Persistent Asthma Patients Research Articles

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

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

Itraconazole Improved Bronchial Wall Thickness in Severe Persistent Asthma: A Double-blind Placebo-controlled Randomized Clinical Trial.

The purpose of this study was to evaluate the effect of 8 months of treatment with itraconazole on airway wall thickness in patients with severe persistent asthma. It was a double-blind, randomized, placebo-controlled clinical trial (IRCT20091111002695N9). Seventy-five subjects with severe persistent asthma received itraconazole (100 mg), prednisolone (5 mg), or placebo twice a day for eight months in three treatment groups (n=25 in each group). The primary objective was to improve the right upper lobe apical segmental bronchus (RB1) wall thickness percentage measured by high-resolution computed tomography scan of the lungs. Other morphometric measurements of RB1, asthma control test (ACT) score, presence of wheezing, dyspnea severity, rate of asthma exacerbation, fractional exhaled nitric oxide (FeNO), and expiratory volume in 1 second (FEV1) were set as the secondary outcomes. Wall thickness percentage reduced significantly from 46% to 43.7% from pre- to post-treatment in the itraconazole-treated subjects. Similarly, lumen area and radius increased significantly in both the prednisolone and itraconazole groups. Itraconazole led to a significant improvement in wheezing, dyspnea severity, FEV1, ACT score, and FeNO. Although prednisolone was also effective in improving pulmonary function tests and ACT scores, it was associated with significantly more side effects than itraconazole. Long-term treatment with itraconazole resulted in a significant reduction in bronchial wall thickness and improvements in clinical findings and pulmonary function tests. Thus, itraconazole could be a helpful add-on treatment option for severe persistent asthma patients to achieve better disease control.

Racial and Ethnic Disparities in Treatment of Uncontrolled Disease Among Severe, Persistent Asthma Patients: An Analysis of Medicare Fee-for-Service Claims

Severe asthma (SA) disproportionately affects Black and certain Hispanic patients. Standard of care recommends escalation of care for patients with uncontrolled disease. This study evaluated gaps in care escalation by race/ethnicity among SA patients following events indicating uncontrolled disease (EUD).

Maternal and neonatal risk factors of asthma in children: Nationwide population based study.

Small population group-based cohorts have found that perinatal factors may contribute to the development of asthma in children. We aimed to investigate maternal and neonatal risk factors for the asthma phenotypes using two databases from the Taiwan's Maternal and Child Health Database (TMCHD) and the National Health Insurance Research Database (NHIRD). Perinatal data was obtained from 2004 to 2008 in the TMCHD and linked the NHIRD toobtain relevant medical information regarding maternal and neonatal risk factors of three asthma phenotypes which were identified as transient early asthma, persistent asthma, andlate-onset asthma. A multivariate logistic regression analysis was conducted to adjust for covariates. The percentage of non-asthmatic patients was 77.02% and asthmatic (transient early asthma, late onset asthma, and persistent asthma) patients were 8.96%, 11.64%, and 2.42%, respectively. Maternal risk factors-including Cesarean section, maternal asthma, maternal allergic rhinitis (AR), and premature rupture of membranes-and neonatal risk factors, such as male gender, gestational age 29-37 weeks, ventilator use, antibiotics use, AR, and atopic dermatitis, were associated with the development of these three asthma phenotypes. Twins and a gestational age of 28 weeks or less premature were associated with the development of transient early asthma and persistent asthma, but not late onset asthma. Triplets and above were associated with the development of transient early asthma, but not late onset or persistent asthma. Various asthma phenotypes have different risk factors; therefore, their distinct risk factors should be identified in order to early diagnosis and treatment.

A comparative study of efficacy and safety of montelukast versus acebrophylline as add-on therapy to inhaled corticosteroids in bronchial asthma

Background: Non-responding to standard doses of inhalational corticosteroids (ICS) remains a challenge in the management of asthma, requiring add-on therapy. Acebrophylline, a theophylline derivative, with multiple mechanisms of action and properties, could work as a suitable alternative to montelukast as an add-on therapy. Aims and Objectives: The aim of this study was to compare the efficacy and safety of montelukast versus acebrophylline as an add-on therapy to ICS in the treatment of bronchial asthma. Materials and Methods: One hundred bronchial asthma patients, fulfilling inclusion/exclusion criteria, were enrolled and randomized in a 1:1 ratio into two groups of 50 each to receive either oral montelukast 10 mg OD or oral acebrophylline 200 mg OD with budesonide. Inhaled salbutamol was permitted as rescue medication during acute exacerbations. Primary outcome measures were change in pulmonary function test (PFT) parameters and asthma control questionnaire (ACQ) scores at baseline and 12 weeks. Adverse events, if any were recorded. Results: There was a statistically significant difference in the improvement of mean PFT parameters at the end of 12 weeks in the montelukast group (P &lt; 0.001), but not in acebrophylline group (P = 0.253). Montelukast was more efficacious than acebrophylline in improving PFT parameters at 6 and 12 weeks. Both treatment modalities significantly improved ACQ score at 12 weeks (P &lt; 0.001), the difference between two groups was not statistically significant (1.4 ± 0.53 in Group A vs. 1.32 ± 0.44 in Group B, P = 0.436). No significant adverse effects were seen in both groups. Conclusion: Montelukast, with low-dose ICS, had better efficacy over acebrophylline. Both montelukast and acebrophylline improved the quality of life in mild-to-moderate persistent asthma patients by decreasing nocturnal symptoms and the need for rescue medications.

GAPS IN CLINICAL CARE ESCALATION AMONG SEVERE, PERSISTENT ASTHMA PATIENTS FOLLOWING INDICATORS OF UNCONTROLLED ASTHMA

<h3>Introduction</h3> Approximately 5-10% of patients with asthma have severe asthma (SA). Standard of care recommends escalation of care with uncontrolled disease. To evaluate current gaps in care in the US, this analysis examined care received among SA patients following events indicating uncontrolled disease (EUD). <h3>Methods</h3> Administrative claims databases for SA patients with Medicare Fee-for-Service, Medicare Advantage, Managed Medicaid, or commercial insurance spanning 2015-2020 were utilized. Severe, persistent asthma patients were indexed hierarchically on asthma-related EUD: ≥1 hospitalization, ≥2 emergency department (ED) visits with systemic corticosteroid treatment (SCS), 1 ED + ≥1 outpatient (OP) visit with SCS, or ≥2 OP visits with SCS. SA patients without any events were matched as controls. All were required to be 12+ years old, have 12 months enrollment pre- and post-index, and have no other major respiratory disease or biologic treatment during the pre-period. Specialist visits and medication escalation were examined during the post-index period. <h3>Results</h3> 181,548 SA patients were identified (90,774 uncontrolled, 90,774 controlled). Across payer channels, 33-51% of uncontrolled SA patients presented no specialist nor medication escalation intervention (Figure). Patients with 2 ED visits were most likely to present an absence of any intervention. <h3>Conclusion</h3> Results demonstrate that a substantial portion of uncontrolled SA patients do not have evidence of care escalation following uncontrolled disease, highlighting substantial gaps in care. Guidelines in the US recommend referral to an asthma specialist for systematic assessment or co-management for all SA patients, particularly those with uncontrolled disease. Accelerating subspecialist referrals and/or medication escalation may improve asthma care.

IF AT FIRST YOU DON'T SUCCEED, TRY TRY AGAIN!

<h3>Introduction</h3> Current asthma guidelines recommend trying a biologic in severe persistent asthmatic patients for six months before switching to a different one. We report a patient who was trialed on no less than three biologics without success until finally improving after treatment with a fourth. <h3>Case Description</h3> 63 year-old male with severe persistent asthma presented using his Albuterol MDI ten times a day with nightly awakenings, despite treatment with high dose Budesonide/Formoterol and Montelukast. He required Prednisone bursts four times a year for asthma exacerbations. His total IgE was 539 with positive serum tests to aeroallergens. Omalizumab was initiated with mild improvement for a few months, but his asthma symptoms returned to baseline after one year of treatment. His absolute eosinophil count was 1,100. He was started on Mepolizumab but developed a rash after the first dose and dyspnea and rash after the second, prompting discontinuation. Patient then tried Benralizumab for a year without improvement. Lastly, Dupilumab was started and his asthma markedly improved, i.e. he was able to sleep through the night, his rescue MDI decreased to two times a week, and he has not required Prednisone in several months. <h3>Discussion</h3> It took trialing four different biologics before finding a therapeutic intervention that worked. It is important to be persistent and flexible when finding treatment options for difficult-to-treat severe asthmatic patients.

Asthma Control and Medication Reliance Among Asthmatics in a General Practice Setting - A Questionnaire Based Study.

The main goal of asthma treatment is to obtain and maintain reasonable control of symptoms with current evidence-based protocols. Asthma is one of the chronic diseases, that, if not well controlled, can lead to the development of serious complications involving not only the respiratory, but the cardiovascular system. In this study, we aimed to determine how well intermittent asthma and mild persistent asthma are controlled among patients aged 15 years and above in a general practice setting using Asthma Control Test (ACT) questionnaire. Furthermore, we used a SABA Reliance Questionnaire (SRQ) to understand whether these patients rely heavily on their prescribed short-acting beta agonist (SABA) medication. This is an audit questionnaire-based study conducted in our primary health care setting in New Zealand from February to May 2021. Forty-three physician-diagnosed intermittent asthma and mild persistent asthma patients aged 15 years and above volunteered to take part in this study. They completed two questionnaires - the ACT to assess asthma control and the SRQ to assess patients’ reliance on SABA reliever inhalers. Overall, 43 patients responded; asthma was well-controlled in 23 patients (53.5%), partially controlled in 15 (34.9%), and uncontrolled in five (11.6%). The total of patients who showed a high reliance on SABA was 31 (72.1%). When comparing SABA reliance with asthma control, 23 (53.5%) patients reported well-controlled asthma; however, 13 (56.5%) of these patients showed a high reliance on SABA. Furthermore, 15 (34.9%) of the patients had partially controlled asthma, and 14 (93.3%) of them also relied highly on their SABA inhalers. We concluded that intermittent asthma and mild persistent asthma remains inadequately controlled in general practice, with the majority of patients showing a high reliance on SABA.

Pediatric Research Challenge, Alignment with the National Research Agenda

Pediatric Research Challenge, Alignment with the National Research Agenda

The anti-inflammatory effects of inhaled steroids and β2-agonist added to inhaled steroids in the treatment of mild asthma

The use of inhaled corticosteroids (ICS) alone may be sufficient for asthma control in mild asthma. We investigated the effect of inhaled steroid and beta-2 agonist combination on airway function and inflammation in mild asthma.We randomized 20 mild persistent asthma patients treated with the 200μg budesonide (10 patients) or budesonide 200μg -formoterol 12μg (10 patients) twice daily for 4 weeks. We investigated the effects of treatment groups on pulmonary function tests by spirometry and eosinophil percentage and eosinophil cationic protein (ECP) levels in serum and induced sputum. We compared values before and after treatment within budesonide and budesonide-formoterol groups and after treatment between groups. We observed that eosinophil percentage and ECP levels in serum and induced sputum decreased significantly after treatment in both treatment groups. Only the decrease in serum eosinophil percentage level was not significant in the budesonide group. On the other that, there was no significant reduction of inflammatory markers between the two treatment groups. The spirometric measurements (FVC, FEV1, FEF25-75) showed a statistically significant increase within the budesonide-formoterol treatment group, but not in the budesonide group. These measurements were not statistically changed between the two treatment groups. In patients with mild asthma, budesonide and formoterol combination therapy did not add to the improvement of airway obstruction and inflammation more than budesonide therapy.

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

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

Role of IL-17 in atopy-A systematic review.

Purpose of ReviewAtopy is defined as the genetic predisposition to react with type I allergic diseases such as food‐, skin‐, and respiratory allergies. Distinct molecular mechanisms have been described, including the known Th2 driven immune response. IL‐17A (IL‐17) is mainly produced by Th17 cells and belongs to the IL‐17 family of cytokines, IL‐17A to F. While IL‐17 plays a major role in inflammatory and autoimmune disorders, more data was published in recent years elucidating the role of IL‐17 in allergic diseases. The present study aimed to elaborate specifically the role of IL‐17 in atopy.MethodsA systematic literature search was conducted in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials, regarding IL‐17 and atopy/allergic diseases.ResultsIn total, 31 novel publications could be identified (food allergy n = 3, allergic asthma n = 7, allergic rhinitis [AR] n = 10, atopic dermatitis [AD] n = 11). In all allergic diseases, the IL‐17 pathway has been investigated. Serum IL‐17 was elevated in all allergic diseases. In AR, serum and nasal IL‐17 levels correlated with the severity of the disease. In food allergies, serum IL‐17E was also elevated in children. In AD, there is a trend for higher IL‐17 values in the serum and skin specimen, while it is more expressed in acute lesions. In allergic asthma, serum IL‐17 levels were increased. In two studies, higher serum IL‐17 levels were found in severe persistent asthmatic patients than in intermittent asthmatics or healthy controls. Only one therapeutic clinical study exists on allergic diseases (asthma patients) using a monoclonal antibody against the IL‐17 receptor A. No clinical efficacy was found in the total study population, except for a subgroup of patients with (post‐bronchodilator) high reversibility.SummaryThe role of IL 17 in the pathogenesis of allergic diseases is evident, but the involvement of the Th17 cytokine in the pathophysiological pathway is not conclusively defined. IL‐17 is most likely relevant and will be a clinical target in subgroups of patients. The current data indicates that IL‐17 is elevated more often in acute and severe forms of allergic diseases.

Rheumatoid arthritis-like polyarthralgia after the initiation of omalizumab treatment: A case series

Omalizumab is a monoclonal antibody that binds to free human IgE in the blood and interstitial fluid. The accepted indication of this medication for asthma is moderate-to-severe persistent asthma patients having a positive skin test or in vitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids.1 After omalizumab was approved for commercial use, acute exacerbation of asthma and systemic steroid administration are known to be reduced in asthmatic patients.

Persistent Uncontrolled Asthma: Long-Term Impact on Physical Activity and Body Composition

RationaleAsthma, obesity and physical activity (PA) are interrelated. However, longitudinal data with objective PA measures and direct assessment of body composition are still lacking.ObjectiveTo study the impact of symptom control on PA and body composition.MethodsIn a longitudinal cohort study of the German Center for Lung Research, we assessed the body composition of 233 asthma patients and 84 healthy controls using bioelectrical impedance analysis. PA (ie average daily steps and time of at least moderate activity, steps/min) was measured by accelerometry for one week. Asthma control was assessed by ACT score, ACQ-5 score and history of severe exacerbations. After two years of follow-up, we studied changes in physical activity and body composition in relation to asthma control.ResultsPatients with uncontrolled asthma had increased fat mass and decreased muscle mass compared to patients with controlled asthma or healthy controls. Both fat mass and muscle mass correlated better with asthma control than the body mass index (BMI). In multivariate regressions adjusted for age and sex, asthma control and physical activity were independent predictors of body composition (R2 = 0.61, p < 0.001). Persistent uncontrolled asthma patients (n=64) had lower physical activity at both baseline (6614 steps/118 min) and follow-up (6195/115). Despite having stable BMI, they also had significant muscle loss (−1.2%, −0.88 kg, p<0.01) and fat accumulation (+1%, +1.1 kg, p<0.01). By contrast, temporarily uncontrolled or controlled asthma patients had higher physical activity at baseline (8670/156) and follow -up (9058/153) with almost unchanged body composition.ConclusionPersistent uncontrolled asthma is associated with sustained physical inactivity and adverse changes in body composition that might be overlooked by relying solely on BMI. Physical activity is an independent predictor of body composition and reliable long-term marker of symptom control.

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

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

Acupuncture for chronic persistent asthma based on the theory of Meridian-viscera Association: study protocol for a multi-center randomized controlled trial in China

BackgroundAcupuncture is effective in symptom and quality of life improvement of chronic asthma, but the efficacy differences between different acupoints are uncertain. In terms of the theory of Meridian-viscera Association, the study aims to investigate the different effectiveness between acupoints in Lung meridian and the acupoints in Heart meridian, so as to provide the evidence to develop a better prescription of the acupuncture treatment of chronic persistent asthma.MethodsThis study is a multicentral randomized controlled trial. A total of 68 chronic persistent asthma patients will be randomly allocated into two groups: the Lung meridian group and the Heart meridian group. This trial will include a 2-week baseline period, a 4-week treatment period with 12 sessions’ acupuncture, and an 8-week follow-up period. The primary outcome is the Asthma Quality of Life Questionnaire (AQLQ). Secondary outcomes are the Asthma Control Test (ACT), Peak Expiratory Flow (PEF), and Forced Expiratory Volume in 1 s (FEV1). The AQLQ and ACT will be collected at baseline, week 4, week 8, and week 12 after randomization. PEF, FEV1, the Self-rating Anxiety Scale (SAS), and the Self-rating Depression Scale (SDS) will be assessed at baseline and week 4.DiscussionThe results will provide evidence for acupuncture prescription selection and the clinical efficacy improvement. The results of this trial will also be used to determine whether or not a full definitive trial will go ahead, which will further confirm the theory of Meridian-viscera Association.Trial registrationChinese Clinical Trial Registry (http://www.chictr.org.cn/showproj.aspx?proj=43803) ChiCTR1900027284. Registered on 7 November 2019

Correlation of Epidermal Fibroblast Growth Factor and Clinical Improvement of Asthma in Children after Zinc Supplementation

Background: Background The presence of remodeling process on the pathogenesis of asthma that involves some growth factors such as epidermal growth factor (EGF) and fibroblast growth factor (FGF) causes the chronicity of the disease. The role of zinc on the pathogenesis of asthma is being widely investigated. This study aimed to analyze the correlation between EGF and FGF2 and clinical improvement of asthma after zinc supplementation.Methods: A quasi-experimental study was conducted in Outpatient Clinic Dr. Soetomo Hospital. The samples were persistent asthma patients from 6-15 years old who received controller therapy. The samples were divided into 2 groups, those who received zinc supplementation as the intervention group, and who received pacebo as the control. EGF and FGF2 plasma level of both groups were measured, and clinical improvement was evaluated with Childhood Asthma Control Test (C-ACT).Results: There were 11 patients who received zinc supplementation and 12 patients in the control group. There was a significant difference (p = 0.000) on the increase of EGF level in the intervention group (55.59 ± 6.48) than the control (5.35 ± 5.55). There was a significant difference (p = 0.000) on the increase of the FGF2 level in the intervention group (6.37 ± 1.41) than the control (0.72 ± 0.48). The increase of EGF (r = 0.592; p = 0.003) and FGF2 (r = 0.607; p = 0.002) would be followed by the increase of C-ACT scores.Conclusion: Zinc supplementation increase EGF and FGF2 levels. This improvement is correlated with clinical improvement of patients.

Density of Dermatophagoides spp. and Its Relationship with House-dust Mite Specific Serum IgE in Persistent Asthma

Background: Asthma is a chronic inflammation of the bronchial tree that emerges as a response to exogenous factors, such as allergens, irritants, and infections. Some asthmatic patients had been reported having symptoms of asthma due to house-dust mites (HDM) allergen exposure. It is associated with immune responses which were increased in the form of specific Immunoglobulin E (IgE) production against HDM allergens. This case-control study aimed to determine the HDM profiles in persistent asthmatic patients, including density of mites, as well as its relationship with specific IgE anti-HDM serum levels.Materials and Methods: A total of 13 patients with persistent asthma and 12 control patients had their specific anti-HDM IgE levels examined using Immulite 2000 xpi. The house dust samples were taken and analyzed with the Fain method.Results: The results have shown that 69% of patients in the persistent asthma group and 25% of normal patients were positive for IgE anti-HDM. Dermatophagoides pteronyssinus is a predominant species with a total of 120 mites (83.9%) of 143 mites. Correlation analysis indicated a positive relationship between IgE anti-HDM levels within the serums of patients and the density of mites in the dust obtained from bedroom spaces (Spearmen Rho, R=0.35, p=0.04).Conclusion: Positive IgE anti-HDM patients in the persistent asthma group were higher (69%) than those in the clinically normal group (25%). The density of mites were dominated by D. Pteronyssinus. The bedroom-dust mites density revealed a positive correlation with serum IgE anti-HDM levels in persistent asthma patients.Keywords: asthma, density, Dermatophagoides spp.,IgE

Evaluating the Clinical Outcomes of Three Medication Regimens for Treating a Sample of Iraqi Persistent Asthmatic patients

Abstract&#x0D; Asthma is a complex disease defined by chronic airway inflammation and airflow limitation causing variable respiratory symptoms which include shortness of breath (SOB), wheezing, chest tightness and cough. Asthma guidelines advocate adding a second long acting bronchodilator to medium doses of inhaled corticosteroids (ICS) rather using high doses of ICS alone to control moderate to severe persistent asthma. The aim of this study was to evaluate the clinical outcomes of three medication regimens indicated for Iraqi patients suffering from persistent asthma. &#x0D; This study was interventional randomized clinical study conducted on a sample of adult Iraqi asthmatic patients in Baghdad City. The study composed of three visits distributed over eight weeks; baseline visit followed by first follow up and second follow up visits after four and eight weeks respectively. The study enrolled 78 adult patients with moderate to severe persistent asthma as diagnosed by specialist physician according to patient history and baseline pulmonary function test (PFT) and allocated them randomly to three groups (each group included 26 patients) to receive equivalent medium doses of budesonide inhaler in addition to either formoterol inhaler, oral modified release aminophylline tablets or tiotropium inhaler (first, second and third group respectively). Sixty four patients completed this study. The mean ages of patients were above 35 years with slightly more male predominance.&#x0D; The study groups developed significant increase of peak expiratory flow rate (PEFR) and forced vital capacity (FVC) values at the first follow up visit compared to baseline values (p&lt;0.001). Thereafter, the first and third groups achieved significant higher values at the second follow up visit compared to first follow up visit (p&lt;0.001), while second group produced no change. All the groups developed significant improvement of Mini asthma quality of life questionnaire (MiniAQLQ) scores and percentage of symptom free days (SFD) at first follow up visit and continued further significant improvement at the second follow up visit (p&lt;0.001). Generally, between groups comparison according to extent of change of study parameters revealed that third group produced the greatest improvement over the entire study period followed by the first group, whereas the second group was associated with the least extent of improvement.&#x0D; This study concluded that all groups caused significant improvement in study parameters compared to baseline values and also concluded that the third group of inhaled [tiotropium/budesonide] was associated with the highest extent of improvement followed by first group, while the second group was the least. &#x0D;

Anxiety, depression, and stress in Korean patients with chronic urticaria.

Background/AimsEmotional distress is thought to cause or maintain chronic urticaria (CU). We aimed to investigate the presence of anxiety, depression, and stress in Korean adult CU patients and to explore their potential impact on treatment.MethodsWe enrolled 79 CU patients and a disease control group comprising 39 persistent asthma patients. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate depression and anxiety. Stress and quality of life (QoL) were assessed by Stress Response Inventory and CU-QoL questionnaires. The sociodemographic and clinical data such as urticaria activity score (UAS-15, UAS-6) were obtained.ResultsThe prevalence of depression and anxiety based on the HADS were 48.1% and 38.0%. Although the prevalence of anxiety didn’t differ between the CU and asthma patients, depression was significantly more prevalent in the CU patients (48.1% vs. 28.2%). Stress tended to be lower in CU patients. Anxiety, depression, and stress exhibited negative correlations with QoL. Anxiety showed significant correlation with UAS-6 and pruritus-visual analog scale (VAS; r = 0.256, r = 0.272, p < 0.05, respectively); depression correlated with sleep difficulty-VAS (r = 0.261, p < 0.05). Stress was associated with UAS-15, UAS-6, pruritus-VAS, and sleep difficulty-VAS (r = 0.251, r = 0.317, r = 0.302, r = 0.258, p < 0.05, respectively).ConclusionsThe current study first presented that Korean CU patients frequently have anxiety and depression, which affect their QoL and demonstrated that anxiety, depression, and stress had different effects on sleep difficulty, pruritus, and urticaria severity in Korean CU patients.