Journal of Asthma最新文献

Background: Asthma is a multifactorial disease affecting approximately 300 million people worldwide. Multiple genes, environmental risk factors, and their interactions have been associated with asthma. Smoking triggers an IL-17-mediated inflammatory response. The IL-17-related inflammatory response may differ between individuals, and this difference is associated with IL-17 polymorphisms.

Objective: Our aim was to investigate the effect of IL-17 polymorphism and its interaction with secondhand smoke on pediatric asthma.

Methods: The study comprised 100 pediatric asthma patients and 100 healthy children. Cotinine levels were analyzed to show SHS exposure (SHSe). A genetic study was conducted to reveal IL-17F(rs763780) and IL-17A (rs8193036, rs2275913) polymorphisms. The study participants were categorized into four groups based on the cotinine results: asthma with SHSe, asthma without SHSe, control with SHSe, and control without SHSe.

Results: The median cotinine concentration was 11.06 ng/ml. Children with asthma had lower cotinine levels than healthy children (p < 0.001). Genotype distributions and allele frequencies of rs763780, rs8193036, and rs2275913 were compared among the four groups, and no significant differences were found.

Conclusion: This study is the first to demonstrate the relationship between IL-17 polymorphisms and SHS interaction in childhood asthma. Neither the presence of IL-17 polymorphisms nor the interaction of these polymorphisms with SHS was found to be associated. The lower cotinine levels in asthmatic children suggest that parents are more susceptible to SHSe. Cotinine levels in our cohort were significantly greater than those found in developed countries. This demonstrates that exposure to SHS is still a serious environmental issue in our country.

Background: Chronic airway diseases such as asthma are often associated with psychiatric disorders like anxiety, depression, and posttraumatic stress disorder (PTSD), which occur 1.5-2.4 times more frequently in individuals with asthma. Despite this, these conditions are under-recognized. Various questionnaire-based screening tools exist for identifying these psychiatric conditions. This systematic review examines existing screening tools for asthma-related psychiatric conditions, evaluating their efficacy, effectiveness, and cost, with the goal of implementing them more broadly in clinical practice.

Data sources: A search was performed using the databases MEDLINE, EMBASE, SCOPUS, CINAHL, and Web of Science for all relevant studies published before July 25, 2024. Costs for clinical use and copyright/open access status were assessed through internet searches and/or direct communication. Original validation studies of the screening tools were also reviewed.

Study selection: A total of 23 studies were included for analysis. Eligible studies focused on screening anxiety disorders, depressive disorders and/or PTSD in individuals with asthma.

Results: Eight psychiatric screening tools were identified, each validated and effective in screening for their respective anxiety disorders, depressive disorders, and PTSD. These tools effectively screen for psychiatric disorders, including in undiagnosed populations. Three are available at no cost for clinical use, while five require a fee.

Conclusions: Considering multiple factors such as ease of administration, effectiveness, and cost, we recommend a combination of PHQ-9, GAD-7, and PCL-5 as screening tools for psychiatric comorbidity in primary care and specialty clinics managing adult asthma. Two of these tools are available in EMRs within Alberta.

Objective: Asthma is a chronic inflammatory airway disease characterized by airway inflammation and remodeling. Abnormal proliferation and migration of human airway smooth muscle cells (HASMCs), induced by platelet-derived growth factor BB (PDGF-BB), are associated with the occurrence and progression of asthma. In this study, we aim to investigate the expression and molecular mechanisms of stomatin-like protein-2 (STOML2) in airway remodeling in asthma.

Methods: PDGF-BB-stimulated HASMCs were used as the asthma cell model. STOML2 expression levels in the serum of patients with asthma and healthy controls were measured using qRT-PCR. Additionally, qRT-PCR and western blotting were used to measure STOML2, E-cadherin, and N-cadherin expression in HASMCs. Extracellular matrix components were detected by western blot assay. The viability and migration of HASMCs were analyzed using MTT and Transwell assays. Tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and IL-6 contents were evaluated using the corresponding kits. The key molecules of the p38 mitogen-activated protein kinase (p38 MAPK) pathway (p38 and p38) were determined using western blotting.

Results: Increased STOML2 expression was observed in both patients with asthma and PDGF-BB-treated HASMCs. STOML2 knockdown inhibits STOML2 expression in HASMCs. PDGF-BB induced proliferation, migration, extracellular matrix deposition, inflammatory responses, and p38 MAPK pathway activation in HASMCs. However, the opposite effects were observed following STOML2 knockdown or SB-203580 treatment, respectively. Furthermore, P79350 treatment reversed the effect of STOML2 knockdown.

Conclusions: Our results showed that silencing STOML2 inhibits inflammation and airway remodeling in PDGF-BB-stimulated HASMCs via the p38 MAPK pathway. Thus, STOML2 is a promising therapeutic target for the treatment of asthma.

Objective: Exposure to tobacco smoke is a major risk factor for poor asthma control. We aimed to assess the response to asthma treatment based on patients' smoking status.

Methods: This post hoc analysis used data from a large prospective asthma cohort treated with inhaled extrafine beclomethasone/formoterol. Patients were retrospectively categorized as current smokers, former smokers, or nonsmokers. Asthma control and symptom severity were evaluated over 6 months using Global Initiative for Asthma (GINA) criteria. The primary outcome was the proportion of patients who achieved an improved GINA category of asthma control, while the secondary outcome was the proportion with well-controlled asthma. To account for baseline differences, the cohorts were propensity score-matched (1:1:1) based on age, sex, body mass index, self-reported physical activity, education level, and FEV₁.

Results: From an initial cohort of 17 098 patients, a matched sample of 2856 (952 per group) was selected, ensuring comparable baseline characteristics. After 6 months, an improved GINA category was observed in 78% of current smokers, 75% of former smokers, and 77% of nonsmokers (p = 0.381). The rates of well-controlled asthma were comparable across groups (current smokers: 58%, former smokers: 54%; nonsmokers: 57%, p = 0.255). Uncontrolled asthma remained infrequent but was more prevalent in current (10%) and former (8.9%) smokers than in nonsmokers (5.7%) (p = 0.002 and p = 0.033, respectively).

Conclusions: Asthma patients, regardless of smoking status, demonstrate a similar response to treatment. Uncontrolled asthma, though rare under treatment, is more common among smokers, due to their higher baseline severity.

Objective: To evaluate the effects of treatment with nebulized budesonide inhalation suspension (BIS) at dosages of 500 µg/day and 250 µg/day on mild to moderate asthma in young children.

Methods: This was a randomized, parallel group, open-label study at 19 Chinese clinical sites. A total of 340 patients (4-7 years) with mild to moderate persistent pediatric asthma were randomly and evenly divided into the 500-µg group (BIS 500 µg/day) and the 250-µg group (BIS 250 µg/day); 323 patients completed the study. The Children-Asthma Control Test (C-ACT), asthma control, Pediatric Asthma Quality of Life Questionnaire (PAQLQ), pulmonary function tests (PFT), additional asthma-related therapy, and adverse effects (AEs) were compared after 1, 3, and 6 months of treatment between groups.

Results: There were no statistically significant differences in C-ACT scores, level of asthma control, PAQLQ scores, PFT parameters, additional medications and AE occurrences from baseline to 6 months post-treatment between the two groups (all p > 0.05). Compared with baseline values, both groups showed improvements in C-ACT and PAQLQ scores, the rate of well-controlled asthma, and PFT parameters (all p < 0.05). The cumulative number of unplanned outpatient visits (50 vs. 49) and hospitalizations (3 vs. 0) in the 250-µg group was higher than that in the 500-µg group (p < 0.05).

Conclusions: The lower dosage of 250 µg/day BIS was found to be as effective as 500 µg/day BIS. For young children with mild to moderate persistent asthma who have well-controlled, a lower dose of BIS treatment can be chosen.

Introduction: A large proportion of women with asthma experience worsening of asthma during pregnancy. Well-controlled asthma during pregnancy decreases the risk of maternal and fetal complications. Long-acting muscarinic antagonists (LAMAs) are part of treatment guidelines for poorly controlled asthma. There are no clinical safety data available on LAMA and short-acting muscarinic antagonists (SAMAs) use in pregnancy.Objective: The aim was to evaluate asthma control and pregnancy outcomes in pregnant women with asthma using muscarinic antagonists.Methods: A prospective observational cohort of pregnant women with asthma referred to the asthma pregnancy outpatient clinic of the Haga Hospital, between 2018 and 2023, was obtained and retrospectively analyzed. Women using muscarinic antagonists were included. Outcomes were asthma control, asthma exacerbations and pregnancy outcomes.

Results: Fourteen (8.9%) of 158 recruited pregnant women used muscarinic antagonists. Most women had poor asthma control with a mean (±SD) Asthma Control Questionnaire (ACQ) score of 2.4 (±1.3). Six (43%) women experienced an asthma exacerbation. One woman using LAMA throughout pregnancy had pre-eclampsia resulting in preterm birth, low birth weight and neonatal hospitalization. Another child was born with low birth weight and was small for gestational age. Two women developed maternal fever.Conclusions: A minority of women with asthma used muscarinic antagonists during pregnancy. Despite the use of muscarinic antagonists, asthma control remained poor during pregnancy. There were no major adverse pregnancy outcomes or congenital malformations in this case series. Since well-controlled asthma during pregnancy leads to fewer complications, pregnant woman with poorly controlled asthma on inhaled corticosteroid (ICS)/long-acting beta-2-agonist (LABA) should be encouraged to continue add-on asthma medication.

Objective: To explore and understand the barriers and facilitators for correctly using maintenance/controller and rescue treatments in adults with mild to moderate asthma (GINA 2020 classification) attending a reference center for asthma in Bogotá, Colombia, during the years 2021-2022.

Methods: A qualitative study with a phenomenological approach using semi-structured interviews with adults with mild to moderate asthma, under a purposive non-probabilistic sampling. Data analysis was conducted using Nvivo software (Version 11.0) through: reading and re-reading, memo generation, coding, category generation, and connection between categories.

Results: Thirty-one patients were interviewed (mean age: 44.3 years) with a 1:1 male/female ratio. 77.4% with moderate asthma. Patients' experiences were grouped into three themes with 12 categories: barriers related to the individual (inadequate knowledge about maintenance inhalers, insufficient understanding of their current state due to lack of information, disagreement in treatment among non-adherent patients, and difficulties in implementation and practical application), barriers related to the healthcare system (lack of follow-up, medication availability, administrative procedures, and waiting times), and patient-related facilitators (adequate knowledge of the functioning and correct use of inhalers for treatment, proactive attitude, and motivation to receive information).

Conclusion: Based on the identified barriers, educating patients about the pathophysiological mechanisms of asthma (inflammation and bronchodilation) and the concept of control adapted to the patient's language could facilitate the appropriate and adherent use of pharmacological therapy.

Background: Preserved ratio impaired spirometry (PRISm) is associated with asthma. However, it is unclear whether PRISm increases the risk of mortality in non-smoking asthma patients compared with normal spirometry.

Methods: This prospective cohort study included 748 adult asthma participants with no smoking history and no airflow obstruction at baseline. Participants were divided into two groups: normal spirometry (FEV₁ ≥ 80% predicted) and PRISm (FEV₁ < 80% predicted). The median follow-up time was 9.6 years. Multivariable Cox regression analyses and Kaplan-Meier survival were used to assess the association between PRISm and all-cause mortality. All analyses took into account the complex survey design.

Results: At baseline, 8.52% of participants exhibited PRISm. Multivariable Cox regression analysis showed that PRISm was independently associated with all-cause mortality after adjusting for confounding factors (adjusted hazard ratio = 6.57, 95% CI: 2.33-18.47, p < 0.001). Kaplan-Meier survival analysis showed that the survival rate in the PRISm group was significantly worse than that in the normal spirometry group (log-rank test p = 0.006). In a sensitivity analysis excluding participants with possible restrictive spirometry, this association remained with almost the same effect size (adjusted hazard ratio = 6.99, 95% CI: 1.67-29.29, p = 0.008).

Conclusions: In asthma patients with no smoking history and no airflow obstruction at baseline, PRISm was significantly associated with an increased risk of all-cause mortality during follow-up. However, this result needs to be interpreted with caution due to the wide confidence intervals.

Objective: Small airway dysfunction (SAD) is a common feature of bronchial asthma. However, its association with asthma phenotypes remains poorly understood. This study aimed to assess the prevalence of oscillometry-defined SAD in steroid-naïve adult bronchial asthma and to explore its association with asthma phenotypes based on peripheral blood eosinophil count (BEC).

Methods: A total of 320 consecutive cases of bronchial asthma patients were enrolled. The severity of impairment in oscillometry parameters was expressed in z-scores. SAD in oscillometry was defined as R5-19 > upper limit of normal and/or X5 < lower limit of normal. The cohort was categorized into eosinophilic asthma (EA) and non-eosinophilic asthma (NEA) using a BEC cutoff of 300 cells/µL.

Results: The mean age of the cohort was 37.5 ± 12.5 years, and 58.1% were male. The median BEC was 350 cells/µL. The mean FEV₁ was 66.7 ± 18.4 %predicted. Oscillometry-defined SAD was observed in 54.4% (95% CI: 48.1-59.4). Patients with SAD exhibited significantly lower spirometric indices compared to those without SAD. The proportion of EA was 58.4% (95% CI: 53.4-64.7). Spirometric parameters did not differ significantly between the EA and NEA. The severity of impairment in R5 and X5 was less in EA compared to NEA, though the difference was not statistically significant. The proportion of impaired R5-19 was significantly less in EA than NEA (47.6% vs. 57.9%; p = .04).

Conclusions: Half of steroid-naïve bronchial asthma patients exhibited SAD at the time of diagnosis. NEA phenotypes are associated with higher impairment in oscillometry.

Objective: The prevalence of comorbidities in patients with uncontrolled asthma ranges from 33.0 to 70.0%. Given this statistic, the main objective of our research focused on adolescents with asthma to determine the relationship between sedentary lifestyle, parental smoking, consumption of alcoholic beverages, intake of foods rich in carbohydrates, and poor oral hygiene with the development of comorbidities. Identifying factors associated with comorbidities in adolescents could help establish measures that facilitate control and limit the development of severe or difficult-to-manage asthma. Methods: In this cross-sectional study, information from 1,178 adolescents was analyzed. Participants answered a self-administered questionnaire and received both a physical and dental examination.

Results: A total of 126 adolescents were diagnosed with asthma. Of this group, the prevalence of allergic rhinitis was 57.1%, drug allergy was 17.5%, dental caries were detected in 69.8%, and gingivitis was detected in 36.5%. Approximately 28.6% of the young people with asthma were overweight, and 11.1% were obese. A multivariate logistic regression analysis found that living in a household with parents who smoke, having a sedentary lifestyle, or inadequate oral hygiene with tooth decay or gingivitis are significantly (p < 0.05) associated with the development of some comorbidities in adolescents with asthma.

Conclusions: Early detection of factors related to comorbidities in patients with asthma can help control respiratory symptoms and limit their progression to severe or uncontrolled asthma. For adolescents suffering from asthma, these findings can be used to promote a healthy lifestyle, by encouraging behaviors, such as healthy eating and adequate physical activity.