Role In Treatment Of Asthma Research Articles

Changes in FeNO, d-ROMs, and BH4 by Intravenous L-Arginine in Children and Its Putative Role in Asthma Treatment.

Pteridines are metabolites of tetrahydrobiopterin (BH4), being coenzymes for nitric oxide synthase (NOS). No study has clarified the relationship among pteridines and NOS, fractional exhaled nitric oxide (FeNO) generated by pteridines, and reactive oxygen species. In this study, we administered arginine, a precursor of NO, and confirmed changes in the levels of pteridines, FeNO, and reactive oxygen species and their relationship to clarify the pathogenesis of airway inflammation in which oxidative stress is involved, such as bronchial asthma. This is a prospective, randomized open-label study. Children, aged 2 to 15 years, who were scheduled for growth hormone stimulation tests and were able to undergo a respiratory function test were recruited. They were randomly divided into two groups: arginine-administered and control groups. In the former, L-arginine hydrochloride was intravenously administered. After administration, the levels of diacron-reactive oxygen metabolites (d-ROMs), serum pteridines, serum amino acids, and fractional exhaled NO (FeNO) were measured. We analyzed 15 children aged 4 to 14 years. In the arginine-administered group, there was an increase in the FeNO level and a decrease in the d-ROMs level, reaching a peak 30 min after administration, compared with the control group. In addition, there was a decrease in the serum biopterin level and an increase in the d-ROMs level, reaching peak 60 min after administration. The administration of L-arginine increased the NO level and decreased the d-ROMs level. Due to this, biopterin may be consumed and decreased, leading to an increase in the d-ROMs level. As a reduction in reactive oxygen species leads to the relief of inflammation, arginine and biopterin may be useful for inhibiting inflammation.

A Clinical Evaluation of ‘Sharngyadi Churna’ and Herbal Nebulizer in the Management of Tamaka Shwasa w.s.r. to Bronchial Asthma : A Research Article.

Tamak shwasais a type of Shwasa Rogain which patients feel excessive difficulty in breathing and drowning in the dark. It may be defined as a disease in which vitiated “Pranvayu”combines with deranged “kapha dosha”in the lungs, causing obstruction in the “Pranavaha srotasa”(respiratory passage). A number of indigenous drugs have been claimed in various text books of Ayurveda, to be effective in the treatment of Tamak shwasa (Bronchial asthma).The shrangyadi churnais one of them. Nebulizer, a drug delivery system is based on aerosol principal and plays a very important role in asthma treatment; especially it is better for children, elderly patients, disabled individuals or those with diseases that make using their hands and taking deep breaths impossible. It delivers medication directly to the lungs. In aerosol through a nebulizer medicines passes straight into lungs and takes less time to work than orally medications. So a study was planned to evaluate the role of shrangyadi churnaas a safe formulation for Tamak shwasa (Bronchial asthma)and a formulation of herbal drugs (Pushkar mulaadi yog), in the form of alcohol based extract was planned for study as nebulizer medicine for the same purpose in this disease.

Anti-asthmatic fraction screening and mechanisms prediction of Schisandrae Sphenantherae Fructus based on a combined approach.

Objective: Schisandrae Sphenantherae Fructus (SSF) is a traditional Chinese medicine used to treat coughs and pulmonary inflammatory diseases. However, the pharmacodynamic material basis and mechanisms for SSF in asthma treatment remain unclear. This study aims to screen the anti-asthmatic fraction and verify the pharmacodynamic material basis, predict the potential mechanism, and verify the interaction ability between compounds and core targets. Methods: First, three fractions from SSF were compared in terms of composition, comparison, and anti-asthmatic effects. Then, the ultra-performance liquid chromatography-quadrupole/time-of-flight-mass spectrometry/mass spectrometry (UPLC-Q/TOF-MS/MS) strategy was used to identify the compounds from the active fraction, and the anti-asthmatic efficacy of the active fraction was further studied by the ovalbumin (OVA)-induced asthma murine model. Finally, network pharmacology and molecular methods were used to study the relationships between active compounds, core targets, and key pathways of PEF in asthma treatments. Results: The petroleum ether fraction (PEF) of SSF showed better effects and could significantly diminish lung inflammation and mitigate the level of serum immunoglobulin E (IgE), interleukin (IL)-4, IL-5, IL-6, IL-13, and IL-17 in mice. A total of 26 compounds from the PEF were identified, among which the main compounds are lignans and triterpenes. Moreover, 21 active compounds, 129 overlap-ping targets, and 10 pathways were screened by network pharmacology tools. The top five core targets may play a great role in asthma treatment. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis suggested that the PEF can treat asthma by acting on multiple asthma pathological processes, including the IL-17 signaling pathway, T helper (Th) 17 cell differentiation, and the calcium signaling pathway. Molecular docking was performed to evaluate the interactions of the protein–ligand binding, and most docked complexes had a good binding ability. Conclusion: The present results might contribute to exploring the active compounds with anti-asthmatic activity.

Antiallergic and antihistaminic actions of Ceasalpinia bonducella seeds: Possible role in treatment of asthma

Ethnopharmacological relevanceSeed kernel of the plant Ceasalpinia bonducella Linn (Caesalpiniacaeae) are used for the treatment of asthma in folk medicine and ancient books. Aim of studyTo assess the pharmacological efficacy of the plant in asthma and to confine and describe the synthetic constituents from the seeds that are in charge of the action. Material and methodsThe viability of petroleum ether, ethanol extract and ethyl acetate fraction from ethanol extract of C. bonducella seeds were screened for the treatment of asthma by various methods viz. effect of test drug on clonidine and haloperidol induced catalepsy, milk-induced leukocytosis and eosinophilia, mast cell stabilizing activity in mice and studies on smooth muscle preparation of guinea pig ileum (in-vitro). Column chromatography of active extract was done to pinpoint the active compound followed by structure elucidation by FTIR, GCMS and NMR spectroscopic methods. ResultsEthyl acetate fraction from ethanol extract of C. bonducella seeds exhibited antihistaminic activity at the dose of 50 and 100 mg/kg, inhibited clonidine-induced catalepsy but not haloperidol-induced catalepsy. Ethyl acetate fraction from ethanol extract significantly inhibited increased leukocyte and eosinophil count due to milk allergen and showed maximum protection against mast cell degranulation by clonidine. The results of guinea pig ileum indicated that the compound 2 methyl, 1 hexadecanol isolated from ethyl acetate fraction of ethanol extract relaxed significantly the ileum muscle strips pre-contracted by which suggests the involvement of β2-agonists on the relaxation of the tissue. All the results are dose dependent. Active ethyl acetate fraction from ethanol extract showed presence of anti-asthmatic compound, 2-methyl, 1-hexadecanol. ConclusionThe ethyl acetate fraction from ethanol extract of seeds of the plant C. bonducella can inhibit parameters linked to asthma disease.

Calcium channel blockers for lung function improvement in asthma: A systematic review and meta-analysis

BackgroundFor decades, calcium channel blockers (CCBs) have been believed to play a role in asthma treatment. However, the clinical efficacy of CCBs for lung function improvement in patients with asthma has not been qualitatively evaluated. ObjectiveTo assess the effect of CCBs vs placebo on lung function test results in adults with asthma. MethodsVarious databases were systematically searched to identify all randomized clinical trials with adults with asthma. We aimed to assess the influence of CCBs on forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), and provocative concentration of bronchoconstrictive agents causing a 20% decrease in FEV1 (PC20) compared with a placebo. All effect estimates were pooled by the generic inverse variance method with random-effects meta-analysis. Subgroup analysis, sensitivity analysis, and heterogeneity investigation were performed. ResultsThirty eligible articles with 301 patients were included in this meta-analysis. Our results revealed that in a standard exercise test CCBs could produce a mean maximal percentage decrease in FEV1 of 11.56% (95% confidence interval, 8.97%–14.16%; P < .001) and an increase in postdose FEV1 by 80 mL (95% confidence interval, 0.02–0.15 mL; P = .01). However, there was no statistical significance for CCBs in postdose FVC, PEFR, or PC20 of histamine and methacholine. ConclusionCCBs may be beneficial for lung function improvement in asthma, especially in exercise-induced asthma. However, there is a lack of evidence for CCBs protecting asthma patients from chemical irritation.

Current role of anticholinergic drugs in the treatment of asthma: key messages for clinical practice

Anticholinergic bronchodilators such as tiotropium, a potent long-acting drug, are central to the symptomatic treatment of chronic obstructive pulmonary disease. Its role in asthma treatment has been recently investigated. This review critically evaluates documented evidence of clinical trials and assesses the therapeutic implications of anticholinergic drugs in asthma management. So far, the results of 10 Phases II and III randomized controlled trials evaluating the effect of adding tiotropium to the treatment of mild-to-moderate or severe asthma have been published. These trials had a duration of 4 to 52 weeks and involved 3368 subjects with mild-to-moderate asthma and 1019 subjects with severe asthma [corrected]. Also, 1 systematic review and 6 meta-analyses have appraised the results of published and unpublished trials investigating the role of tiotropium in asthma. The results of the trials in mild to moderate asthma showed that adding tiotropium to inhaled corticosteroids (ICSs) was not inferior to adding long-acting β2-agonists (LABAs). In addition, the safety and efficacy of tiotropium were similar to those of salmeterol. The results of studies on severe asthma showed that adding tiotropium to a treatment with high doses of an ICS plus LABA results in further improvement in lung function, increases the time to the first severe exacerbation of asthma and to worsening of asthma, and improves asthma control. Except for dry mouth, the safety profile of tiotropium was similar to placebo both in moderate and in severe asthma. Adding tiotropium to an ICS or ICS plus LABA improves lung function, symptoms, and asthma control, and in severe asthma, it increases the time to exacerbations, with good safety profile. The effect seems independent of baseline characteristics such as age, level of bronchial obstruction, smoking status, allergic status, and bronchial reversibility.

Parental perceptions and beliefs about childhood asthma: a cross-sectional study

AimTo assess parental perceptions and beliefs about asthma in children.MethodsWe invited 6000 children aged 3 to 15 years from different schools in Lebanon to participate in the study from September 2007 to May 2008. In the first phase, in order to determine the prevalence of asthma in children, parents of all participating children filled out a small questionnaire. In the second phase, only parents of children with asthma filled out a detailed questionnaire about their perceptions of asthma.ResultsPhase I included parents of 4051 children, 574 (14%) of whom had asthma and were recruited to phase II. Out of these, 389 parents entered the final data analysis. Around 54% of parents believed that asthma was hereditary and 7% believed it was contagious. When asked about triggering factors, 51% stated virus infection, 75% dust, and 17% food. Sixty percent of children with asthma lived with someone who smoked. Sixty-seven percent of parents believed that herbs had a role in asthma treatment and only 49% received asthma education. There was a significant difference in education level (P = 0.01) between the parents who denied the label of asthma (79%) and those who accepted it (21%). Sixty-seven percent of parents preferred oral over inhaler treatment, 48% believed inhalers were addictive, 56% worried about inhalers’ side effects, and 76% worried about using inhaled corticosteroids. Significantly more parents from rural (53%) than from urban areas (38%) believed that inhalers were addictive (P = 0.004).ConclusionParents of children with asthma had considerable misperceptions about the use of inhalers and the safety of inhaled corticosteroids. To improve asthma care in children, it is necessary to provide adequate education to parents.

3D-QSAR Study of Potent Inhibitors of Phosphodiesterase-4 Using a CoMFA Approach

Phosphodiesterase-4 (PDE4) plays an important role in treatment of asthma andchronic obstructive pulmonary disease. Thirty-one analogs displaying variable inhibition ofPDE4 were selected to develop models for establishing three-dimensional quantitativestructure-activity relationships (3D-QSAR). Comparative molecular field analysis(CoMFA) was conducted on the group of analogs to determine the structural requirementsfor potency in inhibiting PDE4. The resulting model exhibited good q2 and r2 values up to0.741 and 0.954 for CoMFA. The contributions from the steric and electrostatic fields were0.915 and 0.085 respectively. The 3D-QSAR model should be very useful for design ofnovel PDE 4 inhibitors.

フルタイド導入による吸入ステロイドのコンプライアンスの改善 第１報 患者アンケートを中心として

It is generally known that the regular use of inhalation steroids plays an important role in asthma treatment. However, when giving instructions for the inhalation of beclomerasone dipropionate using Inspire Ease® spacers (BDP+IE), difficulty of inhalation techniques may sometimes lead to a reduction in patient compliance. The inhalation of fluticasone propionate (FP) using Diskhaler®, which was newly introduced in Japan in December 1998, shows a stronger antiinflammatory action and thus requires a simpler inhalation technique. It is thus considered that switching from BDP + IE to FP might therefore improve patient compliance with inhalation steroids.To investigate the patient preference for both inhalation agents, we conducted a questionnaire survey in 95 asthmatic patients in whom BDP + IE was switched to FP. Furthermore, we examined whether or not any improvement in the pulmonary functions was observed in the patient evaluation.As a result, 76.8% of the patients preferred FP because of its easier portability, it was easier to use and required a smaller numbers of inhalations. The subjective symptoms improved in 58.9% of the patients while the pulmonary functions improved in most patients. However, some elderly patients reported BDP + IE to be preferable mainly due to the fact that they were accustomed to the procedure.We conclude the use of FP improves compliance since 76.8 % of the patients preferred it to BDP+IE which thus increased patient compliance which therefore resulted in an improvement of pulmonary functions

Comparative efficacy of inhaled corticosteroids and antileukotriene drugs in asthma.

Asthma is an inflammatory disease of the airways that is best treated by minimising exposure to factors that provoke the inflammation (e.g. allergens) and by administering drugs that reduce the inflammatory response. The cornerstone of asthma treatment is inhaled corticosteroids. Their effectiveness is a result of their potent and broad anti-inflammatory properties. Antileukotriene drugs (leukotriene modifiers) provide an alternative and novel approach to the treatment of asthma. The novelty of these new compounds is that their effectiveness is firmly based on the pathophysiology of asthma, specifically the role played by the cysteinyl leukotrienes. At the same time, the availability of the antileukotriene drugs has stirred debate over when they should be used and how they compare to inhaled corticosteroids. Although the answers are not fully known at this time, the currently available published and presented data are adequate for us to draw some conclusions about their relative effectiveness and role in asthma treatment. The antileukotriene drugs are more effective than placebo, but they are not as effective as inhaled corticosteroids in improving lung function [measured as the forced expiratory volume in 1 second (FEV(1)) or peak expiratory flow rate (PEFR)], reducing beta(2)-agonist use, and decreasing symptom-free days. In contrast, they may have similar beneficial effects on reducing asthma exacerbations and decreasing peripheral blood eosinophil counts. In the absence of knowing a priori the response of an individual patient to treatment with either therapy, the data favour initiating treatment with an inhaled corticosteroid. However, for patients with mild to moderate disease there are a number of circumstances that support using an antileukotriene drug first. A few examples are aspirin intolerance, predominantly exercise-induced symptoms and problems with using an inhaler or the adverse effects of inhaled corticosteroids such as dysphonia and thrush. For patients with more severe disease, inhaled corticosteroids remain the treatment of choice. Antileukotriene drugs should be considered as add-on therapy, especially in view of their possible complementary effects on reducing airway inflammation.

PAF receptor antagonists in the treatment of asthma

Platelet-activating factor (PAF) has attracted much attention as a mediator in the pathophysiology of asthma due to the molecule's ability to induce characteristic features of this disease. These include bronchoconstriction, mucus hypersecretion, vascular leakage and oedema, eosinophil recruitment and bronchial hyperreactivity to airway spasmogens. Based on these observations it has been hypothesised that PAF receptor antagonists may have a beneficial role in future treatment of asthma. Results from experimental animal models of asthma have suggested possible efficacy of several receptor antagonists. Following the encouraging results from these models, the first clinical trials using PAF receptor antagonists have been undertaken. However, results from published trials have been conflicting and somewhat discouraging. A possible role of antagonists cannot be excluded, though, as these trials were performed on subjects with mild, stable asthma, and also more potent and specific receptor antagonists are under...