Moderate Asthma Research Articles

Retrospective investigation of automated hematology analyzer-determined indicators of neutrophil activation in blood samples from horses with asthma.

To investigate indicators of neutrophil activation in the blood of healthy and asthma-affected horses and assess associations between corticosteroid treatment and these variables. 48 horses (14 with severe equine asthma [SEA], 21 with mild to moderate equine asthma [MEA], and 13 healthy controls). In a 3-part retrospective study, hematology analyzer data for horses included in previous studies were reviewed. Neutrophil size, neutrophil light absorbance (NLA), and myeloperoxidase (MPO) index were recorded. Data for each variable were compared among groups for the entire study sample (part 1). Changes in each variable were assessed for one subset of horses (5 SEA-affected and 6 controls) after treatment for 2 weeks with dexamethasone (0.06 mg/kg, PO, q 24 h; part 2) and for another subset (8 SEA-affected horses) after the same treatment and after a 1-week posttreatment washout period (part 3). All 3 variables were significantly greater for the SEA group, compared with the MEA and control groups in part 1. Following dexamethasone treatment, the control- and SEA-group NLA and MPO index significantly decreased and SEA-group neutrophil size significantly decreased in part 2; immediate posttreatment results for SEA-affected horses were similar in part 3, with significantly increased neutrophil size and nonsignificant increases in NLA and MPO index following washout. Results suggested horses with exacerbated SEA have larger neutrophils that contain more MPO, compared with neutrophils of MEA-affected and healthy control horses. The clinical value of these variables for the diagnosis of equine asthma was deemed limited owing to data overlap among groups.

Remodeling in equine asthma-Effects of antigen avoidance and pharmacological therapy

The term remodeling describes the process resulting in a tissue that is structurally and architecturally altered compared to its healthy counterpart. At least in severe equine asthma, this occurs mainly, but not exclusively, as a consequence of neutrophilic airway inflammation and is characterized by hypertrophy of the smooth muscle layers in airway and arterial walls as well as fibrosis of the bronchial walls and pulmonary interstitial tissue. To date, much less is known for mild to moderate equine asthma. For a long time it was assumed that these processes are irreversible, and at least for the remodeling of airway smooth muscle this is valid until today. In contrast, remodeling of the extracellular matrix disappears almost completely following long-term remission in consequence to strict antigen avoidance and environmental improvement as well as after glucocorticoid therapy. The remodeling of the arterial vasculature is also reversible following at least 12 months of antigen avoidance and bronchodilatory therapy, but not by inhaled glucocorticoids alone. Although not proven to date, the mild to moderate forms with a good prognosis for complete recovery may be a progenitor for severe equine asthma, in which lung function is restricted even during disease remission despite the absence of obvious clinical signs. Early diagnosis and therapy are, therefore, essential for the management of equine asthma prior to the development of irreversible remodeling, in particular of the bronchial smooth muscle. Antigen avoidance is of highest importance, and should be supported by glucocorticoids and bronchodilators.

A feasibility trial of a digital mindfulness-based intervention to improve asthma-related quality of life for primary care patients with asthma

Asthma outcomes remain suboptimal, despite effective pharmacotherapy. Psychological dysfunction (such as anxiety) is common, and associated with poorer outcomes. We evaluated a digital mindfulness programme as an intervention to improve asthma-related quality of life for primary care patients, in a prospectively registered randomized-controlled feasibility study. We offered ‘Headspace’, a widely-used digital mindfulness intervention, to adults with asthma through 16 UK GP practices. Participants were randomized on a 2:1 basis to the mindfulness intervention, or waitlist control. Participants completed questionnaires (including asthma symptom control, asthma-related quality of life, anxiety, depression) at baseline, 6-week and 3-month follow-up. 116 participants completed primary outcomes at 3-month follow-up: intervention 73 (79%), control 43 (84%). Compared to baseline, the intervention group but not the control group reported significantly improved asthma-related quality of life, with a between-group difference favoring the intervention group that was not significant (Mean difference = 0.15, 95%CI − 0.13 to 0.42). Intervention use varied (ranging from 0 to 192 times) but was generally high. Digital mindfulness interventions are feasible and acceptable adjunct treatments for mild and moderate asthma to target quality of life. Further research should adapt ‘generic’ mindfulness-based stress-reduction to maximize effectiveness for asthma, and validate our findings in a fully-powered randomized controlled trial.Trial registration Prospectively registered: ISRCTN52212323.

English

BACKGROUND Bronchial asthma is a major public health concern especially in the paediatric population. An elevated immunoglobulin E (IgE) level is considered as an objective marker of allergy. Because IgE is a mediator of allergic response, quantitative measurement of IgE together with other clinical markers, can provide useful information for the differentiation between atopic and non-atopic diseases. In this study, we wanted to determine serum IgE and absolute eosinophil count (AEC) levels and correlate both levels with severity of asthma in children in the age group of 2 - 15 years admitted in the paediatric department. METHODS This is a descriptive cross-sectional study. After taking the informed consent from the parent or guardian, relevant information on asthmatic symptoms and severity, other associated manifestations, precipitating factors, and family history of asthma were recorded in a pre-designed proforma. A total of 65 children (age group 2 – 15 years old) with bronchial asthma were studied. Investigations such as hemogram and serum IgE levels were determined. Asthma severity was assessed according to global initiative for asthma (GINA) guidelines. RESULTS Among 65 children, 69.2 % were boys. Receiver operating characteristic curve (ROC) analysis showed that total IgE cut-off concentration of 168 IU/ml, distinguishes children with intermittent asthma from those with mild persistent disease. IgE cut-off concentration of 989 IU/ml distinguishes mild persistent from those with moderate persistent asthma. Both showed adequate or good diagnostic efficacy. Cut off value of 168 IU/ml may prove useful in practice, indicating that 75 % of children in intermittent group will have serum concentration of total IgE < 168 IU/ml. No association was observed between AEC and increasing severity of asthma. Only atopic dermatitis with asthma showed increasing trend of IgE levels. CONCLUSIONS Asthmatic children with higher asthma severity have a higher serum total IgE concentration (168 IU/ml and 989 IU/ml are the cut off values for differentiating intermittent from mild persistent and mild persistent from moderate persistent). KEYWORDS Serum IgE, Absolute Eosinophil Count, Childhood Asthma, Asthma Severity

New possibilities of therapy of T2-associated diseases

New opportunities for the treatment of T2-associated diseases in recent years, the number of patients with atopic dermatitis (ATD), having a moderate and severe form of course, has been increasing. According to research, 30% of the world's population suffer from allergic diseases, such as bronchial asthma (BA), ATD, food allergies, anaphylaxis, chronic polypous rhinosinusitis. The development of these diseases is based on the pathophysiological mechanism of T2-mediated immune inflammation, where cytokines IL-4 and IL-13 play a key role. Diseases based on this type of inflammation belong to the group of T2-associated diseases. Thanks to targeted therapy with dupilumab, which affects the main links of pathogenesis, it is possible to effectively cope with the main manifestations of severe and moderate ATD and BA.
 Aim. To evaluate the effectiveness of biological therapy with dupilumab 300 mg subcutaneously for 52 weeks of T2-associated diseases, including a combination of severe ATD and BA, uncontrolled course in a teenager C. (born 2006).
 Materials and methods. The analysis of the medical history of the patient C., born in 2006, who received therapy with dupilumab 300 mg subcutaneously every 2 weeks for 52 weeks with the diagnosis Main: ATD, common form, severe course. Secondary diagnosis: BA, persistent course, uncontrolled, moderate severity. Dynamic monitoring of the total blood count with the calculation of the absolute number of eosinophils in peripheral blood was performed. The allergological examination included the determination of specific IgE-AT to 300 allergens using ALEX2 technology. Criteria for the effectiveness of ATD therapy were evaluated on the SCORAD scale in dynamics, an AST test was used for BA, as well as a study of the function of external respiration before treatment and during therapy.
 Results. The study showed high efficacy and safety of biological therapy with dupilumab 300 mg subcutaneously every 2 weeks for 52 weeks of T2-associated diseases, including a combination of severe ATD and BA, uncontrolled course in patient C. (born in 2006). The conducted allergological examination with the help of the ALEX2 Allergochip made it possible to establish the molecular components of the primary causal allergens, predict the course of an allergic disease, and carry out successful elimination measures against food allergens, preserving the maximum set of nutrients in the patient's diet.
 Conclusion. Therapy with dupilumab 300 mg subcutaneously every 2 weeks for 52 weeks of T2-associated diseases, with manifestations of severe ATD and BA, uncontrolled course leads to clinically significant improvement in the course of diseases, control of symptoms of diseases. ATD shows a decrease in itching of the skin, normalization of sleep, improvement of quality of life. With BA, a significant reduction in exacerbations, normalization of respiratory function indicators, complete control of the disease has been achieved. The targeted biological drug dupilumab has a targeted effect on the key links in the pathogenesis of ATD and BA and reduces the burden of severe diseases. Therefore, the use of dupilumab in ATD and BA contributes to achieving disease control and improving the patient's quality of life.

Association Between Allergic Diseases and Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Children Aged 6–12 Years Using the Filipino Version of the Vanderbilt ADHD Parent Rating Scale

BACKGROUND: Over the last decades, the hypothesis that an allergic response could lead to the development of attention-deficit/hyperactivity disorder (ADHD) was raised and clinical studies investigated the co-existence of both. These studies had shown that allergic diseases and neurobehavioral disorders were concurrent and could be associated with genetic factors, neuroimmunity and microbial dysbiosis. To date, this was the first study in the Philippines to evaluate the prevalence and association of allergic diseases, its severity and ADHD symptoms. OBJECTIVE: The objective of this study was to determine the association of allergic diseases and ADHD symptoms among children aged 6–12 years based on parental report using the Filipino version of the Vanderbilt ADHD Parent Rating Scale. METHODS: School-aged children between 6 and 12 years with physician diagnosed allergies (bronchial asthma, allergic rhinitis, atopic dermatitis, allergic conjunctivitis, drug allergy, food allergy and/or acute or chronic urticaria) were randomly selected. Skin prick test (SPT) to aeroallergens was done. The parents completed the Filipino version of the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), a screening tool for ADHD. RESULTS: Among the 415 patients, 135 (32.5%) of them screened positive for ADHD symptoms. Upon assessment of the Vanderbilt parent rating subscale responses, 13.49% of the children were categorized as predominantly inattentive subtype, 6.02% as predominantly hyperactive/impulsive subtype and 13.01% as combined inattention/hyperactivity. Three hundred and seventy six (91%) children were diagnosed with asthma. Among these asthmatics, 119 (32%) had ADHD symptoms with the following subtypes – predominantly inattentive subtype (13.56%), predominantly hyperactive/impulsive subtype (5.05%) and combined inattention/hyperactivity (13.03%). Combined inattention/hyperactivity subtype had a significant proportion of severe asthmatics, as compared to mild or moderate asthma (p value = 0.026). Furthermore, 389 (94%) children were diagnosed with allergic rhinitis. Among these patients, 130 (33%) had ADHD symptoms with the following subtypes – predominantly inattentive subtype (13.62%), predominantly hyperactive/impulsive subtype (6.43%) and combined inattention/hyperactivity (13.37%). However, evidence was not sufficient to demonstrate an association between ADHD subtypes and allergic rhinitis severity. Lastly, 206 (50%) children were diagnosed with atopic dermatitis. Among these patients, 71 (34%) had ADHD symptoms with the following subtypes – predominantly inattentive subtype (14.56%), predominantly hyperactive/impulsive subtype (4.85%) and combined inattention/hyperactivity (15.05%). However, there was insufficient evidence to demonstrate a link between ADHD subtypes and atopic dermatitis severity. CONCLUSION: Children with allergies, especially those with severe asthma, are more likely to have ADHD symptoms. Key words: attention deficit hyperactivity disorder, allergic disease, allergic sensitization, asthma

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.

The Efficacy of the Dyson Air Purifier in Improving Asthma Control: Protocol for a Single-Center, Investigator-Led, Randomized, Double-Blind, Placebo-Controlled Trial.

BackgroundIndoor air quality has been shown to influence asthma control and outcomes. Air purifiers and high-efficiency particulate air filtration devices can improve indoor air quality by reducing the indoor levels of air pollution and allergens. However, the influence of this improved indoor air quality on asthma control remains unclear; hence, randomized controlled trials are needed to further elucidate this phenomenon.ObjectiveThis study aims to investigate the effect of reducing the levels of allergens and pollutants in the bedroom and living room through the use of Dyson air purifiers (Dyson Pure Cool) on asthma control.MethodsThis is an 18-month long, investigator-led, randomized, double-blinded, placebo-controlled, single-center trial. Subjects will be randomized in a 1:1 ratio to active or placebo Dyson filters. The primary outcome is the change in the scores of Asthma Control Questionnaire 6 and Asthma-specific Quality of Life Questionnaire from baseline. Secondary outcomes include changes in lung function (forced expiratory volume in one second, forced expiratory volume in one second/forced vital capacity ratio, and midexpiratory flows), peak expiratory flow measurements, airway hyperresponsiveness (assessed by methacholine bronchial challenge), fractional exhaled nitric oxide, and indoor air pollutant levels. The sample size will be 50 subjects, and all subjects will have a confirmed diagnosis of mild persistent to moderate persistent asthma along with an Asthma Control Questionnaire 6 score of >1.5.ResultsThis study was approved by the West Midlands Research Ethics Committee (18/WM/0277). The study results will be published in peer-reviewed scientific journals; presented at relevant scientific conferences; and shared in plain English with participants in our newsletters, in our clinics, and via the David Hide Asthma and Allergy Research Centre website. Our trial began in September 2019 and is expected to end in August 2021.ConclusionsThis is a double-blinded, placebo-controlled, randomized, investigator-led study to investigate the efficacy of a novel air purifier in improving asthma control in adults. The trial period of 18 months will facilitate the collection of robust data and will therefore generate clear signals. However, this extended trial duration may lead to patient withdrawal. Furthermore, this trial is conducted at a single center and in a location with a homogenous cohort of people, which may affect translatability. Nonetheless, it is hoped that the findings of this trial may help further inform clinicians regarding the utility of this novel device as an adjunct in asthma care.Trial RegistrationClinicalTrials.gov NCT04729530; https://clinicaltrials.gov/ct2/show/NCT04729530International Registered Report Identifier (IRRID)DERR1-10.2196/28624

A Cross-sectional Observational Study on Pharmacoeconomic Burden of Asthma in a Tertiary Care Teaching Hospital

Background: Asthma remains one of the most common chronic respiratory diseases. Even with significant advancement in the diagnosis and management of asthma, its control remains suboptimal. As the overall health expenditures are escalating, the healthcare community has become more sensitive to the concept of Pharmacoeconomic.
 Objective: We aimed to assess the healthcare cost; economic burden associated with the management of asthma.
 Methodology: A Prospective Observational Study was conducted in a Hospital of Vadodara, Gujarat, India with the sample of 120 patients. Patient’s data, financial data and the healthcare cost were collected while interviewing the patient. The healthcare costs included were direct medical cost, direct non-medical cost, and indirect cost.
 Result: The average costs per asthmatic patient per month with severe, moderate and mild asthma were found to be USD 65.27, USD 50.89, and USD 48.85, respectively. The average overall cost with or without co-morbidity were calculated as USD 56 and USD 38, respectively. Out of USD 53.6, the average direct medical cost was USD 29.6, the average direct non-medical cost was USD 17.4, and the average total indirect cost was USD 6.6. The mean total cost for inpatient was calculated to be USD 105.12 and for outpatient it was USD 56.09. The 43% of the population had burden of illness less than 30% and 40% of the population had burden of illness between 60-80%. Only 6.6% of population had more than 80% of Pharmacoeconomic burden of asthma.
 Conclusion: In our study, it was concluded that the patients with severe asthma and/or co-morbidity have higher treatment cost. Out of the overall cost, the maximum cost borne by the patient was the direct medical cost. The hospitalization increased the total health care cost by about 47%. The 43% of the population has less than 30% of burden of asthma while only 6.67% of population had more than 80% of burden of asthma.

Altered IgA Response to Gut Bacteria Is Associated with Childhood Asthma in Peru.

Alterations in gut microbiota in early life have been associated with the development of asthma; however, the role of gut bacteria or the IgA response to gut bacteria in school-aged children with asthma is unclear. To address this question, we profiled the microbial populations in fecal and nasal swab samples by 16S rRNA sequencing from 40 asthma and 40 control children aged 9-17 y from Peru. Clinical history and laboratory evaluation of asthma and allergy were obtained. Fecal samples were analyzed by flow cytometry and sorted into IgA+ and IgA- subsets for 16S rRNA sequencing. We found that the fecal or nasal microbial 16S rRNA diversity and frequency of IgA+ fecal bacteria did not differ between children with or without asthma. However, the α diversity of fecal IgA+ bacteria was decreased in asthma compared with control. Machine learning analysis of fecal bacterial IgA-enrichment data revealed loss of IgA binding to the Blautia, Ruminococcus, and Lachnospiraceae taxa in children with asthma compared with controls. In addition, this loss of IgA binding was associated with worse asthma control (Asthma Control Test) and increased odds of severe as opposed to mild to moderate asthma. Thus, despite little to no change in the microbiota, children with asthma exhibit an altered host IgA response to gut bacteria compared with control participants. Notably, the signature of altered IgA responses is loss of IgA binding, in particular to members of Clostridia spp., which is associated with greater severity of asthma.

Efficacy and safety of once-daily, single-inhaler fluticasone furoate/umeclidinium/vilanterol versus fluticasone furoate/vilanterol in Japanese patients with inadequately controlled asthma: the CAPTAIN study

Objective In CAPTAIN, a double-blind, parallel-group, Phase IIIA study, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) improved lung function, symptoms and asthma control versus FF/VI in patients with inadequately controlled asthma. Here, we report efficacy and safety from a Japanese cohort in CAPTAIN. Methods Adults with inadequately controlled asthma despite inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) were randomized (1:1:1:1:1:1) to once-daily FF/VI (100/25 mcg or 200/25 mcg) or FF/UMEC/VI (100/31.25/25 mcg, 100/62.5/25 mcg, 200/31.25/25 mcg, or 200/62.5/25 mcg) for ≥24 weeks. Endpoints included change from baseline in clinic trough FEV1 (primary), annualized rate of moderate/severe asthma exacerbations (key secondary), clinic FEV1 3 h post-dose, and Asthma Control Questionnaire (ACQ)-7, St George’s Respiratory Questionnaire (SGRQ) (all Week 24), Evaluating Respiratory Symptoms (E-RS): Asthma total scores (Weeks 21–24) (all secondary). Adverse events and adverse events of special interest were monitored. Clinical trials.gov registry no: NCT02924688. Results Overall, 229 of 2436 patients in the intention-to-treat (ITT) population were from Japan. In this cohort, change from baseline in trough FEV1 for FF/UMEC/VI 100/62.5/25 mcg versus FF/VI 100/25 mcg was 105 mL (95% confidence interval −5, 216) and 69 mL (–42, 179) for 200/62.5/25 mcg versus 200/25 mcg. These observations were supported by clinic FEV1 at 3 h post-dose. Moderate/severe exacerbation incidence was low and similar across pooled treatment groups (FF/VI, FF/UMEC 31.25 mcg/VI, FF/UMEC 62.5 mcg/VI). All pooled groups demonstrated clinically important improvements from baseline in ACQ-7, SGRQ and E-RS: Asthma total scores. Safety profiles were consistent with the overall ITT population, with no new safety concerns. Conclusion FF/UMEC/VI is an effective option with a favorable risk-benefit profile in Japanese patients with uncontrolled moderate or severe asthma on ICS/LABA.

Risk Assessment-Based Enhanced Analytical Quality-by-Design Approach to Eco-Friendly and Economical Multicomponent Spectrophotometric Methods for Simultaneous Estimation of Montelukast Sodium and Bilastine

Concomitant montelukast and bilastine are used as additive therapy for seasonal allergic rhinoconjuctivitis and mild to moderate asthma. According to a literature review, no UV-visible spectrophotometric method has been reported yet for simultaneous estimation of montelukast sodium and bilastine in their combined pharmaceutical dosage forms. Five different multicomponent spectrophotometric methods were therefore developed and validated for simultaneous estimation of montelukast sodium and bilastine using a risk assessment-based enhanced analytical quality-by-design approach. The identification and assessment of method risk parameters were carried out using the risk priority number ranking and filtering method according to the International Conference on Harmonization (ICH) Q9 guideline. The wavelength for detection and solvents such as 0.1 N NaOH and 0.1 N HCl were found to be critical method parameters for the development of the target methods. The developed methods were validated as per the ICH Q2(R1) guideline. The developed and validated methods were applied for assay of combined pharmaceutical dosage forms of montelukast sodium and bilastine and results were found to be in good agreement with their label claims. The developed methods did not include the usage of any organic solvent and are a good alternative to the costly chromatography method. Hence, the methods are eco-friendly and economical for the simultaneous estimation of bilastine and montelukast sodium. Five multicomponent spectrophotometric methods were developed for simultaneous estimation of montelukast sodium and bilastine using a risk-based analytical quality-by-design approach. An assay of combined tablet dosage forms of montelukast sodium and bilastine was then carried out using the developed methods.

Ventricular Function and Pulmonary Artery Pressure in Children with Mild and Moderate Bronchial Asthma

Background: Bronchial asthma is a chronic airway disease. Cardiac affection in children with bronchial asthma was reported mainly in cases with severe asthma and during acute exacerbations. Aim of the Work: To study cardiac affection in children with mild and moderate bronchial asthma using conventional and tissue Doppler imaging [TDI] echocardiography. Patients and Methods: This was a prospective case control study. Study involved 160 children aged 6-14 years old who were following in outpatient pediatric clinic, Al-Hussein hospital, Al-Azhar University, Cairo, Egypt, during the period from January 4, 2016, till February 15, 2017. All children underwent peak expiratory flow rate [PEFR] assessment. Echocardiography was done for all to assess systolic and diastolic functions of right ventricle [RV] and left ventricle [LV] using conventional and tissue Doppler imaging [TDI] echocardiography. Results: TDI parameters showed evidence of RV diastolic dysfunction in patients with moderate asthma in the form of significantly lower tricuspid valve [TV] e’ [12.1 ± 2.7 cm/s], lower TV e’/a’ ratio [1.28 ± 0.18], prolonged RV isovolumetric relaxation time [IVRT] [71.8 ± 2.4 ms], and higher RV myocardial performance index [0.49 ± 0.04] compared to control group. Also, patients with mild asthma had impaired RV diastolic function in the form of significantly lower TV e’/a’ [1.51 ± 0.13] and longer RV IVRT [65 ± 2.9 ms] compared to control group. Pulmonary artery pressure was significantly elevated in moderate asthma group [18.4 ± 9.2 mmHg]. RV IVRT was the only parameter showing a significant negative correlation to PEFR Conclusion: Pediatric patients with mild and moderate bronchial asthma may have RV diastolic dysfunction. TDI is a good screening tool to detect early changes in cardiac function in such patients. RV IVRT measured by TDI is a sensitive tool to detect early diastolic impairment.

Health-Related Quality of Life and Health Utilities of Mild, Moderate, and Severe Asthma: Evidence from the Medical Expenditure Panel Survey.

BackgroundLittle information is known about the health-related quality of life (HRQOL) and the patient’s preference values by the severity of asthma. We evaluated the HRQOL and health utility impairment associated with asthma severity using the SF-12 and SF-6D.MethodsWe conducted a cross-sectional analysis of 2010–2016 Medical Expenditure Panel Survey database of asthma patients aged ≥18 years and categorized them into mild, moderate, and severe asthma. Study outcomes included the SF-12 physical component summary (PCS) and mental component summary (MCS) for measuring HRQOL and SF-6D for health utility. Survey regression models were used to estimate HRQOL and utilities for mild, moderate, and severe asthma.ResultsOf 10,222 patients with asthma, 75.4%, 23.9%, and 0.8% had mild, moderate and severe asthma. We observed that the greater the severity, the lower the SF-6D scores: 0.731 in mild, 0.723 in moderate, and 0.659 in severe asthma (P < 0.001). Patients with severe asthma had a significantly lower PCS compared to those with mild asthma (−5.3; P < 0.001) but there was no significant difference in MCS (−1.9; P = 0.309) controlling for socioeconomic and clinical variables. Asthma severity, women, older age, and having a lower level education and public insurance were significantly associated with lower PCS (P < 0.01).ConclusionAsthma patients had worse physical HRQOL than mental health, especially patients with severe asthma. These data suggest that the management of physical health of female, older aged, and low education patients with asthma should be focused on improving HRQOL.

Nebulization Practice and use of Antibiotic in the Treatment of Childhood Asthma at the Rural Area

Background : Management of childhood asthma is not optimum in our country especially at the community level.&#x0D; Objectives : The study was conducted to see the nebulization practice in the management of moderate and sever acute asthma in children at the community level.&#x0D; Methodology : This cross-sectional observational study was conducted in different private clinics and pharmacy of Daudkandi Upazila of Cumilla during the period of November 2017 to March 2018. Total 30 doctors’ diagnosed cases of acute exacerbation of moderate and severe asthma between 2-15 years of age were included in this study. Each patient’s treatment advice was followed up to see whether the use of nebulized Salbutamol and Antibiotic in the management of acute asthma was appropriate or not. All data were recorded in to a pretested proforma. Data were analyzed manually, and values were expressed as frequency and percentage.&#x0D; Results : Among the cases 25 (83.33%) cases had moderate and 5 (16.67%) cases had severe exacerbation of asthma. For nebulization, salbutamol was used to all cases and ipratropium bromide was added to 11 (36.7%) cases. Nebulization frequency was as per national guideline but the ratio of salbutamol respiratory solution to normal saline was not appropriate in most of the cases. Antibiotic was given to all cases and among them parenteral Ceftriaxone was given to 22 (73.3%) cases.&#x0D; Conclusion : Frequency of nebulization was appropriate but ratio of Salbutamol respiratory solution to normal saline was inappropriate. Antibiotic was given to all cases.&#x0D; Northern International Medical College Journal Vol.11 (2) Jan 2020: 471-474

Dupilumab elicits a favorable response in type-2 inflammatory comorbidities of severe atopic dermatitis

BackgroundThis case is the first report describing rapid, successful treatment of severe atopic dermatitis (AD) and comorbid type-2 inflammatory diseases in the same patient, with dupilumab treatment, with no side-effects.Case presentationWe report on effects of dupilumab in a patient with severe AD, a long-standing history of a mild, perennial allergic rhino-conjunctivitis, moderate asthma and chronic rhinosinusitis with nasal polyps (CRSwNP).ConclusionsPatients suffering from AD, asthma, allergic rhinitis and CRSwNP may be eligible for dupilumab single treatment that is possibly advantageous also from the pharmaco-economic standpoint.

The place of impulse oscillometry system in the diagnosis of early obstructive disorders associated with asthma

Asthma is one of the most common and socially significant human diseases. To date, spirometry is included in most recommendations as the gold standard for the diagnosis of obstructive disorders. However, in real clinical practice, this procedure does not always reveal signs of bronchial obstruction, not only in the early stages of the disease but also in more severe controlled bronchial asthma. Tests of oscillatory mechanics are increasingly being used to detect early violations of the pulmonary ventilation function. These tests are based on the forced oscillation technique, and the latest modification is impulse oscillometry system. Theaimof this study was to investigate the capabilities of impulse oscillometry in diagnosing early changes in the function of the respiratory system in patients with asthma and identifying the most informative parameters of the method.Methods. A total of 146 patients with an established diagnosis of mild and moderate asthma were examined during remission. The patients were divided into 2 groups by the severity of asthma. The comparison group included 40 people with no signs of lung abnormalities.Results. Disorders of the pulmonary ventilation function were found in 23% of patients with asthma by spirometry, in 42% by bodypletismography in 42%, and in 72% of patients by impulse oscillometry. Impulse oscillometry system revealed obstructive changes localized in the central respiratory tract in 11% of patients, and obstruction of mixed localization was found in 6% of respondents. Peripheral respiratory tract disorders were diagnosed in 56 % of patients. Most respiratory tract lesions were located in the small bronchi in both groups. The obstructive disorders in large bronchi and generalized obstruction were observed more often in the 2ndgroup. Among impulse oscillometry parameters, the increase in Delta (Rrs5– Rrs20) was most often recorded in both examined groups of patients with asthma.Conclusion. Compared to standard methods, impulse oscillometry system is more sensitive. Therefore, it has advantages in diagnosing respiratory system dysfunctions both in the early stages of asthma and in more severe cases during remission.

Children with under-diagnosed asthma presenting to a pediatric emergency department

Background Undiagnosed asthma in children presenting to the emergency department (ED) for respiratory illnesses might be associated with subsequent asthma morbidity and repeat ED visits. Objective To examine the prevalence of undiagnosed asthma among children presenting for ED care, and explore associations with sociodemographic and clinical characteristics. Methods We surveyed parents of children ages 2–17 years seeking ED care for respiratory symptoms (including asthma) regarding sociodemographic characteristics, asthma symptoms, prior asthma care and morbidity, and prior asthma diagnosis. Undiagnosed asthma was defined as a positive screening for asthma and no prior diagnosis. We compared sociodemographic and clinical factors of those with diagnosed versus undiagnosed asthma using chi-square, t-tests and multivariable logistic regression model. Results Of 362 children, 36% had undiagnosed asthma. Undiagnosed children were younger, had younger parents, and had parents less likely to speak English versus diagnosed children (all p < 0.05). Among undiagnosed children, 42% had moderate or severe asthma and 66% reported ≥1 exacerbation in the prior 12 months. Parent-reported controller medication use was higher among diagnosed versus undiagnosed children (60% vs. 21%, p=.001). In a multivariable logistic regression (adjusting for insurance, education, income and preferred language), no controller usage (aOR 4.26), no asthma exacerbations in the prior year (aOR 2.41) and younger age (aOR 0.76) were significantly associated with undiagnosed asthma. Conclusion Children presenting to the ED with undiagnosed asthma commonly experience significant prior asthma morbidity. Strategies to improve asthma diagnosis and messaging to their parents may reduce future morbidity.

Life Quality and Cytokines Profile in Patients with Asthma and Osteoarthritis

The objective of this study was to evaluate levels of leptin, adiponectin, IL-4, IL-6, TNF-α, oxidative damage, and antioxidant status in patients with bronchial asthma (BA), compared to patients who suffer from both BA and osteoarthritis (OA), and analyze the quality of life in such patients. Methods and Results: The study included 103 patients (34 men and 69 women) diagnosed with moderate asthma aged from 30 to 70 years (mean age of 58.52±7.14 years). The levels of IL-4, IL-6, TNF-α, adiponectin, leptin, total antioxidant status (TAS), and total oxidative damage (TOD) were measured. Two questionnaires were used in this study: Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Test (АСТ). The levels of leptin, TNF-α, and Il-6 were significantly higher in Group 2 than in Group 1. On the contrary, the IL-4 level was higher in Group 1 than in Group 2. The TAS value was significantly higher in Group 1 than in Group 2 (P=0.0001). The TOD value was significantly higher in Group 2 than in Group 1 (P=0.0000). The domains of AQLQ(S) activity, symptoms, and emotions were decreased in patients of Group 2. The values of the ACT test were 18.0±2.61 points and 16.78±1.92 points in Group 1 and Group 2, respectively (P=0.0077). Conclusion: In patients with both asthma and osteoarthritis, levels of inflammatory cytokines, such as leptin, IL-6, and TNF-α, are significantly elevated as well as values of total oxidative status, which correlate with poorer asthma control and quality of life.

Cost utility of fractional exhaled nitric oxide monitoring for the management of children asthma

IntroductionFractional exhaled nitric oxide is a simple, non-invasive measurement of airway inflammation with minimal discomfort to the patient and with results available within a few minutes. This study aimed to evaluate the cost-effectiveness of asthma management using fractional exhaled nitric oxide monitoring in patients between 4 and 18 years of age.MethodsA Markov model was used to estimate the cost-utility of asthma management using fractional exhaled nitric oxide monitoring versus asthma management without using fractional exhaled nitric oxide monitoring (standard therapy) in patients between 4 and 18 years of age. Cost data were obtained from a retrospective study on asthma from a tertiary center, in Medellin, Colombia, while probabilities of the Markov model and utilities were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective.ResultsThe model showed that fractional exhaled nitric oxide monitoring was associated with a lower total cost than standard therapy (US $1333 vs. US $1452 average cost per patient) and higher QALYs (0.93 vs. 0.92 average per patient). The probability that fractional exhaled nitric oxide monitoring provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness-to-pay thresholds.ConclusionAsthma management using fractional exhaled nitric oxide monitoring was cost-effective for treating patients between 4 and 18 years of age with mild to moderate allergic asthma. Our study suggests evidence that could be used by decision-makers to improve clinical practice guidelines, but this should be replicated in different clinical settings.