Journal of Asthma最新文献

Objective: The obese-asthma phenotype has gradually increased in the last few years. We aimed to assess the differences between obese and non-obese patients with asthma.

Methods: This research is a subanalysis of the Turkish Adult Asthma Registry (TAAR). Clinical presentation, disease control, severity, and demographics of obese and non-obese (normal-weight, overweight) patients were compared.

Results: The obesity rate in TAAR was 32.2% (n = 619/1919; 18-83 years; 527 F/92 M). Patients with asthma and obesity had higher rates of childhood obesity, longer symptom duration, later onset of asthma, and more severe asthma. These patients were more likely to be female, older, less educated, and live in rural areas. Patients with obesity had more scheduled visits and emergency visits compared with non-obese patients, but similar asthma control, oral corticosteroid use, hospitalizations, intensive care unit admissions, and unscheduled visits. They also had a higher frequency of T2-high but lower frequency of possible T2-low phenotypes compared with normal-weight asthmatics. The risk of severe asthma in patients with obesity was 6.04 times higher for allergic than non-allergic patients and 3.58 times higher for the T2-high phenotype than for possible T2-low phenotypes. A one-unit increase in the asthma control test reduced the risk of severe asthma by 22%.

Conclusions: A good definition of this phenotype is important to ensure that appropriate treatment strategies are implemented to achieve the control goal. We also believe that prevention of childhood obesity is an effective and pivotal strategy to achieve the goal of asthma control.

ObjectiveOral corticosteroids (OCS) are used to treat uncontrolled asthma, either as short rescue courses of treatment for severe disease exacerbations, or as long-term maintenance therapy in addition to other controller medications. Although the adverse events (AEs) associated with OCS are well understood by healthcare professionals (HCPs), the patient's perspective may be underappreciated. This review discusses the patient perspective on OCS use.Data sourcesA PubMed literature review was performed.Study selectionArticles were selected to include those primarily containing data on patient perspectives on OCS use in asthma or other airway diseases, including qualitative and quantitative studies. Articles including only clinical data and those primarily focused on another indication were excluded. Additional articles meeting the criteria were permitted based on author knowledge and the bibliographies of systematic reviews on other topics.Results6066 articles were identified from the PubMed search; 111 were assessed more closely for eligibility. Fourteen articles were eventually selected by the reviewers for inclusion and confirmed by all authors. Several key themes were identified: 1. Key AEs were prominently reported by patients (including weight gain, skin thinning, known osteoporosis/osteopenia, and sleep/mood disturbances); 2. Impact of OCS on day-to-day lives; 3. Patient perceptions of OCS; 4. Effect of perceptions on treatment adherence.ConclusionHCPs should consider the impact that OCS have on their patients' wellbeing, including short courses. It is essential for HCPs to discuss the short and long-term risks of OCS with patients prior to initiation of treatment and consider alternatives for patients on long-term OCS.

Objective: Around 7.7% of Americans have asthma, including 20.2 million adults and 4.6 million children. This study examines asthma mortality trends and disparities across U.S. demographic and geographic groups from 1999 to 2020.

Methods: A retrospective analysis was conducted using the CDC WONDER database to examine asthma-related deaths in the U.S. from 1999 to 2020. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 were calculated. Trends and annual percent changes (APCs) were assessed overall and stratified by sex, race, region, and age.

Results: From 1999 to 2020, the U.S. recorded 221 161 asthma-related deaths (AAMR: 3.07), mostly in medical facilities. Mortality declined from 1999 to 2018 (APC: -1.53%) but surged from 2018 to 2020 (APC: 28.63%). Females, NH Blacks, and NH American Indians had the highest mortality rates. Older adults (≥65) had the greatest burden, with younger groups showing notable increases post-2018. Rural areas and the West reported slightly higher rates than urban and other regions. Hawaii and the District of Columbia had the highest AAMRs, while Florida and Nevada had the lowest.

Conclusion: Asthma-related mortality in the U.S. declined until 2018 but sharply increased from 2018 to 2020, with rises across all demographic groups, regions, and settings. Females, NH Blacks, and older adults consistently had higher mortality rates, while younger age groups showed recent alarming increases. Targeted interventions are urgently needed to address inequities and recent mortality surges.

Background: Both depression and asthma have a significant impact on the quality of life for individuals. Studies have shown that patients with depression often experience comorbid asthma; however, the precise relationship between these two conditions remains unclear. The objective of this study is to investigate the causal relationship between depression and asthma.

Methods: In a cross-sectional study, we utilized data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 and employed logistic regression to assess the correlation between depression and asthma. In the subsequent Mendelian randomization (MR) analysis, we selected single nucleotide polymorphisms (SNPs) closely linked to both depression and asthma as instrumental variables, based on summary data from genome-wide association studies (GWAS). The inverse variance weighted method (IVW) was then applied to ascertain the causal relationship between depression and asthma.

Results: Based on the results of the cross-sectional study, it was found that the status of depression was significantly associated with a higher risk of asthma (OR = 2.15, 95%CI = 1.79 ∼ 2.59, p < 0.001). Furthermore, in the MR analysis, a causal relationship was further identified between depression, severe depression, and the increased incidence of asthma (OR = 1.11, 95%CI = 1.05 ∼ 1.18, p < 0.001), (OR = 1.01, 95%CI = 1.01 ∼ 1.02, p < 0.001); the results of the reverse MR analysis indicated no causal relationship between asthma and the increased incidence of depression and severe depression (OR = 1.01, 95%CI0.99 ∼ 1.03, p = 0.50), (OR = 1.07, 95%CI: 0.82 ∼ 1.40, p = 0.64).

Conclusion: This study has revealed a causal relationship between depression and an increased risk of developing asthma, offering new insights for the clinical intervention of both asthma and depression.

Objective: The significance of measuring Fractional Exhaled Nitric Oxide (FeNO) has grown, particularly in monitoring respiratory diseases like asthma. FeNO levels indicate inflammation and a rise in response to respiratory irritants. This study investigates whether repeated exposure to irritants in metal casting and coating leads to respiratory inflammation and assesses the benefits of including FeNO measurement in periodic occupational health screenings.

Methods: This cross-sectional study involved 99 workers aged 18-65 in the foundry and metal coating sectors in the İkitelli Organized Industrial Zone. The study group included 54 workers exposed to metal dust and fumes, while the control group comprised 45 workers in non-exposure roles (e.g. secretarial, assembly, packaging). Data were collected through face-to-face interviews, recording demographics, smoking habits, symptoms. FeNO levels were measured and analyzed with pulmonary function test parameters.

Results: FeNO levels were significantly higher in the study group compared to the control group (p = 0.02). No significant relationships were found between FeNO levels and age, height, weight, BMI, waist circumference, years of work, or symptom presence, but a significant negative correlation was observed between FeNO levels and FEV1/FVC. Additionally, current smokers had significantly lower FeNO levels compared to those who had quit or never smoked (study, p = 0.014; control, p = 0.011).

Conclusions: Monitoring FeNO levels in occupational health assessments may facilitate early intervention and preventive measures, protecting worker health. Incorporating FeNO measurement into periodic screenings could enhance occupational health practices.

Background: Viral infections constitute a primary trigger for asthma exacerbations. While vaccines protect against viral infections by eliciting a Th1 immune response, the impact of the asthmatic immune milieu which is characterized by Th2 cytokine dominance and elevated IgE levels on post-vaccination antibody production remains elusive. Therefore, vaccination protocols tailored to asthma patients need to be formulated.

Methods: The levels of IgG specific for SARS-CoV-2 S protein were measured in the sera of vaccinated and unvaccinated individuals by ELISA. The differences in antibody titers between asthma patients and healthy controls, as well as among distinct asthma subgroups were analyzed.

Results: The vaccinated individuals had significantly elevated serum antibody levels compared to their unvaccinated counterparts. There were no significant differences in the antibody titers of asthma patients and healthy controls after completion of the three-dose vaccination regimen. Furthermore, no discernible variations in antibody titers were detected among the asthma subgroups.

Conclusion: Asthma patients can safely adhere to the same vaccination strategies as the general healthy population, negating the need for any specialized vaccination protocols based solely on the asthmatic immune landscape.

Objective: Asthma and severe asthma are problems affecting all age groups, but asthma is frequently undiagnosed in the elderly, due to the poor perception of airflow limitation, lack of fitness, and presence of multiple comorbidities. Even so, the proportion of patients with severe asthma aged ≥65 is significant, and data on efficacy of asthma medications in the elderly are sometimes limited. We report here the effectiveness and safety of mepolizumab (an IL-5 inhibitor) in elderly (≥65 years) patients.

Methods: The REDES study was an observational, multicenter study of the effectiveness and safety of mepolizumab 100 mg SC every 4 weeks in 318 severe asthma patients in Spain. This post-hoc analysis compares the effectiveness and safety of patients ≥65 years old to patients <65 years after 12 months of mepolizumab treatment.

Results: 27% of patients were ≥65 years old, compared with 73% of patients <65 years. Elderly patients showed a trend toward less frequent comorbid nasal polyps (p = 0.06) and a lower proportion of atopic sensitization (as detected by prick test or specific IgE) (p = 0.02). Similar improvements were noted in ACT score (p < 0.0001), comparable exacerbation reductions (p < 0.0001), and lung function parameters (p < 0.04 in elder group and p < 0.0001 in younger elder group), although an apparent greater reduction of OCS daily dose was observed in elder patients (p = 0.0002). No new safety signals were reported in the elderly population.

Conclusions: This study further supports mepolizumab as an effective and well tolerated therapy in the difficult to treat population of elderly patients with severe asthma.

Background: Allergic asthma is a chronic respiratory condition characterized by inflammation and constriction of the airways in response to specific allergens. This study aimed to assess serum and biopsy biomarkers to predict the severity of allergic asthma.

Methods: A total of 18 allergic asthma patients and 15 healthy controls (HCs) were included from April to August 2021 in Par hospital, Erbil-Iraq. The blood and bronchial biopsy were taken, the serum biopsy marker were assessed via ELISA and immunohistochemistry (IHC) methods.

Results: It was showed no significant difference in age between allergic asthma patients and HCs (p = 0.285), although patients with allergic asthma had a significantly higher BMI (p = 0.028). Allergic asthma patients exhibited significantly elevated levels of serum eosinophil cationic protein (ECP), fibroblast growth factor 23 (FGF-23), and fibroblast growth factor 18 (FGF-18) compared to HCs (p < 0.0001). IHC analysis revealed significantly higher levels of myeloperoxidase (MPO) positive cells, activated eosinophils (EG2) positive cells, mast cells, FGF-18 positive cells, and FGF-23 positive cells in bronchial biopsy samples from allergic asthma patients compared to HCs (p < 0.0001). Additionally, serum FGF-18, EG2 positive cells, and FGF-18 positive cells were negatively correlated with lung function (FEV1/FVC), while asthma score showed a significant positive correlation with these markers.

Conclusion: Serum FGF-18, EG2 positive cells, and FGF-18 positive cells are promising biomarkers that can predict improvements in the FEV1/FVC ratio and reductions in asthma score, highlighting their potential utility in assessing the severity of allergic asthma and guiding treatment decisions.

Objectives: Cardiovascular disease (CVD) is a major cause of death in Korea, and studies have reported that asthma can have a negative impact on CVD. This study aimed to identify the association between asthma and CVD, including the current status, treatment status, and duration of asthma in Korean adults.

Methods: The Korea National Health and Nutrition Examination Survey (2016-2021) was used, and 34,384 adults aged 19 years or older were included. Exposures were asthma-related characteristics, and outcomes were hypertension, ischemic heart disease, and stroke. The association between asthma characteristics and CVD was analyzed using the chi-square test and multiple logistic regression analysis.

Results: The asthma diagnosis experience rate of the population was 3.1%; 1.6% were currently suffering from asthma, 1.0% were receiving asthma treatment, 0.6% were receiving regular medication, and 1.5% had a disease duration of 11 years or more. The CVD diagnosis rates in the population were 20.2% for hypertension, 2.3% for ischemic heart disease, and 1.8% for stroke. Compared to those who had no asthma diagnosis, those who had been diagnosed with asthma (OR = 2.06, 95% CI = 1.47-2.87), received asthma treatment (OR = 1.93, 95% CI = 1.22-3.04), and had a long duration of asthma (OR = 3.54, 95% CI = 1.71-7.33) had a significantly higher risk of ischemic heart disease. However, hypertension and stroke were not significantly correlated with asthma-related characteristics.

Conclusions: Asthma diagnosis and asthma-related characteristics were associated with an increased risk of ischemic heart disease. Our study suggests that research on risk assessment and management of CVD in patients with asthma would be needed.

Objective: The current study aimed to evaluate a novel paper card-based spacer (MDI Plus) in vitro and in vivo as a cost-effective alternative to traditional spacers (AeroChamber Plus).

Methodology: The in vitro part evaluated salbutamol's aerodynamic particle size distribution (APSD) after 0, 20, 50, 120, and 200 uses of Ventolin pressurized metered dose inhaler (pMDI) when connected to MDI Plus using an Andersen cascade impactor at an inhalation flow of 28.3 L/min. The in vivo part recruited a cohort of adult asthmatic patients. It assessed their pMDI usage and the number of training sessions to enhance their ability to use their pMDI alone and in combination with MDI Plus and AeroChamber Plus. Moreover, the amount of salbutamol deposited within the spacer devices, on the pMDI, and on the hand of the patients after 0, 20, 50, 120, and 200 uses were evaluated.

Results: The durability tests revealed that while there were reductions in aerodynamic performance over the lifespan of the pMDI, the decreases were insufficient to render the spacer ineffective. The fine particle fraction decreased slightly, and the mass median aerodynamic diameter increased somewhat, but the spacer maintained functional performance. The study indicated that spacers significantly improved patients' ability to use their MDIs correctly with minimal training. The MDI Plus showed a slightly significant positive impact (p < 0.05), requiring fewer training sessions for effective use. The amount left in the MDI Plus was significantly lower than within the AeroChamber Plus (p < 0.05). The amount deposited on the MDI and the hands of the patients after multiple storage in the MDI Plus box and uses was insignificant and within the allowed limits.

Conclusion: The MDI Plus simultaneously can act as an pMDI packaging box and spacer, serving as a practical, affordable, and accessible alternative to traditionally commercially available plastic spacers, particularly in resource-limited settings.