Journal of Asthma and Allergy最新文献

[This corrects the article DOI: 10.2147/JAA.S516225.].

Purpose: Allergic rhinitis (AR) is a global health concern caused by allergen exposure. This Indian study utilized the Score for Allergic Rhinitis (SFAR) questionnaire to estimate the prevalence of AR among patients with nasal symptoms visiting doctors' clinics/hospitals.

Patients and methods: This multicenter, cross-sectional study assessed AR using the SFAR questionnaire in patients with nasal symptoms visiting doctors' clinics/hospitals. It included patients aged ≥11 years across 19 states/union territories of India from September 2022 to April 2023. The score was digitally calculated using the Kribado^TM device, with a score of ≥7 indicating the presence of AR. Patient-reported data covered demographics, seasonal patterns, symptoms, allergens/triggers, and prevalence. Associations among various risk factors were analyzed.

Results: This study involved 3358 doctors, including ENT surgeons and chest physicians, and 40,001 patients across India. Among all patients, 53.7% (n=21,480) had SFAR scores ≥7. Sneezing was the most common symptom, reported by 69.1% of patients overall and 86.8% in the AR+ subgroup. House dust mites were the most prevalent allergens, affecting 73.8% of patients. Nose-related issues peaked from October to January. Half of the patients had a family history of asthma, eczema, or AR. In the AR+ subgroup, only 46% were diagnosed with allergies by a doctor, and 31.5% underwent allergy testing. After adjusting for variables, AR was significantly linked to nasal symptoms, including itchy and watery eyes, and a history of doctor-diagnosed allergies.

Conclusion: The in-clinic prevalence of AR in patients with nasal symptoms, as indicated by the SFAR questionnaire, is substantially high in India. A positive family history, indoor dust exposure, nasal symptoms, the months of October to January, and females were strongly linked to AR in Indian patients. The SFAR score is an effective in-clinic screening tool to support early AR diagnosis and management in India.

Background and purpose: Biologics are crucial for severe asthma treatment, but their high costs pose challenges. Omalizumab (OML) is dosed on the basis of patient-specific factors. The purpose of this study is to clarify the clinical characteristics of severe asthmatics who maintain long-term control on omalizumab including healthcare cost considerations.

Patients and methods: A retrospective, multicenter cohort study was conducted. Patients receiving OML at three institutions were enrolled. Patients continuing OML (C-OML) were compared with those switching to other biologics (S-OML) in terms of clinical background, cost-effectiveness, and type-2 inflammation levels.

Results: Forty-seven patients were enrolled. The C-OML group achieved exacerbation control comparable to that of the S-OML group, with a median OML dose of 300 mg/month, resulting in significantly lower personal payments (p < 0.01). Compared with the S-OML group, the C-OML group had a greater prevalence of overweight (p = 0.04), a lower prevalence of eosinophilic chronic rhinosinusitis (p < 0.01), and a trend toward a higher prevalence of allergic rhinitis (p = 0.06). Effective asthma control with OML was associated with nonsevere type-2 inflammation (eosinophils < 300/μL and FeNO < 50 ppb).

Conclusion: Patients with nonsevere type-2 inflammation and a high BMI can achieve effective asthma control with OML, reducing treatment costs. Identifying this phenotype can improve the cost-effectiveness of biologic therapies for patients with severe asthma.

Allergic bronchopulmonary aspergillosis is characterized by hypersensitivity to Aspergillus spp. and often causes intractable asthma. Studies have been conducted on biologics administered to patients with allergic bronchopulmonary aspergillosis; however, treatment may not always be successful. This may be due to the limitations of the current biologics that selectively target a single cytokine. Tezepelumab, a human monoclonal antibody that blocks the activity of thymic stromal lymphopoietin, broadly suppresses type 2 inflammation by regulating the upstream cascade of airway inflammation. Therefore, it is expected to have favorable effects in patients with allergic bronchopulmonary aspergillosis. We report three cases of allergic bronchopulmonary aspergillosis with uncontrolled symptoms despite the maximal use of conventional anti-asthmatic drugs such as inhalative agents, anti-leukotriene receptor antagonists, and antifungal drugs. None of the patients had previously received biologics. The addition of tezepelumab produced a marked clinical response in all three patients, which included fewer exacerbations and a reduced dosage of oral systemic corticosteroids and/or reduced as-needed short-acting beta-2 agonists. The patients' pulmonary symptoms were better controlled, peripheral blood eosinophil counts and immunoglobulin E levels decreased, and quality of life scores and respiratory function parameters improved. Mucous plugs accompanied by atelectasis and infiltrative shadows observed on chest computed tomography also improved. Tezepelumab may be a promising treatment option for allergic bronchopulmonary aspergillosis in patients with severe asthma, offering effective symptom control and enabling reduction in systemic corticosteroid use.

Introduction: Discoordination between inhalation and pressurized metered-dose inhaler (pMDI) actuation when delivering inhaled corticosteroids (ICS) is a common technique error that can lead to worsened treatment outcomes. Valved holding chambers (VHCs) are thought to improve the delivered dose if inhalation is delayed, but this effect has not been sufficiently quantified.

Methods: The aerodynamic particle size distribution of fluticasone propionate (FP) and ciclesonide (CIC) was studied under three conditions: inhalation initiated before actuation without a VHC, inhalation started at actuation without a VHC, and inhalation started at actuation with a VHC. We used a Next Generation Impactor connected to an anatomical adult throat model and a breathing simulator that produced a single, adult-type inhalation.

Results: We found that when inhalation was initiated simultaneously with actuation, the effective dose delivered decreased markedly for both FP and CIC compared to when inhalation was begun correctly, ie, before actuation. However, when a VHC was used and inhalation was started at actuation, delivered dose improved substantially for both medications. This protective effect of the VHC was especially pronounced for CIC, with both the fraction of particles in the 1-5 µm range and those under 1 µm returning to the same levels as when inhalation was initiated correctly.

Discussion: Although our study was conducted in vitro and did not involve patients, the findings likely have relevance for clinical practice. Therefore, promoting the use of VHCs in both children and adults may be beneficial, but this should be confirmed in clinical studies.

Background: Allergic rhinitis (AR) triggered by pollen is a growing global public health concern. This study aimed to: 1) analyze IgE reactivity to grass and weed pollen in Thai AR patients; 2) assess the prevalence and intensity of IgE-reactive protein bands; and 3) investigate cross-reactivity among pollen species.

Methods: Sera were collected from Thai adult AR patients in Bangkok, Thailand, and skin prick test (SPT) data were obtained. ELISA assessed IgE reactivity to pollen extracts from four grasses (Bermuda grass, para grass, Johnson grass, Manila grass) and two weeds (nutsedge, careless weed) using 119 patient sera. Immunoblot identified IgE-reactive protein bands using 65 patient sera with positive SPT. Cross-reactivity was confirmed by immunoblot and ELISA inhibition assays.

Results: Johnson grass showed the highest ELISA optical density (OD) values. Significant positive correlations (r_s = 0.740 to 0.935, p < 0.0001) in IgE reactivity were observed among pollen species, with stronger correlations among grasses. Immunoblot identified 30 kDa and 63 kDa proteins as major IgE-reactive proteins in grasses, and 25 kDa and 75 kDa proteins in nutsedge. Strong positive correlations were found within grass species for number of bands, ELISA OD, and SPT wheal size. A positive correlation existed between ELISA and SPT results (r_s = 0.27, p = 0.030). Inhibition assays confirmed cross-reactivity among grass and weed species.

Conclusion: This study highlights variability in pollen sensitization, cross-reactivity, and potential novel allergens in Thai AR patients. These findings are crucial for enhancing pollen allergy understanding and improving diagnostic and treatment, particularly in tropical/subtropical regions.

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.