Journal of Asthma and Allergy最新文献

Introduction: We previously showed that individuals without a prior history of asthma, presenting with unexplained respiratory symptoms and normal spirometry, may exhibit airway hyperresponsiveness and underlying eosinophilic (T2) inflammation, features suggestive of undiagnosed early-stage asthma. Improving our understanding of the inflammatory processes that contribute to asthma onset is essential, as it may ultimately lead to earlier detection, timely intervention and improved long-term outcomes.

Purpose: This study aimed to evaluate several key inflammatory biomarkers in this well-characterized population and examine their associations with clinical presentation to identify early signs of asthma.

Patients and methods: This retrospective, observational cohort sub-study included Canadian adults with respiratory symptoms and normal pre- and post-bronchodilator spirometry. Demographics and clinical data were extracted from study files. Plasma and serum levels of biomarkers associated with T2 airway inflammation and epithelial shedding, including IL-4, IL-5, IL-13, IL-25, IL-33, eotaxin, eotaxin-3, TARC, periostin and TNF-α, were measured using ELISA and multiplex electrochemiluminescent assays. Airway hyperresponsiveness was defined as a PC₂₀ <16 mg/mL, and T2 airway inflammation as sputum eosinophils >2% and/or FeNO >25 ppb.

Results: Among 128 adults (mean age ±SD: 58.0 ±13.9 years, 52% women), 45 (35%) had T2 airway inflammation. Most biomarker levels were low or undetectable, with substantial inter-individual variability. No significant differences in biomarker levels were observed between individuals with and without airway hyperresponsiveness or T2 airway inflammation. Eotaxin levels negatively correlated with post-bronchodilator FEV₁/FVC ratio (r=-0.18, P=0.0433), and eotaxin-3 positively correlated with FeNO (r=0.18, P=0.0482).

Conclusion: This panel of clinically accessible T2 biomarkers may not reliably reflect early pathophysiological signs of asthma in symptomatic adults with normal spirometry. Longitudinal follow-up of this cohort, along with the integration of airway sampling, may provide further insight into the role of these biomarkers in asthma development and progression.

Purpose: This study aims to evaluate the link between sleep disorders and patients with severe asthma enrolled in the Severe Asthma Network Italy (SANI) registry. We investigated the prevalence and the overall disease burden sleep disorders in severe asthmatics, identifying their clinical features, risks factors and treatable traits.

Patients and methods: We performed a retrospective analysis using data from the SANI registry, stratifying patients based on the presence or absence of sleep disorders at their baseline visit, to gather their clinical, functional, and demographic information.

Results: About 26.1% of severe asthmatics have concomitant sleep disorders, especially overweight patients. Severe asthmatic patients with sleep disorders have significantly more frequent rhinitis, chronic rhinosinusitis with (CRSwNP and without nasal polyps (CRSsNP), gastroesophageal reflux disease (GERD), cardiovascular disease (CVD) and type II diabetes. These patients more frequently use intranasal corticosteroids and show higher exacerbation rate needing systemic corticosteroids. They show less severe lung function impairment but worse asthma control and quality of life, increased asthma-related hospital admission and number of unscheduled medical visits. Multivariate analysis shows that overweight, moderate-to-severe rhinitis, CRSwNP, CRSsNP, GERD and CVD are independent risk factors for sleep disorders.

Conclusion: Sleep disorders are a common and relevant feature among patients with severe asthma. The two diseases influence each other worsening the severity of symptoms, quality of life and overall healthcare burden. These data suggest that, treating comorbidities, including sleep disorders, might result in a better management of asthma and so a better health outcome.

Purpose: Pulmonary rehabilitation (PR) is a well-established non-pharmacological intervention for patients with asthma. While PR improves asthma control and exercise capacity, its impact on airway inflammation remains unclear. Fractional exhaled nitric oxide (Fe_NO) is a biomarker of type 2 airway inflammation, yet its response to PR has not been extensively studied. Therefore, aim of this study was to investigate diurnal variations in Fe_NO and how Fe_NO develops during PR in asthmatic patients with different levels of Fe_NO.

Patients and methods: This prospective, single-center study investigated Fe_NO changes in asthma patients undergoing a comprehensive three-week inpatient PR program. The study observation period covered 15 consecutive days of FeNO measurements. Patients were divided into three subgroups according to their initial Fe_NO measurement: low (<25 ppb), intermediate (25-50 ppb) and high (>50 ppb). Fe_NO was measured three times a day, along with assessments of asthma control, lung function, blood eosinophils and exercise capacity before and after PR.

Results: Sixty-two patients were included. Only patients in the high Fe_NO group (n=22) showed a significant 40% decrease in Fe_NO from pre to post PR (93±29 ppb to 56±27 ppb, p<0.001), independent of medication changes. Fe_NO levels of patients with low (17±8 ppb to 16±10 ppb) and intermediate levels (39±12 ppb to 30±10 ppb) remained unchanged. Asthma control and exercise capacity improved across all three subgroups, with the greatest gains observed in patients with initially high Fe_NO. No significant Fe_NO changes occurred in the low and intermediate Fe_NO groups.

Conclusion: PR significantly reduced Fe_NO levels in asthma patients with high baseline Fe_NO, suggesting an anti-inflammatory effect beyond pharmacological treatment. These findings highlight the role of PR as a complementary strategy in asthma management, particularly for patients with persistent airway inflammation despite optimized medication. Further randomized trials are needed to confirm these results and explore long-term effects.

Purpose: Bananas are one of the most widely consumed fruits globally, particularly in Thailand. However, banana fruits have been recognized as allergenic, with the WHO/IUIS currently listing six identified banana allergens. This study investigates the proteome and allergenome of crude protein extracts from Musa 'Kluai Hom Thong' bananas.

Patients and methods: Proteins were separated using two-dimensional gel electrophoresis (2DE) and characterized through 2DE-IgE immunoblotting with sera from 20 banana-allergic patients. Reactive protein spots were analyzed using LC-MS/MS, and proteins were identified via database searches against UniProt-Musaceae.

Results: A total of 559 proteins were identified, with 35 reactive protein spots detected across the sera samples, corresponding to 19 distinct proteins. Notably, none of these proteins have been previously reported as banana allergens, categorizing them as potential novel allergens. Among these, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and pathogenesis-related (PR) proteins are notable, as they are major allergens in other fruits and organisms.

Conclusion: Nineteen IgE-reactive proteins were identified from Musa 'Kluai Hom Thong', with GAPDH and PR proteins proposed as candidate novel allergens associated with systemic reactions and cross-reactivity. Future multi-center studies incorporating functional assays are needed to validate their clinical relevance and diagnostic potential.

Objective: This study investigated age-related variations in airway hyperresponsiveness (AHR) based on pulmonary function, fractional exhaled nitric oxide (FeNO), total immunoglobulin E (IgE), eosinophils, basophils, neutrophils, monocytes, and lymphocytes.

Methods: A total of 1,500 patients treated at the Second Hospital of Shanxi Medical University from 2021 to July-September 2023 were enrolled and stratified into four age groups. General information, smoking history, pulmonary function, FeNO (including FeNO50, FeNO200, and CaNO), and blood biomarkers (total IgE, eosinophils, basophils, neutrophils, monocytes, lymphocytes) were collected. Intergroup comparisons and correlation analyses were performed.

Results: Pulmonary function: The positive rate of bronchial provocation test and the decline rate of FEV1 were higher in adolescents and the elderly, exhibiting a "U-shaped" distribution. FEV1, FVC, MEF50, and MEF25 increased with age until 18 years old and then declined. FEV1/FVC showed an overall decline with age. Exhaled nitric oxide test: The positive rate of type 2 inflammation in small airways showed a "U-shaped" distribution. CaNO was highest in the elderly group, overall displaying a "U-shaped" trend. No age-related differences were observed in FeNO50 and FeNO200. Laboratory indicators: Eosinophils, total IgE, and lymphocytes decreased with age. Basophils were highest in the young adult group. Neutrophils were lower in adolescents and higher in the elderly. Monocytes were elevated in both adolescent and elderly groups.

Conclusion: AHR is more prominent in adolescents and the elderly, showing a "U-shaped" age distribution. Adolescents exhibited Th2-type inflammation (mainly eosinophil-driven), while the elderly showed non-Th2-type inflammation (mainly neutrophil- and monocyte-driven). Pulmonary function peaks in young adulthood and declines more rapidly after middle age, with small airway obstruction worsening in the elderly. The elevated CaNO in the elderly group dissociated from decreased blood eosinophils, suggesting localized eosinophilic inflammation or impaired migration, potentially indicating an eosinophil non-dependent inflammatory phenotype.

Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare multi-organ autoimmune disease characterized by eosinophilic infiltration of peripheral blood and tissues, and necrotizing granulomatous inflammation of small and medium-sized blood vessels. In the prodromal stage of EGPA, patients may present with features of refractory asthma, with the involvement of other organs occurring later when the diagnosis of EGPA is made. The difficulty of early diagnosis makes treatment difficult.

Methods: We retrospectively describe patients (N=13) who attended the asthma clinic at the First Affiliated Hospital of Guangzhou Medical University between 2008 and 2024. The disease course was categorized into three stages: asthma, lung-limited or lung-dominant EGPA (L-EGPA), and systemic EGPA (S-EGPA). Patients with severe eosinophilic asthma served as controls. We evaluated baseline demographic, as well as organ involvement, complication, laboratory findings, lung function, high-resolution computed tomography (HRCT), and treatment across different disease stages. A case-crossover design and Bayesian conditional logistic regression were employed to evaluate the impact of medication use on disease progression.

Results: We identified a group of EGPA patients who exhibited consistent disease progression to transit from asthma to L-EGPA, and eventually to S-EGPA. These stages exhibit distinct clinical and imaging features, with significantly elevated eosinophilic inflammatory markers in induced sputum or blood being a hallmark of L-EGPA. This distinction may aid in differentiating refractory asthma from L-EGPA.

Conclusion: In conclusion, the L-EGPA phase may represent a distinct stage in EGPA development that is often challenging to distinguish from refractory asthma. Characterizing this phase and identifying specific biomarkers could facilitate earlier diagnosis and treatment, potentially improving patient outcomes-a hypothesis that warrants further validation.

Purpose: To evaluate the Achieving Clinical Audits with Electronic Records (ACAER) program in supporting primary care providers in quality improvement initiatives across asthma and COPD.

Patients and methods: This observational cohort study included individuals aged ≥12 years with documented diagnosis of asthma or COPD, receiving asthma or COPD therapy, at high risk of exacerbation and hospitalization. Data were derived from the intervention, linked patient questionnaires completed as part of practice evaluation and quality improvement, and routine primary care electronic medical records (EMR) within the Optimum Patient Care Research Database Australia (OPCRDA). Changes in exacerbation rates and maintenance treatment were evaluated.

Results: 7512 asthma and 6526 COPD patients were evaluated with EMR collection. A subset of 1327 asthma patients and 629 COPD patients were classified as active and high-risk. Patient questionnaires and evaluation reports were sent out between 29 October 2019 and 21 September 2021, the intervention period. For those at risk during the entire study period (2018-2023; N=1276), 48.4% and 59.3% of patients in the high-risk asthma and COPD populations, respectively, had maintenance therapy change in the first year post-intervention. Exacerbation rates fell after the intervention period in the high-risk asthma (74.8 to 32.4 per 1000 per month) and COPD (122.9 to 91.2 per 1000 per month) populations. High-risk asthma patients had increasing rates of exacerbations in the 2 years prior to the intervention period (linear trend: 2.79 exacerbations per 1000 per month [1.34, 4.24]; p=0.001), which declined and remained stable after the intervention (p=0.87; up to 2023). Exacerbation rates for high-risk COPD patients were stable pre-intervention (p=0.29). Post-intervention rates initially declined and then showed a marginal non-statistically significant increase (p=0.28).

Conclusion: Our findings support the potential for the ACAER asthma and COPD program to drive treatment change and improve long-term outcomes in high-risk patients in primary care settings.

Background: Viral-induced wheezing, a common respiratory issue in children, is characterized by wheezing triggered by viral infections. This study aims to evaluate parental knowledge, perceptions, and practices regarding viral-induced wheezing in Jordan.

Methods: A cross-sectional survey was conducted with 510 parents, recruited from schools and online platforms.

Results: The study found that 32.1% of parents had good knowledge about viral-induced wheezing, and 73.5% were aware that it could resolve in children over time. Parents of children with asthma, allergic rhinitis, or atopy were more informed about viral-induced wheezing. Regression analysis showed a significant association between children's recurrent upper respiratory tract infections and parental knowledge. During wheezing episodes, the majority of parents (91.8%) administered medications, and 80.1% used herbal remedies.

Conclusion: Parents of children with frequent upper respiratory tract infections exhibited greater knowledge related to wheezing management. Enhancing parental education may contribute to improved symptom recognition and management. These findings underscore the need for targeted educational initiatives and future longitudinal studies to explore the long-term impact of parental knowledge on respiratory outcomes.

Allergic rhinitis (AR) is a prevalent chronic inflammatory allergic disease, characterized by paroxysmal nasal congestion, itching, sneezing, and rhinorrhea, which affects mental health in severe cases. Western medical treatments primarily rely on glucocorticoids and antihistamines, which, while providing symptomatic relief, are associated with varying degrees of side effects and fail to ensure long-term efficacy. The pathogenesis of AR is intricately related to immune system dysregulation, and the treatment of AR has not yet been fully clarified. Natural products, having co-evolved with humans over millennia, boast structural diversity and rich biological activity, and they can precisely interact with intracellular targets such as enzymes, receptors, and ion channels, positioning them as a vital resource for therapeutic interventions. Notably, validated natural products often contain multiple active constituents, which confer broader therapeutic effects compared to single-component compounds. These constituents also exhibit lower acute toxicity than synthetic drugs, ensuring superior long-term. The synergistic interactions among their components endow them with dual potential for both prevention and treatment. Natural products modulate AR pathogenesis through various signaling pathways, addressing key etiological factors such as immune dysregulation, inflammatory responses, as well as oxidative stress. These developments will drive research and application of natural products in AR management, unlocking their untapped potential. This review systematically examines the mechanisms by which natural products regulate AR pathogenesis through signaling pathways, drawing on both animal studies and laboratory research, though clinical data are still relatively limited. By elucidating their specific mechanisms of action, this work not only provides novel insights for developing effective, long-term AR management drugs but also offers scientific guidance for experimental research and clinical application in AR therapeutics.

Purpose: The COVID-19 pandemic altered patterns of indoor allergen exposure. However, longitudinal dynamics of sensitization kinetics across allergens remain poorly characterized. This study delineated allergen-specific sensitization dynamics during 2019-2022, contrasting responses to dust mites and cat dander.

Patients and methods: The retrospective cohort study of 43,314 children (0-17 years) in Shenzhen, China, analyzed specific IgE (sIgE) reactivity. Adjusted odds ratios (aORs) were calculated using logistic regression (adjusted for age/sex; 2019 baseline) and E-values assessed unmeasured confounding.

Results: Dust mite sensitization increased significantly in 2020 (Dermatophagoides pteronyssinusfarinae aOR = 1.291.42, 95% CI: 1.16-1.441.29-1.57, both P <0.001), declined in 2021, and partially rebounded in 2022. Conversely, cat dander sensitization exhibited a delayed peak, rising significantly only by 2022 (aOR = 1.83, 95% CI: 1.30-2.65, P <0.001, E-value = 3.07). German cockroach sensitization decreased by 35% in 2022 (aOR = 0.65, 95% CI: 0.54-0.78, P <0.001, E-value = 2.26). Adolescents (6-17 years) showed heightened cat dander sensitization (2022: aOR = 2.05, P =0.001, E-value = 3.52), while males had steeper cockroach declines (2022: aOR = 0.61, P <0.001). Food sensitization remained stable except wheat (aOR = 0.80, P =0.005).

Conclusion: We identify distinct allergen-specific dynamics. Dust mites acted as early-response allergens linked to confinement intensity, while cat dander emerged as delayed-response allergens likely driven by cumulative behavioral and exposure changes. Targeted environmental interventions (eg, pest control) significantly reduced cockroach sensitization. These findings advocate for allergen-tailored, time-resolved prevention strategies during public health crises, with priority protection for adolescents.

Clinical trial registration: National Medical Research Registration Information System/MR-44-24-056093.