Moderate Asthmatic Patients Research Articles

Therapeutic Effect of Avishan-e-Shirazi (Zataria Multiflora Boiss) Root Extract on Oxidative Stress Markers in Moderate Asthmatic Patients

Avishan-e-Shirazi (Zataria Multiflora Boiss) is a plant widely recognised for its medicinal and culinary purposes. Objectives: To evaluate the therapeutic effect of plant’s root extract on pulmonary function tests and oxidative stress markers among moderate Asthma tic patients. Methods: A total participant of 66 patients with pulmonary disease, 30-40 age, were selected for the 2-month research trial. Individuals were enrolled and distributed equally in two groups, 33 each. In the control group, 53.8% of individual were man, and 46.2% were women. In the treatment group, 49.1% of participants were man, and 50.9% were women. The groups G0 was considered as a control group with no root extract, and group G1 where conventional treatment and root extract were advised to participants. The participants were selected from the Jinnah Hospital, Pakistan. The 5mg/kg/day dried root extract supplements 3 times a day were given to the individuals daily for 2 months. Results: The mean age group of Asthma tic patients enrolled in the study was 35 ± 2.98 years in G0, and in G1, it was 34 ± 3.05. The mean BMI was 31.34 and 30.98 kgm-2 in both groups, respectively. There was a significant improvement in FEV1 levels and MDA enzyme levels with a p-value less than 0.05. The NO2 levels were also better. Similarly, the enzymes thiolase and SOD levels also improved with a p-value less than 0.05 in the treatment group. Conclusions: The current study concluded that Avishan-e-Shirazi root extract could improve the pulmonary function and inflammation among Asthma patients.

Is It Possible to Predict Systemic Adverse Effects in Subcutaneous Allergen Immunotherapy? Single-Center Experience

Introduction: Subcutaneous immunotherapy (SCIT) is the oldest and an efficient immunotherapy method that has been used for the treatment of allergic diseases. Systemic adverse effects (SAEs) may occur during the SCIT. For this reason, there may be problems in the continuing treatment. In this study, we primarily aimed to determine the frequency of SAEs, the risk factors that may be associated with SAEs, and clinical and laboratory parameters that can predict systemic reactions in the patients who underwent SCIT. Second, we aimed to evaluate the reasons for discontinuing SCIT and the conditions special to Turkey. Methods: The files of 295 patients who had received SCIT were evaluated retrospectively. Results: SCIT was administered against house dust mites (HDM) in almost all patients (n: 291, 98.6%). A total of 14,357 injections were administered to 295 patients included in the study, and 47.8% (n: 141) of the patients discontinued treatment. The most common reason for discontinuing treatment was the supply problem in Turkey for immunotherapy preparations (n: 70, 49.6%). The second reason was that the injection visits were not continued regularly, even though there were no adverse effects related to the treatment (n: 44, 31.2%). SAEs were observed in 16.6% of the patients and 0.66% of the injections. SAEs were more frequent in girls, in asthmatic patients, and in moderate asthmatic patients (p = 0.005, p = 0.016, p = 0.043, respectively). Treatment was terminated in 13 patients (4.4%) due to SAEs. The most common SAE was bronchoconstriction (n: 40, 85.1%). None of our patients developed hypotension or loss of consciousness. Median blood eosinophil count and basophil count and the skin prick test diameter for Dermatophagoides farinae were observed to be significantly higher in the group with SAE (p = 0.024, p = 0.034, p = 0.045, respectively). Conclusion: Although SAE may develop in pediatric patients undergoing HDM-specific SCIT, severe reactions are rare. Girls, asthmatic patients, especially moderate asthmatic patients, and patients with high blood eosinophil and basophil levels should be monitored more carefully for the development of SAE.

Hypertonic saline inhalation therapy among patients with moderate asthma and functional dyspepsia commorbidity

Aim: Dry powder hypertonic saline inhalation use possibilities evaluation in moderate asthma and functional dyspepsia patients. Materials and Methods: 68 moderate asthma and functional dyspepsia patients were examined and treated according to the standard protocols, serum and erythrocytes membrane fatty acid levels were evaluated. The groups of patients with (n=35) and without (n=33) additional dry powder hypertonic saline inhalation use were compared after 1 month. Results: After additional use of dry powder hypertonic saline inhalations vs only standard treatment the rate of well controlled asthma was 3 fold higher with significantly higher FEV1. We also observed positive dynamics of serum arachidonic and docosahexaenoic acids levels indicating resolution of inflammatory reaction with erythrocytes membranes linoleic acid level normalization (source of antiinflammatory cytokines synthesis) among patients with dry powder hypertonic saline inhalation use vs without it. Among patients who used only standard therapy compared to the control group, the erythrocytes membrane linoleic acid level remained decreased with high serum arachidonic and docosahexaenoic acids levels. Follow-up results (after 1 year) showed a significant decrease in exacerbations frequency among patients who underwent dry powder hypertonic saline inhalation vs only the standard treatment. Conclusions: Among moderate asthma patients with functional dyspepsia use of dry powder hypertonic saline inhalation therapy additionally to the standard treatment allows to improve not only clinical and functional parameters but serum and erythrocytes membranes fatty acids spectrum as well leading to the systemic inflammatory reaction reduction and exacerbations prevention in remote period.

“EFFECTIVINESS OF PAPWORTH METHOD VERSUS BUTEYKO TECHNIQUE IN IMPROVING QUALITY OF LIFE IN MILD TO MODERATE ASTHMATIC PATIENTS - A RANDOMISED COMPARATIVE STUDY

TITLE OF THE STUDY: Effectiviness of papworth method versus buteyko technique in improving quality of life in mild to moderate asthmatic patients- A Randomized comparative study OBJECTIVE: The purpose of this study was to determine effectiveness in papworth method and butekyo in patients in moderate asthma. 40 patients are selected according to the inclusion and exclusion criteria. METHODOLOGY: Patients are assigned in 2 groups by using random allocation method. Group-A (papworth method) consists of 20 patients, Group-B (buteyko) consists of 20 patients. Before starting the intervention pre assessment was taken by using outcome measures Nijmegen dysfunctional breathing questionnaire and peak expiratory flow rate has been noted in 2 the groups. PROCEDURE: The intervention program is given for 4 weeks in Group-A papworth method exercises and GroupB received buteyko. After the completion of 4 weeks intervention post-test assessment has been taken by using outcome measures of Nijmegen dysfunctional breathing questionnaire and peak expiratory flow rate. RESULTS: Statistical analysis of the data in both the groups A and B had shown significant difference in pre and post intervention. But on comparing the mean values of Group A & B, Group A has shown more improvement than Group B. CONCLUSION: This findings suggests, papworth method combined along with buteyko technique is more effective in moderate asthma patients.

Biomarkers associated with severity classification of asthma identified by comprehensive bioinformatics analysis

Using an integrated bioinformatics approach to find novel biomarkers that can predict asthma severity. From June 2022 to December 2022, this clinical medical study was conducted and completed in the Department of Allergy, Zhongnan Hospital of Wuhan University. The gene chip dataset GSE43696 was screened and downloaded from the high-throughput Gene Expression Omnibus (GEO) database, and the gene chip data preprocessing was completed using package "affy" in R and "rma" algorithm in turn. Use the the "edgeR" and "limma" packages to screen out the differentially expressed genes (DEGs) between normal controls, mild to moderate asthma patients and severe asthma patients, and then use the "clusterProfiler" package to perform GO enrichment analysis and KEGG pathway enrichment analysis of DEGs, finally use the STRING website to construct a protein-protein interaction (PPI) network of DEGs to further screen key genes. Using the R language "WGCNA" package, the weighted gene co-expression network analysis (WGCNA) was performed on the dataset GSE43696, and the modules significantly related to the severity of asthma were screened out, then the hub genes were obtained by intersecting the WGCNA analysis results with the DEGs screened by PPI. Datasets GSE43696 and GSE63142 were used to verify the expression of hub genes, and the diagnostic value was evaluated according to the ROC curve, then the potential function of hub genes in dataset GSE43696 was further clarified by gene set enrichment analysis (GSEA). The results showed that a total of 251 DEGs were screened, including 39 in the normal group and mild to moderate asthma group, 178 in the normal group and severe asthma group, and 34 in the mild to moderate asthma group and severe asthma group, mainly involved in biological processes such as response to toxic substance, response to oxidative stress, extracellular structure organization, extracellular matrix organization. Two modules significantly correlated with asthma severity were screened out (red module, P=7e-6, r=0.43; pink module, P=5e-8, r=-0.51), and finally six hub genes were obtained, including B3GNT6, CEACAM5, CCK, ERBB2, CSH1 and DPPA5. The comparison of gene expression levels and ROC curve analysis of datasets GSE43696 and GSE63142 further verified the six hub genes, which may associated with o-glycan biosynthesis, alpha linolenic acid metabolism, linoleic acid metabolism, pentose and glucoronate interconversions. In conclusion, through a variety of bioinformatics analysis methods, this study identified six hub genes significantly related to the severity of asthma, which potentially provided a new direction for the prediction and targeted therapy of asthma.

The effect of anti-IL5 monoclonal antibodies on regulatory and effector T cells in severe eosinophilic asthma

IntroductionBiological treatments have redesigned the clinical management of severe eosinophilic asthmatic (SA) patients. Despite emerging evidence supporting the role of natural Killer (NK), and T regulatory cells (Treg) in the pathogenesis of asthma, no data is available on the effects of anti-IL5/IL5R therapies on these cell subsets. MethodsWe prospectively enrolled fourteen SA patients treated with benralizumab (n = 7) or mepolizumab (n = 7) and compared them with healthy controls (HC) (n = 11) and mild to moderate asthmatic (MM) patients (n = 9). Clinical parameters were collected at baseline (T0) and during follow-up. Cellular analysis, including the analysis of T/NK cell subsets, was determined through multicolor flow cytometry. ResultsAt T0, SA patients showed higher percentages of CD4 TEM (33.3 ± 17.9 HC, 42.6 ± 16.6 MM and 66.1 ± 19.7 in SA; p < 0.0001) than HC and MM patients. With different timing, the two drugs induce a reduction of CD4 TEM ( 76 ± 19 T0; 43 ± 14 T1; 45 ± 23 T6; 62 ± 18 at T24; p < 0.0001 for mepolizumab and 55 ± 21 T0; 55 ± 22 T1; 43 ± 14 T6; 27 ± 12 at T24; p < 0.0001 for benralizumab) and an increase of Treg cells (1.2 ± 1.3 T0; 5.1 ± 2.5 T1; 6.3 ± 3.4 T6; 8.4 ± 4.6 at T24; p < 0.0001 for mepolizumab and 3.4 ± 1.7 T0; 1.9 ± 0.8 T1; 1.9 ± 1 T6; 5.1 ± 2.4 at T24; p < 0.0001 for benralizumab). The change of CD56dim PD-1+ significantly correlated with FEV1% (r = − 0.32; p < 0.01), while Treg expressing PD-1 correlates with the use of oral steroids ( r = 0.36 p = 0.0008) and ACT score (r = 0.36 p = 0.0008) p < 0.001) ConclusionsBeyond the clinical improvement, anti-IL-5 treatment induces a rebalancing of Treg and T effector cells in patients with SA

Effects of theophylline combined with inhaled corticosteroids on patients with moderate and severe asthma and changes of T lymphocyte subsets in peripheral blood.

Asthma is a common respiratory disease. Theophylline combined with inhaled corticosteroids (ICS) is a promising therapy for asthma. This study explored the therapeutic effects of ICS combined with theophylline on moderate and severe asthma patients and T lymphocyte subsets (CD3+CD8+ T cells) in peripheral blood. A total of 202 moderate and severe asthma patients were selected, with 101 treated with theophylline combined with ICS and 101 treated with ICS alone as controls. Lung function [forced expiratory volume within 1 second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF)] were tested using a spirometer. Asthma symptom control was evaluated by asthma control tests (ACT). The life quality was evaluated using the Asthma Quality of Life Questionnaire (AQLQ). The number and percentage of CD3+ T, CD3+CD4+ T and CD3+CD8+ T cells in peripheral blood mononuclear cells were assessed by flow cytometry. The correlation between CD3+CD8+ T cells and lung function and asthma control of patients after combination therapy was analyzed by Pearson correlation analysis. Compared with moderate and severe patients treated with ICS alone, theophylline improved the efficacy of ICS. Theophylline combined with ICS decreased IL-4 and IL-6 levels, and CD3+ T and CD3+CD8+ T cell number and percentage. After combined treatment, CD3+ CD8+ T cells in peripheral blood of patients were positively correlated with lung function and negatively correlated with asthma control. The additional use of theophylline improved the efficacy of corticosteroids in asthma patient treatment and reduced inflammation level and CD3+ T and CD3+CD8+ T cell contents in peripheral blood.

Does Short Term Atorvastatin Treatment Improve Symptomatic Control in Patients with Mild to Moderate &amp; Uncontrolled Asthma?

Introduction: Asthma is a chronic disease characterized by recurrent episodes of breathlessness and wheezing. Keeping in view the problems in asthma control and side effects of available medication, there is a need for alternative treatments with better efficacies and fewer side effects. Atorvastatin is a statin that blocks HMG CoA reductase enzyme found in the liver, inhibiting the synthesis of cholesterol. Blockade of this pathway also inhibits production of GTPases which are involved in airway inflammation, airway remodeling and contraction of smooth muscles of the bronchi. Aims &amp; Objectives: To evaluate the symptomatic control in mild to moderate and uncontrolled asthma patients using standard treatment versus its combination with atorvastatin. Place and duration of study: This study was conducted in Pulmonology Department of Lahore General Hospital; Lahore over a 4-week duration from October 2018 till February 2019. Material &amp; Methods: Patients of mild to moderate and uncontrolled asthma were enrolled in this study based on inclusion and exclusion criteria. Patients were divided into two groups by lottery method, Group 1 and Group 2, with 34 patients in each group. Group 1 was continued with standard therapy of asthma and the Group 2 was administered atorvastatin 40 mg, once daily in addition to standard therapy for 4 weeks. The control of asthma before and after treatment was assessed based on Global Initiative for asthma (GINA) guideline questionnaire score. SPSS (Statistical Package for Social Sciences) version 22 was used for analysis of data. P-Value &lt; 0.05 was taken as significant. Results: Nonsignificant results were obtained when comparison between the groups was made based on GINA guidelines questionnaire score by Mann Whitney Utest Conclusion: It was concluded that atorvastatin has no role in symptomatic control in patients of mild to moderate and uncontrolled asthma.

IgA+ memory B-cells are significantly increased in patients with asthma and small airway dysfunction.

Comprehensive studies investigated the role of T-cells in asthma which led to personalised treatment options targeting severe eosinophilic asthma. However, little is known about the contribution of B-cells to this chronic inflammatory disease. In this study we investigated the contribution of various B-cell populations to specific clinical features in asthma. In the All Age Asthma Cohort (ALLIANCE), a subgroup of 154 adult asthma patients and 28 healthy controls were included for B-cell characterisation by flow cytometry. Questionnaires, lung function measurements, blood differential counts and allergy testing of participants were analysed together with comprehensive data on B-cells using association studies and multivariate linear models. Patients with severe asthma showed decreased immature B-cell populations while memory B-cells were significantly increased compared with both mild-moderate asthma patients and healthy controls. Furthermore, increased frequencies of IgA+ memory B-cells were associated with impaired lung function and specifically with parameters indicative for augmented resistance in the peripheral airways. Accordingly, asthma patients with small airway dysfunction (SAD) defined by impulse oscillometry showed increased frequencies of IgA+ memory B-cells, particularly in patients with mild-moderate asthma. Additionally, IgA+ memory B-cells significantly correlated with clinical features of SAD such as exacerbations. With this study we demonstrate for the first time a significant association of increased IgA+ memory B-cells with asthma and SAD, pointing towards future options for B-cell-directed strategies in preventing and treating asthma.

Asthma Associated Cytokines Regulate the Expression of SARS-CoV-2 Receptor ACE2 in the Lung Tissue of Asthmatic Patients.

It is still controversial whether chronic lung inflammation increases the risk for COVID-19. One of the risk factors for acquiring COVID-19 is the level of expression of SARS-CoV-2 entry receptors, ACE2 and TMPRSS2, in lung tissue. It is, however, not clear how lung tissue inflammation affects expression levels of these receptors. We hence aimed to determine the level of SARS-CoV-2 receptors in lung tissue of asthmatic relative to age, gender, and asthma severity, and to investigate the factors regulating that. Therefore, gene expression data sets of well-known asthmatic cohorts (SARP and U-BIOPRED) were used to evaluate the association of ACE2 and TMPRSS2 with age, gender of the asthmatic patients, and also the type of the underlying lung tissue inflammatory cytokines. Notably, ACE2 and to less extent TMPRSS2 expression were upregulated in the lung tissue of asthmatics compared to healthy controls. Although a differential expression of ACE2, but not TMPRSS2 was observed relative to age within the moderate and severe asthma groups, our data suggest that age may not be a key regulatory factor of its expression. The type of tissue inflammation, however, associated significantly with ACE2 and TMPRSS2 expression levels following adjusting with age, gender and oral corticosteroids use of the patient. Type I cytokine (IFN-γ), IL-8, and IL-19 were associated with increased expression, while Type II cytokines (IL-4 and IL-13) with lower expression of ACE2 in lung tissue (airway epithelium and/or lung biopsies) of moderate and severe asthmatic patients. Of note, IL-19 was associated with ACE2 expression while IL-17 was associated with TMPRSS2 expression in sputum of asthmatic subjects. In vitro treatment of bronchial fibroblasts with IL-17 and IL-19 cytokines confirmed the regulatory effect of these cytokines on SARS-CoV-2 entry receptors. Our results suggest that the type of inflammation may regulate ACE2 and TMPRSS2 expression in the lung tissue of asthmatics and may hence affect susceptibility to SARS-CoV-2 infection.

AEROBIC TRAINING MODULATE PULMONARY AND SYSTEMIC INFLAMMATORY AND FIBROTIC RESPONSE IN PATIENTS WITH ASTHMA

TOPIC: Pulmonary Rehabilitation TYPE: Original Investigations PURPOSE: Airway remodeling is a hallmark of asthma, characterized by structural changes in the airways, including epithelial metaplasia, subepithelial fibrosis, angiogenesis and thickening of smooth muscle. Airway remodeling promotes irreversible loss of lung function and subside the airway hyperresponsiveness and is associated with severity of the disease. In addition, airway remodeling is caused by an unresolved chronic inflammatory response, involving exacerbated release of profibrotic mediators. Aerobic exercise (AE) is the main component of pulmonary rehabilitation and in pre-clinical studies in models of asthma, AE reduced airway remodeling, by reducing the release of pro-fibrotic mediators and increasing the release of anti-fibrotic mediators. However, no clinical study has tested whether AE could promote any effect on airway remodeling in asthmatic patients. METHODS: Treadmill aerobic exercise (AE) (12 weeks, 3x/week, 40min/session, 60-80%MaxHR) was applied to 17 persistent moderate asthmatic patients (42.11±19.13). Body mass index (BMI), lung function, induced sputum, breath condensate, whole blood analysis and CD4+ cells proliferation, 6MWT, exhaled nitric oxide, was evaluated. RESULTS: AE improved VEF3 (L) (p<0.03) and PEF (L/min) (p<0.005) and PEF (%) (p<0.004), reduced the number of total leukocytes, eosinophils, neutrophils, lymphocytes and macrophages (p<0.01), as well as the levels of IL-1beta, IL-4, IL-5, IL-6, IL-8, IL-13, IL-17, IL-23 (p<0.01) in induced sputum. AE also reduced the levels of IL-1beta, IL-5, IL-6, IL-13, VEGF (p<0.01), while increased the levels of anti-inflammatory IL-1ra and IL-10 (p<0.01) and anti-fibrotic Relaxin 3 (p<0.01) in breath condensate. Systemically, AE reduced the number of eosinophils, neutrophils and lymphocytes (p<0.01), as well as the levels of IL-1beta, IL-5, IL-6, IL-13, VEGF (p<0.01), while increased anti-inflammatory IL-1ra, IL-10 (p<0.01) and anti-fibrotic Relaxin 3 (p<0.01) in plasma. AE improved 6MWT (p<0.01) and reduced exhaled nitric oxide (p<0.01) and CD4+ cells proliferation (p<0.01). CONCLUSIONS: In conclusion, AE improves airway and systemic inflammation reducing pro-inflammatory cytokines, while increased anti-inflammatory and anti-fibrotic mediators systemically and into the lungs. CLINICAL IMPLICATIONS: These findings present unprecedented findings on auxiliary treatment and prevention of the health consequences of people with asthma through the practice of physical exercise. From a social point of view, it demonstrates a low-cost and easily accessible intervention, while from a scientific point of view, it will promote research ideas in a promising field. DISCLOSURES: No relevant relationships by thiago alves, source=Web Response no disclosure on file for Helida Aquino-Santos; No relevant relationships by RENILSON FERREIRA, source=Web Response no disclosure on file for Claudio Frison; No relevant relationships by Victor Hugo Palmeira, source=Web Response No relevant relationships by 119 Maysa Alves Rodrigues Rangel, source=Web Response No relevant relationships by Anamei Silva-Reis, source=Web Response No relevant relationships by Rodolfo Vieira, source=Web Response

Exploring the Potential Pathogenic Mechanisms of Asthma Deterioration Based on Modular Drivers

Asthma is a complicated chronic airway inflammatory disease caused by the interaction of genetic susceptibility and environmental impact. Although biologists have explored the pathogenesis of asthma in various aspects, the exact molecular mechanism continues to be elusive. In this study, we conducted a modular study of asthma-related genes to explore their core pathogenic driving genes. Firstly, the expression profiles of normal, mild to moderate and severe asthma patients were analyzed to screen the differentially expressed genes. Secondly, differential genes of asthma were integrated, co-expressed and clustered into modules. Next, enrichment of GO function and KEGG pathway of module genes were analyzed. Finally, non-coding RNA (ncRNA) and transcription factors that regulate modules are predicted by hypergeometric test. In summary, we have obtained 14 co-expression modules, among which CDCA5, JUNB and other genes are significantly differentially expressed in asthmatic patients, and have an active regulatory role in dysfunction module, so they are recognized as asthma-driving genes. Enrichment results showed that module genes were significantly involved in cell growth, transcription factor activity, cellular response to drugs and the transport of various ions. In addition, they also radically regulate Wnt, TGF-beta, JAK-STAT and extracellular matrix signaling pathways. Finally, we identified significant regulatory dysfunction modules of ncRNA pivot (including miR-181a-5p and let-7d-5p) and TF pivot (including NFKB1, ESR1 and MYC). Overall, our work has uncovered a co-expression network involved in the regulation of core pathogenic genes of asthma. It helps to reveal the core dysfunction modules and potential regulatory factors of this disease, and to enhance our understanding of the molecular mechanisms of asthma-related diseases.

Determinants of blood eosinophilia in moderate and severe asthmatic patients during childhood: Evidence from the severe asthma molecular phenotype (SAMP) cohort.

Asthma is a heterogeneous disease in which the interaction between genetic and environmental factors plays a major role. The significance of blood eosinophil is unclear. The aim of the study was to determine the significance of blood eosinophil count in moderate-to-severe asthmatic children of preschool age and school age. This was a prospective cross-sectional study performed from 2011 to 2015 including children from the severe asthma molecular phenotype (SAMP) cohort at Trousseau Hospital (Paris, France). We included children with severe and moderate asthma, or severe and moderate recurrent wheeze, aged from 1 to 15years at the time of exploration. We analyzed data from 402 children: 248 of preschool age and 154 of school age. Blood eosinophil count third quartile thresholds were 322 and 600cells/μL for the preschool- and school-age groups, respectively. In multivariate analysis, a blood eosinophil count over this threshold was associated with elevated total IgE (OR=5.33, P<.01), multiple hospitalizations for asthma attacks (OR=4.96, P=.03), and a maternal history of asthma (OR=4.91, P=.01) in preschool children; and with staphylococcal toxin-specific IgE (OR=2.75, P=.03) in children of school age. Random forest analysis reinforced these results. High blood eosinophil count is linked to both atopic features and control of asthma with different parameters associated with these features depending on age.

Exosomal MicroRNAs as Biomarkers in Allergic Asthma

Exosomes are extracellular vesicles that are involved in intracellular communication and different biological processes. Recently, the importance of microRNAs (miRNAs) in exosomes has been considered as biomarkers in asthma diagnosis. This study aimed to determine the expression of selective miRNAs from plasma-derived exosomes in moderate and severe asthmatic patients compared with healthy controls. Forty-six subjects including 22 patients with severe and mild to moderate allergic asthma and 24 healthy controls have entered this study. MiRNAs were extracted from the plasma exosomes and selective miRNAs (miR-21, miR-16, miR-Let7, miR-148a, miR-155, miR-125, miR-150, miR-146a, miR-223, miR-126) expressions levels were determined; using quantitative polymerase chain reaction (qPCR). In this study, we found a significant up-regulation of miR-223 and miR-21 in moderate asthmatic patients compared to the healthy controls (p=0.002, p=0.006). MiR-223 and miR-21 had the probability of 83% and 76% diagnosis estimation in moderate asthmatic patients respectively. Therefore, they could be used as biomarkers in these patients. No expression of miR-125, miR-126, and miR-155 was found in plasma exosomes by qPCR in this study. The other miRNAs had no significant expression between different groups. Based on our findings,miR-223 and miR-21 may be considered biomarkers or used for targeted immunotherapies in asthma.

Carvacrol improves pulmonary function tests, oxidant/antioxidant parameters and cytokine levels in asthmatic patients: A randomized, double-blind, clinical trial

BackgroundCarvacrol effects on inflammatory mediators, lung pathology and tracheal responsiveness were indicated in animal models of pulmonary diseases. PurposeTo evaluate carvacrol effects on respiratory symptoms, pulmonary function tests (PFT), oxidative stress markers and cytokine levels in asthmatic patients. Study DesignThis study was a randomized, placebo-controlled double-blind, clinical trial. MethodsThirty-three moderate asthmatic patients were divided to the two groups of: placebo group (n = 16) and carvacrol group (1.2 mg/kg/day, n = 17). Prepared capsules were taken for two months along, 3 times/day along with routine medications. Respiratory symptoms, PFT, and oxidative stress markers were evaluated before the treatment (step 0), and one (step I) and two months (step II) after the beginning of the treatment. However, cytokine levels in serum and supernatant of peripheral blood mononuclear cells (PBMC), and their gene expression were evaluated in step 0 and II. ResultsIn carvacrol-treated group, respiratory symptoms significantly decreased after one- and two-month treatment with carvacrol compared to pre-treatment values (p < 0.05 to p < 0.001). Compared to step 0, PFT values were significantly increased in step I and II, in treated group with carvacrol (p < 0.05 to p < 0.001). Most oxidative stress markers were improved following carvacrol treatment (p < 0.05 to p < 0.001). Treatment with carvacrol for two‐month also significantly improved cytokine levels in serum and supernatant of PBMC, compared to step 0 (p < 0.05 to p < 0.001). However, no significant changes were observed in the above-noted parameters in the placebo group. ConclusionDue to anti-inflammatory and antioxidant effect, carvacrol could be suggested as a therapeutic agent for asthma.

The Potential Role of miRNA-19b-3p and miRNA-320c in Patients with Moderate Bronchial Asthma.

Bronchial Asthma (BA) is a complex heterogeneous disease with a number of molecular immunopathological mechanisms underlying airway inflammation, hyperreactivity, and bronchial remodeling. MicroRNAs are important regulators in the pathogenesis and progression of chronic respiratory diseases, including BA. The aim of the study is to investigate the level of expression of cell-free circulating miR-19b-3p and miR-320c in the blood plasma by comparing their plasma levels with IL-4 in the moderate BA patients and control group. The level of expression miR-19b-3p and miR-320c were evaluated by qRT-PCR using the comparative threshold cycle (Ct) method. U6 small nuclear RNA was taken as an endogenous control. The content of IL - 4 in blood plasma was determined by using ELISA. miR-19b-3p and miR-320c were significantly dysregulated in moderate asthmatic patients in comparison with control group. The area under the ROC curve of miR-19b-3p and miR-320c showed 0.8088 (95% CI 0.6925 to 0.9251, P value =0.0001) and 0,9048 (95% CI 0,7792 to 1,000, P value <0,0001), respectively. BA patients showed a considerably positive correlation between the expression level of microRNA-320c and IL-4 levels. These cell-free circulating microRNAs are probably deregulated in other inflammatory/ pathological diseases, so they could be useful to understand the molecular pathogenesis of BA or to investigate the "inflammatory reaction" in this disease.

The Depiction of Lung Function and Fractional-Exhaled Nitric Oxide (FeNO) among Asthmatic Outpatients: A Preliminary Study

Background: Asthma is a heterogeneous disease manifested by airway inflammation and wheezing, dyspnea, breathlessness and cough which are varied in intensity and time accompanied with variably restricted expiratory airflow. Asthma patients experienced decreased lung function that occured during asthma attack accompanied by increased levels of fractional-exhaled nitric oxide (FeNO) caused by the pathophysiological process of asthma and the resulting ventilation problems. The study aimed to reveal the depiction of lung function using spirometry dan FeNO level among asthmatic outpatients. Methods: This was a cross sectional study involving 13 uncontrolled-moderate persistent asthmatic outpatients at Asthma Clinic of Persahabatan General Hospital during October 2019 – March2020. The involved respondents had to undergo the spirometry test and the measurement of FeNO level. Results: The uncontrolled-moderate persistent asthmatic patients were dominated by female with mean age of 48.38+12.494 years old. The mean predicted FEV1 was 70.38+20.230% of whom 61.54% patients showed moderate obstruction. The mean FEV1/FVC ratio was 72.85+12.681% of whom 53.85% patients showed obstruction inFEV1/FVC ratio. The mean FeNO level was 29.62+9.152 ppb of whom 76.92% patients had FeNO level ranging 25-50 ppb. Conclusion: The moderate persistent asthmatic patients showed a decreased lung function with reduction of FEV1, obstructive FEV1/FVC ratio as well as increasing FeNO level.

Многофакторный анализ дифференциально-диагностических параметров у больных бронхиальной астмой средней тяжести с пульмогенной артериальной гипертензией и эссенциальной артериальной гипертензией

Objective: to analyze differential diagnostic parameters in patients with moderate bronchial asthma with pulmogenic arterial hypertension with essential arterial hypertension. Material and Methods: 25 patients with moderate bronchial asthma with pulmogenic arterial hypertension (the 1st group) and 25 patients with moderate bronchial asthma with essential arterial hypertension (the 2nd group) were included in the study. Both groups of patients received step therapy (berodual + inhaled glucocorticosteroids). All patients underwent complex ultrasound examination of intracardiac hemodynamics, examination of blood flow in the right ventricle excretory tract. Systemic arterial pressure was measured according to N. S. Korotkov’s method. ECG was studied (24-hour monitoring). Cold test (at -20 °C-40 °C) was performed in both groups of patients, blood gas composition and pulmonary ventilation function indices were studied. Results: As a result of research established reliable differences in the spirographic indices, blood gas composition in patients with moderate bronchial asthma with pulmogenic arterial hypertension (the 1st group), and reliable differences in partial pressure of oxygen and carbon dioxide (p &lt; 0,05). The 1st group of patients has also higher values of PaCO2 and reliably (p &lt; 0,0,5) and lower values of PaO2, SaO2 in comparison with the comparison group of patients with bronchial asthma of average severity with essential arterial hypertension (the 2nd group). Our data have shown, that in the 1st and 2nd group patients systolic-diastolic cardiac function indexes reliably (p &lt; 0,05; p &lt; 0,001) differed from those ones in healthy subjects. At the same time systolic pressure in the pulmonary artery in the 1st group patients was higher than in the 2nd group patients, and left ventricular ejection fraction was significantly different from that in healthy people and was lower in the 1st group patients than in the 2nd group. We have revealed a reliable correlation between systolic blood pressure and Sа02 (r = 0,52, p &lt; 0,05), studied after cold test, which confirmed the hypothesis of the formation of pulmogenic arterial hypertension against the background of hypoxia. More pronounced changes of FEV1, Sа02, systolic blood pressure in group 1 patients were to some extent due to significant cold hyperresponsiveness in this category of patients. Conclusions: the results of our studies have shown that the decrease of FEV1, FEV50, FEV75, PaO2, SaO2, increased systolic pressure in the pulmonary artery, signs of right heart hypertrophy, disturbances of systolic-diastolic heart function were more pronounced in moderate bronchial asthma patients with pulmogenic arterial hypertension than in moderate bronchial asthma patients with essential arterial hypertension. The proportion of patients (in %) with rhythm disturbances, especially sinus tachycardia, extrasystoles were detected significantly more frequently in group 1 patients than in group 2 patients, which was due to a more pronounced disturbance of systolic-diastolic heart function, higher systolic pressure in the pulmonary artery in persons with moderate bronchial asthma with pulmogenic arterial hypertension.

Written Asthma Action Plan in Emergency Department Improves Knowledge and Asthma Control among Adult Acute Asthma Patients

Self-management of asthma using the written asthma action plan (WAAP) is important in ensuring effective management of asthma as it reduces hospital visits. This study evaluates the improvement in knowledge and asthma control using WAAP among adult patients with acute asthma presenting to Emergency Department (ED). This randomized control trial was conducted over a 19-month period in an ED of a university hospital. Adult patients with acute mild to moderate asthma were included in the study. Patients were randomized into intervention and control group. A self-administered knowledge questionnaire was distributed to all patients. Both groups received asthma counselling guided by asthma flyers. The intervention group was further counselled on individualized WAAP. The control group received standard verbal advice upon discharge. Subsequently at 1 month and 3 months a follow up was conducted. Knowledge and asthma control were assessed via a telephone survey. Fifty patients were assigned randomly to intervention (WAAP) and control group. Each group received 25 patients. The knowledge score of the intervention group was significantly more than the control group (16.88+0.44 vs 13.36+3.72; p 19) at 1 month compared to control group (20.64+3.26 vs 17.72+4.17). Both groups achieved good control at 3 months follow up. Self-management with WAAP in ED improves knowledge and asthma control among acute mild to moderate asthma patients.

The impact of asthma on quality of life and symptoms in patients with chronic rhinosinusitis

Objective The study aims to evaluate how asthma influences on clinical symptoms, imaging scores and HRQL in CRS patients. Methods The study enrolled CRS patients and collected data about asthma status, clinical symptoms, allergic sensitization, computed tomography (CT) and 22-item SinoNasal Outcome questionnaire (SNOT-22). Matching pairs of asthmatic and non-asthmatic CRS patients were defined based on age, gender and nasal polyp presence. The difference between pairs in clinical symptoms, CT and SNOT-22 was then analyzed. The study enrolled mild to moderate asthma patients. Results From 250 CRS patients 65 (26%) had asthma. We found 60 CRS asthma and CRS non-asthma pairs based on age, gender and nasal polyp presence. There was no difference in total SNOT-22 score between asthma (46.5) and non-asthma (43.5) CRS groups (p < .357). There were more patients with allergy positive medical history in asthma group (66.1%) when we stratified for CRS phenotypes, gender and age. Comparing visual analogue scale (VAS) scores for clinical symptoms, smell (p < .013) was the only symptom significantly worse in CRS asthma group. Although there was no difference in Lund-Mackay score, there was a slightly higher osteitis score in CRS asthma group (5.21 vs. 3.45; p = .059). Conclusion CRS patients with asthma have significantly worse impairment of smell and taste when compared to non-asthmatic CRS patients. This is the only significant difference which is independent of nasal polyp presence, gender, age and allergy.