Pre-existing Asthma Research Articles

Clinical characteristics of adult asthma patients hospitalized by COVID-19 in Mexico City: a real-world study

Background The COVID-19 pandemic raised concerns about whether individuals with chronic respiratory diseases, such as asthma, were at higher risk of severe outcomes. Although several studies were published on this topic, not all included asthma as a risk factor. Therefore, describing the clinical characteristics of COVID-19-infected asthma patients in a specialized respiratory center is valuable as a real-life study. Objective To investigate the clinical characteristics and disease severity in SARS-CoV-2-infected adults with pre-existing asthma hospitalized at the National Institute of Respiratory Diseases (INER) in Mexico City. Methods We conducted a retrospective, observational study on adults with confirmed COVID-19 hospitalized from March 2020 to June 2021. Out of 2,249 reviewed medical records, we identified asthmatic patients and compared them with a matched non-asthmatic control group to assess asthma’s impact on COVID-19 severity and outcomes. Results Based on the clinical records, asthma prevalence among hospitalized patients was low (1.51%); of these, 73% had allergic and 27% had non-allergic asthma. COVID-19 severity did not vary significantly between asthma phenotypes, although there was higher mortality among patients with non-allergic asthma. Most patients in both groups developed a severe form of the disease and higher mortality rates than non-asthmatics, though the differences were not statistically significant. Conclusion Asthma prevalence among patients with COVID-19 was low, but mortality was higher in asthma patients. Although the small sample size limits the generalizability of these findings, this study in a Mexican population hospitalized in a reference hospital provides insights for improving asthma management in future pandemics.

Copper Oxide Nanoparticles Induce Pulmonary Inflammation and Exacerbate Asthma via the TXNIP Signaling Pathway.

Copper oxide nanoparticles (CuO NPs) have seen increasing use across various industries, raising significant concerns about their potential toxicity and the exacerbation of pre-existing conditions like asthma. Asthma, a chronic inflammatory condition of the airways, can be triggered or worsened by environmental factors such as allergens, air pollutants, and chemicals, including nanoparticles. This study aimed to investigate the pulmonary toxicity induced by CuO NPs and their impact on asthma, with a particular focus on the role of thioredoxin-interacting protein (TXNIP). Using an ovalbumin (OVA)-induced asthma model, we found that CuO NP exposure led to significant increases in inflammatory cell infiltration, cytokine production, airway hyperresponsiveness, OVA-specific immunoglobulin (Ig)E levels, and mucus production. These pathological changes were closely associated with the upregulation of TXNIP-related signaling pathways, including phosphorylated apoptosis signal-regulating kinase (p-ASK)1, the Bax/Bcl-2 ratio, and cleaved caspase-3 activation. Complementary in vitro experiments using NCI-H292 respiratory epithelial cells showed that CuO NP treatment enhanced TXNIP signaling and increased mRNA expression and the production of inflammatory cytokines. Notably, TXNIP knockdown significantly attenuated these CuO NP-induced effects. In conclusion, our findings suggest that CuO NP exposure not only induces pulmonary toxicity but also exacerbates asthma, primarily through the activation of the TXNIP signaling pathway.

Assessment of Ambient Air Pollution Levels: A Five-Year Analysis of PM2.5, NO, NO2, NOX, CO, and SO2

The study conducted on the air quality of five highly polluted cities in India over the last five years (2015-2020) sheds light on the detrimental effects of air pollution and the need for monitoring and mitigation. The research focused on six major air pollutants: PM2.5, NO, NO2, NOX, CO, and SO2. The study's findings reveal that the concentrations of these air pollutants consistently exceeded the limits set by the National Ambient Air Quality Standards 2009 and the World Health Organization's Ambient Air Quality Standards. This indicates that the air quality in these cities was consistently poor and posed a significant health risk to the population. The study emphasises that certain subpopulations, such as the elderly, young children, and individuals with pre-existing health conditions like asthma, are more vulnerable to the harmful effects of air pollutants. Elevated levels of pollutants in the air can lead to severe health effects and contribute to the development of serious diseases. Furthermore, the study highlights that the air quality significantly improved in 2020 due to the nationwide lockdown imposed in response to the COVID-19 pandemic. The restrictions on mobility and industrial activities resulted in reduced emissions, leading to a temporary improvement in air quality. These conclusions underscore the critical importance of understanding the harmful effects of air pollutants and taking measures to protect human health and preserve the quality of the environment.

The association between ibuprofen administration in children and the risk of developing or exacerbating asthma: a systematic review and meta-analysis

BackgroundIbuprofen is one of the most commonly used analgesic and antipyretic drugs in children. However, its potential causal role in childhood asthma pathogenesis remains uncertain. In this systematic review, we assessed the association between ibuprofen administration in children and the risk of developing or exacerbating asthma.MethodsWe searched MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and Scopus from inception to May 2022, with no language limits; searched relevant reviews; and performed citation searching. We included studies of any design that were primary empirical peer-reviewed publications, where ibuprofen use in children 0–18 years was reported. Screening was performed in duplicate by blinded review. In total, 24 studies met our criteria. Data were extracted according to PRISMA guidelines, and the risk of bias was assessed using RoB2 and NOS tools. Quantitative data were pooled using fixed effect models, and qualitative data were pooled using narrative synthesis. Primary outcomes were asthma or asthma-like symptoms. The results were grouped according to population (general, asthmatic, and ibuprofen-hypersensitive), comparator type (active and non-active) and follow-up duration (short- and long-term).ResultsComparing ibuprofen with active comparators, there was no evidence of a higher risk associated with ibuprofen over both the short and long term in either the general or asthmatic population. Comparing ibuprofen use with no active alternative over a short-term follow-up, ibuprofen may provide protection against asthma-like symptoms in the general population when used to ease symptoms of fever or bronchiolitis. In contrast, it may cause asthma exacerbation for those with pre-existing asthma. However, in both populations, there were no clear long-term follow-up effects.ConclusionsIbuprofen use in children had no elevated risk relative to active comparators. However, use in children with asthma may lead to asthma exacerbation. The results are driven by a very small number of influential studies, and research in several key clinical contexts is limited to single studies. Both clinical trials and observational studies are needed to understand the potential role of ibuprofen in childhood asthma pathogenesis.

A Review on the Morbidity and Mortality in COVID-19 Patients with Pre-existing Asthma in India

Abstract: The global epidemiology of asthma shows a complex association with COVID-19 regarding morbidity, comorbidity, and mortality. This study aimed to shed light on the relationship between COVID-19 and pre-existing asthma, specifically within the Indian context, considering the large population and significant burden of asthma. To review and integrate the available data on morbidity, comorbidity, and mortality outcomes of COVID-19 patients with pre-existing asthma in India, fulltext articles were searched between December 1st, 2019 to April 20th, 2023, in Science Direct and PubMed on studies with COVID-19 patients suffering from asthma. A total of 893 articles were screened based on a certain inclusion criterion, and 15 full-text articles were eligible for the review. The studies included 10,239 participants comprising 73.47% (n= 7523) of COVID-19 patients. More males (n= 4993) were affected by COVID-19 infection compared to females (n= 2510). A total of 262 (3.48%) COVID-19 patients had pre-existing asthma, and 58 deaths (0.77%) were observed among them. South India exhibited the highest number of COVID-19 patients with asthma comorbidity (5.38%), while North India had the lowest number of COVID-19-infected patients with preexisting asthma (1.69%). The highest mortality was found among patients with asthma across India (7.14%), and the lowest mortality (0.12%) was reflected in cases from North India. This review showed less asthma comorbidity and mortality cases in COVID-19 patients in India. The study indicated higher COVID-19 infection rates in males. Regional disparities were observed in COVID-19 patients with asthma comorbidity and mortality. In contrast, few studies have reported higher asthma comorbidity and mortality in COVID-19 patients with pre-existing asthma.

Effects of Pregnancy-Onset Asthma on Perinatal Outcomes: A Retrospective Cohort Study

BackgroundIt is unknown whether women with pregnancy-onset asthma are predisposed to worse pregnancy outcomes compared to women with pre-pregnancy asthma. ObjectiveTo explore whether pregnancy-onset asthma leads to worse perinatal outcomes compared with pre-pregnancy asthma. MethodsWomen who were discharged with a diagnosis of asthma and gave birth to a live singleton were included in this retrospective cohort analysis. Women were separated into groups based on whether the asthma was diagnosed during or before pregnancy. Clinical characteristics, perinatal outcomes, and asthma exacerbations (AE) between the two groups were compared. Results335 women were included in this study, of whom 39 (11.6%) had pregnancy-onset asthma and 296 had pre-pregnancy asthma. All the pregnant women in the pregnancy-onset group experienced asthma exacerbations (AE) during pregnancy. The proportion of chronic hypertension, chronic hypertension with superimposed preeclampsia, and spontaneous preterm births in the pregnancy-onset group was significantly higher than that in the pre-pregnancy asthma group. After adjusting for age, BMI, onset of asthma during pregnancy, and severity of AE through multivariate analysis, pregnancy-onset asthma was an independent risk factor for spontaneous preterm birth (aOR 7.71, 95% CI 1.30–46.12), severe AE was an independent risk factor for gestational hypertension and preeclampsia (aOR 3.58, 95% CI 1.30–9.87). ConclusionsDuring pregnancy, pregnancy-onset asthma in women is associated with an exacerbation of the condition. Obstetricians should be vigilant for signs of asthma onset during pregnancy. Other health-care providers should watch out for symptoms of gestational hypertension and preeclampsia in pregnant women with pre-existing or new-onset asthma.

Coronary and Cerebrovascular Events and Exacerbation of Existing Conditions After Laboratory‐Confirmed Influenza Infection Among US Veterans: A Self‐Controlled Case Series Study

ABSTRACTBackgroundInfluenza may contribute to coronary/cerebrovascular events and exacerbate underlying conditions.MethodsWe used self‐controlled case series (SCCS) design to analyze data from US Veterans ≥18 years with coronary/cerebrovascular or exacerbation event +/−1 year of lab‐confirmed influenza (LCI) during 2010–2018. We estimated the incidence ratio (IR) (95% CI) of the event for risk interval (Days 1–7 post‐LCI) versus control interval (all other times +/−1 year of LCI) with fixed‐effects conditional Poisson regression. We included biomarker data for mediation analysis.ResultsWe identified 3439 episodes with coronary/cerebrovascular‐related hospitalizations. IRs (95% CI) for LCI risk versus control interval were STEMI 0.6 (0.1, 4.4), NSTEMI 7.3 (5.8, 9.2), ischemic stroke 4.0 (3.0, 5.4), hemorrhagic stroke 6.2 (3.4, 11.5), and coronary spasm 1.3 (0.5, 3.0). IR significantly increased for NSTEMI and ischemic stroke among those ≥ 65 years. IR for NSTEMI and ischemic stroke dropped 26% and 10%, respectively, when white blood cell (WBC) and platelet count were considered. LCI was significantly associated with exacerbation of preexisting asthma, chronic obstructive pulmonary disease, and congestive heart failure.ConclusionsWe found significant association between LCI and hospitalization for NSTEMI, ischemic stroke, and hemorrhagic stroke, the latter possibly due to unaccounted time‐varying confounding in SCCS design.

Association between exposure to airborne trichloramine and health effects in indoor swimming pool workers.

The main objective of this study was to comprehensively investigate the association between trichloramine (TCA) exposure and respiratory health effects in swimming pool workers. In this study, air sampling was performed for TCA concentrations at fixed locations (static measurements) and on individual workers (personal measurements) in six indoor public swimming pools during periods of high swimmer attendance over the winter school break. Health effects were evaluated using questionnaires and fractional exhaled nitric oxide (FENO) tests performed before and after the working day. In these swimming pools, the environmental TCA concentration ranged from 0.11 to 0.88 mg/m³. Worker exposure ranged from 0.05 to 0.72 mg/m³ for personal measurements. Furthermore, in each swimming pool, the average worker exposure to TCA exceeded the recommended occupational exposure limit of 0.35 mg/m³. Personal TCA measurements were consistently lower than static measurements performed around the pool, with a reduction ranging from 21% to 49%. This can be explained by the time that the workers spend in the pool area, office, and break room. The most common respiratory health effects self-reported by the workers were coughing, shortness of breath, and sneezing with prevalence rates of 38%, 37%, and 35%, respectively. This study demonstrated an association between TCA exposure and eye irritation. Analysis of the FENO tests revealed that individuals with preexisting asthma or allergies exhibited sustained FENO elevation. The findings suggest that occupational exposure to TCA in indoor swimming pools is a matter of concern. Implementing and improving workplace safety measures is crucial for safeguarding the respiratory health of swimming pool workers.

Role Effectuated by Immune Microenvironment on the Prognosis of COVID-19 Infected Asthmatic Patients and the Potentialities of Repurposing Immunomodulatory Drugs

Abstract:: The WHO declared the Coronavirus Outbreak in 2019 (COVID-19), caused by the SARSCOV- 2 virus, as a pandemic on 11 March 2020. When the world was trying to contain the first wave of the outbreak, the newer mutated strains emerged in the UK and South Africa, and accelerated cases of daily infections in some parts of the globe ignited tribulations afresh. Though the mortality percentage is much lower compared to previous SARS and MERS virus outbreaks, overactivated innate immunity and "cytokine storms" were suspected to cause fatality in COVID-19. Innate immunity, s one of the earliest components of host interaction with various infectious pathogens, may play an integral part in cytokine storm generation and contribute to the disease's severity. The effect of COVID-19 on asthma, which is a heterogeneous disease with variable phenotypes, is somewhat contentious. This study aims to address whether pre-existing asthma will have an advantageous or deleterious effect relative to non-asthmatic patients from an immunological perspective, particularly innate immunity. Also, the prospective of immunomodulatory drugs in combating COV-2 infection and disease advancement are highlighted in this review.

Impact of liquid sublingual immunotherapy on asthma onset and progression in patients with allergic rhinitis: a nationwide population-based study (EfficAPSI study)

BackgroundThe only disease-modifying treatment currently available for allergic rhinitis (AR) is allergen immunotherapy (AIT). The main objective of the EfficAPSI real-world study (RWS) was to evaluate the impact of liquid sublingual immunotherapy (SLIT-liquid) on asthma onset and evolution in AR patients. MethodsAn analysis with propensity score weighting was performed using the EfficAPSI cohort, comparing patients dispensed SLIT-liquid with patients dispensed AR symptomatic medication with no history of AIT (controls). Index date corresponded to the first dispensation of either treatment. The sensitive definition of asthma event considered the first asthma drug dispensation, hospitalisation or long-term disease (LTD) for asthma, the specific one omitted drug dispensation and the combined one considered omalizumab or three ICS+/-LABA dispensation, hospitalisation or LTD. In patients with pre-existing asthma, the GINA treatment step-up evolution was analysed. FindingsIn this cohort including 112 492 SLIT-liquid and 333 082 controls, SLIT-liquid exposure was associated with a significant lower risk of asthma onset versus control, according to all definitions (combined: HR [95%CI]=0·62 [0·60-0·63], sensitive: 0·77 [0·76-0·78], and specific: 0·67 [0·61-0·72]). Exposure to SLIT was associated with a one-third reduction in GINA step-up regardless baseline steps. InterpretationIn this national RWS with the largest number of person-years of follow-up to date in the field of AIT, SLIT-liquid was associated with a significant reduction in the risk of asthma onset or worsening. The use of three definitions (sensitive or specific) and GINA step-up reinforced the rigorous methodology, substantiating SLIT-liquid evidence as a causal treatment option for patients with respiratory allergies. FundingStallergenes Greer

SARS-CoV-2 booster vaccine dose significantly extends humoral immune response half-life beyond the primary series

SARS-CoV-2 lipid nanoparticle mRNA vaccines continue to be administered as the predominant prophylactic measure to reduce COVID-19 disease pathogenesis. Quantifying the kinetics of the secondary immune response from subsequent doses beyond the primary series and understanding how dose-dependent immune waning kinetics vary as a function of age, sex, and various comorbidities remains an important question. We study anti-spike IgG waning kinetics in 152 individuals who received an mRNA-based primary series (first two doses) and a subset of 137 individuals who then received an mRNA-based booster dose. We find the booster dose elicits a 71–84% increase in the median Anti-S half life over that of the primary series. We find the Anti-S half life for both primary series and booster doses decreases with age. However, we stress that although chronological age continues to be a good proxy for vaccine-induced humoral waning, immunosenescence is likely not the mechanism, rather, more likely the mechanism is related to the presence of noncommunicable diseases, which also accumulate with age, that affect immune regulation. We are able to independently reproduce recent observations that those with pre-existing asthma exhibit a stronger primary series humoral response to vaccination than compared to those that do not, and further, we find this result is sustained for the booster dose. Finally, via a single-variate Kruskal-Wallis test we find no difference between male and female humoral decay kinetics, however, a multivariate approach utilizing Least Absolute Shrinkage and Selection Operator (LASSO) regression for feature selection reveals a statistically significant (p<1×10-3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$<1\ imes 10^{-3}$$\\end{document}), albeit small, bias in favour of longer-lasting humoral immunity amongst males.

Long COVID exhibits clinically distinct phenotypes at 3–6 months post-SARS-CoV-2 infection: results from the P4O2 consortium

BackgroundFour months after SARS-CoV-2 infection, 22%–50% of COVID-19 patients still experience complaints. Long COVID is a heterogeneous disease and finding subtypes could aid in optimising and developing treatment for the...

KAMEL: Knowledge Aware Medical Entity Linkage to Automate Health Insurance Claims Processing

Automating the processing of health insurance claims to achieve "Straight-Through Processing" is one of the holy grails that all insurance companies aim to achieve. One of the major impediments to this automation is the difficulty in establishing the relationship between the underwriting exclusions that a policy has and the incoming claim's diagnosis information. Typically, policy underwriting exclusions are captured in free-text such as "Respiratory illnesses are excluded due to a pre-existing asthma condition". A medical claim coming from a hospital would have the diagnosis represented using the International Classification of Disease (ICD) codes from the World Health Organization. The complex and labour-intensive task of establishing the relationship between free-text underwriting exclusions in health insurance policies and medical diagnosis codes from health insurance claims is critical towards determining if a claim should be rejected due to underwriting exclusions. In this work, we present a novel framework that leverages both explicit and implicit domain knowledge present in medical ontologies and pre-trained language models respectively, to effectively establish the relationship between free-text describing medical conditions present in underwriting exclusions and the ICD-10CM diagnosis codes in health insurance claims. Termed KAMEL (Knowledge Aware Medical Entity Linkage), our proposed framework addresses the limitations faced by prior approaches when evaluated on real-world health insurance claims data. Our proposed framework have been deployed in several multi-national health insurance providers to automate their health insurance claims.

Clearing the Air: Understanding the Impact of Wildfire Smoke on Asthma and COPD

Wildfires are a global natural phenomenon. In North America, wildfires have not only become more frequent, but also more severe and longer in duration, a trend ascribed to climate change combined with large fuel stores left from modern fire suppression. The intensification of wildfire activity has significant implications for planetary health and public health, as exposure to fine particulate matter (PM2.5) in wildfire smoke is linked to adverse health effects. This review focuses on respiratory morbidity from wildfire smoke exposure. Inhalation of wildfire PM2.5 causes lung injury via oxidative stress, local and systemic inflammation, airway epithelium compromise, and increased vulnerability to infection. Wildfire PM2.5 exposure results in exacerbations of pre-existing asthma and chronic obstructive pulmonary disease, with an escalation in healthcare utilization, including emergency department visits and hospitalizations. Wildfire smoke exposure may be associated with asthma onset, long-term impairment of lung function, and increased all-cause mortality. Children, older adults, occupationally-exposed groups, and possibly women are the most at risk from wildfire smoke. Future research is needed to clarify best practices for risk mitigation and wildfire management.

Examining the Trajectory of Health-Related Quality of Life among Coronavirus Disease Patients.

Recent studies have reported a reduction in health-related quality of life (HR-QoL) among post-coronavirus disease 2019 (COVID-19) patients. However, there remains a gap in research examining the heterogeneity and determinants of HR-QoL trajectory in these patients. To describe and identify factors explaining the variability in HR-QoL trajectories among a cohort of patients with history of COVID-19. A prospective study using data from a cohort of COVID-19 patients enrolled into a registry established at a health system in New York City. Participants were enrolled from July 2020 to June 2022, and completed a baseline evaluation and two follow-up visits at 6 and 12months. We assessed HR-QoL with the 29-item Patient Reported Outcomes Measurement Information System instrument, which was summarized into mental and physical health domains. We performed latent class growth and multinomial logistic regression to examine trajectories of HR-QoL and identify factors associated with specific trajectories. The study included 588 individuals with a median age of 52years, 65% female, 54% White, 18% Black, and 18% Hispanic. We identified five physical health trajectories and four mental health trajectories. Female gender, having pre-existing hypertension, cardiovascular disease, asthma, and hospitalization for acute COVID-19 were independently associated with lower physical health. In addition, patients with increasing body mass index were more likely to experience lower physical health over time. Female gender, younger age, pre-existing asthma, arthritis and cardiovascular disease were associated with poor mental health. We found significant heterogeneity of HR-QoL after COVID-19, with women and patients with specific comorbidities at increased risk of lower HR-QoL. Implementation of targeted psychological and physical interventions is crucial for enhancing the quality of life of this patient population.

It is possible a co-infection with two atypical pathogens? A strange case report

“Atypical” pneumonias are clinically distinct and fo not tipically present with high fever, productive cough or lobar consolidation. The primary etiological agents include Mycoplasma Pneumoniae, Chlamydia Pneumoniae and Legionella Pneumophila. This case report details a young asthmatic patient who developed a dual infection with Chlamydia Pneumoniae and Mycoplasma Pneumoniae, which exacerbated the patient’s asthma symptoms, resulting in significant complications. A literature review highlights the potential for such atypical infections to aggravate respiratory conditions in patients with pre-existing asthma. Clinical management involving antibiotic therapy and respiratory support, led to a gradual resolution of symptoms. This case underscores the importance of considering atypical infections in differential diagnosis of asthmatic patients experiencing acute symptom worsening.

Adjuvant effect of inhaled particulate matter containing free radicals following house-dust mite induction of asthma in mice

Introduction Exposures to particulate matter (PM) from combustion sources can exacerbate preexisting asthma. However, the cellular and molecular mechanisms by which PM promotes the exacerbation of asthma remain elusive. We used a house dust mite (HDM)-induced mouse model of asthma to test the hypothesis that inhaled DCB230, which are PM containing environmentally persistent free radicals (EPFRs), will aggravate asthmatic responses. Methods Groups of 8–10-week-old C57BL/6 male mice were exposed to either air or DCB230 aerosols at a concentration of 1.5 mg/m3 4 h/day for 10 days with or without prior HDM-induction of asthma. Results Aerosolized DCB230 particles formed small aggregates (30–150 nm). Mice exposed to DCB230 alone showed significantly reduced lung tidal volume, overexpression of the Muc5ac gene, and dysregulation of 4 inflammation related genes, Ccl11, Ccl24, Il-10, and Tpsb2. This suggests DCB230 particles interacted with the lung epithelium inducing mucous hypersecretion and restricting lung volume. In addition to reduced lung tidal volume, compared to respective controls, the HDM + DCB230-exposed group exhibited significantly increased lung tissue damping and up-regulated expression of Muc5ac, indicating that in this model, mucous hypersecretion may be central to pulmonary dysfunction. This group also showed augmented lung eosinophilic inflammation accompanied by an up-regulation of 36 asthma related genes. Twelve of these genes are part of IL-17 signaling, suggesting that this pathway is critical for DCB230 induced toxicity and adjuvant effects in lungs previously exposed to HDM. Conclusion Our data indicate that inhaled DCB230 can act as an adjuvant, exacerbating asthma through IL-17-mediated responses in a HDM mouse model.

Increased Burden of Pertussis Among Adolescents and Adults With Asthma or COPD in the United States, 2007 to 2019

Individuals with chronic respiratory illnesses may be at higher risk of pertussis infection and severe pertussis than those without. What is the incidence of pertussis and pertussis complications in cohorts with preexisting asthma or COPD vsage- and sex-matched control patients from the general population in the United States? This observational, retrospective study included individualsaged ≥ 10 years from an administrative health claims system between 2007 and 2019. Individuals with preexisting asthma or COPD were matched with control patients from the general population. The incidence of pertussis infections and pertussis-related complications were assessed overall and by age. The incidence of asthma or COPD exacerbations was also assessed before and after diagnosis of pertussis. In the general population, incidence per 100,000 person-years of pertussis infection ranged from 5.33 in 2007 to 13.04 in 2012, with highest (all years) in those aged 10 to 17 years. The risk of pertussis was higher for the asthma (rate ratio, 3.57; 95%CI, 3.25-3.92) and COPD cohorts (rate ratio, 1.83; 95%CI, 1.57-2.12) than the general population. Those with asthma or COPD had a 4.12-fold (95%CI, 3.16-5.38) and 2.82-fold (95%CI, 2.14-3.27) increased risk of pertussis with complications than the general population, respectively. Exacerbations were most frequent 30days before pertussis diagnosis (incidence rate [IR], 25%) in the asthma cohort and 30days before (IR, 26%) and after (IR, 22%) pertussis diagnosis, remaining elevated for 180days after diagnosis, in the COPD cohort. Among these insured individuals, asthma or COPD increased the risk for pertussis disease and complications vsthe general population. COPD and asthma exacerbations were observed most frequently within 30days of receiving a pertussis diagnosis and remained elevated, suggesting a long-term effect of pertussis in the COPD cohort.

Asthma and clinical outcomes of COVID-19 in a community setting

ObjectivesThe association between asthma and COVID-19 mortality remains inconclusive. We examined the association between asthma and clinical outcomes of patients with COVID-19. Study designA case–control study based on a surveillance cohort in Harris County, Texas. MethodsUsing the data of 21,765 patients who reported having at least one chronic health condition, we investigated the association between asthma and COVID-19 severity, characterized primarily by hospitalization and death. Unconditional logistic regression models were used to estimate the multivariable odds ratio (mOR) and its 95 % confidence interval (CI) of COVID-19 severity associated with asthma and other chronic lung diseases, adjusting for demographic and other comorbidities. A P-value < 0.005 was considered statistically significant after correcting multiple testing. ResultsIn total, 3034 patients (13.9 %) had asthma, and 774 (3.56 %) had other chronic lung diseases. The case death rate among patients with asthma and other chronic lung diseases was 0.75 % and 19.0 %, respectively. Compared to patients without the respective conditions, patients with asthma had lower odds of death (mOR = 0.44, 95 % CI: 0.27–0.69), while patients with other chronic lung diseases had higher odds of hospitalization (mOR = 2.02, 95 % CI: 1.68–2.42) and death (mOR = 1.95, 95 % CI: 1.52–2.49) (P-values < 0.005). Risk factors for COVID-19 mortality included older age, male gender, diabetes, obesity, hypertension, cardiovascular disease, active cancer, and chronic kidney disease. ConclusionsThe public health surveillance data suggested that preexisting asthma was inversely associated with COVID-19 mortality.

Fatal Occupational Asthma in Cannabis Production - Massachusetts, 2022.

Multiple respiratory hazards have been identified in the cannabis cultivation and production industry, in which occupational asthma and work-related exacerbation of preexisting asthma have been reported. An employee working in a Massachusetts cannabis cultivation and processing facility experienced progressively worsening work-associated respiratory symptoms, which culminated in a fatal asthma attack in January 2022. This report represents findings of an Occupational Safety and Health Administration inspection, which included a worksite exposure assessment, coworker and next-of-kin interviews, medical record reviews, and collaboration with the Massachusetts Department of Public Health. Respiratory tract or skin symptoms were reported by four of 10 coworkers with similar job duties. Prevention is best achieved through a multifaceted approach, including controlling asthmagen exposures, such as cannabis dust, providing worker training, and conducting medical monitoring for occupational allergy. Evaluation of workers with new-onset or worsening asthma is essential, along with prompt diagnosis and medical management, which might include cessation of work and workers' compensation when relation to work exposures is identified. It is important to recognize that work in cannabis production is potentially causative.