Journal of Asthma最新文献

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.

Objective: To identify circulating inflammatory proteins with potential causal roles in asthma development through integrated genetic and pathway-based analyses, and to evaluate their potential as therapeutic targets.

Methods: We used genetically anchored instrumental variables from 180 protein quantitative trait loci (pQTLs) to assess the causal effects of 91 circulating inflammatory proteins on asthma risk, using large-scale GWAS datasets. Analytical robustness was evaluated through pleiotropy and heterogeneity testing. Functional enrichment and literature-based pathway analyses were performed to support biological plausibility and validate findings.

Results: Four proteins showed significant causal effects on asthma: CCL19 and LIFR were protective (OR = 0.89 and 0.91, p ≤ 6.8E-03), while ARTN and IL6 were associated with increased risk (OR = 1.15 and 1.18, p ≤ 1.1E-04). We also identified reverse causal effects of asthma on 11 cytokines, including MMP10, TGFB1, IL33, and IL18R1. Most of these proteins were enriched in pathways related to cytokine signaling and immune response (p < 0.001). All identified proteins had prior literature support linking them to asthma or airway inflammation.

Conclusions: Our findings highlight a subset of circulating inflammatory proteins that are likely causal in asthma pathogenesis and may serve as promising targets for therapeutic intervention. These results offer novel insights into the immunological mechanisms underlying asthma and support the utility of genetic causal inference in target prioritization.

Background: Oxidative stress is crucial in the immune response and airway inflammatory process associated with asthma. While the relationship between dietary antioxidants and asthma remains debated in observational studies, this study uses two-sample Mendelian randomization (MR) to explore a potential causal link.

Methods: We acquired six distinct categories of absolute circulating antioxidants and five different types of metabolic circulating antioxidants from the most recent genome-wide association study data of the European population, including vitamin A (retinol), vitamin C (ascorbic acid), vitamin E (tocopherol), β-carotene, lycopene, and urate. The latest data regarding asthma was obtained from the FinnGen database. We utilized single nucleotide polymorphisms as instrumental variables to conduct five MR methods. To confirm the accuracy of the results, additional sensitivity analyses were performed to eliminate any potential confounding factors, such as heterogeneity and pleiotropy.

Results: MR and sensitivity analyses revealed an association between circulating urate and asthma, suggesting a potential increase in asthma risk (OR = 1.090; 95% CI = 1.030-1.150; p = 0.004). No causal relationship was found for other antioxidants.

Conclusions: This MR analysis suggested that genetically determined circulating urate may increase asthma risk. Further large-scale randomized controlled trials and mediated MR analysis are needed to explore underlying mechanisms.

Objectives: Asthma affects approximately 24.9 million people in the United States, including 4.7 million children. However, limited research has explored how parents manage pediatric asthma in relation to air quality. In this study, we examine parental perception of air quality and pediatric asthma management among families living in Cache Valley, Utah. In addition, we explore the association between the residents' perception of local air quality and their asthma-related health concerns.

Methods: We used data drawn from in-depth interviews conducted between August to November 2019 using a semi-structured interview guide. All the interviews were transcribed, cleaned for accuracy, and coded for thematic analysis. We applied the Socio-Ecological Model as a theoretical framework to capture different factors operating at multiple levels (such as individual, interpersonal, institutional, community, policy level) of influence.

Results: Fifty-seven percent of participants reported a family history of asthma, and 76% reported their child received medical treatment for asthma. Nearly half (48%) noted that asthma interfered with their child's daily activities, and 52% reported modifying behavior in response to daily air-quality reports.

Conclusion: The Socio-Ecological Model offers a comprehensive framework for understanding pediatric asthma management, encompassing individual experiences, family interactions, community conditions, institutional practices, and broader policy interventions. Analysis across these multiple spheres highlight the intricate interplay of factors-from household routines to institutional support systems-in shaping asthma outcomes.

Introduction: Asthma epidemics linked to thunderstorms (thunderstorm asthma; TSA) have been reported internationally for several decades. TSA can have severe impact on an individuals' health, resulting in severe outcomes, including death. TSA events can also put intense pressures on local health care services.

Objective: To describe changes in healthcare seeking behavior associated with a period of thunderstorm activity in England, June 2023, using routinely available health surveillance data.

Methods: Asthma and difficulty breathing-type presentations were analyzed from telehealth advice calls and emergency department attendances.

Results: This was the largest TSA event documented in England since the English syndromic surveillance programme was established over 25 years ago. The scale of the increase in asthma-type activity was above previously reported TSA events in England and activity coincided with forecasted storm alerts, both temporally and geographically. However, increases in asthma-type patient contacts were only observed around storm alerts occurring during periods of high pollen activity. Additionally, increases in asthma-type patient contacts during the TSA episode were not observed in young children (under 5 years) or older adults (65 years and over).

Conclusion: This work supports the evidence of the health impact of TSA in England. It also particularly adds to the evidence base that pollen is a leading causal factor in TSA episodes in England. Further investigations into the spatiotemporal relationships between TSA, storm and pollen activity would help in the identification of drivers affecting different age groups, as well as to inform messaging to both healthcare professionals and the public regarding the timing of events and mitigation steps that may be taken.

Severe asthma is a heterogeneous disease involving multiple inflammatory pathways, with significant therapeutic challenges. Biologic therapies targeting T2 inflammation improve outcomes but may, in rare cases, trigger hypersensitivity reactions due to anti-drug antibodies, excipients, or protein structure. Additionally, some patients exhibit suboptimal or no response. Tezepelumab, a thymic stromal lymphopoietin inhibitor, offers a novel upstream approach, addressing diverse endotypes.

We present a 30-year-old female with severe T2-high asthma, multiple allergies, and poor disease control despite optimal therapy. She experienced an allergic reaction with omalizumab and dupilumab and had inadequate response to benralizumab. Enrolled in an early access program for tezepelumab, she showed remarkable clinical improvement, with significant FEV1 increase and FeNO reduction, allowing discontinuation of systemic corticosteroids and supplemental oxygen.

Objective: This review explores recent advances in taste receptors type 2 (TAS2Rs) as potential therapeutic targets for bronchial asthma, focusing on the regulatory effects of bioactive compounds from bitter traditional Chinese medicines to provide new strategies for asthma prevention and treatment.

Methods: Relevant studies were identified through PubMed, including in vitro experiments, animal models, and clinical observations. Literature on the activation of TAS2Rs by bitter traditional Chinese medicine-derived compounds such as alkaloids, flavonoids, and terpenoids was analyzed, emphasizing mechanisms involving airway smooth muscle (ASM) relaxation, anti-inflammatory responses, and immune modulation.

Results: TAS2Rs are widely expressed in the respiratory tract. Their activation induces ASM relaxation, inhibits inflammatory factor release, and modulates immune responses. Bitter compounds like kudinoside A, baicalin, naringin, and artesunate act as TAS2R agonists, improving airway hyperresponsiveness and inflammation. Some components, such as baicalin, can also regulate TAS2R expression at the gene transcription level.

Conclusions: TAS2Rs regulate key respiratory processes, offering a new target for treating asthma and other respiratory diseases. Bitter traditional Chinese medicine bioactive compounds show anti-inflammatory and bronchodilatory effects by activating TAS2Rs, showing clinical promise. However, most of the related research is still in the basic research stage, and clinical evidence remains insufficient. Future efforts should focus on large-scale clinical trials and further mechanistic studies to promote the modernization of bitter traditional Chinese medicine in asthma treatment.

Objective: Despite the health benefits of physical activity (PA), many individuals with asthma are not sufficiently active. Wearable devices (WD) are increasingly popular tools for promoting PA, but limited research has examined their effectiveness among individuals with asthma. This study aims to compare PA levels between WD users and non-users with asthma.

Methods: Data were drawn from the 2017 Behavioral Risk Factor Surveillance System. Participants who self-reported a diagnosis of asthma were included in this secondary data analysis. Based on the self-report, participants were categorized as WD users or non-users. PA measures included total weekly minutes of PA, weekly minutes of vigorous PA, and whether participants met national PA guidelines. Survey-weighted unadjusted and adjusted linear and logistic regression analyses were conducted to assess associations between WD use and PA outcomes.

Results: Among the included 497 participants with asthma, 28.19% (95% CI [19.36, 38.30]) of participants were WD users and 71.81% (95% CI [61.7, 80.64]) were non-users. 65.91% (95% CI [57.36, 73.82]) of the participants met the PA guidelines. The unadjusted and adjusted linear regressions found no statistically significant differences in weekly PA and weekly vigorous PA between WD users and non-users. Further, no statistically significant associations were found between WD usage and meeting PA guidelines (p > .05).

Conclusions: WD use was not associated with higher PA levels among individuals with asthma. Further research is needed to identify strategies that enhance the effectiveness of WD in promoting PA in this population.

This article examines the chronic asthma of Ernesto "Che" Guevara not merely as a biomedical condition, but as a metaphorical and existential element of his revolutionary identity. Drawing on Aristotle's theory of metaphor and S. Sontag's cultural critique of illness, it explores how Guevara's lifelong struggle with asthma shaped his medical vocation and informed his political radicalism. Through a close reading of primary sources-including Guevara's letters, diaries, and biographical accounts-this study contextualizes his disease as both a personal crucible and a symbol of rebellion. The article situates Guevara within a lineage of physician-activists, alongside Albert Schweitzer and Frantz Fanon, to consider the transformative potential of embodied suffering in revolutionary praxis.