rhinovirus infections were associated with a more compromised 12-month asthma course.A total of 130 children aged 4 to 6 years and who have a gestational age of at least 36 weeks. They had to have a diagnosis of mild-to-moderate persistent asthma by using Global Initiative for Asthma (GINA) criteria within the last 2 years. Patients were recruited from 5 centers in Europe. Subjects had to be asymptomatic for at least 4 to 6 weeks at baseline. Exclusion criteria included severe persistent asthma, concurrent immunotherapy treatment, and nonatopic chronic disease.A standardized questionnaire on symptoms of asthma, rhinitis, eczema, infections, immunizations, environmental factors, and family history was completed at study entry. Baseline blood tests and nasopharyngeal swab samples were obtained. Daily medication and symptom diary was recorded. Subjects had 6-month follow-up visits for 2 years to review symptoms of asthma and rhinitis and collect nasopharyngeal samples. Guardians contacted the study center if subjects developed signs of a respiratory tract infection, had an exacerbation of asthma, had a noted decrease in forced expiratory volume in 1 second of >15% or peak flow of >30%, or had increase in symptom scores on diary of ≥4. A clinic visit was then scheduled to obtain a nasopharyngeal sample to identify respiratory pathogens.Among 130 study subjects, 62% were boys, 55% had aeroallergen sensitization, 38% had active atopic dermatitis, and 38% had vitamin D supplementation. A total of 59% had mild persistent asthma, 25% intermittent asthma, and 83% had peak expiratory flows in the normal range. Of 571 visits, 54% were positive for any virus, and rhinovirus was detected in 39% of visits. Patient characteristics were only assessed with rhinovirus because of the low number of other respiratory viruses. The use of supplemental vitamin D was inversely associated with rhinovirus infection (P < .05). Rhinovirus was associated with more acute illness, including prolonged runny nose, severe night cough, and more sleep disturbance (all P < .05). Rhinovirus infection was also analyzed for its impact on asthma activity for the following year. Rhinovirus infection was associated with an increase in asthma activity, with more night awakenings and more days of exercise triggered symptoms (P < .05). Increased rhinitis activity was also noted in the 12-months follow-up.Rhinovirus infection has both acute and long-term impact on preschool asthma stability. Vitamin D supplementation appears to modify rhinovirus infection and may have a protective effect against infection.Rhinovirus infection has been a well-known trigger for asthma exacerbation, and the findings in this study are not surprising. Increasing asthma severity was noted for acute rhinovirus infection as well as for the 12-month period after rhinovirus infection. If vitamin D supplementation is truly protective against rhinovirus infection, than it may also have an impact on long-term control of childhood asthma. Controlled trials are required to confirm this prospective observation.

Association between house dust mites sensitization and level of asthma control and severity in children attending Mansoura University Children\u2019s Hospital

BackgroundHouse dust mites (HDM) are considered as a major source of indoor aeroallergen all over the world that precipitate allergic reactions including rhinoconjunctivitis, food allergy, atopic dermatitis, and allergic asthma. In this study, we aimed to assess the clinical and laboratory profile of some Egyptian asthmatic children who are sensitized to house dust mites and determine the association of HDM sensitization and severity of asthma according to recent GINA guidelines.ResultsThe most frequent clinical phenotype among the HDM-positive group was a cough (96.7%), while the clinical phenotypic wheeze was frequent in HDM negative group (96.7%). There is a statistically significant difference between studied cases classified according to sensitivity to HDM regarding level of asthma control (50.0% were uncontrolled among cases sensitive to HDM and 56.7% of cases non-sensitive to HDM were controlled (p = 0.001*). Severity according to treatment results was significantly higher among cases sensitive to HDM (26.7% of cases sensitive to HDM versus 3.3% of cases non-sensitive to HDM), p = 0.017.ConclusionsHDM sensitization is associated mainly with cough asthma phenotype and allergic rhinitis in our studied cases. HDM sensitization increases asthma severity and decreases the ability to control asthma symptoms.Trial registrationClinicalTrial.gov, NCT04958616.

Health insurance, pediatric asthma, and emergency department usage.

This study synthesized current research on the relationships between type of insurance and emergency department usage for children with asthma in the United States. Thematic analysis is in the context of the Affordable Care Act (ACA). A systematic mapping review yielded 20 articles published in the last 10years on topics of insurance, emergency department usage, and pediatric asthma. Analysis indicates continued trends of increased emergency department use among asthmatic children since enactment of the ACA, running counter to the goal of fiscal efficiency for the healthcare system and reduction of health inequities. Barriers to care persist, particularly among communities of color, despite provisions to improve access to primary and preventive care. Inadequate access to primary care is associated with poor adherence among asthmatic children with public insurance. Those with health insurance through their parents' employer experience barriers due to cost-sharing expenses. This leads to increased asthma severity and low medication adherence, resulting in the need for emergency care. A disconnect between increased health insurance coverage and utilization of primary care in some populations implies unmet service needs that warrant further investigation. Findings inform policymakers and public health leaders of persistent health inequities resulting in preventable emergency department usage.

OR14: Antibiotic use during pregnancy increases asthma severity in murine offspring.

OR14: Antibiotic use during pregnancy increases asthma severity in murine offspring.