Journal of Asthma and Allergy最新文献

Asthma, a chronic respiratory condition, impacts over 339 million individuals globally, including 25 million in the United States, contributing to significant morbidity and healthcare costs. Despite advances, challenges persist in managing exacerbations, ensuring medication adherence, and patient education. This narrative review explores the transformative potential of artificial intelligence (AI) in improving asthma management through predictive analytics, personalized treatment, and continuous patient engagement. A search of the United States National Library of Medicine's PubMed database was performed for articles pertaining to asthma and artificial intelligence, machine learning (ML), neural network, or deep learning. The current research on AI applications in asthma care was then reviewed, including algorithms, AI-driven tools for personalized medicine, and digital platforms for patient engagement. Case studies and clinical trials assessing AI's impact on predictive accuracy and treatment adherence were reviewed. AI, particularly ML, enhances asthma management by analyzing data from wearables and patient records to predict exacerbations, stratify risk, and inform personalized treatment. Studies demonstrate AI's capability to recommend tailored interventions, monitor adherence through smart applications, and facilitate real-time treatment adjustments. Ethical challenges include ensuring patient trust, data security, and equitable technology access. In conclusion, AI's integration in asthma care holds significant promise for predictive interventions, personalized regimens, and continuous support, ultimately aiming to improve patient outcomes and reduce healthcare burdens. Continued advancements in AI will bridge current care gaps, fostering a patient-centric, proactive approach in asthma management.

Objective: Different types of inflammation in the sinuses require different treatments. Ethmoid dominance was proposed as an indicator on computed tomography (CT) images for type 2 chronic rhinosinusitis with nasal polyp (CRSwNP). This study evaluated the predictive value of the ethmoid-to-maxillary (E/M) ratio based on different CT scoring systems in type 2 CRSwNP.

Methods: Adult patients with bilateral CRSwNP planning to undergo sinus surgery were prospectively recruited. CT images were evaluated using the Lund-Mackay (L-M) and Zinreich scoring systems which involved a more meticulous quantification of opacification on CT images. Tissue eosinophil count (TEC) was determined by histopathological analysis. The expression levels of type 2 cytokines in nasal polyps, including IL-5, IL-13, and eosinophil cationic protein (ECP), were measured using real-time PCR.

Results: A total of 174 participants were enrolled. Eighty of these participants exhibited an E/M ratio >1, 49 presented with E/M ratio=1, and 45 showed an E/M ratio <1 based on L-M CT scores. Twenty of the 49 (40.8%) patients with E/M ratio=1 on L-M score turned to E/M ratio >1 after re-evaluation by Zinreich scoring system. The E/M ratio based on the L-M and Zinreich scoring systems both exhibited correlation with the tissue markers of type 2 inflammation, including TEC, interleukin (IL)-5, IL-13, and ECP expression levels, although the Zinreich E/M ratio showed a higher correlation coefficient.

Conclusion: The E/M ratio based on the L-M and Zinreich scoring systems correlated with tissue markers of type 2 inflammation. A scale with an E/M ratio of 1 in the L-M system should be further investigated using a more detailed scoring system to determine the presence of an ethmoid-dominant shadow. This could help clinicians better evaluate CT images to determine the severity of type 2 inflammation in patients with CRSwNP and provide optimal therapeutic strategies.

Background: The Saudi Initiative for Asthma (SINA) defines severe asthma as asthma that is uncontrolled at SINA step 4 despite optimized management. Choosing the biologic agent that is most appropriate for each patient can be difficult for clinicians. Thus, switching to another biologic agent due to no or suboptimal response is a common practice among asthma specialists. Therefore, this study aims to evaluate the safety and efficacy of switching biologics in patients with severe asthma at a tertiary care center.

Methods: This was an observational retrospective cohort single-center study conducted at King Abdulaziz Medical City-Central Region, Riyadh, Saudi Arabia. All adult patients ≥18 years of age with a confirmed diagnosis of severe asthma and who were switched from one biologic agent (omalizumab, mepolizumab and dupilumab) to another were included.

Results: Thirty-three patients were included in the final analysis. In the majority of patients (81%), switching occurred due to lack of clinical efficacy. Most patients were maintained on the first and second biologic for 6 months or more. Most switching occurred from omalizumab to mepolizumab and dupilumab was the most frequently used last-line biologic (54%). Compared to the first biologic, the mean number of exacerbations decreased after switching to a different biologic (6.6 vs 3.9, p = 0.1). On the other hand, sinus symptoms improved after patients were switched to a different biologic (18.5% vs 37.5%, p = 0.1).

Conclusion: Switching from one biologic agent to another is effective and safe in patients who are not optimally controlled on the initial treatment. National and international guidelines should define and include criteria for switching biologics.

Asthma is a chronic, complex, and heterogeneous respiratory condition marked by airway hyperresponsiveness and reversible airflow limitation. Recent evidence highlights the significant role of metabolic changes, particularly glycolytic reprogramming, in the pathogenesis of asthma. Glycolysis, a fundamental pathway for both anaerobic and aerobic oxidation, not only generates adenosine triphosphate (ATP) but also supplies substrates for lipid-based ATP storage. While initially studied in the context of cancer, glycolysis has been associated with asthma through its interplay with programmed cell death, which is crucial in asthma pathophysiology. This study offers a comprehensive overview of current research on glycolytic reprogramming in asthma, emphasizing its potential implications and significance. The findings aim to inform future studies and contribute to the development of asthma-related precision medicine. A deeper understanding of the interplay between glycolysis and the development and progression of asthma may facilitate the development of innovative therapeutic approaches for this complex condition.

As a vital component of the immune system, macrophages play a critical role in the progression of asthma. The two classic polarization states of macrophages, M1 and M2, exhibit distinct functions. M1-polarized macrophages eliminate pathogens through the secretion of pro-inflammatory cytokines, while M2-polarized macrophages secrete anti-inflammatory factors to facilitate tissue repair. However, in asthma, the activation of M1 macrophages is often associated with excessive inflammatory responses, whereas M2 macrophages contribute to airway remodeling and chronic inflammation. These processes collectively exacerbate airway inflammation and remodeling, thereby aggravating asthma symptoms. Reactive oxygen species (ROS), as crucial signaling molecules, have been shown to regulate macrophage polarization and promote both M1 and M2 polarization states. This review summarizes the primary endogenous and exogenous sources of ROS in asthma and elaborates on the mechanisms by which ROS influence M1/M2 polarization of macrophages. Endogenous ROS arise chiefly from NOX2, xanthine oxidase, peroxisomes and mitochondria, whereas ozone and fine particulate matter are major exogenous sources. ROS activate MAPK, NF-κB and NLRP3 cascades, boosting IL-1β, IL-6 and IL-27 release by M1 cells, while low NOX2 flux or mitochondrial H₂O₂ supports STAT6-dependent ARG1 expression and drives an M2 program. Additionally, we discuss the impact of different macrophage polarization states on asthma pathophysiology and the potential applications of macrophage-modulating agents in asthma treatment, particularly those targeting ROS-mediated polarization pathways. ARG1 rich M2 cells convert L-arginine into proline, fostering collagen deposition; Ym1/2, Fizz1 and CD206 correlate with airway remodeling and declining lung function. Emerging antioxidant and macrophage-polarization strategies that selectively modulate ROS show promise in rebalancing M1/M2 responses and attenuating airway hyper-responsiveness. This review provides new insights into the interplay between ROS and macrophage polarization and highlights the potential for developing therapies aimed at modulating macrophage polarization via ROS regulation.

Background: The emergency room (ER) approach for patients with asthma exacerbations (AEs) should be based on a comprehensive, multidisciplinary approach to ensure effective and timely care. This study aims to analyze the compliance level of recommended indicators, as defined in a consensus document, for the management of AEs in the ER using available electronic medical records.

Methods: An open-label, observational, non-interventional, retrospective study of adult patients treated in hospital ER for AEs was conducted at La Paz University Hospital and Salamanca University Hospital. Data were collected from medical records regarding a set of predefined measures and variables concerning asthma severity, ER stay, and subsequent discharge.

Results: During 2019, a total of 1,019 patients accounted for 1,089 AEs were evaluated. Clinical variables predominantly included historical data, such as previous hospitalizations, Intensive Care Unit admissions, and prior exacerbations, which were recorded in 45.8% of medical records. Auscultation details were extensively documented (99.8%), yet respiratory rate (25.4%) and spirometry (less than 10%) were notably lower. Regarding discharge planning, 69.6% of patients had a defined care plan, and 59.5% received Inhaled Corticosteroids plus Long-Acting Beta-Agonists combination treatment at discharge. Medical referrals resulted in 25.5% being referred for specialized care and 87.2% to primary care. 13.3% had a specific post-discharge care timeframe.

Conclusion: This study highlights significant variability in the documentation and adherence to recommended indicators for AE management in the ER. Moreover, discharge planning and follow-up care were suboptimal. These findings underscore the need for improved standardization and implementation of evidence-based protocols in emergency asthma care.

Purpose: Severe asthma is frequently accompanied by comorbidities such as chronic rhinosinusitis, nasal polyps, allergies, and gastroesophageal reflux disease (GERD). With increasing age, non-communicable conditions such as cardiovascular diseases and multimorbidity become more prevalent. This study aimed to analyze the prevalence of comorbidities and their impact on asthma-related outcomes over a two-year period using data from the Swiss Severe Asthma Registry (SSAR).

Patients and methods: We included 234 patients with baseline data and 2 years of follow-up visits from the SSAR. Patient's asthma control (ACT), quality of life (QoL), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), diffusing capacity of the lungs for carbon monoxide (DLCO) and fraction expiratory nitric oxide (FeNO) and their association to comorbidities were analyzed longitudinally using general estimation equations (GEEs) with log link function.

Results: Over the study period, ACT and QoL scores significantly improved, and the frequency of exacerbations declined. The prevalence of the examined comorbidities remained stable. However, the presence of chronic obstructive pulmonary disease (COPD) was significantly associated with lower ACT scores, reduced QoL, and impaired pulmonary function (all p < 0.05). GERD was also linked to lower ACT and QoL (p < 0.05), while depression was associated with a significant decrease in DLCO (p < 0.05).

Conclusion: Our findings underscore the strong impact of comorbidities-particularly COPD, GERD, and depression-on asthma control, quality of life, and lung function in patients with severe asthma. These results highlight the need for integrated, multidisciplinary management strategies targeting comorbid conditions to improve overall asthma outcomes. Further research should explore these subgroups in more detail to guide personalized treatment approaches.

Recurrent pulmonary infections (RPIs) represent a common yet clinically complex entity, primarily triggered by aspiration or the presence of foreign bodies. They are notoriously insidious and challenging to detect clinically. These infections typically involve the invasion of bacteria, viruses, or fungi, leading to inflammation and damage of lung tissue. The development of RPIs may also arise from the interplay of multiple factors. Due to their inherent complexity and association with poor prognosis, RPIs constitute a significant cause of mortality stemming from pulmonary infections. Understanding the risk factors associated with RPIs secondary to foreign body aspiration is crucial for effective clinical management. This narrative review synthesizes current knowledge on the pathogenesis, diagnosis, management, and prevention of RPIs caused by foreign body aspiration. We emphasize the heightened vulnerability of pediatric and elderly populations. The review delineates characteristic clinical presentations and outlines appropriate diagnostic modalities. Furthermore, it provides perspectives on antimicrobial therapy and the critical importance of foreign body removal. The synthesis aims to inform future research directions, preventive strategies, and therapeutic approaches, ultimately seeking to improve patient outcomes and mitigate the risk of recurrent infections.

Purpose: Asthma is the most common chronic disease among adolescents, yet disparities exist in its diagnosis and management across racial and gender groups. This study aims to assess asthma knowledge, awareness, and healthcare access among adolescents, with a focus on racial and gender disparities. The goal is to identify gaps in asthma education and knowledge, as well as other barriers that may contribute to the underdiagnosis of asthma within these groups.

Patients and methods: This cross-sectional survey included adolescents aged 10-18 years, with responses collected through Qualtrics. A total of 90 participants were selected, with no restrictions based on asthma status. Written informed consent was obtained from parents of participants under 18, while participants who were 18 years old provided their own written consent in accordance with IRB guidelines. Participants' knowledge of asthma symptoms, triggers, and healthcare access was assessed using multiple-choice and Likert scale questions. Data were analyzed for demographic differences in asthma knowledge and healthcare access across racial and gender groups.

Results: The study found that asthma education was minimal, with only 8% of participants reporting prior formal asthma education. Despite this, 53.4% of participants considered themselves knowledgeable about asthma, 59.5% could identify three or more asthma symptoms, and 50.6% identified more than three triggers. Racial disparities were evident, with Asian adolescents having a significantly lower asthma diagnosis rate compared to other racial groups (6.5% vs 47.4%, P<0.01), a lower rate of self-reported asthma knowledge (45.1% vs 64.9%, P=0.08), and lower odds of finding healthcare access "extremely easy" (OR=0.179, 95% CI: 0.076-0.455, P=0.00018). Although there was no difference in the rate of previous asthma diagnoses, males were more likely to seek medical help compared to females (OR=2.55, 95% CI: 1.037-6.268, P=0.032).

Conclusion: This study highlights significant gaps in asthma education, perception of healthcare access, and healthcare seeking behaviour particularly among Asian adolescents and females, and underscores the need for targeted interventions to address racial and gender disparities in asthma diagnosis and care.

Background: Atopic dermatitis (AD), a chronic inflammatory skin condition, affects up to 20% of children and 10% of adults globally, driven by a type 2 immune response via IL-4 and IL-13 through IL-4Rα. The rs1801275 variant in IL-4Rα gene, a glutamine-to-arginine substitution (Q576R), increases AD severity and atopic comorbidities. This study examines rs1801275's prevalence and clinical impact in Vietnamese population.

Methods: A cross-sectional study (January-May 2021) with 113 AD patients (Hanifin and Rajka criteria) and 213 healthy controls has been conducted. Demographics, clinical features, and SCORAD severity were assessed via questionnaires and dermatologist evaluations. rs1801275 variant was genotyped using allele-specific real-time PCR. Frequencies were compared, and associations with AD severity were analyzed using Fisher's Exact Test, Kruskal-Wallis test, and logistic regression, adjusting for age and sex.

Results: Allele frequencies (A: 82.74% vs 79.58%; G: 17.26% vs 20.42%) and genotypes of AD patient and control groups, respectively, showed no significant difference (p = 0.315), indicating no link to AD susceptibility. However, the G allele was associated with higher SCORAD severity in the dominant model (AG+GG vs AA: median 40 vs 30.5, p = 0.010; OR 4.67, p = 0.005) and additive model (p = 0.023), with a dose effect (AA: 30.5, AG: 39, GG: 49.65). Age group independently predicted severity (OR 2.31-2.43, p < 0.05).

Conclusion: The rs1801275 variant correlates with increased severity in G allele carriers, per SCORAD, in dominant model. These findings support personalized AD management in Vietnam, though larger studies are needed for GG genotypes.