Journal of Asthma最新文献

Objective: Social Determinants of Health (SDoH), encompassing economic, educational, medical, and environmental factors, are closely linked to respiratory health, yet their relationship with asthma diagnosis remains incompletely understood. This study explores the relationship between individual and cumulative SDoH and asthma prevalence, while investigating racial disparities in the association between SDoH and asthma risk.

Methods: Data on individual and cumulative SDoH and asthma diagnosis were obtained from self-reported survey questionnaires. Multivariable weighted logistic regression models were used to examine the relationship between individual and cumulative SDoH and asthma. Stratified analyses by sex and race/ethnicity were conducted, with additional adjustments for survey period, diabetes, hypertension, coronary heart disease, and total energy intake performed for sensitivity analyses.

Results: The study included 26,224 adults with a weighted mean age of 46.69 years. Employment status, poverty-to-income ratio, food security, regular health-care access, and marital status were found to be closely associated with asthma diagnosis. The risk of asthma increased with the accumulation of adverse SDoH, consistent with sensitivity analysis results. Compared to those with zero unfavorable SDoH, individuals with 6 or more adverse indicators had a significantly higher risk (AOR = 5.93, 95% CI: 3.11-11.31). As the cumulative number of adverse SDoH increases, there is a significant trend of heightened asthma prevalence among non-Hispanic black, non-Hispanic white, and other racial groups, whereas Hispanic Americans do not exhibit this trend.

Conclusions: Our research indicates that both individual and cumulative exposure to adverse SDoH are associated with asthma incidence and may contribute to racial disparities in the American population. To address asthma discrepancies and promote health equity, future primary prevention strategies must integrate interventions targeting social determinants of health.

Background: Biologic agents targeting airway inflammation improve symptoms and reduce corticosteroid use in severe asthma. Obesity is associated with more severe disease and greater corticosteroid dependence. However, data are limited on whether obesity modifies the clinical response to biologics.

Objective: To compare clinical outcomes of biologics in severe asthma patients with and without comorbid obesity.

Methods: We conducted a retrospective, single-center observational study of adults with severe asthma receiving biologics. Patients were classified by obesity status (BMI > 30 kg/m²). Baseline characteristics and outcomes at 6 months were compared, including proportion of patients experiencing at least one exacerbation, changes in weight and lung function, and biologic switching/discontinuation.

Results: Eighty-one patients were included (mean age 58 ± 17 years; mean BMI 28.1 ± 7.7 kg/m²), of whom 28 (34.5%) were obese. Obese patients had higher prevalence of obstructive sleep apnea (25% vs. 3.8%, p < 0.001) and more often received triple inhaled therapy (85.7% vs. 54.7%, p = 0.005). Baseline proportion of patients experiencing at least one exacerbation were similar between obese and non-obese patients (median 3 [IQR 1-3] vs. 2 (1-3), respectively; p = 0.356). At 6 months, the proportion of patients with at least one exacerbation was 28.6% in obese patients (8/28) and 20.8% in non-obese patients (11/53), with no significant difference between groups (OR 1.53, 95% CI 0.53-4.39; p = 0.431). Obese patients experienced modest but significant weight loss (p = 0.045). Biologic switching/discontinuation rates were similar.

Conclusions: Obesity did not significantly alter the clinical response to biologics in severe asthma, suggesting comparable efficacy across BMI categories.Further studies with deeper phenotyping are needed to optimize treatment strategies for this complex phenotype.

Background: Asthma-COPD overlap (ACO) lacks unified diagnostic criteria. We aimed to comprehensively phenotype ACO and identify independent predictors and inflammatory biomarkers.

Methods: In this cross-sectional, single-center study, 120 hospitalized patients were prospectively enrolled and classified into asthma (n = 40), ACO (n = 40), and COPD (n = 40) according to GINA 2023 and GOLD 2023 criteria. Demographics, lung function, fractional exhaled nitric oxide (FeNO), quantitative high-resolution computed tomography (HRCT) parameters, and systemic and airway inflammatory biomarkers were compared. Multivariable logistic regression was performed to identify independent predictors of ACO. A composite predictive score derived from eight variables was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: ACO patients demonstrated intermediate clinical, inflammatory, and structural characteristics between asthma and COPD. Multivariable analysis identified male sex, age, airway wall area percentage (WA%), pulmonary artery systolic pressure (PASP), FeNO, blood eosinophil count, serum IgE, and sputum eosinophil percentage as independent predictors of ACO. The combined predictive model showed excellent discriminative performance, with an area under the ROC curve (AUC) of 0.94 (95% CI 0.939-0.969, p < 0.001).

Conclusions: ACO exhibits a distinct intermediate inflammatory and structural phenotype. An integrated model combining clinical features, imaging metrics, and inflammatory biomarkers provides high diagnostic accuracy and may facilitate early identification and personalized anti-inflammatory treatment.

Objective: This study aimed to synthesize existing evidence comparing telemedicine with usual care and to examine the relative effectiveness of different telemedicine strategies in the management of asthma among adults.

Methods: A systematic search of MEDLINE/PubMed, Cochrane Library, Web of Science, and Scopus identified randomized clinical trials published from inception until March 16, 2025. Telemedicine interventions were categorized as case management, consultation, education, monitoring, reminding, or combined approaches. Outcomes included asthma control, quality of life (QoL), and medication adherence. Results were synthesized using network meta-analysis and expressed as standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs).

Results: Thirty-nine trials were included. Compared to usual care, asthma control improved significantly with combined strategies (N = 14; SMD:-0.55; 95%CI:-0.85, -0.25; p < 0.001), tele-education (N = 3; SMD:-0.62; 95%CI:-1.21, -0.02; p = 0.042), and tele-monitoring (N = 3; SMD:-1.20; 95%CI:-1.97, -0.42; p = 0.003). No significant benefit was found for case management, consultation, or reminder strategies. Based on SUCRA rankings, tele-monitoring, tele-education, and combined approaches were most effective for asthma control. For QoL, combined strategies showed a significant benefit over usual care (SMD:0.32; 95%CI:0.02, 0.62; p = 0.037). SUCRA rankings for QoL placed tele-education first, followed by tele-monitoring and combined strategies.

Conclusion: Telemedicine strategies, particularly monitoring, education, and combined approaches, improve asthma control and QoL in adults. However, heterogeneity in intervention design and limited reporting across outcomes suggest cautious interpretation and the need for further research before widespread clinical application.

Objective: Asthma with nasal polyps constitutes a distinct eosinophilic phenotype marked by inflammation and altered coagulation. This study aimed to compare systemic coagulation and fibrinolytic profiles in eosinophilic asthma with and without nasal polyps.

Methods: Seventy-two participants were enrolled: eosinophilic asthma with nasal polyps (n = 28), eosinophilic asthma without nasal polyps (n = 22), and age-, sex-, and body mass index-matched healthy controls (n = 22). To minimize confounding, participants were devoid of chronic comorbidities or medications affecting coagulation. Asthma patients were stable on maintenance corticosteroids. Blood eosinophil counts and hemostatic biomarkers [tissue plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1), α2-antiplasmin, D-dimer, fibrinogen, activated partial thromboplastin time (aPTT), international normalized ratio (INR), Factors V and VIII, and thrombin-antithrombin III complex (TAT)] were measured.

Results: Compared with controls, non-polyp asthma showed higher tPA and fibrinogen levels, whereas the nasal polyp subgroup exhibited shorter aPTT and higher PAI-1. TAT levels were significantly lower in the nasal polyp subgroup than in the non-polyp subgroup (p < 0.05). In the overall asthma group, eosinophils correlated negatively with Factor V and PAI-1. Distinctly, the nasal polyp subgroup showed the lowest aPTT and Factor VIII levels, with eosinophils positively correlating with Factor VIII (r = 0.638, p < 0.001).

Conclusion: Eosinophilic asthma with nasal polyps is characterized by distinct hemostatic alterations, including shorter aPTT, higher PAI-1, and lower TAT levels compared to the non-polyp phenotype. These findings suggest a specific link between type 2 inflammation and systemic hemostasis regulation in this subgroup.

Background: Asthma prevalence increases with age, yet assessment in elderly patients is often limited by difficulties in performing reliable spirometry. Alternative, noninvasive methods such as the Forced Oscillation Technique (FOT) and fractional exhaled nitric oxide (FeNO) measurement may improve evaluation of asthma control in this population.

Objective: To evaluate asthma control and treatment effectiveness in elderly patients using the Asthma Control Test (ACT), GINA classification, spirometry, FOT, and FeNO, and to compare their clinical usefulness.

Methods: A total of 105 patients aged ≥65 years with diagnosed bronchial asthma were enrolled. All participants completed the ACT and underwent spirometry (FEV₁, FVC, FEV₁/FVC), FOT (R5, R20, R5-R20, X5, AX), and FeNO measurement according to ATS/ERS recommendations. Treatment intensity was classified by GINA steps (1-5). Nonparametric tests and Spearman's rank correlation were used for statistical analysis.

Results: ACT scores correlated significantly with spirometric, oscillometric, and FeNO parameters. Lower ACT scores were associated with reduced FEV₁% predicted and increased airway resistance and reactance (R5, AX), as well as higher FeNO levels (all p < 0.001). Patients treated at higher GINA steps (4,5) exhibited poorer asthma control, higher FeNO, and less favorable FOT indices. Reductions in FeNO following treatment intensification were accompanied by improvements in FEV₁ and FOT parameters, particularly AX and R5-R20.

Conclusions: FOT provides a useful, noninvasive assessment of asthma control in elderly patients and complements spirometry. FeNO adds important information on airway inflammation and treatment response. Their combined use may enhance monitoring of asthma control when spirometry is limited.

Objective: To evaluate the effects of a combined training program on the control of asthma, physical fitness, and quality of life in asthmatic adolescents.

Methods: This is an intervention study that used combined resistance and aerobic training (36 sessions of 60 min each) in asthmatic adolescents. To assess the improvement in clinical control of asthma, the Asthma Control Test (ACT) was carried out weekly. Assessments of quality of life (Asthma Quality of Life Questionnaire - AQLQ), physical fitness (Sport Brazil Project-PROESP-BR), and body composition (Tetrapolar Bioimpedance) were performed, in addition to evaluations of respiratory variables. The diagnosis of Exercise-induced bronchospasm (EIB) was confirmed by a drop in FEV1 of 10% or greater compared to baseline at 5, 10, 15, and 30 min after the treadmill bronchoprovocation test.

Results: A total of 19 individuals (52.7% female) participated in the study, with a mean age of 15.2 ± 2.2 years. Patients with EIB presented an improvement of approximately 3 points on the ACT, and 4/12 no longer had EIB after the intervention. Increases in Forced Vital Capacity (p < 0.029) and respiratory muscle strength (p < 0.001), and improvements in physical fitness parameters, body composition, and quality of life (p < 0.001) were also observed in asthmatics.

Conclusion: Asthmatic adolescents undergoing a combined training program presented improvements in forced vital capacity, respiratory muscle strength, physical fitness, and quality of life. Furthermore, after 4 weeks of training, an improvement in asthma control was observed in people with EIB.

Objective: Children from Latino backgrounds face unique challenges in managing asthma. Barriers are compounded when children live in urban settings and are exposed to urban stressors (e.g. barriers to medication use, neighborhood stress). Asthma management in schools is often directly implicated. This study aims to address these gaps in care by developing a 4-session, peer-facilitated, culturally tailored asthma self-management group intervention in urban public-school settings.

Methods: We developed and tested the ASMAS (Asthma Self-Management in Schools) intervention, utilizing an iterative process guided by previous work and theoretical models. Feedback from focus groups was used to further tailor ASMAS. We enrolled 81 middle school students in a cross-site pilot randomized controlled trial (RCT) to evaluate the efficacy of ASMAS compared both to Attention Control and No-Treatment Control conditions. Outcomes included asthma control, asthma-related sleep disruption, school absences, asthma self-efficacy, and availability of rescue inhaler and asthma action plan (AAP) at school.

Results: Compared to Attention Control participants, youth who received ASMAS had improved asthma outcomes over time (baseline to end-of-treatment) including asthma control (t = 2.1, p<.05, d = .4, M_diff = 1.5), asthma-related sleep disruptions (t = -0.24, p <.05, d = -0.4, M_diff = -3.6), school absences (d = -0.2), asthma management self-efficacy (t = 2.3, p <.05, d = .4, M_diff = 0.3) and rates of AAP (t = 1.8, p = .06; d = .3, M_diff = 20%) and rescue inhalers availability (t = 2.0, p <.01, d = .7, M_diff = 23%). Similar patterns were maintained at 4-month follow-up.

Conclusions: Results demonstrate ASMAS' feasibility and highlight the potential benefits of the tailored asthma intervention. A full-scale RCT to evaluate ASMAS' effectiveness, implementation, and sustainability is warranted.

Objective: Asthma is a respiratory condition that causes lung dysfunction and inflammatory cell infiltration. Methylene blue (MB), a phenothiazinium, is an antioxidant and anti-inflammatory. It has been proposed as a treatment for numerous illnesses, but its asthma treatment efficacy remains untested. The study examined the protective and anti-inflammatory effects of MB on asthma.

Methods: A total of 32 female BALB/c mice aged 6-8 weeks were randomly assigned to four equal groups: control, OVA (model), MB (10 mg/kg), and MB (20 mg/kg). Mice received 25 µg OVA and 2 mg Al(OH)₃ gel intraperitoneally to develop asthma on days 0 and 7. After receiving the medication, all mouse groups except the control inhaled 5% OVA vaporized in phosphate buffer saline (PBS) for 60 min on days 14-16. From days 11 to 16, the treatment groups received intraperitoneal MB at 10 and 20 mg/kg. On day 17, mice were anesthetized, and bronchoalveolar lavage fluid (BALF) and blood samples were collected to assess leukocyte infiltration, histological alterations, oxidative stress, and T helper type 2 (Th2)-associated cytokines like IL-4, IL-13, and immunoglobulin E.

Results: MB significantly reduced histopathological alterations, oxidative stress biomarkers, and antioxidant levels by lowering malondialdehyde (MDA) and increasing glutathione (GSH) and glutathione peroxidase (GPx). The dose-dependent reduction in inflammatory cell infiltration and OVA-specific IgE was considerable. This study represents the inaugural examination of MB's immunomodulatory effects on allergic asthma in murine models.

Conclusion: These findings suggest that MB may serve as an anti-asthmatic agent by modulating oxidative stress and inflammation, representing a promising therapeutic approach for allergic asthma.