Moderate Asthma Research Articles

Improvement of glucocorticoid sensitivity and attenuation of pulmonary allergic reactions by exogenous supplementation with betaine in HDM and LPS-induced allergic mouse model.

Childhood asthma is a heterogeneous disease that exhibits different characteristics and varying severity; however, the metabolite alterations underlying the difference in asthma severity, especially in severe asthma, are not well understood. The aim of this study was to identify the plasma metabolic profile of children with different asthma severity and explore the potential intervention targets in severe asthma and glucocorticoid resistance. Untargeted liquid chromatography mass spectrometry was utilized to analyze plasma metabolites in 54 children with mild-to-moderate asthma, 50 children with severe asthma and 39 healthy controls. Multivariate statistical analyses were used to explore plasma metabolic alterations that were strongly associated with asthma severity. Meanwhile, the severe allergic airway inflammation mice with glucocorticoid resistance were constructed to validate the potential therapeutic capacity of metabolites. The plasma metabolic profiles of children with mild to moderate asthma and severe asthma exhibited significant alterations. The distinct plasma metabolite shifts were accompanied by functional alterations in lipid metabolism, particularly choline metabolism, glycerophospholipids and sphingolipid metabolism. 11-cis-retinol, LysoPC (20:4 [8Z,11Z,14Z,17Z]), and glycerophosphatidylcholine were associated with exacerbated airway inflammation and lung function. Furthermore, 2-Hydroxyestradiol, LysoPC (18:3 [6Z,9Z,12Z]), zeaxanthin, and betaine were shifted exclusively in the severe asthma group and may serve as potential biomarkers. Subsequent in vivo studies demonstrated that betaine supplementation partially improved glucocorticoid resistance. Overall, children with different asthma severity displayed distinct plasma metabolic patterns. These may contribute to the difference in response to glucocorticoids in childhood asthma and could be potential targets and interventions.

Phase I Study of the Safety, Tolerability, and Pharmacokinetics of Inhaled Voriconazole in Healthy Volunteers and Subjects With Stable Asthma.

The aim of this study was to evaluate safety, tolerability, and pharmacokinetics (PK) of single and multiple doses of a novel inhaled formulation of voriconazole (ZP-059). In the single ascending dose part, 4 cohorts of 6 healthy subjects received one dose of inhaled voriconazole (5-40 mg). In the multiple ascending dose part, 3 cohorts of 6 subjects with mild asthma received voriconazole 10 mg twice daily [BID], 20 mg BID or 40 mg once daily. In the 2-period crossover part, 16 subjects with mild to moderate asthma each received one dose of inhaled voriconazole 20 mg and one dose of oral voriconazole 200 mg. A bioanalytical method was developed and validated to simultaneously determine concentrations of voriconazole and its metabolite N-oxide voriconazole in serum and sputum. Inhaled voriconazole was well tolerated with no treatment emergent adverse events (TEAEs) leading to treatment discontinuation. The PK profile of inhaled voriconazole showed rapid absorption, apparent greater than proportional increase in exposure with increasing dose, a consistent half-life across dosing, and large clearance and volume of distribution. Following repeat administration limited accumulation was observed. Systemic exposure following inhaled voriconazole was much lower than following oral voriconazole. Serum data confirmed that voriconazole was extensively metabolized also when administered by inhalation. Sputum data following inhaled voriconazole were limited but demonstrated increasing exposure with increasing dose. The current study shows the newly developed dry powder inhaled formulation of voriconazole to be safe and well tolerated, providing a possible improved treatment approach for patients affected by allergic bronchopulmonary aspergillosis. Trial Registration: ClinicalTrials.gov ID: NCT04229303.

Bronchial vessel density is correlated with airway smooth muscle cell proliferation in horses with mild and moderate asthma.

In severe equine asthma, structural remodeling of the airways ultimately leads to bronchial wall thickening and airflow obstruction. Increased bronchial vascularization has been described in horses affected by the severe form of the disease, but whether it contributes to bronchial remodeling in milder forms of asthma remains to be determined. In a blinded, retrospective case-control study, we evaluated the presence of bronchial angiogenesis in horses with mild and moderate equine asthma (MEA) and its correlation to airway smooth muscle remodeling. Endobronchial biopsies from the Equine Respiratory Tissue Biobank collected between August 14, 2014, and May 31, 2019, from 9 horses with MEA and 7 healthy controls were studied. The vascular basement membrane was identified by immunohistochemistry, allowing the measurement of the number of bronchial vessels, vascular area, and mean vessel size by histomorphometry. The correlations between angiogenic parameters, airway smooth muscle (ASM) remodeling features, and airway neutrophilia were studied. No differences between groups were observed for the angiogenic parameters evaluated. The number of vessels was correlated to ASM cell proliferation in MEA horses (Spearman r = 0.73) but not in controls. Airway neutrophilia correlated negatively with mean vessel size in horses with MEA (Pearson r = -0.83) but not in control horses. Major changes in bronchial vascularization do not occur in central airways in MEA. Contrary to previous findings in horses with severe equine asthma, angiogenesis is not a prominent feature of MEA, but it might be associated with ASM remodeling.

Factors influencing health-related quality of life in children with asthma: insights from Addis Ababa public hospitals.

Bronchial asthma is a global health problem in particular a respiratory condition characterized by broncho spasms that negatively affect the quality of life (QOL) of children. However, there is a paucity of data regarding the health-related quality of life of asthma in children in Ethiopia, and the study area. The objective of this study was to assess the health-related quality of life among asthmatic children aged 7-17 in selected hospitals in Addis Ababa, Ethiopia. An institutional-based analytical cross-sectional study involving 136 asthmatic children aged 7-17 years was conducted in the selected hospital in Addis Ababa, from February to April 2024. Respondents were chosen using a systematic random sampling method. Structured, interviewer-administered, and pretested questionnaires, were used to collect data. The data were coded and entered into Epi-Data 3.1 before being exported to SPSS version 25 for analysis. Logistic regression was employed to identify factors influencing health-related quality of life Statistical significance was set at p < 0.05 with a 95% confidence interval. The study found that 46% [95% CI: 37.6-54.4%] of the study participants had a poor quality of life. Factors associated with an increased likelihood of poor quality of life included caregivers' lack of formal education (Adjusted Odds Ratio [AOR]: 1.39 [1.80-10.69]), a family history of asthma (AOR: 2.51 [1.46-4.299]), longer asthma duration (AOR: 3.47 [1.89-6.39]), uncontrolled asthma (AOR: 3.47 [1.89-6.39]), moderate persistent asthma (AOR: 2.4 [1.40-4.20]), and comorbidities (AOR: 2.4 [1.40-4.20]). The study highlights almost half of asthmatic children had a poor quality of life in Addis Ababa. Factors such as caregivers' lack of formal education, a family history of asthma, longer duration and increased severity of asthma, uncontrolled asthma, and comorbidities were significantly associated with poor quality of life. Therefore, implementing targeted education programs, encouraging family history assessments, and strengthening comorbidity screening and management for children and their families in Addis Ababa are recommended.

Triple inhaler therapy in adolescents and adults with moderate or severe persistent asthma.

Expert guidelines, meta-analyses, and multiple randomized controlled trials have demonstrated the effectiveness of long-acting inhaled antimuscarinic agents (LAMAs) as an additive medication for patients with poorly controlled moderate or severe persistent asthma. LAMAs play an essential role in blocking acetylcholine binding to muscarinic receptors and reducing bronchoconstriction and mucus production. By adding this medication to other combination inhalers, patients can use a triple inhaler to improve FEV1 values and reduce exacerbations.

Association of sleep disordered breathing with severity and control of persistent asthma in Indian children.

To assess the association of pediatric sleep disordered breathing (SDB) with control and severity of asthma, and to evaluate the comorbidities associated with both. Based on the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ), children (5-15 years) with persistent asthma were classified as; with SDB (SDBS-PSQ≥0.33) and without SDB (SDBS-PSQ<0.33), in a cross-sectional study. Baseline characteristics were compared. Control of asthma into well-controlled, not-well, and poorly controlled was assessed using childhood - asthma control test (c-ACT). Comorbidities like adeno-tonsillar hypertrophy, gastroesophageal reflux disease (GERD), obesity and allergic rhinitis (AR) for presence of SDB in asthma were assessed. Sixty asthmatics were included. Mild, moderate, and severe persistent asthma was observed in 26.67%, 40% and 33.33% respectively, with 18.33% asthmatics having SDB. 42.3% of uncontrolled asthmatics had SDB. Baseline characteristics were similar in both groups. Asthmatics with SDB had higher frequency of severe persistent (63.6% vs 26.5%, p=0.018) and uncontrolled asthma i.e. partly & poorly controlled (100% vs 30.6%, p<0.001) versus asthmatics without SDB. Mean SDBS-PSQ score was higher in uncontrolled asthmatics compared to well-controlled asthmatics (0.255±0.19 vs 0.047±0.06, p<0.001). Mean c-ACT score was lower with SDB (14.45±3.20 vs 20.04±4.56, p<0.001), indicating poor control of asthma. A negative relationship was established between c-ACT and SDBS-PSQ (p<0.001, r2=-0.36). Higher occurrence of AR was found in asthmatics with SDB (72.7% vs 20.4%, p=0.001). SDB may be associated with poor control and worsening severity of asthma. Concomitant AR was found in asthmatic children with SDB.

Uncovering the spectrum of healthcare resource utilization and costs across moderate to severe asthma: high-cost subgroups and impact of biologics

ABSTRACT Objectives The healthcare burden of moderate asthma is not as well studied as severe asthma. This study used 2019 US claims data to characterize patients in Global Initiative for Asthma (GINA) steps 3 to 5 (moderate to severe) during the first 90 days of 2019. Methods Patient characteristics, healthcare resource utilization and costs were described for all patients and GINA groups. Patients in GINA 3 accounting for the top 10% and 20% of asthma-related total costs were also analyzed. Results In the overall asthma population (N = 337 015), mean asthma-related healthcare cost per patient was $12 560; for GINA 3, 4 and 5, costs were $10 265, $12 923, and $22 601, respectively. For the GINA 3 top 10% and 20% cost subgroups, these expenditures were higher than for GINA 5 ($54 549 and $94 386, respectively), driven by outpatient and inpatient costs. The high-cost GINA 3 subgroups were older, more often female and had a higher comorbidity burden versus GINA 4 or 5. An exploratory analysis suggested that biologic initiation significantly increased costs in patients initially in GINA 3 (p < 0.0001), but significantly reduced costs in GINA 3 top 10% and 20% cost subgroups (both p < 0.01). Conclusion Results indicate patients receiving GINA 3 treatment can have a high disease burden and may benefit from treatment with a biologic.

Budesonide/formoterol turbuhaler vs pMDI salbutamol for acute asthma in outpatient emergency department: a prospective, randomized, open-label study

Background The Global Initiative for Asthma (GINA) has suggested the need for more studies on inhaled corticosteroid (ICS)-formoterol in the Emergency Department (ED). Objectives We aimed to compare the outcomes of budesonide/formoterol (160/4.5 mcg/inhalation) turbuhaler versus pressurized metered-dose inhaler (pMDI) salbutamol (100 mcg/puff) in acute asthma in the outpatient ED. Methods This single-centre, prospective, randomized, and open-label study involved adult asthma patients with mild to moderate asthma exacerbation who attended the outpatient ED of a tertiary hospital in Malaysia. The intervention arm received budesonide/formoterol (Symbicort® 160/4.5 mcg) turbuhaler, while the control arm received pMDI salbutamol with a valved holding chamber. Stratified randomization with variable baseline ICS use was employed. Direct discharge rate from outpatient ED was the primary outcome. Vital signs pre- and post-treatment between the two arms were also compared. Results Seventy-four (n = 37 for each arm) asthma patients were recruited. Baseline clinical characteristics were comparable between the two arms. Direct discharge rates from ED were comparable between the intervention (94.6%) and the control (91.9%) arms (p = 1.000). Post-treatment outcomes (respiratory rate, oxygen saturation, peak expiratory flow rate) were similar between the two arms, except for the higher increment of heart rate (p < 0.001) and lesser reduction of blood pressure in the control arm (p = 0.013). Intravenous hydrocortisone use was significantly higher in the control arm (n = 19, 51.4%) than in the budesonide/formoterol arm (n = 6, 16.2%) (p = 0.001). Conclusion Budesonide/formoterol turbuhaler is as effective as pMDI salbutamol in treating asthma exacerbation in the outpatient ED with less effect on heart rate and lower usage of intravenous corticosteroids.

Assessment of Exercise Capacity in Patients Diagnosed with Moderate and Severe Bronchial Asthma: Preliminary Prospective Observational Study.

The main objective of the study was to assess exercise capacity and physical activity levels in patients with bronchial asthma compared to a control group without asthma, as well as to investigate how asthma severity affects the results of the 6MWT and physical activity as measured by the IPAQ questionnaire. A total of 63 individuals were studied, divided into two groups: Group A, consisting of 33 individuals with bronchial asthma, and Group B, consisting of 30 individuals from the general population without bronchial asthma. In both groups, the following assessments were performed: The Six-Minute Walk Test (6MWT), The International Physical Activity Questionnaire (IPAQ) and the Borg rating of perceived exertion scale (the Borg RPE scale) ABB. It was demonstrated that patients with moderate asthma covered more distance during the 6MWT than patients diagnosed with severe asthma. The difference in metres covered between the two groups was statistically significant (p < 0.001), which could be observed during the walk test. The results indicate that a larger proportion of patients with asthma (76%) fall into the insufficient physical activity category compared to those without asthma (24%). Conversely, a higher percentage of non-asthmatic individuals (66.67%) report sufficient physical activity compared to asthmatic patients (33.33%)(P=0.005). This study demonstrated that asthma severity significantly impacts exercise capacity, as shown by shorter distances covered in the 6-minute walk test (6MWT) among patients with severe asthma. While overall physical activity levels (measured by the IPAQ) were not significantly different between asthma and non-asthma groups, asthma patients exhibited significantly more sitting time, suggesting a more sedentary lifestyle.

Molecular allergen sensitization drives phenotypes of severe asthma in children: Evidence from a megacity cohort (SAMP).

Several major sensitization profiles have been described in children with asthma, but it remains unclear how these profiles relate to asthma phenotypes. The aim of this study was to determine allergenic sensitization profiles in a megacity cohort (SAMP). This was a cross-sectional analysis performed from 2011 to 2015 including preschool and school-age children with severe and moderate asthma from the SAMP cohort. We performed ALEX multiplex array and carried out cluster analysis. Data from 367 children were analyzed: 224 of preschool age and 143 of school age, respectively 84 (38%) and 114 (80%) presented at least one allergic sensitization. At preschool age, three clusters were identified: Cluster 1, Few sensitizations to inhaled allergen molecular families and non-type 2 (T2) inflammation (n = 61); Cluster 2, Predominant sensitization to HDM molecular families (n = 16); Cluster 3, Severe asthma with multiple sensitizations to inhaled and food allergen molecular families (n = 7). At school age, five clusters were identified: Cluster 1, Few sensitizations to inhaled allergen molecular families and non-T2 inflammation (n = 43); Cluster 2, Predominant sensitization to HDM molecular families (n = 31); Cluster 3, Predominant sensitization to PR-10 protein family (n = 25); Cluster 4, Severe asthma with predominant sensitization to tropomyosin family (n = 11); Cluster 5, Severe asthma with multiple sensitizations to inhaled and food allergen molecular families (n = 4). These results underline the heterogeneity of sensitization profiles in severe allergic childhood asthma. The most severe asthma phenotypes were associated with multiple sensitizations to both inhaled and food allergen molecular families as expected, and to the tropomyosin molecular family, a novel finding.

Impact of asthma severity on surgical outcomes in patients with chronic rhinosinusitis comorbid with asthma

BackgroundPatients with chronic rhinosinusitis with nasal polyps comorbid with asthma often experience poor outcomes following endoscopic sinus surgery. ObjectiveThis study was designed to evaluate the impact of asthma severity on the long-term outcomes after surgery in these patients. MethodsEighty-three patients with chronic rhinosinusitis with nasal polyps comorbid with asthma who underwent endoscopic sinus surgery were prospectively enrolled in this study. Patients were classified into mild, moderate, and severe asthma groups based on their preoperative asthma severity. Clinical symptom scores, nasal endoscopy scores, and asthma control test results were recorded preoperatively, and at 1 year and 12 years postoperatively. ResultsSeventy-one patients completed the 12-year follow-up. All patients showed significant improvement in nasal symptom scores and nasal endoscopy scores. However, 48 of 71 (67.6%) patients experienced nasal polyp recurrence, and 22 (31.0%) of them underwent revision surgery. Patients in the severe asthma group had the highest rate of nasal polyp recurrence (P=0.02) and revision surgery (P=0.01), and the least improvement in smell disturbance (P=0.04) and general symptom (P=0.02) compared with the other asthma groups. ConclusionPreoperative asthma severity significantly influenced the outcome of endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps comorbid with asthma, in whom endoscopic sinus surgery had a long-term beneficial effect.

New variants of the DAD1 and OXA1L genes are associated with asthma and atopy in an adult population

Asthma is a complex disease characterized by reversible and intermittent airway obstruction that has shown a high prevalence and unacceptable mortality in adults. In recent years, several genome-wide association studies (GWAS) have identified variants linked to asthma susceptibility. The DAD1 gene is known for regulating programmed cell death, and OXA1L is described for its involvement in mitochondrial biogenesis and oxidative phosphorylation. The present study aimed to identify variants in the DAD1 and OXA1L genes and to evaluate the association with asthma and atopy markers in adults. 1,084 individuals were divided into mild to moderate asthma, severe asthma, and participants with no asthma (controls). Association analyses were performed using a multivariate logistic regression model adjusted for sex, age, body mass index (BMI), smoking, forced expiratory volume in 1 s (FEV1), and component ancestry master (PC1) using PLINK 1.9 software. This study identified new variants in the DAD1 and OXA1L genes that had never been described before. The C allele of rs200470407 in OXA1L was negatively associated with poor asthma control (OR: 0.32; p-value 0.049) and increased IL-13 (p-value < 0.0001). The alternative allele of rs1681577 was associated with severe asthma (OR: 2.23; p-value 0.01), pulmonary obstruction (OR: 4.12; p-value 0.046), and eosinophilia (OR: 2.42; p-value < 0.001). Our findings demonstrate that variants in the DAD1 and OXA1L genes are linked to asthma and atopy in Brazilian adults.

Neuropsychiatric diagnoses after montelukast initiation in paediatric patients with asthma

BackgroundThe evidence base on montelukast-associated adverse outcomes is inconclusive in children and young persons (CYP) with asthma. We aimed to investigate 1-year incidence of neuropsychiatric diagnoses after initiation of montelukast...

Lung Ultrasound Findings in Children With Asthma Exacerbations.

We sought to assess whether the presence and extent of lung ultrasound (LUS) findings were associated with asthma exacerbation severity in children. We enrolled a convenience sample of patients aged 5-18 years presenting with acute asthma exacerbation to a tertiary care pediatric emergency department. Severity of an asthma exacerbation (mild, moderate, severe) was assessed within 1 hour of the LUS using the Hospital Asthma Severity Score, a validated asthma assessment tool. LUS was performed by trained pediatric emergency providers. The presence of LUS findings (B-lines, consolidations, pleural effusion, and pleural line abnormalities) was assessed using a standardized criterion based on consensus guidelines. A total of 111 patients with a median age of 8 years (interquartile range 6-12) were enrolled. LUS was positive in 57% of patients. Pleural line abnormalities were observed in 34%, B-lines in 29%, consolidations <1 cm in 24%, and consolidations ≥1 cm in 7%. Patients with moderate and severe asthma exacerbations were more likely to have any B-lines (31% and 43%, respectively) than patients with mild exacerbations (12%; P = .021); however, the presence of ≥3 B-lines or confluent B-lines did not differ across severity groups. The presence of other findings did not differ based on asthma severity. LUS findings are observed in a substantial portion of children presenting with asthma exacerbations. B-lines were the only LUS finding significantly associated with asthma severity, while lung consolidations <1 cm and >1 cm were not correlated with severity. These findings provide valuable information for the diagnostic use of LUS in pediatric patients with asthma exacerbation.

Serum Vitamin D Level Is Unchanged in Equine Asthma.

Vitamin D deficiency is associated with asthma development and severity of symptoms in humans, but whether the same occurs in horses is unknown. We aimed to determine whether the serum vitamin D levels differ in horses with asthma compared to control animals and, secondarily, to explore clinical, respiratory, and environmental parameters associated with its concentration in equids in a retrospective cross-sectional study. The total serum vitamin D (25(OH)D) was measured by radioimmunoassay in 45 serum samples from the Equine Respiratory Tissue Biobank (15 control animals, 14 horses with mild or moderate asthma (MEA), and 16 horses with severe asthma (SEA)). Descriptive clinical and environmental parameters, bronchoalveolar lavage fluid cytology, and lung function data were extracted. There was no difference in serum 25(OH)D levels between healthy controls, horses with MEA, and horses with SEA (respectively, means of 57.9 ± 11.6, 55.6 ± 20.0, and 64.6 ± 14.5 nmol/L; p = 0.3), suggesting that this micronutrient does not play a major role in equine asthma pathophysiology.

Depigmented, Polymerized Cat Epithelium Extract Is Safe and Improves Rhinitis and Asthma Symptoms in Cat-Allergic Patients: A Real-World Retrospective Study.

Exposure to cat allergens is often difficult to avoid. Here, we evaluated the safety and effectiveness of a depigmented, polymerized cat epithelium extract (Dpg-pol-cat) for the treatment of allergic rhinoconjunctivitis and asthma. Real-world, retrospective study of patients ≥12 years of age with cat allergy and moderate to severe allergic rhinitis/rhinoconjunctivitis, with or without asthma, who started allergen immunotherapy (AIT) with Dpg-pol-cat extract during routine visits to the Allergy Department. Safety and effectiveness (improvement in FEV1) of AIT were evaluated. The use of rescue medication and patient perceptions were also assessed. A total of 62 patients were included, of whom 34 (54.8%) received AIT for at least 12 months. There were 15 adverse events, 8 local and 7 systemic, of which 3 led to discontinuation of AIT. Patients with moderate to severe rhinitis decreased from 88.2% at baseline to 29.4% at 12 months (p < 0.0001) and patients with moderate asthma decreased from 76.5% to 38.2% (p = 0.0004). FEV1 improved from a mean (standard deviation) of 3,188.9 (771.4) mL to 3,419.6 (878.4) mL (p = 0.0023). The use of rescue medication for rhinitis decreased from 94.1% to 23.5% (p < 0.0001). All patients requiring rescue medication for conjunctivitis (20.6%) were off medication at 12 months, and 97.1% and 92.6% of patients reported improvement in rhinitis and asthma symptoms, respectively. AIT with Dpg-pol-cat extract shows a favorable safety and effectiveness profile in patients with allergic rhinitis/rhinoconjunctivitis due to cat allergy, with or without allergic asthma, representing a valuable treatment option for these patients.

Effect of treatment on quality of life of rural asthmatic children

Introduction: Medications relieve symptoms of asthma but affected children are significantly bothered by physical, educational and emotional impairments. Urban studies from India evaluated on how this disease affects quality of life. Aim of our study was to evaluate quality of life of rural asthmatic children both before as well as after the treatment. Methods: Asthmatic children 7 to 17 years visiting to rural tertiary care teaching hospital were included. Tool used for the study was Pediatric Asthma Quality of Life Questionnaire - Standard (PAQLQS) which were measured at the time of inclusion and four weeks after treatment. It assessed the QOL (Quality of Life) under symptoms, activity limitation and emotional function domains. Mean difference in pre and post treatment PAQLQ score was assessed. Results: Total 46 children were included from rural setup. Majority were male 60% and had a normal BMI (54%) which was followed by undernutrition (28%). Majority children in both age group 7-11year and 12-17 year, presented with moderate asthma (80%) and (62%) (according to GINA 2022) respectively followed by mild. The rural cohort post treatment showed significant improvement in individual (p&lt;0.005) as well as in overall PAQLQ post treatment (p&lt;0.002). Conclusion: The study has highlighted that good asthma control even after short duration of treatment helped in improvement quality of life of affected children. To maintain quality of life it is expected that the patient remains adhered to proper treatment.

Epidemiology of Childhood Asthma in the UK.

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

Levels of female sex hormones in patients with premenstrual bronchial asthma

According to the clinical recommendations of the Ministry of Health of the Russian Federation in 2021, at least 348 million patients worldwide suffer from bronchial asthma (BA). The treatment of patients with BA has objective difficulties due to the progression of obstruction and insufficient diagnosis of pathogenetic forms of BA. It is known that in women, hormonal status, namely female sex hormones such as estradiol and progesterone, contributes to the course and development of BA. This article presents an original clinical study of 48 patients suffering from mild to moderate asthma with a regular menstrual cycle, and the relationship between the increase in symptoms of asthma and the phase of the menstrual cycle is estimated. According to the results of the study, all patients were divided into groups with regular asthma (RA) and premenstrual asthma (PMA). A significant increase in the level of estradiol was obtained (934.50 (405.00; 1010.25) pmol/l) in patients with PMA in the second phase of the menstrual cycle in relation to the control group (494.00 (328.00; 487.00) pmol/l) and the group of patients with RA (694.50 (495.25; 993.00) pmol/l). No significant and significant changes in progesterone, prolactin, LH, or FSH were detected. The revealed decrease in respiratory function in patients with PMA in the second phase of the menstrual cycle emphasizes and probably explains the worsening of symptoms of asthma in this group of patients, which, with possible hormonal correction, can lead to stabilization of the course of asthma.

Comparative Study of Inhaled Corticosteroids and Leukotriene Receptor Antagonists As Controller Options for Mildly to Moderately Persistent, Stable Asthma.

Asthma is a chronic inflammatory disease of the airways characterized by bronchoconstriction, airway hyperresponsiveness, and variable airflow limitation. This results in symptoms such as wheezing, difficulty breathing, chest tightness, chest pain, and coughing. The primary objective of the study is to compare the efficacy of inhaled corticosteroids (ICS) versus leukotriene receptor antagonists (LTRA) in improving asthma control, lung function, and quality of life in patients with mild to moderate persistent asthma. This prospective comparative study was conducted at Khyber Teaching Hospital and Dow University Hospital from January 2018 to July 2021. 210 patients suffering from asthma were included in the study. Patients aged 18 years and older, diagnosed with mild to moderate persistent asthma as per Global Initiative for Asthma (GINA) guidelines, and requiring pharmacological intervention were included in the study. Participants were randomly allocated into two groups.Treatment efficacy was compared based on asthma control (Asthma Control Test (ACT) score), lung function (forced expiratory volume in one second (FEV1),peak expiratory flow rate (PEFR)), and quality of life using validated questionnaires. In this study involving 210 patients with asthma, Group A (ICS) had a mean age of 36.23 ± 7.09 years, while Group B (LTRA) had a mean age of 35.23 ± 8.01 years. Both groups exhibited similar baseline asthma control, as indicated by ACT scores of 17.2 ± 3.5 for Group A and 16.8 ± 3.2 for Group B. Significant improvements were observed in both groups at the end of the study, with ACT scores rising to 21.8 ± 2.1 (p < 0.001) for Group A and 20.5 ± 2.5 (p < 0.001) for Group B. Additionally, lung function, measured by FEV1 and PEFR, showed similar enhancements; Group A improved from a baseline FEV1 of 2.5 ± 0.8 L to 3.2 ± 0.6 L (p < 0.01), while Group B improved from 2.4 ± 0.7 L to 3.0 ± 0.5 L. The PEFR values also increased significantly from 300 ± 50 L/min to 380 ± 40 L/min (p < 0.001) for Group A and from 290 ± 45 L/min to 360 ± 30 L/min (p < 0.001) for Group B. Both treatments were well-tolerated, with adverse events being low and comparable between the groups. This study reveals that both ICSand LTRAsignificantly improve asthma control, lung function, and quality of life in patients with mild to moderate persistent asthma, with ICS showing superior efficacy. ICS led to greater improvements in ACT scores and lung function parameters, supporting its use as a more effective treatment option in this patient population.