Mild Persistent Asthma Research Articles

Patterns of Rescue and Maintenance Medication Claims Surrounding an Asthma Exacerbation in Patients Treated as Intermittent or Mild Persistent Asthma.

To examine patterns of short-acting ß2-agonist (SABA) and maintenance therapy claims surrounding the subset of severe asthma exacerbations associated with outpatient, urgent care, or emergency department visits or hospitalization (termed serious exacerbations) in patients treated as intermittent or mild persistent asthma. This was a retrospective study of 2010-2017 administrative claims from MerativeTM MarketScan® US databases for patients ≥12 years filling a SABA prescription for asthma (index). Patients had ≥12 months continuous insurance eligibility pre- and post-index and ≥1 additional SABA and/or maintenance medication fill appropriate for mild persistent asthma post-index. Prescription fills were assessed over 30 days before and after a serious exacerbation event. Of 323,443 patients (mean [standard deviation] age: 34.9 [18.2] years; 62.0% female) treated as intermittent or mild persistent asthma, 51,690 (16.0%) experienced ≥1 serious exacerbation post-index. During the 30 days pre-event, a greater proportion of patients filled a SABA versus maintenance therapy (24.6% vs 19.0%; odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.35-1.43; p < 0.001); during the 30 days post-event, patients were more likely to fill maintenance medication versus SABA (88.6% vs 67.0%; OR [95% CI]: 3.88 [3.75-4.01]; p < 0.001). The closer in time prior to the event, the greater the likelihood of filling a SABA versus maintenance prescription (OR [95% CI]; 1-7 days pre-event: 1.42 [1.36-1.48]; 8-14 days pre-event: 1.34 [1.27-1.41]; 15-30 days pre-event: 1.18 [1.12-1.24]; all p < 0.001). Over 4.5 times more patients filled a maintenance therapy within 7 days post-event (45,014) versus all 30 days pre-event (9835) (OR [95% CI]: 28.7 [27.7-29.7]; p < 0.001). These patterns of SABA rescue and maintenance fills suggest that a "window of opportunity" may exist to interrupt a serious exacerbation occurrence for patients treated as intermittent or mild persistent asthma if symptoms and inflammation are addressed concomitantly.

Class III Obesity as a Risk Factor for Persistent Asthma.

The burden of asthma remains steady with no decline observed in the past few decades. Obesity prevalence has been steadily increasing with a rate of 41.9% in the United States between 2017-2020. Obesity is an inflammatory chronic condition that may partially contribute to the burden and severity of asthma. This study aimed to examine whether the association between obesity and asthma varies with the categories of obesity (class I, II, and III) and persistent asthma (mild, moderate, and severe asthma). We hypothesized that subjects with elevated body mass index (BMI) are more likely to be diagnosed with persistent asthma than subjects without obesity with asthma. As a retrospective and cross-sectional study, this study used a total of 1,977 records of subjects with asthma (age ≥ 19 y) hospitalized in Nevada between 2016-2021. BMI and persistent asthma were evaluated as the main exposure and outcome of interest. Logistic regression was used to estimate the magnitude of the association between obesity and persistent asthma. Among the selected subject records, subjects with obesity were more likely to be diagnosed with persistent asthma compared to subjects without obesity (odds ratio 1.50 [CI 1.10-2.05]). Subgroup analyses revealed that subjects with class III obesity (BMI ≥ 40) were more likely than subjects without obesity to be diagnosed with mild persistent asthma (odds ratio 2.21 [CI 1.18-4.16]) and severe persistent asthma (odds ratio 1.74 [CI 1.12-2.70]). Obesity was identified as a risk factor for persistent asthma, particularly class III obesity. This in turn increases the potential for greater health care utilization and economic burden. Public health and clinical interventions are necessary among those with comorbid asthma and obesity.

Concordance of provider chart notation and guideline-based classification of asthma severity

Objective To evaluate concordance of asthma severity classification via physician chart notation compared with guideline-based criteria in adolescents with diagnosed asthma. Methods Of 284 urban primary care and subspecialty clinic patients aged 13–18 years approached through convenience sampling, 203 surveys were completed (RR = 71.5%). We assessed concordance with sensitivity, specificity, and positive predictive values; overall agreement was evaluated with weighted kappa coefficients and McNemar’s test. Results When considering prescribed treatment according to NAEPP guidelines as a gold standard, the sensitivity for chart notation was very good for intermittent (95%) and less for non-intermittent severity ratings (51%, 58%, and 67% for moderate, severe, and mild persistent asthma, respectively). Overall agreement between chart notation and guideline-based asthma criteria ranged from fair-to-good for mild- (k = 0.36), moderate- (k = 0.44), and severe-persistent severity (k = 0.66). Although the agreement for intermittent severity was highest (k = 0.88), it did not significantly differ by between the two classifications (p ≥ 0.05). Conclusions Concordance for all non-intermittent asthma severity classifications varied between physician and medication-driven 2007 NAEPP guideline classifications in an ethnically diverse urban adolescent patient sample. Physicians should remain aware of the potential for this discordance and refer to the guidelines to classify and treat adolescents with asthma.

Effectiveness of allergen-specific immunotherapy in children with bronchial asthma sensitized to house dust mites

Background. The only method of treatment that can change the natural course of allergies is allergen-specific immunotherapy, which allows reducing the sensitivity of the child’s body to the causative allergen and decreasing the activity of chronic inflammation. The evidence base for the effectiveness of allergen-specific immunotherapy in the treatment of bronchial asthma (BA) has significantly expanded recently. However, the truly important results remain too limited to make clinically useful conclusions about the efficacy of sublingual allergen-specific immunotherapy (SLIT) in people with BA and further evidence is needed. The purpose of the study is to evaluate the effectiveness of SLIT as an additional treatment for atopic BA of varying severity in children sensitized to house dust mites. Materials and methods. The main group consisted of 80 children with BA aged from 5 to 17 years, they were divided into three groups according to the severity of the disease: group 1 — 20 children with mild intermittent asthma, group 2 — 30 children with mild persistent asthma, group 3 — 30 children with moderately severe persistent asthma. Thirty practically healthy children without BA were also examined as a control group. For SLIT, a sublingual ORALTEK spray produced by Inmunotek (Spain) was used, a mixture of house dust mite allergens Dermatophagoides pteronyssinus 50 %/Dermatophagoides farinae 50 %, 1 ml of the solution contains 30,000 IU of natural allergen extract. To assess the effectiveness of the treatment, we conducted an analysis of the total score of clinical manifestations of asthma and allergic rhinitis and the degree of asthma control according to the Asthma Control Test. We also analyzed the state of cellular and humoral immunity in the dynamics of therapy. These indicators were evaluated within 1 month before the beginning and a month after the end of the one-year course of therapy. To assess the validity and reliability of the obtained results, statistical data processing was carried out using Microsoft Excel 2016 and Statistica for Windows 10 programs. The Student’s t-test was applied to assess the reliability of the results. The difference between the compared values was considered statistically significant at p &lt; 0.05. Results. The results of the statistical analysis confirmed a significant improvement in the control indicators of patients who received SLIT: reduction in the total score of clinical manifestations, the frequency of clinical symptoms and the use of emergency drugs (p &lt; 0.05). By the end of the study, the dynamics of a decrease in these indicators compared to the data before the start of treatment (according to the above list) was as follows: in patients of group 1 — 82.5, 91.8, 94.5 %, in patients of group 2 — 80.5, 88.4, 92.7 %, in patients of group 3 — 76.7, 85.3, 91.2 %. After treatment with the addition of SLIT to the basic therapy, a reliable increase in IgE and sIgA was observed, an increase in the spontaneous proliferative response of T-lymphocytes to the mitogen in all three groups to the level of the controls, a probable decrease in eosinophilic inflammation and an improvement in indicators of the cellular and humoral immunity (p &lt; 0.001). Conclusions. The prescription of SLIT to children with mild intermittent BA, mild persistent BA and perennial allergic rhinitis, moderate persistent BA and perennial allergic rhinitis provides an opportunity to obtain stable control of the disease, reduces the number of visits to the doctor and justifies the wide use of this method in clinical allergy practice.

Evaluation of adherence to guideline-directed therapy and risk factors for exacerbation in mild asthma: a retrospective chart review

BackgroundA significant update was made to both the Global Initiative for Asthma (GINA) in 2019 and the National Heart Lung and Blood Institute (NHLBI) asthma guidelines in 2020 for mild asthma. These groups no longer recommend short-acting beta-agonists (SABA) as monotherapy for mild (GINA) or mild-persistent (NHLBI) asthma. With the lag that can occur between guideline or evidence updates and changes in practice, this study sought to evaluate whether guideline adoption had occurred.MethodsIn this retrospective chart review, patient electronic medical records from a large healthcare system were evaluated from July 1 of 2021 to July 1 of 2022 to determine how many patients with mild asthma were prescribed as needed or daily inhaled corticosteroids (ICS) in addition to as needed SABA. The secondary outcome was to evaluate the incidence of exacerbations in patients with mild asthma, comparing those on guideline-directed therapy or not. In addition, we evaluated other patient factors increasing exacerbation risk in mild asthma.ResultsFor the primary outcome, of the 1,107 patients meeting inclusion criteria, 284 patients (26%) did not have documentation of guideline-directed therapy for mild asthma during the study period, while 823 (74%) were on guideline-directed therapy (Diff:48.7%; 95% CI:45.1 to 52.3%, p < 0.001). For the secondary objective, 161 patients had an exacerbation (12% on guideline-directed therapy, 15.4% not on guideline-directed therapy). This difference in incidence of exacerbation between the two treatment groups was not statistically significant (Diff: -3.4%; 95% CI: -8 to 1.1%; p = 0.133). In addition, being female, having GERD, and being obese were all statistically significant factors associated with having asthma exacerbations among our patient population.ConclusionsNearly one-fourth of patients with mild persistent asthma were not on guideline-directed therapy, despite updates in asthma guidelines (GINA 2019, NHLBI 2020). Factors such as being female, having GERD, and being obese were all statistically significant factors associated with having asthma exacerbations among patients with mild persistent asthma.

Correlation Serum Vitamin D with Level of control of Childhood Asthma

Background: Childhood asthma is the most prevalent chronic condition in children, and it, like many other chronic illnesses, has a significant impact on the social and emotional life of children and their families. Objectives: To study the correlation of Serum Vitamin D With Level Of Control Of Childhood Asthma. Methods: A comprehensive clinical history was taken, including the child's dietary patterns and the amount of hours spent outside during the day to assess the child's exposure to sunshine. An evaluation of the respiratory system was carried out. The child's nutritional status was determined using WHO growth charts. Diagnostic investigations like Chest x-ray, complete blood count (CBC), erythrocyte sedimentation rate (ESR), absolute eosinophil count (AEC), nasal smear cytology, Peak Expiratory Flow Rate (PEFR), and spirometry were all performed. Results: A total of 150 children with Asthma were divided into groups based on severity, The Intermittent (n=34), mild persistent (n=93), moderate persistent (n=23) and severe persistent (n=0), Since there was no case classified in the severe persistent group only 3 groups were classified. Intermittent: Out of 34 children having intermittent asthma severity, Vitamin- D was deficient in 35.29% of the cases, Insufficient in 17.64% of the cases, Sufficient in 47% of the cases. Mild Persistent: Out of 93 children having mild persistent asthma severity, Vitamin- D was deficient in 58% of the cases, Insufficient in 19.35% of the cases, Sufficient in 22.58% of the cases. Moderate Persistent: Out of 23 children having moderate persistent asthma severity, Vitamin-D was deficient in 56.5% of the cases, Insufficient in 17.39% of the cases, Sufficient in 26% of the cases. Conclusion: Asthmatics have a significant prevalence of Vitamin D deficiency and insufficiency. Although there was no significant relationship between asthma severity and Vitamin D levels, low Vitamin D levels were correlated to a protracted duration of illness and a larger proportion of exacerbations, suggesting that Vitamin D may have a role in asthma exacerbations.

Акушерские осложнения в III триместре беременности у пациенток с бронхиальной астмой

Aim: to analyze the rate of asthma-associated obstetric complications in the third trimester of pregnancy, with attention to the severity and level of symptom control Patients and Methods: a retrospective phase involved the analysis of the course of the third trimester of pregnancy in 120 women with asthma. The women were divided into five groups: mild intermittent asthma (n=34), mild persistent controlled asthma (n=40), mild persistent poorly controlled asthma (n=10), moderate to severe persistent controlled asthma (n=26), and moderate to severe persistent poorly controlled asthma (n=10). The prospective phase included examination and treatment of pregnant women in the groups with uncontrolled asthma (n=20). The level of symptom control was assessed using the Asthma Control Test (ACT). Additionally, nitric oxide in exhaled air (NOex) was measured. The control group included 20 women without allergic disorders. Results: the study demonstrated an association between the level of symptom control and the development of associated hypertensive disorders. Severe preeclampsia was reported only in moderate to severe poorly controlled asthma. A significant correlation was revealed between ACT, NOex level, and de novo increase in systolic blood pressure (BP) in the third trimester (Rs=0.581; Rs=0.828). C-section was most often performed for fetal indications (acute hypoxia) in women with moderate to severe persistent poorly controlled asthma. These findings indicate that the choice of delivery method should be based on the level of symptom control at the end of the third trimester, rather than disease severity. Achieving complete control of asthma in pregnant women reduces the risk of acute fetal hypoxia and the rate of emergency C-sections. Conclusions: achieving and maintaining complete asthma control during pregnancy reduces the risk of associated obstetric complications and improves perinatal and maternal outcomes KEYWORDS: asthma, pregnancy, obstetric complications, hypertension, asthma-associated obstetric complications, C-section. FOR CITATION: Pashchenko A.A., Dobrokhotova Yu.E., Fomina D.S. Obstetric complications in the 3rd trimester of pregnancy in women with asthma. Russian Journal of Woman and Child Health. 2024;7(2):98–103 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-2.

Association of Sputum Eosinophilia With Easily Measured Type-2 Inflammatory Biomarkers in Untreated Mild Persistent Asthma

A multicenter clinical trial in patients with mild persistent asthma indicated that response to inhaled corticosteroids (ICS) is limited to those with sputum eosinophilia. However, testing for sputum eosinophilia is impractical in most clinical settings. We examined associations between sputum eosinophilia and type 2 inflammatory biomarkers in untreated mild persistent asthma. Induced sputum, blood eosinophil count (BEC), fractional exhaled nitric oxide (FeNO), and serum periostin were obtained twice during the 6-week run-in period in a clinical trial that enrolled patients 12 years and older with symptomatic, mild persistent asthma without controller therapy. The optimal threshold for each biomarker was based on achieving 80% or greater sensitivity. Performance of biomarkers (area under the receiver operating characteristics curve [AUC], range 0.0-1.0) in predicting sputum eosinophilia 2% or greater was determined; AUCs of 0.8 to 0.9 and more than 0.9 define excellent and outstanding discrimination, respectively. Of 564 participants, 27% were sputum eosinophilic, 83% were atopic, 70% had BEC of 200/uL or higher or FeNO of 25 ppb or greater; 64% of participants without sputum eosinophilia had elevated BEC or FeNO. The AUCs for BEC, FeNO, and both together in predicting sputum eosinophilia were all below the threshold for excellent discrimination (AUC 0.75, 0.78, and 0.79, respectively). Periostin (in adults) had poor discrimination (AUC 0.59; P= .02). In untreated mild persistent asthma, there is substantial discordance between sputum eosinophilia, BEC, and FeNO. Until prospective trials test the ability of alternative biomarkers to predict ICS response, BEC or FeNO phenotyping may be an option to consider ICS through a shared decision-making process with consideration of other clinical features.

Calcium-sensing receptor protein as a prognostic predictor of asthma formation and exacerbation in young children

Asthma remains the most common non-communicable disease among children, which often has a chronic course and leads to disability. Particular attention should be paid to the diagnosis of asthma in young children. To date, the calcium-sensing receptor (CaSR) is considered to be one of the specific markers in the development of bronchial obstructive diseases. Purpose - to assess the level of CaSR protein and its significance in preschool children with asthma. Materials and methods. The study included 37 patients divided into 3 groups. The Group 1 - children with mild persistent asthma (n=20), the Group 2 - children with moderate persistent asthma (n=17), the Group 3 - almost healthy children (n=20). The study of CaSR protein levels in the blood serum of patients with asthma was performed twice - in the first 2 days of clinical manifestations of the disease and when remission was achieved. The level of CaSR protein in the blood serum was analyzed by enzyme-linked immunosorbent assay (ELISA). All statistical analyses were performed using StatSoft STATISTICA version 8.0 (Tulsa, Oklahoma) and MedCalc version 17.2 statistical software. Results. There was no significant difference in CaSR protein levels between the Group 1 and the Group 2. The level of CaSR protein was significantly lower in the Group 1 and the Group 2 both in the period of acute and remission than in the control group. The level of the marker in the period of disease flare-up in the Group 1 and the Group 2 was significantly lower than in children of the same groups in the period of remission. Conclusions. In all patients with asthma, the level of CaSR protein at the acute stage of the disease is lower than at the remission stage, which is obviously associated with its redistribution from the peripheral blood to the smooth muscle of the lungs. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Expression of HIF-1α in pediatric asthmatic patients.

Several studies have suggested that HIF-1α regulates eosinophil activity and induces epithelial inflammation via NF-κB activation in the pathophysiology of asthma. The purpose of this study was to examine the expression of the transcription factors HIF-1α and nuclear HIF in mononuclear cells obtained from peripheral blood samples of healthy pediatric patients, asthmatic patients, and asthmatic exacerbations, regardless of disease severity. HIF-1 levels were measured using immunocytochemistry in 133 patients aged 6 to 17 years in this crosssectional and comparative study. A microscope was used to examine glass slides, and positive cells were counted in four fields per slide using an image analyzer. HIF-1α and nuclear HIF levels were significantly higher in asthma patients and even higher in patients experiencing asthma attacks (p<0.0001, 95% CI). There was no significant difference in the percentage of HIF-1α expression between groups with intermittent asthma and those with mild persistent asthma, nor between patients with asthma and those experiencing asthma exacerbations. When compared to healthy individuals, the expression of nuclear HIF and HIF-1α is increased in peripheral mononuclear cells in asthma patients and even more so in asthma exacerbations. This suggests that HIF-1α is important in the pathogenesis of this disease.

The Interaction Between Asthma, Emotions, and Expectations in the Time of COVID-19.

The main aim was to gain insight into the experience of adult people with a diagnosis of at least 6-months of mild or moderate persistent asthma according to the Global Initiative for Asthma (GINA), and their emotions, beliefs, and expectations during the first wave of COVID-19. Qualitative semi-structured interviews using the Interpretative Phenomenological Analysis (IPA) were carried out by phone involving 31 people (mean age=58.2; SD=16.2). Interviews were audio recording, transcribed verbatim and analysed through thematic analysis. Five superordinate themes and themes were dedicated to illness (symptoms of asthma; difficulties related to COVID-19), experienced emotions (lockdown period; medical changes; emotions COVID-19 related), beliefs (about asthma; about COVID-19), expectations (related to asthma; related to COVID-19) and behaviours (to protect; risk taken; adherence; contacts with General Practitioners; support). The prevalence of emotions such as fear, worry and anxiety emerged in the participants' narratives. All are accompanied by a preference for action and problem solving. A sense of protection, connection to self and other, and commitment to life were revealed as central concepts for enhancing well-being even at a time of deterring. The common threads of the presence of uncertainty and vulnerability open the outlook of a treatment that ensures greater continuity and ownership of care in the patient, preserving the sense of self-efficacy even in times of greater instability.

Association of Interleukin-4 in Immunoglobulin-E Mediated Asthma: A Cross Sectional Study

Backgrounds: Interleukin 4 (IL 4) is a cytokine associated with the cause of several allergic diseases such as asthma due to their function in the differentiation of T helper type 2 lymphocytes and induction of the IgE isotype switch. Object: The study aims to determine the association IL-4 level with total serum IgE levels and asthma severity. Methods: A cross-section study was performed. Eighty-seven subjects were recruited from Karbala Teaching Hospital for Children in the period extending from January 25 to May 24, 2022, including children with asthma, were subjected to measure IL 4 level using Elabscience ELISA kit and measured total IgE level using AccuBind IgE ELISA kit. Results: Eighty-seven subjects of asthmatic children in which the mean age was 7.833 ± 3.652. There are 65.52% and 34.48% of asthmatic children (male and female, respectively). Total serum IgE was 398.889 ± 227.156 IU/ml, while the IL-4 level was 5.18 ± 8.224. There was a significant difference in IL 4 levels depending on asthma severity (P= 0.037). IL-4 levels in severe persistent asthma were higher than IL-4 levels in mild and moderate persistent asthma. Further, there was a highly significant difference in IL 4 levels depending on asthma controlled (P= 0.004). IL-4 levels in not well-controlled asthma were higher than IL-4 levels in well and partial controlled asthma. In addition, there was no significant correlation between IL-4 levels and total serum IgE levels (P=0.436). Conclusion: IL 4 has an important role in predicting asthma severity and asthma control in children. These findings have important implications for the treatment of IgE-mediated asthma. Despite this, IL 4 levels have no significant correlation with total serum IgE levels. J MEDICINE 2023; 24(2): 89-95

Elevated serum polyclonal immunoglobulin free light chains in patients with severe asthma.

Background: Inflammation plays a pivotal role in the pathophysiology of asthma. Free light chains (FLC) can cause inflammation by mast cell antigen-activation. Serum immunoglobulin (Ig) FLC κ, but not λ, were shown elevated in adult males with asthma. We sought to investigate if serum Ig FLC concentrations are affected by asthma severity and their relationships with inflammatory outcomes. Methods: By using immunoassays, we measured serum κ and λ Ig FLCs in 24 severe persistent asthma patients, 15 patients with moderate persistent asthma, 15 steroid-naïve mild persistent asthma patients and 20 healthy control subjects in a cross-sectional observational study. Total and specific serum IgE concentrations, fractional exhaled nitric oxide (FENO), lung function, peripheral blood eosinophils and neutrophils, and C reactive protein (CRP) were also measured. Results: Serum κ FLC concentrations were elevated in severe asthma patients compared mild asthma patients (p < 0.05) and healthy subjects (p < 0.05). Serum λ FLCs were higher in severe asthma patients than in healthy subjects (p < 0.05) and correlated with blood eosinophil counts (percentage, κ: r = 0.51, p = 2.9678-6; λ: r = 0.42, p = 1.7377-4; absolute values, κ: r = 0.45, p = 6.1284-5; λ: r = 0.38, p = 7.8261-4), but not with total or specific serum IgE. In severe asthma patients, serum Ig FLC correlated with serum CRP (κ: r = 0.33; p = 0.003; λ: r = 0.38, p = 8.8305-4) and blood neutrophil cell counts (percentage, κ: r = 0.31; p = 0.008; λ: r = 0.29, p = 0.01; absolute values, κ: r = 0.40; p = 3.9176-4; λ: r = 0.40, p = 4.5479-4), were elevated in subjects with blood eosinophilia (≥300 cells/µL) (n = 13) compared with non-eosinophilic subjects (n = 10) (κ: 19.2 ± 1.2mg/L versus 12.1 ± 1.3mg/L, p < 0.001; λ: 27.2 ± 2.6mg/L versus 16.8 ± 2.5mg/L, p < 0.01), but were similar in atopic (n = 15) versus nonatopic subjects (n = 9) (κ: p = 0.20; λ: p = 0.80). Serum FLC were negatively correlated with lung function tests, including forced expiratory volume in one second (FEV1) (κ: r = -0.33; p = 0.0034; λ: r = -0.33; p = 0.0035), and FEV1/forced vital capacity ratio (κ: r = -0.33; p = 0.0034; λ: r = -0.33; p = 0.0036). Conclusion: Serum Ig FLCs are elevated in severe asthma adults and might represent new surrogate markers of inflammation. The pathophysiological implications of these findings require further research. This study was approved by the ethics committee of the University Hospital Agostino Gemelli Foundation and Catholic University of the Sacred Heart (approval number P/1034/CE2012).

A multicomponent nutraceutical (&lt;i&gt;Perilla frutescens&lt;/i&gt;, quercetin, and vitamin D3) as add-on therapy in patients with grass pollen-induced mild persistent asthma and rhinitis

Background Allergic asthma is an inflammatory disease characterized by a type 2 immune response. Pollens are a common cause of seasonal asthma. Allergic rhinitis (AR) frequently associates with asthma. The treatment usually aims at controlling inflammation and relieving symptoms. Inhaled corticosteroids are the most effective controller and short-acting b2-agonists (SABA) as a reliever for asthma. Oral antihistamines and nasal corticosteroids (NC) are the mainstays for AR. A multicomponent nutraceutical containing perilla, quercetin, and vitamin D3 significantly prevented AR exacerbations in children. Thus, the current study explored the add-on use in adult patients with mild persistent asthma and AR due to grass pollen allergy.&#x0D; Methods The treatment lasted three months. Asthma and AR symptoms, asthma control test, spirometry, nasal eosinophils, and use of rescue medications (SABA and NC) were evaluated in the previous grass season and throughout the treatment. All patients were treated with ciclesonide (320 mcg/day) and cetirizine (10 mg/day). Patients were randomly stratified into Group A, taking the nutraceutical, and Group B using the predetermined therapy.&#x0D; Results 90 patients (13-59 years old) were enrolled, and 84 completed the trial. Group A significantly improved all outcomes (p&lt;0.001). Group B did not achieve an improvement in AR symptoms, nasal eosinophils, and nasal steroid use. The intergroup analysis showed that Group A patients experienced less severe bronchial symptoms (- 32 %), AR symptoms (- 39 %), better asthma control (+ 38 %), higher FEV1 (+ 10 %), lower SABA (- 30 %) and NC use (- 41 %), and nasal eosinophils count (- 35 %) than Group B (p&lt;0.0001 for all).&#x0D; No clinically relevant adverse events occurred.&#x0D; Conclusion A multicomponent nutraceutical containing perilla, quercetin, and vitamin D3, as an add-on treatment to inhaled ciclesonide and cetirizine, provided a clinically relevant benefit in patients with mild persistent asthma and AR due to grass pollen uncontrolled by standard therapy.

Bioinformatics analysis of ferroptosis-related gene AKR1C3 as a potential biomarker of asthma and its identification in BEAS-2B cells

Ferroptosis is a newly discovered type of cell death and has recently been shown to be associated with asthma. However, the relationship between them at the genetic level has not been elucidated via informatics analysis. In this study, bioinformatics analyses are conducted using asthma and ferroptosis datasets to identify candidate ferroptosis-related genes using the R software. Weighted gene co-expression network analysis is performed to identify co-expressed genes. Protein–protein interaction networks, the Kyoto encyclopedia of genes and genomes, and gene ontology enrichment analysis are used to identify the potential functions of the candidate genes. We experimentally validate the results of our analysis using small interfering RNAs and plasmids to silence and upregulate the expression of the candidate gene in human bronchial epithelial cells (BEAS-2B). The ferroptosis signature levels are examined. Bioinformatics analysis of the asthma dataset GDS4896 shows that the level of the aldo-keto reductase family 1 member C3 (AKR1C3) gene in the peripheral blood of patients with severe therapy-resistant asthma and controlled persistent mild asthma (MA) is significantly upregulated. The AUC values for asthma diagnosis and MA are 0.823 and 0.915, respectively. The diagnostic value of AKR1C3 is verified using the GSE64913 dataset. The gene module of AKR1C3 is evident in MA and functions through redox reactions and metabolic processes. Ferroptosis indicators are downregulated by the overexpression of AKR1C3 and upregulated by silencing AKR1C3. The ferroptosis-related gene AKR1C3 can be used as a diagnostic biomarker for asthma, particularly for MA, and regulates ferroptosis in BEAS-2B cells.

Symptom control and health-related quality of life in allergic rhinitis with and without comorbid asthma: A multicentre European study.

Allergic rhinitis (AR) is a major non-communicable disease that affects the health-related quality of life (HRQoL) of patients. However, data on HRQoL and symptom control in AR patients with comorbid asthma (AR+asthma) are lacking. In this multicentre, cross-sectional study, patients with AR were screened and administered questionnaires of demographic characteristics and health conditions (symptoms/diagnosis of AR and asthma, disease severity level, and allergic conditions). HRQoL was assessed using a modified version of the RHINASTHMA questionnaire (30, 'not at all bothered' - 150 'very much bothered') and symptom control was evaluated by a modified version of the Control of Allergic Rhinitis/Asthma Test (CARAT) (0, 'no control' - 30, 'very high control'). Out of 643 patients with AR, 500 (78%) had asthma as a comorbidity, and 54% had moderate-severe intermittent AR, followed by moderate-severe persistent AR (34%). Compared to the patients with AR alone, patients with AR+asthma had significantly higher RHINASTHMA (e.g., median RHINASTHMA-total score 48.5 vs. 84, respectively) and a significantly lower CARAT score (median CARAT-total score 23 vs. 16.5, respectively). Upon stratifying asthma based on severity, AR patients with severe persistent asthma had worse HRQoL and control than those with mild persistent asthma. The association was significantly higher among non-obese participants compared to obese ones, with RHINASTHMA-upper symptoms score but not with CARAT. Our observation of poorer HRQoL and symptoms control in AR patients with comorbid asthma supports the importance of a comprehensive approach for the management of AR in case of a comorbid allergic condition.

Level of Serum Selenium in Bronchial Asthma Patients in a Tertiary Care Center: A Cross-sectional Study

Introduction: Selenium (Se) is a trace element that has role as an antioxidant in acute stress like; systemic inflammatory responses or trauma. Literature shows positive correlation between low serum Se levels and bronchial asthma. Aim: To determine the level of serum Selenium (Se) in bronchial asthma and to compare the Se levels with the age-matched control group without asthma. Materials and Methods: This cross-sectional study was conducted at the Departments of Physiology and Pulmonary Medicine of a Government Tertiary-care Hospital in Kerala, from November 2021 to March 2022. A total of 24 patients of Bronchial Asthma, between 20-55 years of age and 24 age-matched controls were selected. Serum Se levels were estimated in cases and controls, using Atomic Absorption Spectrometer (AAS). Statistical analysis of the data was done using unpaired sample t-test and correlation was tested with Chi-square test, using Statistical Package for Social Sciences (SPSS) version 27.0. Results: Serum Se levels of 24 patients with Bronchial asthma, aged between 25-55 years and the Se levels in the age-matched controls were obtained. The mean Se level in the study group was (67.21±39.57 ngm/L) significantly lower (p-value was 0.0001) than that of the control (108.38±19.22 ngm/L). The mean age was 39 years±10.8 years. Out of them, 40% were females and the remaining 60% were males. The severity of Asthma ranged between mild persistent asthma to moderate asthma. And the mean duration of asthma was 5.59 years. Conclusion: Serum Se in adult bronchial asthma patients aged between 20 years to 55 years, with mild to moderate severity was significantly lower than that in the control group

Method for lung inflation determining in asthma patients with osmotic airway hyperresponsiveness

Aim. To develop a method for determining the lung inflation by the indexes of forced expiratory flow­volume spirometry.Materials and methods. In 43 patients with mild persistent uncontrolled asthma in combination with osmotic airway hyperresponsiveness, the lung function indexes were assessed by spirometry using a bronchodilation test and bodyplethysmography.Results. From the entire set of parameters, using regression analysis, two equations were con­structed, with the inclusion of the main spirometric indicators (FEV1 in % of the due value, AFEVt and AFEF75 after the bronchodilation test, in %). The equations obtained make it possible to calculate lung inflation indices in asthma patients with osmotic airway hyperresponsiveness to select patients for referral for bodyplethysmography and multispiral computed tomography of the lungs in order to diagnose the severity of hyperinflation.Conclusion. The developed regression models provide an opportunity for a preliminary assessment of the presence and degree of lung hyperinflation in asthma patients with osmotic airway hyperresponsiveness, to determine personal approaches to basic anti-inflammatory therapy and, if necessary, to correct it in a timely manner.

ASTHMA SEVERITY AND RISK OF ISCHEMIC HEART DISEASE(IHD)

<h3>Introduction</h3> A previous meta-analysis found only a subgroup of asthmatics (females with adult-onset asthma) at increased risk for IHD. We examined the relationship between asthma severity classifications and IHD. <h3>Methods</h3> The study included a 100% sample of the Colorado All Payers Data set from 1/ 2017 to 6/2020. Asthma and IHD were based on AHRQ's CCS grouping systems for ICD diagnostic codes. Asthma severity was classified as Mild, Moderate, or Severe Persistent (ICD10 nomenclature). Cough and exercise asthma were classified as Mild persistent. Logistic regression analysis was used to predict the association between Asthma, asthma severity subgroups and IHD. Results were reported as Odds Ratios (OR). <h3>Results</h3> Our study included 3,841,761 patients (ages 0-65+, 54% female) with 209,351 patients having a diagnosis of asthma. Controlled for age and sex, the association between asthma and a diagnosis of IHD was as follows: OR 1.477 (1.420, 1.536) P (<0.0001). Associations as per subgroups of asthma severity were as follows: Mild- OR .957 (.906,1.010) P (0.2); Moderate- OR 1.552(1.456, 1.655) P (<0.0001); Severe- OR 2.509(2.264, 2.781) P (<0.0001). <h3>Conclusions</h3> Risk for IHD was 48% greater in patients with asthma versus non asthmatics. Subgroup analysis revealed significantly increased risk for IHD in patients diagnosed with moderate or severe persistent asthma but not in those with mild persistent asthma. Asthma severity might be a useful paradigm with which to assess the risk of IHD.

Atypical pulmonary carcinoid tumor encapsulated by a Staphylococcus aureus infection.

We present a 13-year-old boy with mild persistent asthma and obstructive sleep apnea who initially presented with fever, dyspnea, cough, night sweats and myalgia for 4 days This article is protected by copyright. All rights reserved.