Journal of Asthma and Allergy最新文献

Background: Increasing physical activity is recommended as a non-pharmacological approach for improving the symptoms, quality of life, and overall health in patients with asthma. However, the systemic effect of physical activity, especially sedentary behavior, in patients with asthma remains unclear.

Objective: The aim of this study was to investigate the association of objectively measured physical activity, including sedentary time, with body composition data and clinical characteristics in patients with asthma.

Methods: The study included 85 patients with asthma and 38 healthy controls. Physical activity indices were assessed for 2 weeks using accelerometers. We investigated the relationship between physical activity levels and clinical characteristics, along with its association with body composition data assessed using dual-energy X-ray absorptiometry and computed tomography in patients with asthma.

Results: In patients with asthma, high blood eosinophil counts and poor asthma control, as assessed by the Asthma Control Questionnaire score, were associated with prolonged sedentary time and reduced step count. Moreover, reduced step count was independently associated with an elevated fat mass index, whereas a prolonged sedentary time and high oral corticosteroid doses were independently associated with a low lean mass index in patients with asthma. Prolonged sedentary time demonstrated a negative correlation with erector spinae muscle area after adjusting for background factors.

Conclusion: Sedentary behavior and physical inactivity are associated with body composition in patients with asthma, suggesting the need for interventions targeting these behaviors to improve health outcomes.

Objective: To assess the efficacy and safety of the combination of N-acetylcysteine and acebrophylline (Combination named Abiways), in patients with moderate to severe COPD and Asthma.

Materials and methods: In this non-randomized, interventional, prospective, single-arm, post-marketing surveillance study, participants were administered Abiways as an add-on therapy for 90 days. The primary endpoint was Quality of Life, evaluated using the COPD Assessment Test (CAT) and Asthma Control Test (ACT) questionnaires. Secondary endpoints included mean FEV1 and FVC changes. Adverse events were recorded throughout the study.

Results: 97 (of 102 subjects enrolled) completed the study (76 COPD and 21 Asthma patients, respectively; mean age 57.9 ± 8.1 years; 33 females, 64 males). Overall, FEV1 improved significantly from 1.287L to 1.484L (p < 0.001) with similar statistical improvements in COPD (1.237 L to 1.414 L; p = 001) and asthma (1.477 L to 1.747 L; p = 0.004) subpopulations. COPD patients showed statistically significant improvements in CAT scores (17.2 ± 1.0 to 10.6 ± 0.9, p = 0.0001); however, such significance was not observed in the ACT scores for asthma patients. FVC remained unchanged in all subgroups. No severe adverse events were reported.

Conclusion: The combination of N-acetylcysteine and acebrophylline improves QoL in moderate to severe COPD patients and FEV1 in both COPD and asthma patients with a favorable safety and tolerability profile. The combination appears safe and effective for managing obstructive airway disease.

Background: Benralizumab, targeting the IL-5 receptor, reduces exacerbations and improves lung function in severe eosinophilic asthma. Data on its effect on fractional exhaled nitric oxide (FeNO), particularly in patients with and without chronic rhinosinusitis with nasal polyps (CRSwNP), are limited.

Objective: This study evaluates benralizumab's impact on FeNO levels in severe eosinophilic asthma, focusing on the presence of CRSwNP.

Methods: We retrospectively analyzed 43 patients with severe eosinophilic asthma treated with benralizumab. Patients were divided into CRSwNP (N=13) and non-CRSwNP (N=30) groups. Baseline characteristics, FeNO levels, FEV1, FVC, ACT scores, exacerbations, and oral corticosteroid (OCS) use were recorded at baseline, 3, 6, and 12 months.

Results: At baseline, FeNO levels were higher in CRSwNP patients than in non-CRSwNP (82.80 ppb vs 41.86 ppb, P = 0.019). Over 12 months, FeNO significantly decreased in CRSwNP patients (-29.69 ppb, P = 0.036) and remained stable in non-CRSwNP patients (+3.55 ppb, P = 0.036). Significant improvements were observed in FEV1 (0.59L vs 0.38L, P = 0.017) and ACT scores (6.46 vs 4.01, P < 0.001) in CRSwNP patients. Both groups showed a notable reduction in exacerbations, which was more pronounced in CRSwNP patients (-3.12 vs -3.60, P < 0.001). OCS withdrawal was achieved in 53.8% of CRSwNP patients and 43.3% of non-CRSwNP patients.

Conclusion: Benralizumab reduces FeNO levels and improves clinical outcomes in severe eosinophilic asthma, especially in patients with CRSwNP. Monitoring FeNO levels provides additional insights into treatment response, highlighting its potential role as a marker in specific patient subgroups.

Patients with asthma frequently experience recurrent symptoms including coughing, wheezing, shortness of breath, and chest tightness. Asthma is a common public health concern. It is characterized by chronic airway inflammation. However, The pathogenesis of asthma is complex. Inflammasomes are signaling platforms that regulate the inflammatory response. There is a correlation between inflammasomes and asthma. Pattern recognition receptors recognize danger signals and participate in inflammasome activation. Nucleotide-binding and oligomerization domain-containing 2 (NOD2), a pattern recognition receptor, senses microbial components and triggers immune responses. There have been studies showing a correlation between NOD2 and asthma. The nucleotide-binding oligomerization domain-like receptor containing pyrin domain 3 (NLRP3) participates in the formation of inflammasomes. NLRP3 are involved in asthma pathogenesis. In this review, we discuss the roles of NOD2 and NLRP3 in the pathogenesis of asthma.

The incidence of allergic diseases has been increasing annually, severely affecting the quality of life of patients. With the growing recognition of traditional medicine, acupuncture, an ancient Chinese therapeutic method, has gradually gained attention for its potential in immune modulation. Studies have shown that macrophages play a crucial role in the development of allergic diseases, and acupuncture may influence allergic reactions by modulating the function of macrophages. This article aims to systematically evaluate the regulatory effects of acupuncture on macrophages in allergic diseases and the corresponding mechanisms. It analyzes existing research findings and explores the clinical application prospects of acupuncture in this context. By understanding how acupuncture affects the activation, secretion, and role of macrophages in immune responses, we hope to provide new insights and directions for the treatment of allergic diseases.

This study aims to demonstrate the bibliometric characteristics of articles on biologics for asthma treatment over the past two decades. There were 3395 articles published in 653 journals from 91 countries/regions from January 1, 2000 to September 30, 2023. The results showed biologics changes the course of asthma has attracted the interest of researchers and asthma remission has recently been proposed by researchers. Therefore, the goal of T2-high asthma management was shifted from controlling to complete remission. There was also growing interest among researchers in alleviating symptoms in T2-low asthma. New biological targets also need to be discovered when patients do not achieve satisfactory therapeutic outcomes with biologic agent, and one of the potential future direction for a treatment breakthrough lies in the combination of two biologics or the utilization of novel biologics that target dual sites. The development of biologics has progressed rapidly and has demonstrated their effectiveness in clinic, however, biologics still face multifaceted challenges and require further research to identify additional targets or enhance efficacy.

Biologic therapies have revolutionized the management of severe asthma (SA), offering significant symptom control and reduced exacerbations for many patients. However, up to 25% of individuals do not show satisfactory responses to these treatments and are categorized as non-responders. Definitions of response and primary non-response to biologics in SA are well-established. In secondary nonresponse, patients show initial response to biological treatment in the first 6-12 months but later lose asthma control, and in SA this phenomenon remains undefined and unstudied in literature. We present 4 cases of severe asthma treated with different biologic agents. All patients demonstrated significant clinical improvement during the first 12 months of therapy but followed by a gradual loss of asthma control, indicative of secondary nonresponse. We discuss the clinical features, potential mechanisms, and implications of secondary nonresponse to biologics in severe asthma, highlighting an unmet need for further research to define this phenomenon and guide future therapeutic strategies.

Background: Eosinophilic gastrointestinal disorders (EGIDs) are chronic immune-mediated conditions characterized by pathological eosinophilic infiltration. The clinical features and therapies for eosinophilic esophagitis (EoE) vary between children and adults. However, there is limited comparison of non-EoE EGIDs across different ages of disease onset.

Methods: We retrospectively analyzed data that included 94 patients (12 juveniles, 57 young adults, and 23 older adults) with a history of non-EoE EGIDs managed in a tertiary hospital.

Results: The study included patients with a mean onset age of 36.6 years, 52.1% of whom had allergic comorbidities. Diarrhea was more common in young adults (18-49 years), while nausea and vomiting were predominant in juveniles (0-17 years) compared to older adults (≥50 years). Reduced flatulence and/or defecation were less common in young adults. Ascites were less frequent in older adults. Notably, patients with the same affected gastrointestinal site also exhibited varying manifestations across age groups: young adults with gastric or ileal involvement had higher diarrhea rates (64% and 68.4%, respectively, p < 0.05), while juveniles with gastric/duodenal involvement exhibited higher nausea, vomiting, and ascites, and those with ileal involvement showed higher ascites (p =0.031). Young adults with colonic involvement had reduced flatulence/defecation less frequently (p = 0.005). Juveniles had significantly higher peripheral eosinophil counts (p = 0.040), and higher total serum IgE levels (p =0.002) compared to older adults. Serum albumin levels were significantly higher, and erythrocyte sedimentation rate (ESR) was significantly lower in the juvenile group compared to the young adult group (p = 0.004, p = 0.045) and the older adult group (p = 0.002, p = 0.002).

Conclusion: Clinical phenotypes of patients with non-EoE EGIDs vary by age of onset. A comprehensive understanding of the features in symptoms and therapies across different age groups can help accelerate diagnosis and enhance patient care.

This case report aims to explore the efficacy and safety of upadacitinib in patients with severe atopic dermatitis during hepatitis C activity period, providing reference for the treatment of severe atopic dermatitis patients in clinical hepatitis C activity period. We reviewed the treatment history of a patient with severe atopic dermatitis with hepatitis C in our hospital and analysed the safety of applying upadacitinib for the treatment of severe atopic dermatitis in conjunction with the review of relevant literature. During the 1-year follow-up, the patient's peripheral rash gradually improved, and the hepatitis C viral RNA load was normalised at the 6-month follow-up, reaching the clinical criteria for hepatitis C cure. The patient took only oral triamcinolone and upadacitinib for half a year after hepatitis C cure, and no recurrence of hepatitis C or liver function abnormality was found. Upadacitinib can be considered as a treatment option for patients with severe atopic dermatitis during hepatitis C activity period, but more clinical cases and drug research are needed to assess its safety during hepatitis C activity period.

Background: Biologic therapy in asthma can be life-changing and affect health-related quality of life, but symptoms are rarely used in the assessment of response.

Aim: To examine the change in health-related quality of life and asthma control between starting a biologic and assessment of biologic response, assessing whether this change can provide early prediction of eventual clinical response at 12 months.

Methods: A service evaluation of severe asthmatics initiating a biologic at the Royal Devon NHS trust between 2019 and 22. Health-Related Quality of Life (Severe Asthma Questionnaire) and asthma control (Asthma Control Questionnaire-6) was captured at baseline, 8 weeks, 16 weeks and 12 months. Patients were classified as responder or non-responder using NICE Criteria for biologic response. Independent samples t-tests were used to determine statistical difference in change from baseline patient reported outcome measure scores between responder and non-responders.

Results: One hundred and eight initiations (103 patients) of biologic therapy were included. At 8 weeks and 16 weeks, responders had greater improvement in Severe Asthma Questionnaire & Severe Asthma Questionnaire Global compared to non-responders (p<0.05). Improvement in Asthma Control Questionnaire only achieved significance between all-responders and non-responders at 16 weeks (p<0.05).

Conclusion: This study provides evidence of the early and sustained improvement in health-related quality of life and symptoms after starting biologic therapy. The findings support the use of the Severe Asthma Questionnaire and the Asthma Control Questionnaire as per the Core Outcome Measures Sets for Severe Asthma (COMSA). We have shown that health-related quality of life and asthma control can assist earlier assessment of response and non-response to biologics.