Moderate Asthma Research Articles

Effect and mechanism of allergen-specific immunotherapy on small airway dysfunction in children with asthma.

The purpose of this study was to investigate the effectiveness of allergen-specific immunotherapy (AIT) on small airway dysfunction (SAD) and the underlying mechanism with a special focus on basophils. Sixty-five children with mild to moderate asthma who were under regular inhaled corticosteroid (ICS) treatment for more than 1 year but whose FEF75 remained below 65% of the predicted value and had positive results for serum Der p or Der f were enrolled. Children with asthma underwent house dust mite (HDM) subcutaneous immunotherapy (SCIT) treatment for 1 year. Clinical symptoms and lung function were evaluated every 3 months during HDM SCIT treatment. Basophil activation test (BAT) was carried out before and after HDM SCIT treatment. RNA sequencing was performed in isolated basophils from peripheral blood after 6 months of HDM SCIT treatment, followed by GO term and KEGG pathway enrichment analysis between patients with and without HDM SCIT treatment. HDM AIT treatment ameliorated clinical symptoms while concurrently improved lung function parameters, such as FEV1/FVC, FEF75, FEF50 and MMEF (p < .05). It is worth noting that FEF75 values showed a highly significant, gradual and persistent increase (from 49.55 ± 1.27% at baseline to 71.89 ± 2.64% after 1 year of therapy) and 22 of 35 patients no longer had SAD after 1 year of treatment. BAT results revealed that AIT treatment significantly reduced basophil activity to the inhalant allergen mixtures containing HDM in vitro challenge from baseline. GO term and KEGG pathway enrichment analysis of basophils revealed that downregulated genes were mainly involved in immune cell activation, antigen presentation, and Th2 cell differentiation. Our study demonstrated that HDM AIT not only improved SAD related lung function parameters, but also reduced basophil activity. RNA sequencing revealed the inhibition of phagocytosis and the phagosome pathway in basophils which may affect the polarization of Th2 cell differentiation after HDM AIT.

Efficacy and safety of benralizumab

The purpose of the review is to analyze Russian and foreign literature sources on the effectiveness and safety of benralizumab in the treatment of moderate and severe bronchial asthma. Benralizumab is a humanized monoclonal antibody directed against the interleukin-5 receptor (IL-5R) subunit. Binding of benralizumab with the alpha chain of IL-5R leads to inhibition of hetero-oligomerization of alpha and beta subunits, thus preventing signal transduction and consequent proliferation of eosinophils and basophils and the cascade of events following it. Benralizumab significantly reduces annual asthma exacerbation rates and is well tolerated by patients with severe uncontrolled asthma. The efficacy and long-term adverse reactions of benralizumab therapy have not been sufficiently studied and require more detailed analysis.

PERINATAL PATHOLOGY AS A RISK FACTOR FOR THE DEVELOPMENT OF BRONCHIAL ASTHMA IN CHILDREN

The aim of the study: to study the perinatal history of children with bronchial asthma depending on the concomitant neurological symptoms. Material and methods of the study: A total of 103 children with moderate bronchial asthma in remission were examined, with an average age of 7.2±1.2 years. The children were divided into 2 groups: the main group, which included 72 children with bronchial asthma and late consequences of perinatal CNS damage, and a comparison group consisting of 31 children with bronchial asthma without concomitant neurological disorders. Results: Based on the data obtained, it was found that perinatal lesions of the central nervous system significantly affect the further development and course of bronchial asthma in children. A burdened heredity for allergic diseases in patients with bronchial asthma against the background of late consequences of perinatal lesions of the central nervous system (the main group) was significantly less common (30.6%; n=22) than in the comparison group - in 67.7% (n=21) of cases. In the main group, the mothers' pregnancies proceeded with some complications (100% of cases), while in the comparison group, only a quarter of the observations revealed a pathological course of pregnancy in mothers, which is undoubtedly a predisposing factor in the formation of perinatal damage to the central nervous system in the main group. KEY WORDS: bronchial asthma, consequences, perinatal damage, central nervous system, neurological symptoms, perinatal history, risk factors, Apgar scale

7726 Central Adrenal Insufficiency From Inhaled Mometasone Manifesting As Growth Deceleration

Abstract Disclosure: S. Gurnurkar: None. F.I. Cooper: None. Introduction: While long courses and/or high-doses of oral steroids have been found to cause adrenal suppression and resultant insufficiency, inhaled corticosteroids from asthma management typically do not affect cortisol production. However, in this case, we describe a patient who presented with 3 years of growth deceleration and was found to have adrenal suppression from her inhaled corticosteroid/long-acting beta agonist, Dulera (mometasone furoate and formoterol fumarate). Case Presentation: An 11-year-old female with history of moderate persistent asthma presented to our endocrinology department with growth deceleration and resultant short stature. The parent noted that the child started to decelerate in height percentiles from the 50th percentile at age 8 to the 6th percentile at age 11. BMI gradually rose from the 85th to 95th percentiles. The parent noted that the child started having worsening asthma symptoms around the start of the growth deceleration, requiring a handful of oral steroid courses and the addition of daily inhaled corticosteroid, Dulera. She had remained on the Dulera for the previous three years, with her asthma under good control. She also took cetirizine daily and albuterol as needed. The last course of oral steroids was three months prior to her first endocrinology visit. The patient’s mid-parental target height was at the 50th percentile and she denied fatigue, headache, or abdominal pain. Family history was negative for endocrine conditions and short stature. Puberty began at age 10. Further workup was recommended. A bone age was concordant with chronologic age. Initial labs including a TSH, free T4, IGF-1, IGFBP-3, CBC, ESR, and CMP were within normal limits. A growth hormone stimulation test with arginine and clonidine was performed. Growth hormone peak was 11 ng/mL, but, interestingly, cortisol resulted as &amp;lt;1.0 ug/dl throughout the test. Due to concerns of adrenal insufficiency, she underwent a high dose ACTH stimulation test. Initial ACTH was 6.3 pg/mL (ref 6-48 pg/mL) and cortisol remained at &amp;lt;1.0 ug/dl at 0, 30, and 60 mins. She was diagnosed with central adrenal insufficiency and prescribed 11 mg/m2 BSA/day of hydrocortisone divided three times daily, with stress dosing and emergency hydrocortisone injection instructions. Conclusion: The existing literature suggests that Dulera (mometasone furoate and formoterol fumarate) does not significantly influence adrenal function nor growth velocity. However, we present the case of a child with 3 years of inhaled Dulera use and significant central adrenal insufficiency. This case report is the first of its kind to detail decreased adrenal function with Dulera in particular. Presentation: 6/2/2024

Prevalence and Clinico-sociodemographic Factors of Asthmatic Children Aged 1 to 14 Years: A Prospective Descriptive Cross-sectional Study in Gandaki Province, Nepal

Introduction Pediatric asthma poses a significant public health challenge, impacting children’s health and quality of life. As asthma prevalence continues to rise globally, understanding its epidemiology is crucial for developing effective management strategies. This study aims to investigate the prevalence and associated demographic, socioeconomic, and clinical characteristics of pediatric asthma among children aged 1 to 14 years. Methods This study employed a prospective descriptive cross-sectional design. Data were collected from a diagnosed asthmatic children attending pediatric department of the GP Koirala National Respiratory Centre and Hospital, Tanahun, Ganaki, Nepal over three months from April 20, 2023 by assessing demographic factors (age, gender, residence), socioeconomic status, clinical history (family history and comorbid conditions), and asthma severity. Data were analyzed with SPSS version 23 using descriptive statistics. Results Prevalence rate of pediatric asthma was 3.08%. The demographic analysis revealed that most participants were aged 1-5 years (53%), predominantly male (64.9%), and resided in urban areas (59.6%). Socioeconomic data indicated that 59.6% came from low-income households, suggesting a potential link between socioeconomic status and asthma prevalence. Clinically, 53% had a family history of asthma, with 26.3% presenting with comorbid allergic rhinitis. Asthma severity assessments showed that 50% had mild asthma, 33.33% had moderate asthma, and 16.67% had severe asthma. Conclusion This study highlights a low prevalence of asthma in the pediatric population at GP Koirala National Respiratory Centre and Hospital, yet emphasizes the burden faced by younger children, especially those from low-income backgrounds. The correlations between asthma prevalence, socioeconomic status, and comorbid conditions underscore the need for targeted public health interventions and comprehensive management strategies. Further research is warranted to deepen understanding and enhance healthcare services for affected children.

The Analysis Study of Comparison of Effectiveness and Safety of Inhalers in Mild-to Moderate Asthma in Adults: A Comprehensive Systematic Review

Background: Asthma, a prevalent and potentially debilitating chronic disease, is traditionally managed using reliever medications such as short-acting β2-agonists (SABA) or low-dose inhaled corticosteroids (ICS). Recent evidence, however, indicates that a combination of as-needed ICS and a rapid-acting long-acting β2-agonist (LABA) provides superior outcomes compared to SABA alone. Furthermore, this combination therapy is at least as effective as regular ICS in mitigating the risk of exacerbations. This emerging evidence highlights a significant shift in treatment strategies for mild asthma, underscoring the potential for enhanced management and improved patient outcomes with the new therapeutic approach. Methods: Following PRISMA 2020 guidelines, this systematic review focused exclusively on full-text articles published in English between 2014 and 2024. Result: The study conducted a comprehensive review of over 400 publications sourced from reputable databases, including ScienceDirect, SagePub, and PubMed. Folowing an initial screening, eight publications were identified as warranting more in-depth analysis. Conclusion: The study found that as-needed ICS/LABA is effective in preventing exacerbations in mild-to-moderate asthma patients, but less effective than regular ICS in improving FEV1 and ACQ scores. Combining ICS/LABA with SMART regimen was highest for severe exacerbations prevention.

Clinical variability of equine asthma phenotypes and analysis of diagnostic steps in phenotype differentiation

BackgroundEquine asthma is a common, non-infectious, chronic lung disease that affects up to 80% of the horse population. Strict phenotyping and identification of subclinically asthmatic horses can be challenging. The aim of this study was to describe equine asthma phenotypes (mild, moderate, and severe asthma) defined by BALF cytology and occurrence of clinical signs in a population of privately owned horses and to identify the variables and examination steps with best discriminative potential. The standardised examination protocol included clinical examinations, blood work, airway endoscopy with bronchoalveolar lavage fluid analysis, arterial blood gas analysis and radiography under clinical conditions performed by one veterinarian.ResultsOut of 26 horses, four were diagnosed with mild (subclinical), seven with moderate, and seven with severe asthma based on clinical examination and BALF cytology. Eight horses served as controls. Cough with history of coughing was the strongest variable in phenotype differentiation. Factor analysis revealed an increasing clinical variability with disease severity and an overlapping of clinical presentations between phenotypes. Elevated mast cell (4/4 horses) and neutrophil counts (3/4 horses) in bronchoalveolar lavage cytology differentiated mild asthmatic horses from healthy horses. Moderate and severe asthmatic horses were characterised by clinical signs and neutrophil counts.ConclusionsThe results indicate that medical history, clinical examination and bronchoalveolar lavage cytology are minimum indispensable steps to diagnose equine asthma and that phenotypes are clinically overlapping. A differentiation of three phenotypes without neutrophil and mast cell counts in bronchoalveolar lavage cytology is not sufficient for clinical diagnostics. A comparably exact diagnosis cannot be achieved by relying on alternative examinations used in this study. Screenings of inconspicuous horses with bronchoalveolar lavage can aid in diagnosing subclinically affected animals, however, group size was small, the procedure is invasive and clinical relevance of slightly elevated cells in bronchoalveolar lavage remains unclear. Clinical relevance could not be clarified in this study, since follow-up examinations or lung function testing were not performed.

Emergency physicians’ preferences in bronchodilator delivery for asthma exacerbations: a cross-sectional study

Objective Asthma is a chronic respiratory disorder characterized by airway inflammation and narrowing often leading to acute exacerbations that necessitate a visit to the emergency department (ED). While life threatening cases usually require bronchodilator delivery by nebulizers, mild to moderate acute asthma exacerbations can be treated by bronchodilators delivered either by metered dose inhalers (MDI). Numerous studies have attempted to compare between the two modalities and have drawn similar conclusions in that both are comparable in efficacy with minimal differences. What is evident, however, is that physicians remain inclined to favor nebulizers in the majority of acute asthma exacerbations. Methods In this questionnaire-based study, a survey was distributed to physicians who treat asthma exacerbations to examine demographics, knowledge, beliefs, and current practice in regard to bronchodilator therapy. Results The majority (90.8%) of physicians prefer short-acting beta agonists via nebulizer, with 9.2% favoring MDI + spacer. Participants include consultants, residents, and specialists across various emergency disciplines. While 90.1% find MDI + spacer equally effective as nebulizers, advantages cited include cost-effectiveness (49.6%), shorter ED stays (63.4%), quicker administration (67.9%), and ease of use (58.8%). Challenges include availability (66.4%) and ineffectiveness in younger patients (45%). Despite this, 65.6% are willing to switch to MDI for initial asthma management in the ED, while 34.4% are resistant. Conclusion Concerns about availability and effectiveness in younger patients remain barriers. However, a significant number are willing to adopt MDIs with spacers, indicating potential for broader use with better availability and training.

Is the Prevalence of Allergic Bronchopulmonary Aspergillosis Greater in Severe Asthma?

Allergic bronchopulmonary aspergillosis (ABPA) is thought to occur more frequently in severe than in mild asthma. However, there are no precise data to support this hypothesis. To determine the prevalence of ABPA in subjects with varying asthma severity. We conducted a secondary analysis of prospectively collected data from 543 adult asthma subjects classified according to the 2004 Global Initiative for Asthma (GINA) guidelines. The asthma severity was categorized into mild, moderate, and severe. We report the prevalence of ABPA in each asthma category. We also performed multivariable logistic regression analysis to identify factors associated with ABPA in subjects with asthma. We classified 81 (15%), 257 (47%), and 205 (38%) subjects as mild, moderate, and severe asthma. We diagnosed ABPA in 106 (19.5%) subjects. The prevalence of ABPA was 11.1% (9 of 81) in mild, 21% (54 of 257) in moderate, and 20.7% (43 of 205) in severe asthma (P= .12). Multivariable analysis identified age and asthma duration as significant factors associated with ABPA, whereas asthma severity was not significantly associated. The prevalence of ABPA does not vary significantly with the severity of asthma. These findings support the revised International Society of Human and Animal Mycology (ISHAM) ABPA working group (AWG) recommendation for screening all asthma patients for ABPA, irrespective of asthma severity. Further large-scale studies across different geographic regions are warranted to validate these findings.

Influenza A (H1N1) in Hospitalized Children.

Influenza A (H1N1) is a contagious respiratory infection caused by the influenza A virus. In the majority of cases, H1N1 influenza is benign. However, it can be dangerous for infants and children with underlying chronic diseases. The severity of influenza depends on various factors, including the virulence of the virus strain, preexisting immunity level, and individual health conditions. The aim of this study is to describe the clinical profile of H1N1 influenza in hospitalized infants and children. This is a prospective and descriptive study conducted from November 1, 2018, to January 31, 2024. In this study, we included all children under 14 years old hospitalized for suspected severe lower respiratory infection who had gone through virological testing. We used a multiplex polymerase chain reaction (PCR) kit: the Film Array-Respiratory Panel. Due to the depletion of multiplex PCR kits, this study continued using rapid influenza diagnostic tests based on immunochromatographic technique. We report 45 confirmed cases of H1N1 influenza, collected during the period from November 1, 2018, to January 31, 2024. The average age was 2 years and 4 months. The main reason for admission was respiratory distress found in all patients. In 53% of the cases, there was an associated comorbidity, including asthma (17 cases), prematurity (2 cases), congenital adrenal hyperplasia (2 cases), cystic fibrosis (1 case), undetermined etiology bronchial dilation (1 case), and Basedow's disease (1 case). The clinical presentation included viral bronchiolitis (17 cases), moderate asthma exacerbation (10 cases), severe asthma exacerbation (7 cases), pneumonia (9 cases), bronchial dilation exacerbation (1 case), and flu-like syndrome with adrenal insufficiency (1 case). Fever was present in 31 patients. Gastrointestinal symptoms such as diarrhea and vomiting were present in 20 cases. Three patients required intensive care, with 2 children being intubated and ventilated (one severe acute asthma and one severe viral bronchiolitis). Two cases were treated with oseltamivir. The average length of hospital stay was 7.5 days, ranging from 3 to 20 days. All cases showed favorable evolution. We conclude that preventive measures remain crucial, and influenza vaccination is highly recommended in cases of underlying morbidity.

Effect of Long-Term Inhaled Corticosteroid Therapy on Metabolic And Anthropometric Parameters in Pediatric Patients with Asthma

Background: The long-term impact of inhaled corticosteroids (ICSs) metabolic parameters of asthmatic children is still uncertain. Objective: This study aimed to evaluate the effects of long-term use of ICSs on metabolic and anthropometric measures in children with asthma in Iran. Methods: This case-control study was conducted among 200 pediatric asthmatic patients who were referred to Abuzar Hospital (Ahvaz, Iran) during nine months. Demographic and clinical data of the patients were recorded. The participants were categorized into two groups: Group 1 (n = 100) comprising children with moderate to severe asthma, and Group 2 (n = 100) consisting of those with mild asthma. Results: The average age of 200 patients was 8.1 ± 2.9 years. The majority of them were male. The prevalence of wasting, stunting, obesity, and overweight was higher among Group 1 compared to Group 2 (p &lt; 0.05). Patients in Group 1 had significantly higher levels of calcium, vitamin D, lipids, and glycemic parameters than those in Group 2 (p &lt; 0.05). In addition, the duration of ICS use was notably longer in Group 1 (p &lt; 0.05). Conclusion: Children with moderate and severe asthma had significantly elevated lipid and glycemic parameters, as well as a higher prevalence of wasting, stunting, obesity, and overweight compared to patients with mild asthma. Further studies involving larger sample sizes and longer durations are necessary to confirm these findings.

Trends in polypharmacy among U.S. adults with asthma, 2001–2020

Objective This study aimed to evaluate trends in polypharmacy prevalence among adults with asthma in the United States. Methods Data from the 2001–2020 National Health and Nutrition Examination Survey were used to estimate the weighted prevalence of polypharmacy. Joinpoint regression analysis was conducted to evaluate trends in polypharmacy. Trends were first evaluated overall and then stratified by asthma severity and asthma control. A multivariable logistic regression model was used to identify factors associated with polypharmacy. Results From 2001 to 2020, a stable trend in polypharmacy among U.S. adults with asthma was observed (average annual percent change [AAPC]=1.02, p=0.71). Trends across different asthma severity were stable (mild asthma: AAPC=2.93, p=0.20; moderate asthma: AAPC=−2.22, p=0.35; severe asthma: AAPC=0.45, p=0.82). Trends in adults with good asthma control and those with poor control stayed constant (good control: AAPC=0.82, p=0.68; poor control: AAPC=−1.22, p=0.82). Several factors, including older age, females, Non-Hispanic Black, health insurance coverage, family income, number of healthcare visits, former smokers, multi-morbidities, asthma severity, and asthma control, were associated with polypharmacy. Conclusions Polypharmacy prevalence has remained constant among U.S. adults with asthma over the past two decades. Despite a stable overall trend, disparities in polypharmacy prevalence persist across different asthma severity and control status, underscoring the need for tailored medication management to improve asthma care.

Features of the parietal and cavity intestinal microbiota in infants born to mothers with bronchial asthma, depending on the mode of delivery

Introduction. Intestinal microbiota is a complex and unique system in its composition, performing a huge number of diverse functions in the body. Its formation begins in utero.Aim. To study the features of the parietal and cavity intestinal microbiota in children born to mothers suffering from moderate bronchial asthma, depending on the mode of delivery.Material and methods. A prospective longitudinal study was carried out, which included children from the first day of life to 12 months. A total of 68 children at high risk of atopy (HRA) from mothers with asthma were included, of whom 22 were born by cesarean section and 46 were born through the vaginal birth canal. Qualitative and quantitative analysis of GM was carried out by real-time PCR with group- and species-specific primers: in the examined children, the dynamics of 4 phylums including 31 microorganisms was assessed. The child’s feces and brush-biopsy were taken from the rectum at 7 control points of measurement.Results and discussion. The data obtained showed that the method of delivery has an impact on the formation of the intestinal microbiota: in children born by cesarean section, in the parietal microbiota, starting from the age of 1–2 months, and in the cavity microbiota – 3–4 months, representatives of phylum Firmicutes (Clostridium leptum gr m.). In children born through the vaginal birth canal, all the first 8 months of life in the cavity and parietal microbiota were dominated by representatives of phylum Bacteroidetes (Bacteroides spp., Prevotella spp.). Clostridium leptum can be a marker of an inflammatory process in the intestinal mucosa in children at high risk of atopy. The research conducted over the past few years has found that Clostridium leptum promotes the secretion of anti-inflammatory (IL-10 and IL-12) and inhibition of the production of pro-inflammatory (IL-8) cytokines, and also boosts the number of Treg cells.Conclusion. The mode of delivery in children with a high risk of atopy is an additional epigenetic factor that influences the nature of both the parietal and cerebrospinal microbiota.

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.

Identification of candidate genes and molecular mechanisms related to asthma progression using bioinformatics

BackgroundAsthma is a heterogeneous disorder. This study aimed to identify changes in gene expression and molecular mechanisms associated with moderate to severe asthma.MethodsDifferentially expressed genes (DEGs) were analyzed in GSE69683 dataset among moderate asthma and its controls as well as between severe asthma and moderate asthma. Key module genes were identified via co-expression analysis, and the molecular mechanism of the module genes was explored through enrichment analysis and gene set enrichment analysis (GSEA). GSE89809 was used to verify the characteristic genes related to moderate and severe asthma.ResultsAccordingly, 2540 DEGs were present between moderate asthma and the control group, while 6781 DEGs existed between severe asthma and moderate asthma. These genes were identified into 14 co-expression modules. Module 7 had the highest positive correlation with severe asthma and was recognized to be a key module by STEM. Enrichment analysis demonstrated that the module genes were mainly involved in oxidative stress-related signaling pathways. The expression of HSPA1A, PIK3CG and PIK3R6 was associated with moderate asthma, while MAPK13 and MMP9 were associated with severe asthma. The AUC values were verified by GSE89809. Additionally, 322 drugs were predicted to target five genes.ConclusionThese results identified characteristic genes related to moderate and severe asthma and their corresponding molecular mechanisms, providing a basis for future research.

Thoughtful prescription of inhaled medication has the potential to reduce inhaler-related greenhouse gas emissions by 85%

IntroductionBoth physicians and patients are increasingly aware of the environmental impacts of medication. The shift of treatment paradigm towards MART-treatment (Maintenance and Reliever Therapy) in asthma affects the treatment-related emissions....

Soluble E-Cadherin Contributes to Airway Inflammation in Severe Asthma.

Impaired airway epithelial barrier and decreased expression of E-cadherin are key features of severe asthma. As a gatekeeper of the mucosa, E-cadherin can be cleaved from the cell surface and released into the apical lumen as a soluble form (sE-cadherin).This study was aimed to investigate the role of sE-cadherin in severe asthma.Induced sputum was obtained from healthy subjects and patients with asthma. Two murine models of severe asthma were established using either TDI (toluene diisocyanate) or OVA (ovalbumin)/CFA (complete Freund's adjuvants). The role of sE-cadherin in severe asthma was evaluated by intraperitoneal injection of DECMA-1, a neutralizing antibody against sE-cadherin. Mice or THP-1-derived macrophages were treated with recombinant sE-cadherin to explore the pro-inflammatory mechanism of sE-cadherin.Severe asthma patients had a significantly higher sputum sE-cadherin level than the health subjects with mild to moderate asthma, which were positively correlated with sputum HMGB1 level and glucocorticoid dosage required for daily control. Allergen exposure markedly increased sE-cadherin level in the bronchoalveolar lavage fluid in mice. Treatment of DECMA-1 significantly attenuated allergen-induced airway inflammation and hyperresponsivenes in both models of severe asthma. While exposure to recombinant sE-cadherin dramatically up-regulated VEGF expression in THP-1-derived macrophages, and increased neutophlil and eosinophil infiltration into the airway as well as the release of VEGF and IL-6 in mice, both of which can be suppressed by pharmacological inhibition of ERK signaling.Taken together, our data indicated that sE-cadherin contributed to the airway inflammation of severe asthma in an ERK-depedent pathway.

Cost-effectiveness analysis of budesonide/formoterol SMART therapy versus salmeterol/fluticasone plus as-needed SABA among patients ≥12 years with moderate asthma from the Chinese societal perspective

Objectives To evaluate the cost-effectiveness of budesonide/formoterol reliever and maintenance therapy compared with salmeterol/fluticasone plus salbutamol as reliever therapy for asthma patients ≥12 years from the societal perspective in China. Methods A Markov model was developed with three health states (non-exacerbation, exacerbation, and death) with a lifetime horizon. The exacerbation rates were obtained from a prospective cohort study conducted in Chinese asthma patients. Healthcare resources utilization data were estimated based on current clinical asthma management guidelines. Asthma-related mortality, cost input and utility values were derived from public database and literature. Model robustness was assessed with one-way sensitivity and probabilistic sensitivity analyses. Results Compared with salmeterol/fluticasone plus salbutamol, budesonide/formoterol reliever and maintenance therapy led to fewer exacerbation events (13.6 vs. 15.9) and 0.0077 quality-adjusted life years (QALY) gain at an additional cost of ¥196.38 over lifetime. The base case incremental cost-effectiveness ratio (ICER) was ¥25,409.98 per QALY gained. The variables that had most impact on the model output included drug costs and medication adherence. At a willingness-to-pay threshold of ¥257,094/QALY (3 times of gross domestic product per capita in China in 2022), the probability of budesonide/formoterol maintenance and reliever therapy being cost-effective versus salmeterol/fluticasone plus as-needed salbutamol was 83.00%. Conclusion From the societal perspective, budesonide/formoterol reliever and maintenance therapy is likely to be a cost-effective option compared with salmeterol/fluticasone plus as-needed salbutamol for Chinese asthma patients ≥12 years.

Clinical experience with ciclesonide as maintenance treatment for not-well controlled mild and moderate asthma in adolescents

Clinical experience with ciclesonide as maintenance treatment for not-well controlled mild and moderate asthma in adolescents

Frequency of Severe Asthma and Its Clinical Phenotypes at the Asthma Clinic in One of the Largest Sudanese Tertiary Pediatric Hospitals: A Cross-Sectional Hospital-Outpatient-Based Study.

Asthma is one of the most common non-communicable diseases. Childhood asthma has been increasing in Sudan, with a 13-16% prevalence among Khartoum school children. To achieve and maintain good asthma control, proper diagnosis, assessment of severity, and appropriate medication administration are crucial, with phenotyping being a key factor in determining patients' specific treatment. To study the frequency of severe asthma and the distribution of its different phenotypes and to investigate associations between age and gender and different phenotypes of asthma. This descriptive cross-sectional hospital-based study was conducted in the Asthma Clinic of Mohamed Al-Amin Hamid Pediatrics Hospital. It included 229 patients who were presented to the clinic from September 2021 to April 2022. Data were collected from the patients and/or their caregivers using a modified validated standard questionnaire and were analyzed using SPSS version 26.0. A p-value of 0.05 or less was considered statistically significant. In this study of 229 participants, 14.4% had severe asthma, with 44.5% and 41% exhibiting mild and moderate asthma, respectively. Most were effectively managed in steps 2 or 3. The cohort, primarily aged 5 or younger (40.2%) with a male majority (62%), showed a mean diagnosis age of 2.9 ± 2.8 years. Impressively, 90% maintained well-controlled asthma. Within severe asthma cases (87% atopic), 39.4% represented a severe allergic asthma phenotype. Elevated eosinophil counts were noted in 45.5% (serum) and 78.8% (sputum cytology), while 57.6% had normal serum IgE levels. The predominant symptom pattern in severe asthma was episodic multi-trigger wheezing (48.5%). Age and gender displayed no significant association with severe asthma phenotype. This study reveals a concerning rise in childhood asthma prevalence in Sudan, emphasizing the importance of tailored treatment strategies. Severe asthma, characterized by atopic eosinophilic involvement, necessitates targeted interventions in pediatric asthma care for specific phenotypes.