Journal of Asthma最新文献

Objective: Benralizumab suppresses type 2 inflammation and improves outcomes of patients with severe eosinophilic asthma (SEA). We investigated real-life clinical experience with this biological therapy in Czechia to provide evidence on effectiveness in the context of the local healthcare system.

Methods: We have analyzed data from the Czech cohort participating in the multi-national observational study BREEZE covering 12 months before the first benralizumab dose and 56 wk after that. Eligibility included the diagnosis of SEA and at least one dose of benralizumab administered in clinical practice. Descriptive statistics were used, and changes from baseline were assessed using paired t-test or Wilcoxon signed-rank test.

Results: Patients in the Czech cohort (n = 51; 76.5% women) initiated benralizumab therapy at the mean age of 56.5 years and with median blood eosinophil count of 540 cells/μL, mean annualized exacerbation rate (AER) of 3.84, and poorly controlled asthma (Asthma Control Test [ACT] < 16 in 72.3%). Maintenance oral corticosteroids (mOCS) were used in 51% of patients. During the treatment, complete blood eosinophils depletion was achieved at week (W) 16, resulting in overall relative reduction in AER at W16 and W48 of 88.6% and 91.7%, respectively. The need for mOCS decreased to 23.3% at W48, and ACT scores significantly increased (p < 0.001 for W16 and W24; p = 0.007 for W48). One patient (2%) discontinued benralizumab up to W56.

Conclusion: Clinically meaningful benefits of benralizumab treatment were confirmed in the Czech cohort, especially reduction of mOCS need, decrease of exacerbations, and improvement of asthma control.

Objective: In underdeveloped countries, allergic disease prevalence is low but rising in developing countries, while in developed countries, it remains high and stable. This study assessed prevalence and risk factors among schoolchildren in southern region of Bosnia and Herzegovina (BiH).

Methods: A cross-sectional study (2020) included 1851 children: 937 aged 6-8 years and 914 aged 11-13 years. Data related to asthma, allergic rhinitis, atopic dermatitis, and associated risk factors were collected using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire.

Results: Diagnosed asthma prevalence was 1.8% in children aged 6-8 years and 2.4% in 11-13 years. Allergic rhinitis was diagnosed in 5.5 and 10.4%, respectively, significantly higher in older children (p < 0.001). Atopic dermatitis prevalence was 16.6% in 6-8 years and 11.8% in 11-13 years, higher in younger children (p = 0.003). Asthma and allergic rhinitis were more common in boys, while atopic dermatitis was more frequent in girls. Asthma was negatively associated with egg consumption and daycare attendance, while furry animal contact, synthetic pillows, and maternal allergic rhinitis increased risk. Allergic rhinitis was associated with maternal smoking during pregnancy, parental allergic rhinitis, and bird contact. Atopic dermatitis was positively related to maternal atopic dermatitis, bird contact, air conditioning, and daycare attendance, whereas sponge pillow use, room sharing, and dog contact appeared protective.

Conclusion: In this region, asthma prevalence was low, allergic rhinitis moderate, and atopic dermatitis high. Broader studies across BiH are needed to monitor trends and guide prevention.

Objective: Shenzhu Pingxiao formula is a classic Chinese medicinal prescription used for asthma. Given that its mechanism is unclear, this study aimed to evaluate anti-allergic asthma (AA) properties and predict the targets of Shenzhu Pingxiao formula.

Methods: Mice were challenged using house dust mites (HDMs). The anti-AA effect of the formula was evaluated by the airway resistance and number of immune cells in bronchoalveolar lavage fluid (BALF). Network pharmacology and molecular docking were used to predict the targets. The real-time reverse-transcription PCR and western blot were applied to analyze key genes and proteins associated with IL-17 signaling pathway.

Results: Administration of formula moderated the number of immune cells and reduced the airway hyperresponsiveness. Administration of formula reduced neutrophil recruitment. HSP90AA1, PTGS2, and MAPK14 involved in IL-17 signaling pathway, were predicted to be key targets for this formula. Vina scores in molecular docking were all ≤ -9 for wogonin-HSP90AA1, wogonin-MAPK14, and wogonin-PTGS2 pairs. Shenzhu Pingxiao formula decreased the expression levels of HSP90AA1, PTGS2, and MAPK14 in HDM-challenged mouse lung.

Conclusions: Shenzhu Pingxiao formula can reduce neutrophil recruitment and exert anti-AA effects via suppression of HSP90AA1/MAPK14/PTGS2 pathway.

Objective: Allergic asthma (AAS) arises from intricate gene-environment interactions, yet its pathophysiological mechanisms remain incompletely understood. This study employs a multi-omics approach to elucidate the regulatory role of metabolites in AAS pathogenesis, aiming to identify novel therapeutic targets and preventive strategies.

Methods: We conducted bidirectional two-sample Mendelian randomization (MR) analysis on 1,400 serum metabolites, followed by co-localization analysis to validate shared genetic loci. Metabolic pathway enrichment focusing on rate-limiting enzymes was performed, complemented by protein-protein interaction (PPI) network construction. MR was systematically applied to assess the impact of 17 lifestyle factors on AAS-associated metabolites.

Results: Six metabolites including Carnitine C14 (OR = 2.660) and 3-hydroxyoleoylcarnitine (OR = 1.620) showed significant associations with AAS after false discovery rate (FDR) correction (FDR < 0.05). Co-localization analysis (PPH3 + PPH4 > 0.9) identified fatty acid metabolism as the central pathway, with ACACB demonstrating significant interaction with salbutamol's target ADRB3. Lifestyle modulation analysis revealed cereal intake suppressed Carnitine C14 metabolism (p = 0.007), while cheese (p = 0.029) and oily fish consumption (p = 0.015) regulated 3-hydroxyoleoylcarnitine levels.

Conclusions: This multi-omics integration study pioneers in delineating fatty acid metabolic reprogramming as a central mechanism in AAS pathogenesis. The identified ACACB-ADRB3 axis presents a novel therapeutic target, while dietary modulations of metabolite profiles offer promising avenues for personalized prevention strategies, advancing precision medicine in asthma management.

Objective: This study evaluated the impact of adenotonsillectomy on asthma symptoms in children by combining observational evidence with pooled analysis.

Data sources: We searched MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest, and Scopus from inception to March 17, 2025.

Study selection: Eligible studies assessed asthma outcomes in children undergoing adenotonsillectomy using retrospective or prospective cohort designs, case series, or database analyses. Eleven studies involving 74,204 participants were identified. Outcomes included asthma control scores (ACT/cACT), acute asthma exacerbations (AAEs), emergency department (ED) visits, oral corticosteroid use, hospitalization, inflammatory biomarkers, and atopic risk. Risk of bias was evaluated using ROBINS-I.

Results: Meta-analysis incorporated five studies with 52,479 participants. Adenotonsillectomy improved ACT/cACT scores by a mean of 2.5 points (95% CI:1.6-3.4; I²=0%), indicating better asthma control. A reduced risk of AAEs was observed (RD = 0.29; 95% CI:0.01-0.58), though with extreme heterogeneity (I²=100%). ED visits showed a small but significant reduction (MD=-0.01; 95% CI:0.00-0.02; I²=0%). Narrative synthesis found corticosteroid courses decreased by 23.7%, hospitalization rates fell by up to 35.8%, and patients reported improved quality of life and lower inflammatory biomarkers. However, most studies carried moderate to severe risk of bias due to confounding and selection issues.

Conclusions: Adenotonsillectomy may improve asthma control, reduce ED visits, and lessen medication use and hospitalization among children. Evidence regarding its effect on exacerbations remains inconsistent, and causality cannot be inferred due to reliance on observational data. Well-designed prospective controlled trials are needed to confirm effectiveness and clarify underlying mechanisms.

Objective: To investigate the association between asthma and the risk of mental health problems in Australian men, and to assess the influence of age on this association.

Methods: Data from 16,021 men aged 10-37 years participating in the Ten to Men, the Australian Longitudinal Study on Male Health were analyzed. Logistic regression models and generalized estimating equations (GEEs) were used to examine the relationship between asthma and anxiety, depression and hazardous alcohol consumption. Stratified models were conducted to explore the impact of age on this association, dividing participants into three groups: Boys aged 10-17 years; Young adults aged 18-30 years; and adults aged 31-57 years.

Results: Men with asthma have 68% higher risk of developing anxiety compared to non-asthmatic men in adjusted models. The risk of anxiety was highest in the young adult group (OR (95% CI) = 2.15 (1.56-2.96)). An association between asthma and depression was also identified (OR = 1.39, 95% CI = 1.11, 1.73) and adults (men aged 31-57 years) were at higher risk (OR = 1.33, 95% CI = 1.02, 1.72). Asthma was not associated with hazardous alcohol consumption in the overall population or within any specific age group.

Conclusions: Australian men with asthma have a greater risk of developing anxiety and depression. The findings contribute to understanding sex-specific impacts of asthma on mental health and identify men at higher risk of anxiety and depression. Our study also provides research evidence to support frequent psychological monitoring in men with asthma.

Background: Postural balance is impaired in adults with asthma; however, this remains poorly understood in older people with asthma.

Objective: To assess postural balance and the incidence of falls in older individuals with moderate to severe asthma.

Methods: A controlled cross-sectional study with follow-up included individuals aged 65-80 years (asthma group, AG; n = 26) and without asthma (control group, CG; n = 27). The control group was matched by sex, age, and body mass index (BMI). The evaluations included comorbidities, fear of falling, muscle strength, and postural balance in different conditions. Subsequently, individuals received a fall diary and were followed up for six months.

Results: AG had more comorbidities, greater fear of falling, and consumed more medications (p < 0.005). AG also had worse postural balance assessed by the Mini-BESTest compared to the CG (23 [18.0-25.0] vs. 24 [21.00-26.00] score; p = 0.03). AG showed a greater CoP oscillation than CG at rest in natural base without foam (1.22 [0.78-1.94] vs. 0.88 [0.64-1.37] cm²; p = 0.04) and at semi-tandem, post-exertion with foam (3.56 [2.59-6.57] vs. 2.54 [1.94-3.42] cm², p = 0.006). No between-group difference was observed in the predicted quadriceps and ankle dorsiflexor muscle strength (p > 0.05). Despite greater fear of falling and poorer balance, no group difference was observed in fall incidence over 6 months (8 vs. 10 falls), which may be partially explained by the follow-up period and the characteristics of the control group.

Conclusion: Our findings partially support the study hypothesis. Older adults with asthma exhibit impaired balance and an increased fear of falling, but this does not necessarily translate into a higher incidence of falls.

Objective: To evaluate the role of staff stress in the implementation of a school-based asthma program in early childhood education programs for low-income urban families.

Methods: Fifteen staff members from four programs participated in focus groups and interviews examining perceptions of the asthma program one year into implementation. Following semi-structured guides, interviews explored general staff workload and stress levels as well as asthma-related stress. Transcripts were coded using thematic analysis with NVivo (Version 13) software.

Results: Using thematic analysis, investigators generated four main themes and 12 sub-themes from the data, characterizing staff stress and experiences at work and with the asthma program. The first two themes detail the inherent stress of working in early childhood education and the specific stress related to providing asthma care. Overall work stress sub-themes relate to busy schedules and overworked staff, while asthma-related subthemes pertain to the anxiety and overwhelm associated with the asthma care responsibilities. The third theme described how this stress impacted program implementation with sub-themes related to understaffing and turnover. The fourth theme detailed how staff asthma education reduced stress and concern. Staff described stress reductions through improvements in asthma knowledge, self-efficacy in asthma skills, reducing uncertainty about asthma symptoms, and agency related to asthma management.

Conclusions: Although they experience high workplace stress levels, early childhood education staff felt that a school-based asthma program both reduced stress and improved their asthma-management competence. By focusing on practicable skills and building confidence, the implementation of an evidence-based program could effectively improve both child health outcomes and staff stress.

Background: Exacerbations of asthma-bronchiectasis overlap syndrome (ABOS) are clinically heterogeneous, with poorly defined inflammatory phenotypes and their links to outcomes.

Objective: To identify phenotypes in ABOS exacerbations and their associations with in-hospital outcomes.

Methods: In this prospective study, 343 patients with ABOS exacerbation were clustered using multidimensional data; findings were validated in 147 independent patients. Associations between phenotypes and outcomes (Intensive Care Unit [ICU] admission, invasive mechanical ventilation [IMV], mortality) were analyzed via multivariable regression.

Results: Three phenotypes were identified: female-paucigranulocytic (Cluster T1), young male-eosinophilic (Cluster T2), and neutrophilic-lymphopenic (Cluster T3). Cluster T3 had the highest risks of ICU admission (adjusted relative risk [RR_adj] = 7.84, 95% CI: 2.21-27.78), IMV (RR_adj=7.84, 95% CI: 2.21-27.78), and mortality (RR_adj=6.86, 95% CI: 2.33-37.67). Neutrophilia showed a dose-dependent association with adverse outcomes (P_trend<0.001), with elevated levels independently predicting composite outcomes (RR_adj=2.06, 95% CI: 1.42-3.03).

Conclusions: ABOS exacerbations exhibit distinct inflammatory phenotypes. The neutrophilic-lymphopenic phenotype strongly predicts in-hospital adverse outcomes, highlighting its potential for acute risk stratification in hospitalized patients.

Objective: Patients with bronchial asthma often experience anxiety in addition to decreased lung function.

Method: This study retrospectively enrolled 204 diagnosed and hospitalized patients with bronchial asthma in our hospital, and randomly divided them into the observation group and the control group. Firstly, the differences in baseline data between two groups of patients were analyzed. Secondly, the differences in anxiety scores (GAD-7, HADS), Peak Expiratory Flow (PEF) levels, and nursing satisfaction between two groups of patients were analyzed at 1 week, 1 month, and 3 months after nursing intervention. Finally, the generalized estimation equation is applied to analyze the interaction between nursing intervention and time.

Result: There were no significant differences between the observation group and the control group in most baseline indicators, such as age and gender. At 1 week, 1 month, and 3 months after intervention, the GAD-7 and HADS levels in the intervention group were significantly lower than those in the control group, while the PEF level and patient satisfaction were significantly higher than those in the control group. Over time, GAD-7 and HADS significantly decrease, while PEF and satisfaction (p < 0.001) significantly increase. The interaction showed that psychological support and respiratory function training significantly reduced anxiety levels at 1 and 3 months after intervention (GAD-7: p = 0.032; HADS: p = 0.002), significantly increased PEF levels at 1 week and 1 month after intervention (p < 0.001), and significantly improved satisfaction levels at 3 months after intervention (p < 0.001).

Conclusion: Psychological support combined with respiratory function training can significantly reduce anxiety levels in patients with bronchial asthma and improve lung function.