Journal of Asthma and Allergy最新文献

Purpose: Biologic (antibody) therapy is a safe, effective, and guideline-recommended treatment for patients with severe and otherwise uncontrolled asthma. The number of older individuals with asthma is increasing but there is a lack of data on the use of biologics in this cohort. Therefore, this study reports the characteristics of older individuals receiving biologic therapy for severe asthma.

Patients and methods: This study was a retrospective data analysis conducted at two centers in Germany.

Results: Eighty-eight patients were included (52 aged 50-59 years and 36 aged ≥60 years). There was a high rate of comorbidities and associated pharmacological therapy use. Nearly half (49%) of participants were current or ex-smokers and 29% had chronic obstructive pulmonary disease. The older age group (≥ 60 years) had significantly more cardiovascular comorbidities, more comorbidities overall, and a worse diffusion capacity compared with the group aged 50-59 years. Baseline lung function parameters, and the change in lung function after 6 months of biologic therapy, did not differ significantly between the two age groups. Participants aged ≥60 years used self-injection less than those aged 50-59 years.

Conclusion: These data help to characterize the specific population of older people receiving biologic therapy for severe asthma, and showed a high rate of comorbidities, polypharmacy, and poor diffusion capacity in this group.

Purpose: Asthma is a chronic inflammatory airway disease that impacts millions of people worldwide. Understanding and reporting its prevalence and characteristic symptoms are essential for a comprehensive investigation of the disease.

Patients and methods: This study aimed to assess the prevalence of asthma and asthma-related symptoms across Iraq. A cross-sectional study was conducted using the European Community Respiratory Health Survey (ECRHS) questionnaire. A questionnaire was created using Google Forms and distributed through various social networking sites.

Results: A total of 1131 participants were included in the study from different rural and urban Iraqi communities. The prevalence of physician-diagnosed asthma was 10.5%. The most commonly reported asthma symptom was waking due to an attack of coughing, reported by 60.9% of participants, followed by shortness of breath triggered by dust or fumes (45.9%) and waking due to shortness of breath (36.6%). Our results indicated that being a male, having allergic rhinitis and a family history of asthma is more like to have asthma according to physician diagnosis. Also, a significant association was found between asthma and having allergic rhinitis, food allergies, drug allergies and family history of asthma with asthma according to ECRHS.

Conclusion: This study highlights the prevalence of asthma and its associated symptoms among adults in Iraq, using the ECRHS questionnaire. The findings highlight the need for improved awareness, early diagnosis, and targeted interventions, particularly for high-risk groups such as older adults, smokers, and those with allergies. Further research is needed to explore environmental and genetic factors contributing to asthma prevalence in the region.

Background: Systemic corticosteroid use in type 2 inflammation-associated diseases including asthma, atopic dermatitis, allergic rhinitis, and chronic rhinosinusitis has been associated with adverse outcomes, and corticosteroid-sparing treatments are available.

Objective: Assess temporal changes in systemic corticosteroid use and the impact of type 2 inflammation multimorbidity (eg multiple concurrent type 2 inflammation-associated diseases) and specialist assessment on systemic corticosteroid exposure.

Methods: Using nationwide databases, all Danish adults with asthma, atopic dermatitis, allergic rhinitis, or chronic rhinosinusitis, based on hospital diagnoses or redeemed prescriptions between 1997 and 2021 were included in an open, serial cross-sectional cohort.

Results: Over 25 years, a total of 2,151,209 Danish adults were included. Of those with a single diagnosis (type 2 inflammation monomorbidity),13.9% had asthma, 19.2% allergic rhinitis, 52.9% atopic dermatitis, and 14.0% chronic rhinosinusitis. In terms of type 2 inflammation multimorbidity, 75.1% of included individuals had one, 21.3% two and 3.5% three diagnoses, respectively. Overall, 9.6% of type 2 monomorbid individuals redeemed systemic corticosteroids, with asthma (16.5%) and atopic dermatitis (6.0%) having the highest and lowest prevalence of use. Systemic corticosteroid use peaked in 2006 (10.6%) and was lowest in 2020 (7.2%). Exposure > 5 mg prednisolone/day was constant around 15% overall among users. Type 2 inflammation multimorbidity was associated with increases in systemic corticosteroid use at 9.6%, 16.0% and 20.9% for one, two and three diagnoses, respectively. A median referral delay of 4.1 [8.1] years from first systemic corticosteroid redemption to specialist assessment was seen. Specialist assessment led to a 64.9% reduction in median annual systemic corticosteroid exposure overall.

Conclusion: In type 2 inflammation associated diseases, systemic corticosteroid use remains common despite the introduction of corticosteroid-sparing treatments. Timely referrals to specialist assessment could reduce the overall systemic corticosteroid exposure.

Background: Due to the inability of children with allergies to exhibit appropriate clinical symptoms, pediatricians often face the challenge of accurately diagnosing allergic diseases in children. Identifying the distribution of allergens is essential for the effective diagnosis and treatment of allergic diseases.

Methods: We investigated the distribution of 28 allergens among 12,292 suspected allergic children in Shenzhen, whose serum-specific IgE was subjected to relevance analysis with influencing factors.

Results: The results showed the overall allergen distribution was 66.36%. Mite, cow's milk, and egg white were the most prevalent allergens. Indoor allergens are significantly higher than outdoor allergens. There was extensive cross-reactivity among homologous species of allergens such as crustacean allergens, plant-derived allergens, etc. A 14KDa profilin as a common ingredient is suspected to be the main cause of the cross-reactivity among these plant-derived allergens. The frequencies of mite, cow's milk and egg white showed different trends with growing age, indicating that the frequencies of allergens are age-related. Various mechanisms of immune systems of children mature at different ages. We found that the proportion of mite sensitivity was highest in children with allergic rhinitis and conjunctivitis, while the proportion of cow's milk and egg white sensitivity was higher in children with allergic dermatitis such as eczema and urticaria.

Conclusion: Age and cross-reactivity play important roles in diagnosing allergies in children. Children at different ages exhibit varying sensitivities to different types of allergens, and identifying cross-reactions helps to comprehensively understand children's allergic status. Pediatricians can develop corresponding prevention and management measures based on allergen results and clinical symptoms.

Purpose: This study aimed to investigate the associations of anaemia status and body mass index (BMI) with asthma severity in adult subjects.

Methods: The study included 300 adults who had asthma and admitted to King Abdulaziz Medical City from about 2017 to 2022. The subjects' demographic data, BMI, anaemia status, and number of asthma-related hospital admissions were analyzed. Associations between anaemia, BMI, and asthma severity were investigated within a cross-sectional comparative design. Anaemia status as well as BMI variations may have an impact on the frequency of asthma-related hospitalizations.

Results: Most subjects in the study were female (74.3%) and over the age of 65. Mild anaemia was the most common condition (41.7%), and (42.3%) of subjects were classified as obese and (22.7%) were overweight. Age was found to be a significant factor in asthma-related hospital admissions (p-value = 0.0002), however sex was not significant. Subjects with mild or moderate anaemia and those who were obese had a higher frequency of asthma-related hospital admissions. Furthermore, the study revealed significant differences in the mean number of asthma-related hospital admissions among the different BMI and anaemia status categories. Subjects with severe obesity had a significantly greater number of asthma-related hospital admissions with a mean of 2.21 compared with the other BMI groups (p-value= 0.029). Subjects with mild anaemia had a significantly greater number of asthma-related hospital admissions with a mean of 2.07 than those with severe anaemia (p-value=0.04). These results highlight the importance of considering comorbid conditions in the clinical assessment and management of asthma.

Conclusion: These findings highlight that anemia and BMI abnormalities can complicate asthma management. Health care professionals should be aware of these factors when assessing severity and developing treatment plans. Further research is needed to explore the underlying mechanisms and evaluate interventions targeting anaemia and BMI to improve outcomes.

Introduction: Asthma causes airway inflammation, leading to symptoms that impair patients' quality of life, making it a significant global public health issue. Inhaled corticosteroids (ICS) with long-acting beta-agonists therapy (LABA) is commonly used to manage moderate to severe asthma. For patients unresponsive to ICS with LABA, omalizumab may be added to improve asthma control. Understanding transcriptomic expressions is crucial as it provides insights into the molecular mechanisms underlying treatment. However, the impact of omalizumab on transcriptomic expressions remains unclear. Therefore, this study aims to investigate the transcriptomic expression profiles and clinical outcomes between patients receiving ICS with LABA therapy and those adding omalizumab.

Materials and methods: This is a prospective, real-world study that enrolled 26 participants, divided into three groups: Group 1, ICS with LABA (n=10); Group 2, ICS with LABA plus omalizumab (n=12); and Group 3, healthy controls (n=4). Assessments included transcriptomic expression profiles, and bioinformatics analysis, IgE, airborne allergen test, pulmonary function test, blood tests, and asthma control test (ACT).

Results: ACT scores were significantly higher in Group 1 and 2 compared to Group 3. IgE levels, dust mite sensitivity, and dynamic pulmonary function changes after bronchodilator administration were notably higher in Group 2. In these patients, down-regulated genes included those related to immune response, NOD-like receptor signaling, RIG-I signaling, IL-17 signaling, and antioxidant activity. Conversely, up-regulated genes were found in the cGMP-PKG signaling pathway, cardiomyopathy-related pathways, and voltage-gated calcium channel activity.

Conclusion: Patients receiving ICS with LABA plus omalizumab still exhibited more dynamic airway changes and higher IgE levels. Downregulation of immune and inflammatory pathways suggests its potential as an add-on treatment for severe asthma. However, upregulated genes were observed in the cGMP-PKG signaling pathway, cardiomyopathy-related pathways, and voltage-gated calcium channel activity.

Background: Genetic factors, along with sociodemographic characteristics, are believed to play a significant role in asthma pathogenesis.

Objective: This study investigated the role of Interleukin-13 (IL-13) and Tumor Necrosis Factor-alpha (TNF-α) gene polymorphisms, in conjunction with clinical characteristics, in predicting asthma severity.

Methods: A total of 214 asthma patients (98 mild, 116 severe) and 121 healthy individuals were genotyped using PCR-RFLP for IL-13 (R130Q, rs20541) and TNF-α (-308A/G, rs1800629) polymorphisms. Sociodemographic and clinical data were collected for statistical analysis.

Results: Compared to controls, the "Q" allele of the IL-13 gene increased the risk of mild asthma twofold but had no significant impact on severe asthma. Conversely, the "G" allele of the TNF-α gene increased the risk of mild asthma twofold and severe asthma threefold. Additionally, the TNF-α "GG" genotype was associated with a sixfold increased risk of asthma, while the "AG" genotype had a protective effect. In the comparison of mild versus severe asthma, the IL-13 "QQ" pattern was protective, while the TNF-α "GG" genotype increased the risk of severe asthma threefold, with "AG" being protective. Severe asthma patients were older, significantly associated with comorbid nasal polyposis (NP), had higher levels of FeNO and blood eosinophils. Logistic regression analysis identified the TNF-α "GG" genotype as independent significant predictor of asthma severity, whereas IL-13 polymorphism showed no association.

Conclusion: The TNF-α "GG" genotype emerges as a significant independent predictor of asthma severity, substantially increasing the risk of both mild and severe asthma. In contrast, IL-13 polymorphism, while associated with mild asthma, plays no significant role in severe asthma. Furthermore, severe asthma was strongly linked to older age, nasal polyposis, elevated FeNO levels, and blood eosinophils.

Background: Total immunoglobulin E (t-IgE) and eosinophils as central effector molecular and cells are crucial biomarkers for allergic diseases. Age, sex and allergic symptoms may influence these biomarkers and the relationship among t-IgE, eosinophils, and atopic diseases remained unknown.

Methods: A five-year retrospective study enrolled 7654 patients with allergic symptoms underwent allergen testing. We collected age, sex, symptoms, and complete blood counts and explored variations in t-IgE and eosinophil across demographic and clinical parameters.

Results: Among atopic patients, t-IgE levels peaked in children, decreasing with age, with a slight increase in the elderly, mirroring eosinophil trends. Females consistently exhibited lower t-IgE and eosinophil levels than males, regardless of atopic status. High t-IgE and eosinophils were the most common in patients ≥12 years with respiratory symptoms. Dust mites often caused respiratory symptoms. Egg allergies typically affected the ear, nose, and throat (ENT). Seafood/peanut allergies were linked to skin symptoms. Interestingly, elevated t-IgE and eosinophil levels did not consistently correlate with positive allergen tests. Among atopic patients, 44.5% exhibited normal t-IgE, and 41.4% had normal eosinophils. In the subgroup (22.8%) with both markers normal, more were females (62.5%). Sensitization to allergens like soy, shrimp, mold combination, Artemisia argyi, common ragweed, and willow/aspen/elm may fail to elevate t-IgE and eosinophils.

Conclusion: Characteristics such as older age, female, skin and ENT symptoms, and allergens may correlate with lower t-IgE and eosinophils in the allergic populations which means we should pay more attention to these population, even if their t-IgE and eosinophils are normal, the allergen test is necessary for treatment strategies.

Clinical trial registration: ChiCTR2300067700 (Date of Registration: 2023-01-18).

Background: OM-85 is a well-characterized bacterial lysate with antiviral properties, enhancement of airway epithelial barrier function, and tolerance induction. However, real-world evidence is needed to evaluate its effectiveness as an add-on therapy in patients with allergic asthma.

Methods: This retrospective cohort study analyzed medical records of 137 adults with moderate to severe allergic asthma over 12 months. Patients receiving standard of care (SoC) asthma therapy alone (GINA step 4, n = 67) were compared to those on SoC+OM-85 (n = 70). All symptom episodes (CEPs) indicative of respiratory tract infections (RTIs) were recorded, and a 3-scale mean severity index (mSI) was calculated. Propensity score weighting was used for Poisson and linear regression analyses.

Results: Patients on OM-85 demonstrated significant reductions in the number of CEPs (60%), asthma exacerbations (71%), unscheduled visits (72%), oral corticosteroid courses (73%), and antibiotic cycles (67%). The mSI was 1.15 points lower in the OM-85 group (p < 0.001).

Conclusion: OM-85 as an add-on to standard asthma therapy significantly reduced RTI-related episodes, exacerbations, and healthcare utilization while lowering symptom severity in adults with allergic asthma.

Background: Asthma is the world's second most prevalent chronic respiratory disease. Current clinical decisions regarding hospitalization for adult asthma patients in emergency departments (EDs) primarily rely on presenting clinical status, acute exacerbation severity, therapeutic response and high-risk factors. Assessing the need for hospitalization of patients with complex comorbidities remains a significant challenge.

Research question: This study aims to develop models that integrate various environmental and clinical factors to predict the hospitalization of adult asthma patients in EDs and to interpret these models.

Study design and methods: A retrospective analysis was conducted utilizing data from asthma patients at a single ED from 2016 to 2023; the data included demographics, vital signs, illness severity, laboratory test results, and comorbidities, along with environmental variables. Predictive models were constructed using the extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), support vector machine (SVM), logistic regression (LR), and random forest (RF). Area under the receiver operating characteristic curve (AUC), accuracy, and F1 score were the primary metrics used to assess model performance.

Results: The analysis included 1140 ED visits. The median age was 51.0 years (interquartile range: 31.0 to 67.0 years), and 56.5% of the patients (644) were female. Overall, 21.8% of patients (249) required hospitalization after their ED visits. The AUC results for predicting hospitalization without external environmental factors were 0.8075 for XGBoost, 0.8233 for LightGBM, 0.7935 for SVM, 0.8033 for LR, and 0.8272 for RF. After integrating ambient air pollutant and meteorological features, the RF model consistently outperformed the other models, achieving an AUC of 0.8555. The most critical parameters for predicting hospitalization were found to be illness severity, oxygen saturation, age, and heart rate.

Interpretation: Machine learning (ML) models based on clinical, meteorological, and air pollution data can rapidly and accurately predict hospitalization of adult asthma patients in EDs.