Journal of Asthma最新文献

Objective: Pediatric patients with asthma are at increased risk for invasive pneumococcal disease, yet optimal vaccination strategies for this population remain unclear. Although pneumococcal vaccines are recommended for high-risk groups, the effectiveness of immunization in children with asthma, particularly regarding booster doses, is not well understood. This study assessed serologic response and clinical outcomes following pneumococcal booster vaccination in pediatric patients with asthma.

Methods: A retrospective chart review was conducted on 64 patients with asthma aged 2-17 years who received at least one pneumococcal booster. Data on demographics, asthma severity, steroid use, and vaccine titers were collected. Immune protection was defined by serotype-specific titer thresholds. Changes in asthma classification and systemic steroid use pre- and post-vaccination were analyzed using chi-squared tests.

Results: At 4-8 weeks post-vaccination, 96.9% of patients demonstrated protective antibody titers. However, 71.4% of those retested more than 6 months later lost protective titers, suggesting waning immunity. Statistically significant reductions in asthma severity (p < 0.001) and systemic steroid use (p < 0.001) were observed post-vaccination. Notably, 100% of patients with severe asthma and 46% with moderate asthma improved in classification. Most patients requiring frequent steroids pre-vaccination showed reduced need afterward.

Conclusions: Pneumococcal booster vaccination elicited a strong initial immune response and was associated with improved asthma outcomes. However, waning immunity highlights the need for further research into optimal vaccine scheduling, booster timing, and the influence of immune-modulating therapies in this high-risk pediatric population.

Background: Poorly controlled pediatric asthma increases morbidity, reduces quality of life, and raises healthcare use. Caregiver education on asthma and medication use is essential for control. In Vietnam, pediatric asthma services are centralized at tertiary centers, limiting access for many families. Telemedicine may help bridge these gaps.

Objectives: To evaluate the effectiveness of telemedicine education on asthma control in children with uncontrolled asthma and its impact on caregiver knowledge, attitudes, and children's MDI technique.

Methods: We conducted a pragmatic randomized clinical trial among children aged 4-16 years with uncontrolled asthma. Participants were randomized 1:1, stratified by age and sex, to receive either a structured educational video call or a brief scheduling call. Changes in C-ACT/ACT scores, caregiver knowledge, caregiver attitudes, and children's MDI technique were compared between groups. A multivariable generalized linear model was used to identify factors associated with improvement in asthma control.

Results: Baseline characteristics were comparable between groups. At a median follow-up of five weeks (IQR 4-8), C-ACT scores were higher in the intervention than control group (median 25.0 vs 19.5, p < .001), with mean change exceeding the minimal clinically important difference. Caregiver knowledge and attitudes and children's MDI technique also improved more in the intervention group (p < .001 for all). In multivariable models, telemedicine education was independently associated with greater improvement in asthma control (β = 4.24, 95% CI: 2.64-5.85, p < .001).

Conclusion: Telemedicine-based education improved asthma control and caregiver-related outcomes and may serve as an effective supportive strategy where access to pediatric asthma services is limited.

Background: Asthma is a significant public health burden worldwide, owing to its prevalence and mortality. The key factor in the death of patients with asthma is oxidative stress. The diet is an important source of both exogenous oxidants and antioxidants. The Composite Dietary Antioxidant Index (CDAI) comprehensively evaluates the antioxidant capacity of the diet, but whether CDAI can assess the risk of death in patients with asthma is unclear.

Objective: This study aimed to investigate the prognostic significance of the CDAI in all-cause mortality in adult asthma patients over 20 years of age.

Method: This study employed a retrospective observational approach to analyze data extracted from the National Health and Nutrition Examination Survey (NHANES) database spanning the period from 1999 to 2018. The participants were divided into three groups based on tertiles of the CDAI. The primary outcome of the study was all-cause mortality, which was analyzed using the Kaplan-Meier survival curve, restricted cubic spline (RCS) and Cox proportional hazards model.

Result: Among 6,066 individuals aged 20 years and over diagnosed with asthma, with a mean age of 45.1 (0.3) years, Kaplan-Meier survival analysis showed a significantly lower all-cause mortality rate in those with a high CDAI category (P-log rank <0.001). Furthermore, the fully adjusted model (Model 3) demonstrated that for each unit increase in the CDAI, there was a corresponding 4% decrease in the probability of all-cause mortality. Additionally, compared with the lowest tertile (T1), a higher CDAI tertile (T3) was associated with a reduced risk (T3: HR, 0.96; 95% CI: 0.93 - 0.99; p for trend, 0.01).

Conclusion: Our study found that CDAI is inversely associated with all-cause mortality among patients with asthma, suggesting that higher antioxidant intake could potentially reduce mortality in this population. Future studies should explore the specific mechanisms by which dietary antioxidants influence asthma outcomes and evaluate the impact of targeted nutritional interventions in clinical practice.

Ethical compliance: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Objective: To systematically evaluate the association between asthma and the risk of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT).

Data sources: PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies published up to May 2025.

Study selection: Observational studies (cohort, case-control, and cross-sectional) reporting the association between asthma and VTE, PE, or DVT with available odds ratios (ORs) or hazard ratios and 95% confidence intervals (or data to calculate them) were included.

Results: The meta-analysis revealed a significant association between asthma and increased risk of VTE. Patients with asthma had a 2.41-fold higher odds of PE (OR = 2.41, 95% CI: 1.77-3.27), 1.56-fold higher odds of DVT (OR = 1.56, 95% CI: 1.49-1.63), and 1.61-fold higher odds of overall VTE (OR = 1.61, 95%: CI 1.45-1.77). Cohort studies showed the strongest association (OR = 4.21, 95% CI 2.56-6.92). Subgroup analysis by region indicated the highest risk in Asia (OR =3.19, 95% CI: 2.06-4.96), followed by America (OR = 2.24, 95% CI: 1.55-3.24) and Europe (OR = 1.64, 95% CI: 1.49-1.81).

Conclusion: Asthma is significantly associated with an elevated risk of PE, DVT, and VTE, with particularly strong associations observed in cohort studies and Asian populations. These findings highlight the need for further research into underlying mechanisms and whether optimized asthma management can reduce thrombotic risk.

Objective: The Mediterranean diet (MD) is known for its anti-inflammatory and antioxidant properties, yet its role in asthma pathophysiology remains underexplored. This study aimed to investigate the association between adherence to the MD and systemic markers of eosinophilic inflammation and oxidative stress in adult patients with bronchial asthma.

Methods: In this cross-sectional study, 86 adult asthma patients from a university outpatient clinic were assessed. Anthropometric measurements, Asthma Control Test (ACT) scores, and dietary habits (via the MedDiet score) were collected. Oxidative stress and antioxidant capacity were evaluated using the d-ROM (derivatives of reactive oxygen metabolites) test and PAT (plasma antioxidant test), respectively. Blood eosinophil percentage and absolute count were also measured.

Results: The majority of patients (83.7%) exhibited moderate adherence to the MD, while only 8.1% demonstrated high adherence. Higher MedDiet scores were significantly associated with lower eosinophil percentages (r = -0.322, p < 0.01) and counts (r = -0.254, p < 0.05), and greater antioxidant capacity (PAT) in patients with severe asthma (r = 0.339, p = 0.047). Full-fat dairy intake was positively associated with oxidative stress (d-ROM), while fruit and olive oil consumption were linked to enhanced antioxidant levels. No significant differences in oxidative stress were observed between asthma severity groups.

Conclusions: Greater adherence to the MD is associated with lower systemic eosinophilic inflammation and enhanced antioxidant capacity in asthma patients. The data indicate that dietary interventions could serve as complementary strategies in asthma care, particularly for severe cases, and that oxidative-stress associations were present and strongest among patients with severe asthma.

Objective: Risk factors associated with asthma symptom control is crucial for disease management. This study aimed to determine the risk factors of patients with uncontrolled asthma and to examine the relationship with their geographical patterns.

Methods: This cross-sectional study was conducted at 36 centers across Turkey. Future risk factors (FRFs) such as exposure to triggers/allergens and inadequate or poor inhalation technique, etc., were identified based on the Global Initiative for Asthma (GINA) guidelines. The associations between FRFs and demographic and clinical characteristics, geographical regions, and levels of asthma control were analyzed.

Results: The study included 2,053 adult asthma patients. At least one FRF was identified in 1576(76.8%) patients. The most common FRFs were exposure to allergens/triggers (n: 664; 32.3%), impaired asthma symptom control (n: 540; 26.3%), and eosinophilia (n: 526; 25.6%). Regarding regional differences, the most prevalent FRFs in the Marmara region were exposure to allergens/triggers and frequent use of short-acting beta-2 agonists (>3 boxes/year). In contrast, eosinophilia was more common in the Southeastern region, while inadequate or poor inhalation technique, noncompliance with treatment, and psychosocial or socioeconomic problems were more frequently observed in the Eastern Anatolia region. Asthma control was achieved in 79.5% of patients without any FRFs; however, this rate decreased significantly to 25% among patients with more than four FRFs.

Conclusions: This study demonstrates that FRFs in asthma vary according to demographic and disease characteristics, as well as geographical distribution. An increased number of FRFs was associated with asthma control. However, an individualized approach remains essential for achieving optimal asthma management.

Background: Existing research have suggested a significant association between micronutrients and childhood asthma, but the specific causal relationship between micronutrients and childhood asthma remains unclear. Therefore, we aimed to assess the causal relationship between micronutrients and childhood asthma using Mendelian randomization methods.

Methods: We conducted two-sample Mendelian randomization analyses and multivariable Mendelian randomization analyses using summary statistics from genome-wide association studies (GWAS) of micronutrients (Copper, Calcium, Carotene, Folate, Iron, Magnesium, Potassium, Selenium, Vitamin A, Vitamin B12, Vitamin B6, Vitamin C, Vitamin D, Vitamin E, and Zinc) and childhood asthma among European individuals from the Open GWAS and FinnGen databases. Five Mendelian randomization methods-Inverse Variance Weighted (IVW), Weighted Median, MR-Egger, Simple Mode, and Weighted Mode-were employed to investigate the causal relationship between micronutrients and childhood asthma.

Results: The IVW method revealed a significant inverse association between zinc and the risk of childhood asthma (OR: 0.002, 95% CI: 0.000-0.153, p = 0.005). Copper (OR: 0.998, 95% CI: 0.947-1.052, p = 0.951), Selenium (OR: 0.967, 95% CI: 0.866-1.079, p = 0.544), Folate (OR: 0.885, 95% CI: 0.603-1.300, p = 0.534), Carotene (OR: 0.849, 95% CI: 0.594-1.215, p = 0.371), Potassium (OR: 1.262, 95% CI: 0.836-1.905, p = 0.268), Vitamin D (OR: 1.237, 95% CI: 0.791-1.934, p = 0.352), Vitamin C (OR: 1.154, 95% CI: 0.759-1.756, p = 0.503), Vitamin B12 (OR: 1.177, 95% CI: 0.754-1.839, p = 0.473), Iron (OR: 0.873, 95% CI: 0.552-1.383, p = 0.563), Vitamin E (OR: 1.082, 95% CI: 0.768-1.524, p = 0.651), Magnesium (OR: 1.190, 95% CI: 0.828-1.712, p = 0.347), Vitamin B6 (OR: 0.928, 95% CI: 0.592-1.456, p = 0.746), Calcium (OR: 1.255, 95% CI: 0.840-1.876, p = 0.268), and Vitamin A (OR: 3.928, 95% CI: 0.001-15166.57, p = 0.745) had no significant causal associations with childhood asthma. The multivariable Mendelian randomization analysis for zinc, Vitamin A, and Vitamin C indicated that zinc is a significant protective factor against childhood asthma (OR: 0.001, 95% CI: 0.000-0.165, p = 0.007). In contrast, Vitamin A and Vitamin C did not show significant causal relationships with childhood asthma when controlling for zinc levels.

Conclusion: Our study confirms the specific causal relationships between micronutrients and childhood asthma using Mendelian randomization methods.

Background: Standardized acute care asthma pathways are associated with improved asthma outcomes in emergency department and inpatients settings. We developed and implemented an ambulatory acute asthma care pathway (the "Pathway") in the pediatric primary care clinic of our academic safety-net hospital.

Objective: To qualitatively assess perceived benefits, disadvantages, facilitators, and barriers associated with use and implementation of this Pathway among pediatric primary care providers.

Methods: We conducted semi-structured interviews with primary care providers to elicit their perspectives about the Pathway. The interview guide, codebook, and analysis were guided by the Promoting Action Research on Implementation in Health Services (PARiHS) framework. Interviews were analyzed to identify themes and subthemes.

Results: Participants included 13 clinicians (attending physicians, nurse practitioners, and resident trainees). Major themes included: (1) Providers appreciate standardization of care facilitated by the Pathway and perceive the Pathway as promoting evidence-based care; (2) providers' experience managing acute asthma and with electronic order sets affects the way they engage with the Pathway; more data about performance measures would help; (3) the clinical context influences the way providers utilize the Pathway; and (4) providers identified successes of Pathway implementation (i.e. provider meeting presentations, in-clinic support from Asthma Team "champions") as well as opportunities for improvement.

Conclusions: Providers report positive experiences with the Pathway and recognize the benefits of standardized, evidence-based care. Increased feedback about performance and outcomes and strategies to improve usability were proposed as opportunities for optimizing Pathway uptake. Future studies will evaluate the impact of the Pathway on improving clinical outcomes.

Objective: To evaluate the independent association between prognostic nutritional index (PNI) and asthma risk in children and adolescents and to identify potential threshold effects.

Methods: This cross-sectional study analyzed data from 11,196 participants aged <20 years from NHANES (2003-2020). The diagnosis of asthma was determined based on questionnaire data. PNI was calculated as 10 × albumin (g/dL) + 0.005 × lymphocyte count (10³ cells/μL) and analyzed as both a continuous and tertile variable. Weighted multivariate logistic regression models assessed associations between PNI and asthma. Restricted cubic spline and two-stage regression models examined nonlinear relationships and threshold effects. Subgroup analyses evaluated association stability across populations.

Results: Among 11,196 participants, 1274 (11.5%) reported physician-diagnosed asthma. PNI was inversely associated with asthma risk (OR = 0.963, 95% CI: 0.933-0.995; p = 0.0235). Participants in the highest PNI tertile (T3: 45.014-56.010) had a 34% lower asthma risk than those in the lowest tertile (OR = 0.659, 95% CI: 0.486-0.895; p = 0.0081). Nonlinear analysis revealed an inverse L-shaped relationship (p < 0.001), with a threshold at PNI = 43.40: above this level, higher PNI was protective (OR = 0.93, 95% CI: 0.87-0.98; p = 0.01). Subgroup analyses found no significant interactions (all p > 0.05).

Conclusion: Higher PNI levels are associated with reduced asthma risk in children and adolescents, with a protective effect at PNI ≥43.40. However, further research is required to elucidate the underlying mechanisms of this association and explore the potential of PNI as a predictive biomarker for asthma in children and adolescents.

Objective: Expiratory large airway collapse (ELAC) is characterized by abnormal (>50%) narrowing of the large airways. It is a potential reason for poor asthma control and increased rate of asthma exacerbations. Continuous positive airway pressure (CPAP) is a potential treatment for ELAC. However, data on adherence to CPAP and its clinical impact in ELAC are limited.

Methods: Sixty-five patients with ELAC [age 61 (55-70) years, 56 females] who were set up on CPAP between December 2014 and May 2022 were included in this retrospective observational cohort study. Etiologies for ELAC included asthma (n = 47), COPD (n = 4), bronchiectasis (n = 3), relapsing polychondritis (n = 3), and large hiatus hernia compromising the bronchi (n = 1); in 7 cases it was considered idiopathic.

Results: Thirty-nine patients were adherent to CPAP. Adherence was not related to demographics, clinical characteristics or CPAP settings (all p > 0.05). Seventy-seven percent perceived benefits in their respiratory symptoms and 95% reported better sleep. In those with asthma, whilst there was no difference in the daily inhaled corticosteroid dose before and after CPAP (p = 0.90), the annual number of systemic corticosteroid courses decreased following CPAP (p = 0.02).

Conclusions: CPAP is well tolerated in patients with ELAC, and many report improvement in their respiratory and sleep-related symptoms. There is an additional benefit in patients with concomitant asthma in terms of steroid reduction that needs to be investigated in future studies.