The current COVID-19 pandemic has changed many medical practices in order to provide additional protection to both our patients and healthcare providers. In many cases this includes seeing patients ...through electronic means such as telehealth or telephone rather than seeing them in person. Asthma exacerbations cannot always be treated in this way.
Current emergency unit asthma guidelines recommend bronchodilators be administered by metered dose inhaler (MDI) and spacer for mild-moderate asthma and include it as a choice even in severe asthma, but many emergency units continue to prefer nebulised therapy for patients who urgently require beta-agonists. The utilization of nebulised therapy potentially increases the risk of aerosolization of the coronavirus. Since nosocomial transmission of respiratory pathogens is a major threat in the context of the SARS-CoV-2 pandemic, use of nebulised therapy is of even greater concern due to the potential increased risk of infection spread to nearby patients and healthcare workers.
We propose a risk stratification plan that aims to avoid nebulised therapy, when possible, by providing an algorithm to help better delineate those who require nebulised therapy. Protocols that include strategies to allow flexibility in using MDIs rather than nebulisers in all but the most severe patients should help mitigate this risk of aerosolised infection transmission to patients and health care providers. Furthermore, expedient treatment of patients with high dose MDI therapy augmented with more rapid initiation of systemic therapy may help ensure patients are less likely to deteriorate to the stage where nebulisers are required.
Asthma is a heterogeneous airway disease with various clinical phenotypes. It is crucial to clearly identify clinical phenotypes to achieve better asthma management. We used cluster analysis to ...classify the clinical groups of 724 asthmatic patients from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA), and in 1843 subjects from another independent Korean asthma cohort of Soonchunhyang University Asthma Genome Research Centre (SCH) (Bucheon, Republic of Korea). Hierarchical cluster analysis was performed by Ward's method, followed by κ-means cluster analysis. Cluster analysis of the COREA cohort indicated four asthma subtypes: 1) smoking asthma; 2) severe obstructive asthma; 3) early-onset atopic asthma; and 4) late-onset mild asthma. An independent cluster analysis of the SCH cohort also indicated four clusters that were similar to the COREA clusters. Our results indicate that adult Korean asthma patients can be classified into four distinct clusters.
While global health agencies have listed asthma as a vulnerability for severe cases of coronavirus disease 2019 (COVID-19), the evidence supporting this is scarce.
A nationwide cohort study was ...conducted using the validated Korean national health insurance claim data of patients diagnosed with COVID-19 between January 1 and April 8, 2020. Asthma comorbidity was determined using a diagnosis code assigned by the physician and the prescription of asthma-related medications. The clinical course of COVID-19 was classified into 3 severity grades according to the requirements for oxygen supply and mechanical ventilation. We also evaluated the association of asthma with overall and in-hospital mortality of COVID-19.
Asthma morbidity was a significant risk factor for severe COVID-19 (grade 2 requiring oxygen supply) (adjusted odds ratio aOR = 1.341, 95% confidence interval CI, 1.051−1.711, P = 0.018) and grade 3 requiring mechanical ventilation or leading to death (aOR = 1.723, 95% CI: 1.230−2.412, P = 0.002) multinomial logistic regression adjusting co-risk factors. Asthma was also significantly associated with mortality of COVID-19 (aOR = 1.453, 95% CI: 1.015−2.080, P = 0.041) and was revealed to have a shorter time to in-hospital mortality of COVID-19 (P < 0.001). Patients with recent asthma exacerbation showed more severe COVID-19 of grade 3 (OR = 7.371, 95% CI: 2.018−26.924, P = 0.003) and higher mortality (OR = 9.208, 95% CI: 2.597−32.646, P < 0.001) in univariable analysis, but the statistical significance was not found in multivariable analysis.
Asthma morbidity was associated with severity and mortality of COVID-19. Patients with asthma should pay more attention to avoid worsening of COVID-19.
Triclosan (TCS), an antimicrobial agent, is an emerging and persistent environmental pollutant that is often found as a contaminant in surface waters and sediments; hence, knowledge of its ...degradability is important. In this study we investigated laccase-mediated TCS transformation and detoxification, using laccase (from the fungus Ganoderma lucidum) in the presence and absence of redox mediators. Transformation products were identified using HPLC, ESI-MS and GC–MS, and transformation mechanisms were proposed. In the absence of redox mediator, 56.5% TCS removal was observed within 24h, concomitant with formation of new products with molecular weights greater than that of TCS. These products were dimers and trimers of TCS, as confirmed by ESI-MS analysis. Among the various mediators tested, 1-hydroxybenzotriazole (HBT) and syringaldehyde (SYD) significantly enhanced TCS transformation (∼90%). The presence of these mediators resulted in products with lower molecular weights than TCS, including 2,4-dichlorophenol (2,4-DCP; confirmed by GC–MS) and dechlorinated forms of 2,4-DCP. When SYD was used as the mediator, dechlorination resulted in 2-chlorohydroquinone (2-CHQ). Bacterial growth inhibition studies revealed that laccase-mediated transformation of TCS effectively decreased its toxicity, with ultimate conversion to less toxic or nontoxic products. Our results confirmed the involvement of two mechanisms of laccase-catalyzed TCS removal: (i) oligomerization in the absence of redox mediators, and (ii) ether bond cleavage followed by dechlorination in the presence of redox mediators. These results suggest that laccase in combination with natural redox mediator systems may be a useful strategy for the detoxification and elimination of TCS from aqueous systems.
Polychlorinated dibenzo-
p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and polychlorinated biphenyls (PCBs) in human have been studied extensively; however, polychlorinated naphthalenes ...(PCNs) have been studied less widely. The mean concentrations of PCNs, PCDDs, PCDFs, and PCBs in 61 healthy human volunteers were 2170 pg/g lipid, 452 pg/g lipid, 116 pg/g lipid, and 120 ng/g lipid respectively, and the mean toxic equivalents (TEQs) contributed by PCNs, PCDDs, PCDFs, and PCBs were 5.88, 5.22, 5.48, and 5.33 pg/g lipid, respectively. PCNs contributed to 26.8% of the total TEQs. 1,2,3,7,8-PeCDD, 2,3,4,7,8-PeCDF, PCB126, and hepta-CN-73 accounted for >62% of the total TEQs in the human serum samples. The overall serum PCN homologue profiles of all subjects were dominated by tetra- and penta-CN homologues, and the most predominant individual congener was hepta-CN-73, which contributed 17.5% of the total serum PCN concentration. Enrichment of hepta-CN-73 in the human serum samples might be due to contributors from combustion sources.
Hepta-CN-73 from combustion sources was the predominant and major toxic congener in human serum.
To assess levels and patterns of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) in polar regions, XAD-resin based passive air samplers were deployed for one year at the Korean ...polar research stations at Ny-Ålesund, Norway (2005−2006) and King George Island, Antarctica (2004−2005). Backward trajectories suggest that these stations are affected by long-range transport from source regions in Northern Europe and Russia and the southern tip of South America, respectively. Relatively high levels of PCB-11, averaging 60 pg·m−3, were observed in Antarctica, suggesting an unusual source of PCB-11 to the Southern Hemisphere. Reflecting the hemispheric distribution of global PCB emissions, the average level of Σ205PCB (excluding three mono-CBs and PCB-11) was five times higher in the Arctic (95 pg·m−3) than in the Antarctic (19 pg·m−3). Levels of Σ9PCB at Ny-Ålesund were similar to those reported for other Arctic sites, while levels at King George Island were lower than at other sites on the Antarctic Peninsula but 1 order of magnitude higher than background levels measured at a more remote Antarctic site. Light homologues were predominant in all samples (except for one Arctic sample), consistent with the hypothesis of global fractionation and predictions of long-range transport potential. Dominance of heavy PCBs on the roof of the main building at Ny-Ålesund and a concentration gradient with distance from the main building at King George Island strongly indicated the influence of local sources. OCP levels were also influenced by long-range transport but not by local sources. This study highlights the feasibility of using passive air sampling to assess both long-range transport and local pollution in remote regions.
In this study, Dechlorane Plus (DP) concentrations were analyzed in marine sediments (depth: ~10cm) from two Korean industrial bays. Two sediments were fractionated into 5 sizes by using ...gravitational split-flow thin fractionation technique and DP distribution was investigated in different particle size fractions. Elevated DP levels in surface sediments were observed at the site closest to land and industrial area. The highest concentrations of DP were detected in the finest grain-size (<10μm, 451.2 and 149.9pg/g dry weight for the two bays). The fraction of anti-DP to the total DP (fanti) in the two fractionated samples increased with reduced grain-size and significantly correlated with organic carbon content (OC), which can be caused by preferential adsorption of anti-DP or higher biodegradation rates of syn-DP in the fine particles. To provide insight into such mechanism, simulated experiments were conducted using activated charcarbon (ACC) to adsorb DP dissolved in methanol and molecular descriptors of both isomers were estimated using Gaussian 03. The adsorption results revealed that syn-DP was preferentially adsorbed by ACC, suggesting syn-DP is more hydrophobic than anti-DP. The preferential adsorption of syn-DP by ACC also supported the hypothesis that the enrichment of anti-DP was more likely due to preferential biodegradation of syn-DP in the sediment. Molecular characterization of anti-DP and syn-DP showed that syn-DP had a higher dipole moment, slightly larger Van der Waals volume, but smaller maximal diameter, which might explain its higher uptake rate in biota.
•DP was first time to be investigated in different particle size fractions.•fanti correlated with organic carbon content.•Syn-DP was preferentially adsorbed by organic carbon.
XAD-2 resin-based passive air samplers (PAS) were deployed for one year at eight cities in Mongolia, China, and South Korea to investigate the spatial distribution of polychlorinated biphenyls ...(PCBs), organochlorine pesticides (OCPs), and dechlorane plus (DP). PCB levels were highly correlated with population size and density in China and South Korea. In Mongolia, PCB levels were relatively high considering the low population. In the cases of OCPs and DP, a country-specific distribution was observed. The highest levels of HCHs (hexachlorocyclohexane isomers) and DDTs (dichlorodiphenyl trichloroethane isomers) were detected at sites in China, whereas the highest endosulfan and DP levels were measured at South Korean sites. These results strongly reflected the patterns of use of these chemicals. Mirex, an insecticide never registered in Mongolia and South Korea, was detected at all sampling sites; this is likely to have resulted from long-range transport. Nevertheless, OCPs were generally low in Mongolia. This study confirms that PAS results reflect well the past and current usage of POPs in Northeast Asia.
► XAD-2 resin-based PAS were deployed for one year in three Asian countries. ► The spatial distributions of PCBs, OCPs, and DP were investigated. ► Different distributions were observed among Mongolia, China, and South Korea.
The current emergence of the coronavirus disease 2019 (COVID-19) pandemic and the possible side effects of COVID-19 mRNA vaccination remain worrisome. Few cases of vaccination-related side effects, ...such as vasculitis, have been reported. Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a type of vasculitis characterized by the histological richness of eosinophils, asthma, polyneuropathy, sinusitis, and skin or lung involvement. Here, we report the first case of new onset EGPA following COVID-19 vaccination in Korea. A 71-year old woman developed a skin rash and presented with progressive weakness of the upper and lower extremities after the BNT162b2 vaccination (Pfizer-BioNTech). She was diagnosed with EGPA and her symptoms improved after systemic steroid and immunosuppressant therapy. Although it is very rare, clinicians should be aware that EGPA may occur after COVID-19 vaccination.
Microbiome primes host innate immunity in utero and play fundamental roles in the development, training, and function of the immune system throughout the life. Interplay between the microbiome and ...immune system maintains mucosal homeostasis, while alterations of microbial community dysregulate immune responses, leading to distinct phenotypic features of immune-mediated diseases including asthma. Microbial imbalance within the mucosal environments, including upper and lower airways, skin, and gut, has consistently been observed in asthma patients and linked to increased asthma exacerbations and severity. Microbiome research has increased to uncover hidden microbial members, function, and immunoregulatory effects of bacterial metabolites within the mucosa. This review provides an overview of environmental and genetic factors that modulate the composition and function of the microbiome, and the impacts of microbiome metabolites and skin microbiota on immune regulation in asthma.
Host and environmental factors that modulate the microbiome and asthma pathogenesis at different ages. Changes in microbiota and their corresponding immune responses in asthma are summarized. Gut bacterial-derived metabolites can either contribute or protect against airway inflammation. Gut-lung axis is a two-way process that influences the systemic immune status. Skin barrier integrity or immune maturation driven by skin microbiomes may play a role in asthma development. Display omitted
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