Journal of Asthma最新文献

Objective: Severe asthma presents significant management challenges, often requiring advanced treatments to control symptoms and reduce exacerbations. The use of monoclonal antibodies has revolutionized the clinical course of patients with severe asthma, showing a significant impact on exacerbations reduction, oral corticosteroids (OCS) cessation and on the improvement of lung function and quality of life. Tezepelumab, an anti-thymic stromal lymphopoietin (TSLP) monoclonal antibody, has emerged as a potential therapeutic option for these patients.

Methods: We conducted an observational, prospective, multicenter study including 20 patients with confirmed severe asthma according to ERS guidelines and GINA recommendations. Patients received Tezepelumab 210 mg every 4 wk due to uncontrolled asthma despite maximal inhalation treatment with ICS/LABA. Data were collected before treatment initiation (T0) and after three months from the first administration (T3).

Results: After three months of Tezepelumab treatment, we reported significant improvements in asthma symptoms and quality of life, as well as a consistent reduction in exacerbations and OCS use. We found no statistically meaningful differences among main clinical and functional outcomes according to inflammatory biomarkers, while lung function improved significantly in patients with less allergic sensitization. No serious adverse event was reported during the follow up, while the rates of mild adverse effects were comparable to those from registration trials.

Conclusion: Tezepelumab demonstrated short-term efficacy in improving asthma control and quality of life, showing a favorable safety profile. Further studies with larger sample sizes and longer follow-up would confirm these findings and identify predictors of response to Tezepelumab.

Objective: Existing research suggests that emotion plays an important role in airway inflammation and asthma symptom control. The objective of this study was to determine whether difficulties regulating emotion were associated with overuse of short-acting inhaled medications and acute medical care usage in adults with asthma.

Methods: The sample included 401 adults with asthma recruited from an online panel of adults with chronic respiratory disease. Sequential binary logistic regression models were used to examine the associations of emotion regulation with short-acting inhaled medication use and acute medical care use, controlling for patient characteristics and comorbid mental health conditions.

Results: Greater difficulties with emotion regulation were significantly associated with greater odds of short-acting inhaler medication overuse (p < 0.001), emergency department visits (p < 0.001), and hospitalizations (p = 0.001).

Conclusions: Emotion dysregulation may play an important role in asthma management. Evidence-based interventions to reduce difficulties in emotion regulation may help improve problematic patterns of short-acting medication overuse and acute service use. The current findings should be interpreted in the context of several limitations, including the use of self-report measures. Future research should use electronic medical records or metered dose inhalers to objectively assess short-acting inhaler overuse and acute medical care use.

Objective: To evaluate the feasibility of a novel intervention of health literacy-informed, telemedicine-enhanced asthma education and home management support for hospitalized children and caregivers, and assess caregiver perspectives of the intervention.

Methods: We conducted a pilot randomized trial of the Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) intervention vs. standardized care (SC) for children (5-13 yrs) hospitalized with asthma. Participants in TEACHH received health literacy-informed teaching prior to discharge, including pictorial materials (e.g. flipchart, action plan), color- and shape-coded medication labels, and medication demonstration. Two Zoom-based follow-up teaching visits were completed within 1-month of discharge. Feasibility was assessed by tracking visit completion, and we measured preliminary outcomes using health records (i.e. total asthma-related acute healthcare visits) and blinded surveys of caregivers 2-, 4-, and 6-months post-discharge (i.e. symptom-free days, quality of life). We interviewed caregivers about their perceptions of TEACHH. Transcripts were coded inductively.

Results: We enrolled 26 children and interviewed 14 caregivers (9 TEACHH, 5 SC). All inpatient sessions were completed, as were 77% of virtual visits. Both groups experienced improved symptoms and quality of life over time. Caregivers valued the teaching, involvement of children, visual tools, and color-coded information of TEACHH. They described child-specific benefits, greater support after discharge, and improved asthma-related communication, and indicated that other families would benefit from similar teaching.

Conclusions: A novel program of patient-centered asthma education was feasible in both hospital and home settings and well received by caregivers. A larger study is needed to assess the impact of TEACHH on childhood asthma morbidity.

Clinicaltrials.gov identifier: NCT04995692 (Registration date 8/9/2021).

Background: Severe asthma, which differs significantly from typical asthma, involves specific molecular biomarkers that enhance our understanding and diagnostic capabilities. The objective of this study is to assess the biological processes underlying severe asthma and to detect key molecular biomarkers.

Methods: We used Weighted Gene Co-Expression Network Analysis (WGCNA) to detect hub genes in the GSE143303 dataset and indicated their functions and regulatory mechanisms using Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and Gene Ontology (GO) annotations. In the GSE147878 dataset, we used Gene Set Enrichment Analysis (GSEA) to determine the regulatory directions of gene sets. We detected differentially expressed genes in the GSE143303 and GSE64913 datasets, constructed a Least Absolute Shrinkage and Selection Operator (LASSO) regression model, and validated the model using the GSE147878 dataset and real-time quantitative PCR (RT-qPCR) to confirm the molecular biomarkers.

Results: Using WGCNA, we discovered modules that were strongly correlated with clinical features, specifically the purple module (r = 0.53) and the midnight blue module (r = -0.65). The hub genes within these modules were enriched in pathways related to mitochondrial function and oxidative phosphorylation. GSEA in the GSE147878 dataset revealed significant enrichment of upregulated gene sets associated with oxidative phosphorylation and downregulated gene sets related to asthma. We discovered 12 commonly regulated genes in the GSE143303 and GSE64913 datasets and developed a LASSO regression model. The model corresponding to lambda.min selected nine genes, including TFCP2L1, KRT6A, FCER1A, and CCL5, which demonstrated predictive value. These genes were significantly upregulated or under expressed in severe asthma, as validated by RT-qPCR.

Conclusion: Mitochondrial abnormalities affecting oxidative phosphorylation play a critical role in severe asthma. Key molecular biomarkers like TFCP2L1, KRT6A, FCER1A, and CCL5, are essential for detecting severe asthma. This research significantly enhances the understanding and diagnosis of severe asthma.

Objective: The study objective was to investigate the factors associated with the physical and psychological wellness of United States (US) adults with asthma.Methods: This cross-sectional analysis used a sample of 2329 US adults with asthma in the 2021 Medical Expenditure Panel Survey data. A logistic regression model investigated the association of the following factors and the dependent variables (physical wellness and psychological wellness): age, sex, race, ethnicity, education, employment, healthcare provision, marriage, income, regular physical activity, current smoker, pain, and limitations. Nationally representative estimates were produced through a weighted analysis. The data structure was maintained using cluster and strata variables. The alpha limit was 0.05.Results: Factors associated with higher odds of reporting good physical wellness included: private (versus no) healthcare provision (odds ratio [OR] = 2.63, 95% confidence interval [CI] = 1.10-6.26), good (versus poor) psychological wellness (OR = 6.83, 95% CI = 4.35-10.72), regular (versus no regular) physical activity (OR = 2.18, 95% CI = 1.42-3.34), little/moderate (versus quite a bit/extreme) pain (OR = 3.51, 95% CI = 2.38-5.15) and no (versus any) limitation (OR = 3.73, 95% CI = 2.30-6.06). In the psychological wellness model, those aged ≥70 (OR = 6.18, 95% CI = 2.72-14.07), 60-69 (OR = 4.64, 95% CI = 2.13-10.10), and 50-59 (OR = 4.96, 95% CI = 2.24-11.02) versus those aged 18-29, and good (versus poor) physical wellness (OR = 6.89, 95% CI = 4.34-10.94) were associated with higher odds of reporting good versus poor psychological wellness.Conclusion: These results may be helpful at targeting resources to optimize the wellness of US adults with asthma. Additional studies are needed to determine any temporal associations between these findings.

Objective: The aim of the present study was to determine the cost-utility of single inhaler combination inhaled corticosteroid and a long-acting β2-agonist (ICS/LABAs) as both maintenance and reliever (SMART) compared with a step-up maintenance treatment with a fixed medium to high dose of ICS combined with LABA and a short-acting β2-agonist (SABA) as reliever (ICS-LABA maintenance plus SABA) among patients aged 12 years or more with poorly controlled asthma in Colombia.

Methods: A Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The main effectiveness data were obtained from a recent meta-analysis. The main outcome was the variable ''quality-adjusted life-years'' (QALYs).

Results: The base-case analysis showed that the budesonide/formoterol (BUD/FORM) SMART strategy was associated with lower overall treatment costs (US $3,062.37 vs. $4,462.02 average cost per patient over 12 months) and the greatest gain in QALYs (0.8511 vs. 0.8258 QALYs on average per patient over 12 months) compared with ICS-LABA maintenance plus SABA at step 4, thus leading to dominance.

Conclusions: In patients aged 12 years or more with uncontrolled asthma at GINA step 3 or 4, the BUD/FORM SMART strategy at either step 3 or 4 is cost-effective compared with the ICS-LABA maintenance plus SABA at step 4 strategy, because it shows a greater gain in QALYs at lower total treatment costs.

Objective: A qualitative data analysis was conducted to better understand experiences of asthma exacerbation among school staff through thematic analysis of stories of children in respiratory distress.

Methods: Qualitative thematic analysis was performed on 40 virtual or in-person interviews conducted with 44 staff from districts participating in a stock inhaler pilot program. Transcripts were iteratively coded by five coders. Stories of instances when a stock inhaler may have been helpful were subject to additional thematic analysis by one coder.

Results: Forty-five stories across 27 interviews were identified. Major themes were split into "Provocation" and "Outcomes of Asthma Incident." "Educational and Communication Factors" in asthma exacerbations were discussed more often than environmental ones. Outcomes were divided into "Disposition" (with 14 participants choosing to describe incidents where emergency services were contacted), "Emotional Response," and "School Response." "Trauma for Students" was mentioned only by school nurses.

Conclusions: Stock inhaler programming can alleviate helplessness, reduce trauma, and avoid costly hospital visits. Personal narratives can be a powerful tool for understanding unique needs and developing tailored, sustainable interventions for individual districts. These stories are incredibly persuasive in convincing other schools, districts, lawmakers, and other stakeholders to implement stock inhaler programming.

Objective: This meta-analysis aims to evaluate the efficacy and safety of montelukast combined with levocetirizine in the treatment of allergic rhinitis with asthma, and to provide objective and effective evidence-based medical evidence for clinical use.

Data sources: PubMed, Web of Science, Cochrane Library, WANFANG DATA, CNKI, and Chinese BioMedical Literature Database were retrieved to identify records related to montelukast combined with levocetirizine in the treatment of allergic rhinitis with asthma.

Study selections: First, the eligibility criteria were employed to screen search results. Then, two investigators independently assessed titles, abstracts, and the full text of all retrieved references to identify potentially eligible studies.

Results: As of 2024-02-03, a total of six articles were included in this meta-analysis, covering 2,950 patients with allergic rhinitis with asthma. The meta-analysis results exhibited a pooled NSS of -1.28 (95%CI: -1.64 to -0.92), suggesting that the combination of montelukast and levocetirizine was effective in the treatment of nasal symptoms of allergic rhinitis complicated with asthma. The meta-analysis of controlled trials showed that the SMD of NSS in the group of montelukast combined with levocetirizine was -2.56 (95%CI: -2.77 to -2.35). The result indicated that compared with the control group, the combination of montelukast with levocetirizine significantly improved the symptoms of allergic rhinitis.

Conclusion: In summary, this meta-analysis demonstrated the efficacy of montelukast combined with levocetirizine in the treatment of nasal symptoms in AR with asthma, indicating that the combination of montelukast with levocetirizine is more effective in improving symptoms of allergic rhinitis than monotherapy and has good safety.

Objective: To elucidate the fundamental principles of single-cell RNA sequencing (scRNA-seq) and summarize its application in asthma research, aiming to enhance understanding of asthma pathophysiology and guide future research directions.Datasource:Recent advances and emerging research in scRNA-seq and its role in the pathogenesis of asthma.Study Selections:This review incorporates studies that analyzed the heterogeneity of asthma cell types and their functional states using scRNA-seq, with particular emphasis on immune cells and airway remodeling. The selection of specific cell types and markers was based on their relevance to asthma pathogenesis, and we discuss the rationale for favoring certain scRNA-seq technologies in these investigations.

Results: ScRNA-seq technology has provided insights into the key mechanisms underlying inflammation and airway remodeling in asthma. It has uncovered the diversity of immune cell subtypes and their specific roles in asthma pathogenesis, revealing critical pathways that contribute to disease progression. These findings offer a theoretical foundation for the development of targeted therapeutic strategies, paving the way for personalized medicine and improved patient outcomes.

Conclusion: ScRNA-seq reveals the complex heterogeneity and functional roles of immune cells in asthma, offering key insights into disease mechanisms and the potential for targeted therapies. However, challenges remain, such as the need for further refinement of data integration methods and addressing the limited clinical applicability of current findings. Future research should focus on overcoming these limitations, improving cell type annotation, and expanding studies to include longitudinal and clinical data to better understand disease dynamics and therapy responses.

Objective: Peripheral perfusion index (PI) is non-invasive method measuring peripheral blood volume in numerical form and indicating perfusion status. In this study, we have investigated whether the relationship between the measurements of PI and definition of bronchial asthma exacerbation classification and treatment.

Methods: This prospective study included in aged 5-12 years children applied to the hospital between January 2020 and June 2020. They were divided into two groups as patients who presented bronchial asthma symptoms and the control group who were selected as children applied to the hospital for routine healthy child follow-up. The severity of the asthma exacerbations was evaluated. Before administering nebulizer therapy, vital signs, oxygen hemoglobin saturation and PI values were recorded. Appropriate nebulizer treatment was initiated for the severity of exacerbation and subsequent changes in the PI values were recorded.

Results: Pretreatment PI values were higher in children with asthma than those in healthy children (p = 0.001). The PI measurements of the patients for diagnosing asthma exacerbation showed a statistically significant area under the ROC curve (p = 0.001), and AUC (0.842) values of the 2.25 cut-off point of the PI value were sufficiently high. In the ROC analysis conducted to determine the need for hospitalization in patients presented with asthma exacerbations, the area under the curve was statistically significant (p = 0.020), and AUC (0.830) values of the 3.25 cut-off point of the PI value were sufficiently high.

Conclusions: The PI measured in patients presented with asthma symptoms may use a valuable parameter for the diagnosing of asthma exacerbations and making hospitalization decisions.