Total Asthma Research Articles

Association between dyslipidemia and asthma in children: a systematic review and multicenter cohort study using a common data model.

The association between dyslipidemia and asthma in children remains unclear. This study investigated the association between dyslipidemia and cholesterol levels in children. A systematic literature review was performed to identify studies investigating the association between dyslipidemia and asthma in children. The PubMed database was searched for articles published from January 2000-March 2022. Data from a cohort study using electronic health records from 5 hospitals, converted to the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM), were used to identify the association between total cholesterol (TC) levels and asthma in children. This cohort study used the Cox proportional hazards model to examine hazard ratio (HR) of asthma after propensity score matching, and included an aggregate meta-analysis of HR. We examined 11 studies reporting an association between dyslipidemia and asthma in children. Most were cross-sectional; however, their results were inconsistent. In OMOP-CDM multicenter analysis, the high TC (>170 mg/dL) group included 29,038 children, while the normal TC (≤170 mg/dL) group included 88,823 children including all hospital datasets. In a meta-analysis of this multicenter cohort, a significant association was found between high TC levels and later development of asthma in children <15 years of age (pooled HR, 1.30; 95% confidence interval, 1.12-1.52). Elevated TC levels in children may be associated with asthma.

Causal association of rheumatoid arthritis with obstructive lung disease: Evidence from Mendelian randomization study

BackgroundObservational studies have found an association between rheumatoid arthritis (RA) and risk of obstructive lung disease (ORDs). However, whether RA plays a role in ORDs development remains unclear. ObjectivesThis study aimed to explore the causal association of RA with ORDs. MethodsBoth univariable and multivariable Mendelian randomization (MR) analyses were employed. Summary statistics for RA were obtained from the genome-wide association study (GWAS) meta-analysis, and the GWAS data source of ORDs, including the chronic obstructive pulmonary disease (COPD) and asthma, was accessed from the FinnGen Biobank. Causal Analysis Using Summary Effect Estimates (CAUSE) method was used to improve statistical power. multivariable and two-step mediation MR was applied to calculate the independent and mediated effects. ResultsThe causal estimates by univariable and CAUSE results indicated genetic predisposition to RA had an effect on the increased risk of asthma/COPD (A/C) (ORCAUSE = 1.03; 95% CI: 1.02–1.04), COPD/asthma related infections (ACI) (ORCAUSE = 1.02; 95% CI: 1.01–1.03) and COPD/asthma related pneumonia or pneumonia derived septicemia (ACP) (ORCAUSE = 1.02; 95% CI: 1.01–1.03). Genetic predisposition to RA was significantly associated with early onset COPD (ORCAUSE = 1.02; 95% CI: 1.01–1.03) and asthma (ORCAUSE = 1.02; 95% CI: 1.01–1.03) risk and suggestively associated with non-allergic asthma (nAA) risk. After adjustment for confounders, independent causal effects remained for the associations of RA with risk of A/C, ACI, and ACP, as well as COPD, early-onset COPD, and asthma [total, nAA and allergic asthma (AA)] risk. Mediation analyses revealed no potential mediator. ConclusionThis study indicates a causal effect of increased genetic predisposition to RA on an increased risk of ORDs, including COPD and asthma, especially early-onset COPD and nAA, and on asthma/COPD related infections, pneumonia or pneumonia derived septicemia.

Associations of dietary fiber intake with chronic inflammatory airway diseases and mortality in adults: a population-based study.

The objective of this study was to investigate the potential association between dietary fiber intakes and the prevalence of chronic inflammatory airway diseases (CIAD), as well as mortality in participants with CIAD. Data was collected from the National Health and Nutrition Examination Survey (NHANES) 2013-2018, with dietary fiber intakes being calculated as the average of two 24-h dietary reviews and divided into four groups. CIAD included self-reported asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). Through December 31, 2019, mortality was identified from the National Death Index. In cross-sectional studies, multiple logistic regressions were used to assess dietary fiber intakes associated with the prevalence of total and specific CIAD. Dose-response relationships were tested using restricted cubic spline regression. In prospective cohort studies, cumulative survival rates were calculated using the Kaplan-Meier method and compared using log-rank tests. Multiple COX regressions were used to assess dietary fiber intakes associated with mortality in participants with CIAD. A total of 12,276 adults were included in this analysis. The participants had a mean age of 50.70 ± 17.4 years and was 47.2% male. The prevalence of CIAD, asthma, chronic bronchitis, and COPD were 20.1, 15.2, 6.3, and 4.2%, respectively. The median daily consumption of dietary fiber was 15.1 [IQR 10.5, 21.1] g. After adjusting for all confounding factors, linear and negative associations were observed between dietary fiber intakes and the prevalence of total CIAD (OR = 0.68 [0.58-0.80]), asthma (OR = 0.71 [0.60-0.85]), chronic bronchitis (OR = 0.57 [0.43-0.74]) and COPD (OR = 0.51 [0.34-0.74]). In addition, the fourth quartile of dietary fiber intake levels remained significantly associated with a decreased risk of all-cause mortality (HR = 0.47 [0.26-0.83]) compared to the first quartile. Dietary fiber intakes were found to be correlated with the prevalence of CIAD, and higher dietary fiber intakes were associated with a reduced mortality in participants with CIAD.

The evaluation of asthma by gender and age groups in Turkey, in 1990-2019: incidence, prevalence, mortality, and disability-adjusted life years

Aims: The aim of this study was to evaluate the incidence and prevalence of asthma, asthma-related DALYs and deaths, and risk factors for asthma by genders and age groups during the study years in Turkey. Methods: The data used in the study were obtained from the estimation data prepared by the Institute for Health Metrics and Evaluation on asthma for Turkey by the global burden of disease study covering the years 1990-2019. During the study years period, death from asthma and Disability-Adjusted Life Years (DALYs) were used as dependent variables. In addition, the effects of Occupational Asthmagens (OA), Smoking (SM), and High Body Mass Index (HBMI), which are known as risk factors for asthma-related deaths and DALYs, were investigated. Comparisons of the variables according to gender and age groups were made with the Mann-Whitney test. The relationships between the variables were examined with the Spearman rank correlation coefficient (Rho). Results: A statistically significant difference was found between the mean rank of total prevalence number, total incidence number, total number of deaths and DALYs scores by gender. Asthma-related deaths due to risk factors (OA, HBMI, SM) were found to be correlated with DALYs and the total number of asthma deaths. Total asthma deaths, and asthma-related deaths because of HBMI and DALYs because of HBMI-induced asthma in women; deaths from asthma because of OA, SM, and DALYs from asthma because of OA and SM were found to be higher in males. Conclusion: HBMI in women and SM and OA in men stand out as risk factors. Therefore, as a result of a detailed investigation of the risk factors leading to the development of asthma, policies should be developed for gender and age groups, and necessary precautions should be taken.

Association of ambient carbon monoxide exposure with hospitalization risk for respiratory diseases: A time series study in Ganzhou, China.

Ambient carbon monoxide (CO) exposure is associated with increased mortality and hospitalization risk for total respiratory diseases. However, evidence on the risk of hospitalization for specific respiratory diseases from ambient CO exposure is limited. Data on daily hospitalizations for respiratory diseases, air pollutants, and meteorological factors from January 2016 to December 2020 were collected in Ganzhou, China. A generalized additive model with the quasi-Poisson link and lag structures was used to estimate the associations between ambient CO concentration and hospitalizations of total respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), and influenza-pneumonia. Possible confounding co-pollutants and effect modification by gender, age, and season were considered. A total of 72,430 hospitalized cases of respiratory diseases were recorded. Significant positive exposure-response relationships were observed between ambient CO exposure and hospitalization risk from respiratory diseases. For each 1 mg/m3 increase in CO concentration (lag0-2), hospitalizations for total respiratory diseases, asthma, COPD, LRTI, and influenza-pneumonia increased by 13.56 (95% CI: 6.76%, 20.79%), 17.74 (95% CI: 1.34%, 36.8%), 12.45 (95% CI: 2.91%, 22.87%), 41.25 (95% CI: 18.19%, 68.81%), and 13.5% (95% CI: 3.41%, 24.56%), respectively. In addition, the associations of ambient CO with hospitalizations for total respiratory diseases and influenza-pneumonia were stronger during the warm season, while women were more susceptible to ambient CO exposure-associated hospitalizations for asthma and LRTI (all P < 0.05). In brief, significant positive exposure-response relationships were found between ambient CO exposure and hospitalization risk for total respiratory diseases, asthma, COPD, LRTI, and influenza-pneumonia. Effect modification by season and gender was found in ambient CO exposure-associated respiratory hospitalizations.

Standard patient training versus Vik-Asthme chatbot-guided training: ‘AsthmaTrain’ – a protocol for a randomised controlled trial for patients with asthma

IntroductionTherapeutic education for patients with asthma has been shown to reduce asthma morbidity. The high availability of smart phones provides the opportunity to furnish patient training via specifically designed chatbot...

Efficacy and safety of house dust mite subcutaneous immunotherapy in polysensitized children with allergic asthma

IntroductionThe aim of this study was to compare the efficacy and safety of 3 years of HDM subcutaneous immunotherapy (HDM-SCIT) in allergic asthma (AA) children with mono- and polysensitized. MethodsThis was a retrospective observational study, 51 AA children (aged 4–14 years) who had completed 3 years of standardized HDM-SCIT were enrolled in. Based on skin prick tests (SPT) and allergen-specific IgE antibody (sIgE) test results, children were classified into two groups: the monosensitized group (n = 31) and the polysensitized group (n = 20). Total asthma symptoms score (TASS), total medication score (TMS), visual analog scale (VAS) scores, fractional exhaled nitric oxide (FeNO), lung function parameters, and adverse reactions were evaluated before treatment and at 6 months, 1, 2, 3 years of HDM-SCIT. ResultsIn terms of effectiveness, compared to baseline, TASS, TMS, VAS, FeNO and lung function parameters were significantly improved in both groups after 3 years of HDM-SCIT (all P < 0.05). The comparison between the two groups showed that efficacy indicators were no statistically significant difference at follow-up time points (all P > 0.05) except PEF%pred at 6 months (P = 0.048). In terms of security, the number of adverse reactions in both groups also no statistical difference between the two groups (all P > 0.05). ConclusionThis study confirmed that no significant difference was observed in the clinical efficacy and safety of HDM-SCIT between mono-and polysensitized children with allergic asthma.

Spatial, temporal and demographic patterns in asthma mortality in China: A systematic analysis from 2014 to 2020

BackgroundAsthma is an important contributor to the burden of non-communicable diseases in China. Understanding spatial, temporal, and demographic patterns in asthma mortality is relevant to the design and implementation of targeted interventions. MethodsThis study collected information on asthma deaths occurring across 605 disease surveillance points (DSPs) as recorded in the population-based national mortality surveillance system (NMSS) of China. Asthma was defined according to the International Classification of Diseases, 10th Revision code J45-J46. Estimates of age-standardized mortality rates and total national asthma deaths were calculated based on yearly population data. Statistical analysis was performed to investigate the influence of various factors on asthma mortality. ResultsBetween 2014 and 2020, a total of 40 116 asthma deaths occurred in DSPs. Standardized asthma mortality per 100 000 people decreased from 1.79 (95% CI: 1.74–1.83) in 2014 to 1.07 (95% CI: 1.03–1.10) in 2020 in China. In 2020, the overall asthma mortality rate was higher for male patients than for female patients, and asthma mortality rates increased substantially with age. Age-standardized asthma mortality per 100,000 people exhibited significant geographic variation, ranging from 0.93 (95% CI: 0.89–0.98) in Eastern China to 1.04 (95% CI: 0.98–1.10) in Central China and 1.37 (95% CI: 1.29–1.45) in Western China in 2020. Asthma mortality in urban areas appeared to be higher than in rural areas. Socioeconomic factors, including gross domestic product per capita and density of hospital beds per 10,000 population, may be related to asthma mortality. Male asthma patients who lived in rural areas and were aged 65 years and above were generally at high risk of asthma-related mortality. ConclusionsThis study found a spatial and temporal trend for a reduction in asthma deaths over seven years in China; however, there remain important sociodemographic groups that have not secured the same decrease in mortality rates. Trial registrationThis was a purely observational study and thus registration was not required.

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Abstract. The goal of modern treatment of patients with bronchial asthma (BA) is to achieve and maintain full control over the disease: good control of clinical symptoms, minimization of fixed bronchial obstruction and unwanted side effects of treatment, as well as reducing the risks of future exacerbations. The controllability of the course of BA with comorbid pathology of the digestive system is currently uncertain according to the literature. The aim of the study: to learn the clinical features of the course of BA with comorbid pathology of the gastrointestinal tract. Materials and methods. The object of the study: 480 patients with asthma, including 194 men and 286 women, with a controlled, uncontrolled and partially controlled course of asthma, who were treated in the department of broncho-obstructive lung diseases in tuberculosis patients of the State Organization (SO) �Yanovsky National Institute of Phthisiology and Pulmonology NAMS of Ukraine�. In order to identify the possible causes of the uncontrolled course of the disease, a questionnaire was conducted using a questionnaire for patients with broncho-obstructive lung disease, developed at the SO �Yanovsky National Institute of Phthisiology and Pulmonology NAMS of Ukraine�. All patients kept a self-observation diary, which recorded: nocturnal asthma (number of awakenings during the night due to respiratory symptoms) � in points, morning chest tightness (in points), daytime symptoms (in points), cough during the day (in points), average dyspnea score (in points). All the symptoms listed above were included in the total asthma score (in points), and the number of inhalations of short-acting ?2 -agonists per day was also noted. The results. It has been established that the loss of asthma controllability always leads to an increase in the number and combination of dysfunction of various organs of the digestive system and vice versa: the appearance and increase of comorbid pathology of the digestive system aggravates the course and worsens the controllability of BA. The most common comorbid pathology of the gastrointestinal tract with a controlled course of BA is an irritable bowel syndrome � in 44.4 % of patients, with a partially controlled course: chronic gastritis 34.5 %, chronic cholecystitis � 22.0 %, and chronic pancreatitis � 67.4 %, with an uncontrolled course, with a high percentage of patients with chronic gastritis, cholecystitis and irritable bowel syndrome, the percentage of patients with calculous cholecystitis increased � 25.0 %. With the controlled course of BA there was no difference in the clinical manifestations of BA either in the group of patients with or without comorbid gastrointestinal pathology. With a partially controlled course of BA with comorbid pathology of the digestive system, exacerbation of BA due to respiratory factors, allergens and pronounced seasonality was determined in 53.5 % of patients with moderate severity, in 28.0 % with severe, of which 67.4 % of patients underwent inpatient treatment up to two times a year, a quarter of patients � more than three or four times a year, 30.2 % with a duration of hospitalization up to 30 days. In the uncontrolled course of BA with comorbid gastrointestinal pathology, 56.1 % of patients noted seasonality of symptoms, 47.8 % � a connection with allergens, physical exertion � 38.0 %, respiratory infections � 51.2 %. Only 46.3 % of patients had exacerbations up to twice a year, 43.9 % up to four times, and 9.8 % more than four times a year. Exacerbations of moderate severity in 53.5 % of patients, severe in 27.9 %, and with a duration of hospitalization for more than thirty days in 92.7 % of patients. Conclusions. The controllability of both affects and depends on the comorbid pathology of the digestive system: the progression of the dysfunction of the digestive system limits the possibilities of drug therapy for BA, nullifying the expected result from the received treatment, not leading to full and long-term control of the disease, forcing to repeat the course of systemic glucocorticosteroids again and again. which again deepens the dysfunction of the digestive system, forming a vicious circle of mutual burden and leads to an increase in the terms of hospitalization, causes disability, and prevents the implementation of rehabilitation measures. Key words: bronchial asthma, controllability, comorbid pathology, digestive system.

Significance of total and specific IgE in asthma of Iraqi adult patients

A case-control retrospective study was conducted during January – June 2019 on 104 patients with asthma (50 females and 54 males) and 111 non-asthmatic healthy subjects matched patients for gender (54 females and 57 males) to assess role of total and specific IgE serum levels in patho-physiology of disease using ELISA and multiplex immunoblot kits. The mean age ± standard deviation of asthma patients was 37.9 ± 12.1 years, while it was lower among control (35.9 ± 10.5 years), but the difference was not significant. Males and females were similarly distributed among asthma cases (48.1 and 51.9%, respectively) and control (48.6 and 51.4%, respectively). Most of asthma cases were observed to have mild disease (49%), followed by moderate and severe asthma (93.4 and 11.5%, respectively). It was also observed that 51.9% of patients had a family history of asthma. With respect to allergen type, 21.2% of asthma cases were seropositive for mixed types of allergens. Median level of total IgE was significantly (p &lt; 0.001(elevated in sera of asthma cases (204.1 ng/ml) compared to control subjects (163.3 ng/ml). The level positively paralleled the severity of disease. The highest level was observed in severe cases (244.9ng/ml, while the lowest level was recorded in mild cases (189.7 ng/ml). The level of specific IgE showed some variations among asthma cases distributed according to the type of allergen, the highest median was recorded in seronegative cases (215.2 ng/ml), while a lowest level was observed in cases seropositive for animal dander (189.3 ng/ml). Logistic regression analysis revealed that total asthma patients, as well as male and female cases were at an increased risk to develop asthma episodes due to elevated serum level of IgE.ROC analysis demonstrated that elevated serum level of IgE occupied a significant (p = 0.001) area under curve (AUC), which was 0.828. In conclusion, the present study confirms the significant role of total and specific IgE in patho-physiology of bronchial asthma and its correlation with disease severity and allergen type in adults

Causal effect of PM1 on morbidity of cause-specific respiratory diseases based on a negative control exposure

BackgroundExtensive studies have linked PM2.5 and PM10 with respiratory diseases (RD). However, few is known about causal association between PM1 and morbidity of RD. We aimed to assess the causal effects of PM1 on cause-specific RD. MethodsHospital admission data were obtained for RD during 2014 and 2019 in Beijing, China. Negative control exposure and extreme gradient boosting with SHapley Additive exPlanation was used to explore the causality and contribution between PM1 and RD. Stratified analysis by gender, age, and season was conducted. ResultsA total of 1,183,591 admissions for RD were recorded. Per interquartile range (28 μg/m3) uptick in concentration of PM1 corresponded to a 3.08% [95% confidence interval (CI): 1.66%–4.52%] increment in morbidity of total RD. And that was 4.47% (95% CI: 2.46%–6.52%) and 0.15% (95% CI: 1.44%-1.78%), for COPD and asthma, respectively. Significantly positive causal associations were observed for PM1 with total RD and COPD. Females and the elderly had higher effects on total RD, COPD, and asthma only in the warm months (Z = 3.03, P = 0.002; Z = 4.01, P < 0.001; Z = 3.92, P < 0.001; Z = 2.11, P = 0.035; Z = 2.44, P = 0.015). Contribution of PM1 ranked first, second and second for total RD, COPD, and asthma among air pollutants. ConclusionPM1 was causally associated with increased morbidity of total RD and COPD, but not causally associated with asthma. Females and the elderly were more vulnerable to PM1-associated effects on RD.

OCULAR SURFACE DISEASE ALLEVIATED WITH DUPILUMAB: A CASE SERIES

<h3>Introduction</h3> Dupilumab is a first-in-class immunobiologic that has demonstrated significant clinical results in treatment of atopic diseases like atopic dermatitis (AD) and asthma. However, adverse ocular surface symptoms arise with treatment at rates of 9-22%. <h3>Methods</h3> Case series of two AKC (atopic keratoconjunctivitis) patients from 2018-2022 were evaluated using Ocular Surface Disease Index (OSDI), Total Ocular Symptom Score (TOSS), SCORing AD (SCORAD), and Asthma Control Test (ACT) assessments. <h3>Results</h3> A 16-year-old female was referred for lifetime AD, asthma, and ocular symptoms consistent with AKC. Mycophenolate and cyclosporine were discontinued due to adverse effects. Benrazilumab 30 mg q4wk resulted in SCORAD decrease (53.7 to 36.2), but the patient still had eczematous lesions, periocular dermatitis, and tearing. Benrazilumab was discontinued and dupilumab 300 mg q2wk was initiated, resulting in improvement within two weeks; she denied conjunctival injections, tearing, OSDI (30 to 6.8), TOSS (25 to 12.5), and SCORAD (36.2 to 23.25). A 20-year-old male with a history of AD, asthma, allergic rhinitis, eosinophilic esophagitis, vernal conjunctivitis, and persistent central corneal ulcers OD presented with pruritus and photophobia. Cyclosporine, cromolyn sodium and prednisone acetate had limited success. Initiation of dupilumab 300 mg q2wk led to near resolution of ocular surface symptoms within three months, OSDI (66.6 to 8.3), TOSS (100 to 6.25), along with resolution of upper AD lesions by 90% and ACT of 24. <h3>Conclusion</h3> Dupilumab, despite its reported adverse ocular surface effects, remediated AKC ocular surface symptoms in addition to improving AD and asthma.

The Effect Of Mouth Breathing On Exercise Induced Bronchoconstriction In Children

BACKGROUND: Exercise induced bronchoconstriction (EIB) is a common finding in the pediatric population. Nose breathing is considered to decreases hyper-responsiveness of the airways. Therefore, nose clip (NC) is used during exercise challenge test (ECT) in adults to increase test sensitivity. Data on the need for NC during ECT in children is scarce. Our aim was to evaluate the effect of breathing with and without NC on EIB in children. METHODS: A prospective study evaluating two ECT’s with/without NC within a month period. Demographic, clinical data, Total Nasal Symptoms Score (TNSS) and Asthma Control Test (ACT) were recorded. RESULTS: Fifty-four children (mean age 16.7 ± 1.2 y/o, 39% Female) were evaluated. Forty-four returned to visit 2. At Visit 1 (with NC) baseline FEV1 was 92.8 ± 11.0%pred and 27/44 (61%) had positive ECT (decline≥12% in FEV1) with mean FEV1 drop of 14.7 ± 11.3%pred. At visit 2 ,8.7 ± 7.7 days post visit 1 (without NC), baseline FEV1 was 88.9 ± 11.3%pred (p < 0.001), mean FEV1 drop was 9.0 ± 10.1%pred (p < 0.0001) and only 14/44 (32%) had positive ECT (p < 0.0001). A total of 14/44 (32%) of children with a positive ECT with a NC turned negative without a NC. CONCLUSIONS: Use of NC during ECT increases the rate of positive tests thus possibly improving the yield of EIB diagnosis in children. Optional physiologic mechanisms could be humidification and warming of the inhaled air through the nose cavity. The findings strengthen the recommendation of nasal blockage during ECT. Larger randomized studies are needed to unfold the full effect of nose breathing during exercise.

Impact of mepolizumab in patients with high-burden severe asthma within a managed care population

Objective To evaluate the real-world impact of mepolizumab on the incidence of asthma exacerbations, oral corticosteroid (OCS) use and asthma exacerbation-related costs in patients with high-burden severe asthma. Methods This was a retrospective study of the MarketScan Commercial and Medicare Databases in patients with high-burden severe asthma (≥80th percentile of total healthcare expenditure and/or significant comorbidity burden). Patients were ≥12 years of age upon mepolizumab initiation (index date November 1, 2015–December 31, 2018) and had ≥2 mepolizumab administrations during the 6 months post-index. Asthma exacerbation frequency (primary outcome), use of OCS (secondary outcome), and asthma exacerbation-related costs (exploratory outcome) were assessed during the 12 months pre-index (baseline) and post-index (follow-up). Results In total, 281 patients were analyzed. Mepolizumab significantly reduced the proportion of patients with any asthma exacerbation (P < 0.001) or exacerbations requiring hospitalization (P = 0.004) in the follow-up versus baseline period. The mean number of exacerbations decreased from 2.5 to 1.5 events/patient/year (relative reduction: 40.0%; P < 0.001). The proportion of patients with ≥1 OCS claim also decreased significantly from 94.0% to 81.9% (relative reduction: 12.9%; P < 0.001), corresponding to a decrease from 6.6 to 4.7 claims/person/year (P < 0.001). Of the 264 patients with ≥1 OCS claim during baseline, 191 (72.3%) showed a decrease in mean daily OCS use by ≥50% in 117 patients (61.3%). Total asthma exacerbation-related costs were significantly lower after mepolizumab was initiated (P < 0.001). Conclusions Mepolizumab reduced exacerbation frequency, OCS use and asthma exacerbation-related costs in patients with high-cost severe asthma. Mepolizumab provides real-world benefits to patients, healthcare systems and payers.

Morning Versus Evening Dosing of Sublingual Immunotherapy in Allergic Asthma: A Prospective Study.

BackgroundSublingual immunotherapy (SLIT) has been proved to be an effective and safe treatment for allergic asthma (AS) in children. Nonetheless, several issues regarding SLIT remain to be resolved, including the information about optimal administration timing.MethodsA total of 163 AS children aged 4-13 years were enrolled and randomized into the morning dosing (MD) group and the evening dosing (ED) group. Participants received SLIT with Dermatophagoides farinae drops between 7:00 a. m. and 9:00 a.m. (for the MD group) or between 8:00 p. m. and 10:00 p.m. (for the ED group). The total asthma symptom score (TASS), total asthma medicine score (TAMS), Asthma Control Questionnaire (ACQ), forced expiratory volume in one second (FEV1), FEV1/forced volume vital capacity (FVC), fractional exhaled nitric oxide (FeNO) and adverse events (AEs) were assessed at baseline, 0.5 and 1 year during the 1-year SLIT.ResultsAfter 1 year, 62 patients in the MD group and 63 patients in the ED group completed the entire study. The clinical efficacy, pulmonary function and FeNO in both groups improved significantly at 0.5 and 1 year (p < 0.001). Compared to the MD group, the ED group showed significant lower ACQ score at 0.5 year (p < 0.001) and lower FeNO at 1 year (p < 0.05). No significant difference between two groups was observed in AE rate (p > 0.05). All AEs occurred in the first month, with no systemic AEs reported.Conclusion1-year house dust mite (HDM) SLIT is effective and well-tolerated in AS children regardless of administration time. SLIT dosing in the evening might enhance the asthma control level and reduce FeNO level compared with SLIT dosing in the morning.

Sub-stratification of type-2 high airway disease for therapeutic decision-making: A 'bomb' (blood eosinophils) meets 'magnet' (FeNO) framework.

Sub-stratification of type-2 high airway disease for therapeutic decision-making: A 'bomb' (blood eosinophils) meets 'magnet' (FeNO) framework.

Asthma mortality among children and adolescents in China, 2008-2018.

Asthma mortality among children and adolescents at the national level in China was unreported. The aim of this study was to analyze the mortality of asthma among children and adolescents in China using a nationally representative database. This was a descriptive study using data from the Disease Surveillance Points (DSPs) system. All asthma-related deaths among children and adolescents aged 0-19years occurring in DSPs across China from 2008 to 2018 were included. Multilevel Poisson regression models were used to compute the total, age-, gender-, region- and residence-specific asthma mortality rates and to investigate the significance of trends and factors associated with asthma mortality. Data from the National Bureau of Statistics were used to estimate the national asthma deaths. Total asthma mortality rate among Chinese children and adolescents fluctuated between 0.020 (0.009, 0.045) and 0.059 (0.025, 0.137) per 100,000 and showed an overall downward trend (RR, 0.909; 95% CI 0.854-0.968) during the study period (2008-2018). Asthma mortality rate was higher in the western China (RR 2.356, 95% CI 1.513, 3.669) and varied over a ninefold range among DSPs in China. The estimated number of deaths decreased by 51.38% from 2008 (n = 148; 95% CI 58,379) to 2018 (n = 71; 95% CI 34,109). Asthma mortality rate among children and adolescents in China was at a low level compared to rates worldwide and decreased significantly from 2008 to 2018. Compared with most countries in the world, the number of asthma deaths was higher in China.

Assessment of airway inflammation and disease burden in moderate to severe asthmatic smokers

BACKGROUND: Conflicting results have been found among studies assessing the effect of smoking on airway inflammation among asthmatic subjects. OBJECTIVE: We sought to compare the inflammatory and clinical characteristics of active smokers and nonsmokers with uncontrolled moderate-to-severe asthma. Methods: We conducted a cross-sectional study comparing active-smoker and nonsmoker subjects with uncontrolled moderate-to-severe asthma. Sociodemographic and clinical data were collected. FeNO levels and spirometry were measured. We obtained sputum and blood cell counts and measured the cotinine level. The clinical data were linked to 3 Québec administrative databases. RESULTS: A total of 40 active smokers and 39 nonsmokers were included. Uncontrolled asthmatic smokers and nonsmokers had the same clinical characteristics. Although, blood eosinophil counts were similar between groups, the number of subjects with a high sputum eosinophil count (> 10%) was higher in nonsmokers. Asthmatic smokers had lower levels of FeNO than nonsmoker asthmatics. The nonsmoker group showed a higher number of total asthma exacerbations (1.9 ± 0.7) than the smoker group (1.0 ± 1.2) (p < 0.01) in the year preceding their assessment. The annual costs related to asthma care tended to be higher in uncontrolled asthmatic nonsmokers (352.05 ± 813.45CAD) than in smokers (263.38 ± 684.00CAD), whereas the annual cost for health care of all causes tended to be lower in nonsmokers (1617.57 ± 1736.53 CAD) than in smokers (2575.07 ± 3453.30 CAD). INTERPRETATION: The clinical characteristics of uncontrolled moderate-to-severe active asthmatic smokers and nonsmokers were similar. Although the FeNO levels were profoundly affected by smoking, the impact of smoking on airway eosinophilic inflammation appeared marginal. CLINICAL TRIAL REGISTRATION: NCT02833727

Profiles of sensitization and comorbidity in asthma patients with markedly increased serum total IgE (>1000kU/L).

Background: Immunoglobulin E (IgE) plays an important role in asthma, but a few patients exhibit extremely high levels of serum total IgE. Objective: This study aimed to investigate the profiles of comorbidity and/or complications, severity, and sensitizations in patients with asthma and with a total IgE level > 1000 kU/L. Methods: We retrospectively analyzed 170 patients with asthma and with total IgE levels of >1000 kU/L from the inpatient data base. Available information, including age, gender, body mass index, diagnosis, results of routine blood tests, pulmonary function, fractional exhaled nitric oxide, induced sputum (if any), IgE (both total and specific) tests and medication records were analyzed. Results: In the study subjects, >80% were adults, and the average total IgE level was median (interquartile range) 1438 kU/L (1181-2255 kU/L). Approximately 15% of the subjects had at least one comorbidity and/or complication, and 78.82% of the subjects were positive for at least one allergen. Airway infections (44.71%) and rhinosinusitis (41.18%) accounted for the two most common conditions despite age groups. Total IgE levels did not differ among the subjects with different conditions. Overall, mites had the highest positive rate (59.4%). Serum total IgE levels were positively correlated with house-dust mite specific IgE (sIgE) levels (r = 0.23; p < 0.05), peripheral blood eosinophil counts (r = 0.21; p < 0.01), and the number of confirmed sIgE positivity (r = 0.19; p < 0.01), and optimal scaling analysis showed that asthma severity was associated with Aspergillus fumigatus sIgE levels. Conclusion: In the subjects with asthma and with a total IgE level of >1000 kU/L, the two most common conditions were airway infections and rhinosinusitis, despite sensitization. A. fumigatus sIgE levels were closely associated with total IgE levels and asthma severity.

Impact of body mass index on omalizumab response in adults with moderate-to-severe allergic asthma

BackgroundEffectiveness of asthma treatment, including biologics, may be different in patients with higher body mass index (BMI). ObjectiveTo evaluate response to omalizumab (dosed by serum immunoglobulin E level and weight) by BMI category. MethodsPooled data from 2 randomized, double-blind, placebo-controlled studies of adults with moderate-to-severe allergic asthma were analyzed by BMI category (<25 kg/m2 [normal or underweight], n = 397; 25 to <30 kg/m2 [overweight], n = 330; ≥ 30 kg/m2 [obese], n = 268). Placebo-adjusted exacerbation rate reductions were evaluated by Poisson regression modeling. Changes from baseline in forced expiratory volume in 1 second, beclomethasone dipropionate (BDP) dose, Total Asthma Symptom Score, and Asthma Quality of Life Questionnaire were evaluated by analysis of covariance. ResultsGreater placebo-adjusted exacerbation rate reductions (95% confidence interval) were observed with increasing BMI (normal or underweight, −37.4% [−69.0% to 26.8%]; overweight, −52.7% [−78.4% to 3.7%]; obese, −71.9% [−86.9% to −39.5%]). There were no differences in forced expiratory volume in 1 second improvement between BMI categories at week 16 (normal or underweight, 76.2 [5.3-147.1] mL; overweight, 98.1 [13.9-182.4] mL; obese, 69.1 [−18.9 to 157.2] mL). No differences in BDP dose reduction (µg) were noted between BMI categories (normal or underweight, 23.0 [15.7-30.3]; overweight, 22.5 [13.5-31.5]; obese, 16.6 [5.8-27.3]). Fewer patients in the higher BMI categories eliminated BDP use. There were trends for smaller improvements with higher BMI in Total Asthma Symptom Score (normal/underweight, −0.52 [−0.82 to −0.22]; overweight, −0.50 [−0.80 to −0.20]; obese, −0.39 [−0.77 to 0.00]) and Asthma Quality of Life Questionnaire (normal or underweight, 0.34 [0.16-0.52]; overweight, 0.34 [0.13-0.55]; obese, 0.15 [−0.08 to 0.39]). ConclusionOmalizumab provides benefit to patients with moderate-to-severe allergic asthma, regardless of BMI. Trial RegistrationStudies 008/009 were conducted before clinical trial registration was required, and therefore clinical trial registration numbers are not available.