Background
Evidence about the association of high blood eosinophil count with asthma exacerbation is inconsistent and unclear. The objective of this meta‐analysis was to determine whether elevated ...blood eosinophil count predicts asthma exacerbation.
Methods
We searched MEDLINE, EMBASE, and additional databases, without any language restriction. We also checked the reference lists of the included studies and of relevant systematic reviews. The main outcome was the occurrence of asthma exacerbation. We calculated global pooled odds ratios (ORs) and their 95% confidence intervals (CIs) and performed predefined subgroup analyses. We appraised the quality of the studies using Newcastle‐Ottawa Scale, examined the heterogeneity between studies, assessed publication bias, and carried out sensitivity analyses.
Results
Among 1567 retrieved publications, 23 observational studies comprising 155,772 participants met the inclusion criteria. High blood eosinophil count was associated with higher odds of asthma exacerbation OR: 1.31 (95% CI: 1.16, 1.49), specifically with asthma‐related outpatient visits OR: 1.46 (95% CI: 1.25, 1.70) and emergency department visits OR: 1.63 (95% CI: 1.29, 2.07). A significant association was observed starting from an eosinophils’ cutoff value of 200 cells/μl. The association was observed for cohort studies OR: 1.30 (95%CI: 1.13, 1.49), North American studies OR: 1.43 (95%CI: 1.31, 1.57), Asian populations OR: 1.67 (95%CI: 1.34, 2.08), children OR: 1.38 (95%CI: 1.22, 1.56), and studies that adjusted for inhaled corticosteroids therapy OR: 1.42 (95%CI: 1.28, 1.56).
Conclusions
Blood eosinophil counts ≥ 200 cells/µL are associated with asthma exacerbation. Blood eosinophil count is a modifiable factor that could be addressed in asthma management strategies.
Asthma and rhinitis often co-exist in the same patient. Although some authors observed a higher prevalence and/or greater severity of asthma in patients with rhinitis, this view is not homogeneous ...and the debate continues. The aim of our study is to describe the prevalence of rhinitis in children and adolescents and to analyse their relationship with the prevalence of asthma. A multicentre study was conducted using the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC). The target population of the study was all those school children aged 6-7 and 13-14 years from 6 of the main health catchment areas of Galicia (1.9 million inhabitants). The schools required were randomly selected, and all children in the targeted age ranges were included. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) between asthma symptoms of the schoolchildren and rhinitis prevalence. The results were adjusted for parental smoking habits, maternal education level, cat and dog exposure, and obesity. A total of 21,420 valid questionnaires were finally obtained. Rhinitis was associated with a significant increase in the prevalence of asthma in both age groups. The highest OR were 11.375 for exercise induced asthma (EIA) for children with recent rhinoconjunctivitis and 9.807 for children with recent rhinitis in 6-7 years old group. The prevalence OR's are higher in EIA and severe asthmatics. Rhinitis in children and adolescents is associated with a higher prevalence and severity of asthma.
Common errors in inhalation therapy: Impact and solutions Rodriguez‐Garcia, Carlota; Barreiro, Esther; Muñoz‐Gall, Xavier ...
The clinical respiratory journal,
November 2020, 2020-11-00, 20201101, Letnik:
14, Številka:
11
Journal Article
Recenzirano
Odprti dostop
Objective
Inhalation therapy is one of the key pillars in the treatment of chronic obstructive diseases, such as asthma and COPD (Chronic obstructive pulmonary disease); however, wide number of ...errors occur with high frequency in the inhalation manoeuvres among these patient. This review discuss the main errors made with inhalation devices, factors associated with poor IT (inhalation technique), their consequences and possible solutions.
Data sources
To do this, we performed a search of any publications available in PubMed between the years 2000 and 2019, using the key words: asthma, COPD, obstructive lung disease, inhalers, misuse and errors.
Study selections
After a review of the titles and s by the working group, the articles chosen were considered the most relevant in providing evidence of the problems and establishing solutions in the inhalation treatment of asthma and COPD.
Results
There are several publications that associated the errors in the inhalation technique with a poor prognosis both of asthma and COPD. Most authors generally agree in that a poor IT is associated with poor control of the symptoms.
Conclusions
It is essential to review the IT in all our patients with asthma and COPD due to the high socio‐economic impact that it involves; an effort must be made to homogenise the evaluation of IT, so that it helps to transmit a clear message to the patients, as well as to the health professionals on what is and what is not a correct manoeuvre.
Summary
Introduction
The aim of analysing the usefulness of the blood eosinophil count (BEC) as a prognostic marker in exacerbations of patients with Chronic Obstructive Pulmonary Disease (COPD), ...evaluating its relationship with hospital mortality, the length of stay and the early and late re‐admissions.
Materials and Methods
We have carried out a retrospective study including all patients who required hospital admission from 1 January 2008 to 31 December 2009, with a diagnosis on hospital discharge of COPD exacerbation. These patients were classified using three cut‐off points of BEC: less than 200 vs ≥ 200/µL, less than 300 vs ≥ 300/µL and less than 400 vs ≥ 400/µL.
Results
There were a total of 1626 hospital admissions during the study period with the diagnosis of exacerbation of COPD. In this study we have included 358 patients. The probability of any late re‐admission increased with a BEC ≥ 300/µL (odds ratio: 1.684) and for those with a BEC ≥ 400/µL (odds ratio: 2.068). The BEC does not appear to be related to hospital mortality or the probability of early re‐admission after an exacerbation of COPD.
Conclusions
In our study an elevated BEC is associated with a higher incidence of late hospital readmissions in COPD exacerbations.
What’s known
In the last few years, the eosinophils have been recognised as an important mediator in patients with chronic obstructive pulmonary disease (COPD).
The impact of blood eosinophil count on the prognosis of COPD exacerbations is still under debate.
What’s new
In our study, which includes a large sample size, an elevated blood eosinophil count is associated with a higher incidence of late hospital readmissions in COPD exacerbations.
Background
Gastroesophageal reflux disease (GORD) is highly prevalent and often coexists with asthma exacerbation. Divergent findings about the association between the two diseases were reported. We ...conducted a systematic review and meta‐analysis to determine whether there exists an association between GORD and asthma.
Methods
We searched MEDLINE, EMBASE, and other databases and then performed a manual search, to identify eligible studies. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using fixed‐ and random‐effect models. We evaluated the quality of included studies, explored heterogeneity between studies, undertook subgroup analyses, assessed publication bias, and performed sensitivity analyses.
Results
We identified 32 eligible studies, conducted in 14 countries and including a total of 1,612,361 patients of all ages. Overall, GORD shows a weak association with asthma exacerbation (OR = 1.27; 95% CI 1.18–1.35). This association was observed in cohort, case‐control, and cross‐sectional designs and in European as well as non‐European populations. Subgroup analyses show that GORD is associated with frequent asthma exacerbations (≥3 exacerbations, OR = 1.59; 95% CI 1.13–2.24) and with exacerbations needing oral corticosteroid therapy (OR = 1.24; 95% CI 1.09–1.41). GORD pediatric patients are at higher odds of asthma exacerbation than adults. We did not detect any evidence of publication bias and the association between GORD and asthma exacerbation held in all undertaken sensitivity analyses.
Conclusions
Gastroesophageal reflux disease and asthma exacerbation are weakly associated.
Objective: To analyse the relationship between paracetamol and asthma. Data sources: An English literature search using electronic search engines (PubMed and EMBASE) was conducted. Study selections: ...Articles published in peer-review journals, from 1990 to December 2015 were included. To perform the search for the most suitable and representative articles, keywords were selected ("asthma," "paracetamol" and "acetaminophen"). The evidence level was rated according to the criteria of the Oxford Centre For Evidence-Based Medicine. Results: The exposure to paracetamol during pregnancy was analysed in several cohort studies, showing an association between the prenatal exposure to paracetamol with suffering from asthma or presence of wheezing in childhood, especially for persistent wheezing. Nevertheless, a recent study concluded that the relationship between asthma and paracetamol is explained, at least in part, by confounding factors. Several works have also associated the exposure to paracetamol in the first years of life or in adults with the development of childhood asthma. Several pathophysiological mechanisms are known that could explain this relationship, such as the glutathione pathway, the decrease in the release of Th1 cytokines that are normally produced during febrile episodes, which would then lead to a predominance of Th2 cytokines, the cytotoxic effect of paracetamol for pneumocytes, a modulator effect on the activity of myeloperoxidase, as well as the possible antigenic effect of paracetamol, mediated by IgE. Conclusions: There are many arguments that suggest a relationship between the use of paracetamol with the appearance of asthmatic symptoms, however the evidence is inconclusive.
Background
Asthma is a heterogeneous disease with several phenotypes, endotypes and severity degrees, in which different T‐cell subpopulations are involved. These cells express specific miRNAs (i.e. ...inflamma‐miRs) that can be released to serum in exosomes after activation and be used as biomarkers of underlying inflammation. Thus, we aim to evaluate specific T‐cell miRNA signatures in serum exosomes from different subgroups of asthmatic patients.
Methods
Samples from healthy donors (N = 30) and patients (N = 119) with different asthma endotypes (T2high‐Atopic/T2high‐Non‐atopic/T2low) and severity degrees (mild/MA and moderate–severe/MSA) were used. Demographic, clinical, haematological and biochemical characteristics were collected. Twelve miRNAs previously associated with different Th subsets were preselected and their levels in serum exosome samples were measured using RTqPCR.
Results
We detected five miRNAs with high confidence in serum exosomes: miR‐16‐5p, miR‐21‐5p, miR‐126‐3p, miR146a‐5p and miR‐215‐5p. All of them, except miR‐16‐5p were upregulated in MSA patients compared to MA. A logistic regression model including each of these miRNAs was created to discriminate both conditions, rendering a ROC curve AUC of 0.896 (0.830–0.961). miR‐21‐5p and miR‐126‐3p, both involved in Th1/Th2 differentiation, were specifically augmented in T2high‐Atopic patients. Of note, all these changes were found in samples collected in autumn. On the contrary, IL‐6high patients with MSA, which were more obese, older, with higher neutrophil and basophil counts and TNF levels, displayed a decrease of miR‐21‐5p, miR‐126‐3p and miR‐146a‐5p.
Conclusion
Immune‐related miRNAs, including miR‐21‐5p, miR‐126‐3p, miR‐146a‐5p and miR‐215‐5p, can be used as clinically relevant non‐invasive biomarkers of the phenotype/endotype and severity of asthma.
We measured the levels of several inflamma‐miRs in serum exosomes from 30 healthy and 119 asthmatic donors with different phenotypes and severities. miR‐21‐5p, miR‐126‐3p, miR146a‐5p, and miR‐215‐5p increased in MSA vs. MA and a logistic regression model was fitted (AUC=0.896). miR‐21‐5p and miR‐126‐3p increased in T2high‐Atopic asthma, whereas miR‐21‐5p, miR‐126‐3p, and miR‐146a‐5p levels were downregulated in IL‐6high MSA patients.Abbreviations: AUC, area under the curve; MA, mild asthma; miRNA, microRNA; MSA, moderate–severe asthma
Background
Asthma is heterogeneous disease with different phenotypes, endotypes and severities. Definition of these subgroups requires the identification of biomarkers in biological samples, and ...serum proteomics is a useful and minimally invasive method for this purpose. Therefore, the aim of this study was to detect serum proteins whose abundance is distinctively associated with different asthma phenotypes (allergic vs nonallergic) or severities.
Methods
For each group of donors (32 healthy controls, 43 allergic rhinitis patients and 192 asthmatics with different phenotypes and severities), we generated two pools of sera that were analysed by a shotgun MS approach based on combinatorial peptide ligand libraries and iTRAQ‐LC‐MS/MS.
Results
MS analyses identified 18 proteins with a differential abundance. Functional/network study of these proteins identified key processes for asthma pathogenesis, such as complement activation, extracellular matrix organization, platelet activation and degranulation, or post‐translational protein phosphorylation. Furthermore, our results highlighted an enrichment of the “Regulation of Insulin‐like Growth Factor (IGF) transport and uptake by Insulin‐like Growth Factor Binding Proteins (IGFBPs)” route in allergic asthma and the lectin pathway of complement activation in nonallergic asthma. Thus, several proteins (eg IGFALS, HSPG2, FCN2 or MASP1) displayed a differential abundance between the different groups of donors. Particularly, our results revealed IGFALS as a useful biomarker for moderate‐severe allergic asthma.
Conclusion
Our data suggest a set of serum biomarkers, especially IGFALS, capable of differentiating allergic from nonallergic asthma. These proteins reveal different pathophysiological mechanisms and may be useful in the future for diagnosis, prognosis or targeted therapy purposes.
This study identifies serum biomarkers for asthma (allergic and nonallergic asthma) and allergic rhinitis using iTRAQ‐based proteomics. Several proteins from the IGF pathway are increased in allergic asthma. Particularly, IGFALS could be a useful biomarker for this phenotype. Proteins from the lectin pathway of complement activation (FCN2 and MASP1) are increased in non‐allergic asthma. Abbreviations: AHSG, alpha‐2‐HS‐glycoprotein; CALU, calumenin; CPN1, carboxypeptidase N subunit 1; CPLLs, combinatorial peptide ligand libraries; C1R, complement C1r subcomponent; C4B, complement component 4B; F2, prothrombin; FCN2, ficolin 2; HAP, high abundant proteins; HSPG2, basement membrane‐specific heparan sulfate proteoglycan core protein; IGF‐ALS, insulin‐like growth factor binding protein acid labile subunit; iTRAQ, isobaric tags for relative and absolute quantitation; LAP, low abundant proteins; LC‐MS/MS, liquid chromatography coupled online to tandem mass spectrometry; MASP1, mannan binding lectin serine peptidase 1; NCAM1, neural cell adhesion molecule 1 precursor
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