sICAM-1 and TNF-α in Asthma and Rhinitis: Relationship with the Presence of Atopy

Background. A genetically determined overproduction of specific immunoglobulin E (IgE) underlies many diseases like asthma or allergic rhinitis. IgE as well as tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) play a critical role in the induction and maintenance of inflammation. While the correlation between IgE and atopy is inseparable, little is known about the correlation of atopy with markers of inflammation. Objective. We investigated the relationship between the serum concentrations of TNF-α, soluble ICAM-1 (sICAM-1), and the presence of atopy in patients with persistent rhinitis or asthma. Methods. Serum concentrations of sICAM-1, TNF-α, and total IgE were investigated in 64 adults with persistent allergic rhinitis, 17 subjects with nonatopic rhinitis, 90 patients with asthma, and 21 healthy individuals. Atopy was diagnosed on the basis of positive family history, skin prick tests, and serum IgE concentration. Results. Total IgE concentration was significantly higher in patients with atopic rhinitis or asthma when compared with nonatopic patients and healthy individuals and was the highest in patients suffering from severe atopic asthma who were not treated with systemic glucocorticosteroids. Although there were marked alterations in IgE in atopic and nonatopic patients, there were no significant differences between atopic and corresponding groups of nonatopic rhinitic and asthmatic patients in sICAM-1 and TNF-α concentrations. (sICAM-1 in rhinitis: atopic vs. nonatopic patients: 224.02 and 221.08 ng/ml, respectively, p > .05; in mild/moderate asthma: atopic vs. nonatopic: 306.22 and 326.39 ng/ml, respectively, p > .05; severe asthma without oral corticosteroids therapy: atopic vs. nonatopic: 418.03 and 468.09 ng/ml, respectively, p > .05; and severe asthma with oral corticosteroids therapy: atopic vs. nonatopic: 320.66 and 308.09 ng/ml, respectively, p > .05). Conclusions. Concentrations of sICAM-1 and TNF-α are significantly higher in patients with asthma compared with those observed in patients with rhinitis, but they are independent of the presence of atopy.     

Time Trends of the Prevalence of Asthma,Rhinitis and Eczema in Thai Children–ISAAC (International Study of Asthma and Allergies in Childhood) Phase Three

Using the same questionnaire as in ISAAC Phase One study conducted in 1995, the ISAAC Phase Three was carried out in Bangkok and Chiang Mai, Thailand, in 2001, among children aged 6–7 and 13–14 years. There was an increase in the prevalence of the three diseases in the younger age group, i.e., current asthma, rhinitis, rhinoconjunctivitis, and flexural eczema. In the older age group, the prevalence of rhinitis and rhinoconjunctivitis increased. There was no change of prevalence of asthma in Bangkok, but prevalence decreased in Chiang Mai. Prevalence of eczema in older children increased in Bangkok, but remained the same in Chiang Mai.     

Changes in the Burden of Comorbidities in Patients with COPD and Asthma–COPD Overlap According to the GOLD 2017 Recommendations

Purpose

Comorbidities associated with chronic obstructive pulmonary disease (COPD) affect quality of life and increase mortality. Asthma–COPD overlap (ACO) may express a different profile of comorbidities compared to COPD alone. It is unclear how recent changes in GOLD recommendations affect the profile of comorbidities in COPD and ACO.

Methods

Eight hundred and thirty-four patients with COPD were recruited from 67 Hungarian secondary care outpatient clinics, 469 of them had ACO. Comorbidities were defined by respiratory specialists based on medical history, patient report, and medications. COPD grades were defined according to the old 2016 and the new 2017 GOLD document. Comorbidities were compared along COPD ABCD groups determined by the old and new GOLD.

Results

66 and 72% of the COPD patients in groups C and D (GOLD 2016) were recategorized to groups A and B (GOLD 2017), respectively. There was no difference in the prevalence of disorders along the 2016 GOLD categories except for osteoporosis in ACO (p?=?0.01). When the patients were categorized according to the 2017 GOLD criteria, the prevalence of osteoporosis (p?=?0.01) was different among the four groups in all COPD patients. Subgroup analysis of non-ACO COPD patients revealed inter-group differences for cardiac arrhythmia (p?<?0.01). No alteration was seen in the prevalence of coronary artery disease, hypertension, diabetes, or the total number of comorbidities.

Conclusion

A significant number of patients are recategorized according to the GOLD 2017 criteria. This change only marginally affects the profile of comorbidities; still this needs to be considered when assessing the patients in daily practice.

     

Is There Any Difference in the Use of Complementary and Alternative Therapies in Patients Asthma and COPD? A Cross-Sectional Survey

Background. Data on the use and efficacy of complementary and alternative medicine (CAM) in patients with asthma are limited, and there is a lack of studies documenting the use of CAM in patients with chronic obstructive pulmonary disease (COPD) in Turkey. Aim. To determine the prevalence of CAM usage in patients with asthma and COPD and to assess the clinical and demographic factors associated with the use of CAM. Materials and methods. A total of 521 patients (313 with asthma and 208 with COPD) were randomly enrolled into this cross-sectional survey. A face-to-face interview was conducted using a structured questionnaire. Results. One hundred sixty-three patients (52%) with asthma and 70 patients (33%) with COPD were reported to be using some form of CAM (p < 0.001). The most popular modalities were herbal remedies (46% and 28% in the two groups, respectively) and animal products (28% and 5% in the two groups, respectively). CAM-practicing asthma patients were typically younger with longer duration of disease and higher income than the CAM-practicing COPD patients. For the patients, the main source of information on CAM practices was their relatives and friends. Only a small number of the patients consulted with their physicians about CAM. The main reasons to use CAM for patients with asthma and COPD were harmlessness and symptomatic relief, respectively. CAM-related adverse effects and difficulties to obtain CAM were significantly higher in patients with asthma than in patients with COPD. Conclusion. There is a high prevalence of CAM usage in patients with asthma and COPD in Turkey. Hence, becoming familiar with CAM therapy and inquiring about patient practice of CAM as part of the routine medical history will allow the physicians to provide reliable information to their patients on these medical practices.     

Asthma management: how effective is it in the community?

Abstract Background: The National Asthma Campaign (NAC) was launched in Australia in 1989 with the major objective of improving asthma management through the implementation of a six‐step asthma management plan. Aim: The objective of the present study was to analyse the management of asthma in a cohort of adults with self‐reported asthma 10 years after the commencement of the NAC. Methods: The subjects were participants in the laboratory phase of a cross‐sectional epidemiological study conducted in Melbourne in 1999?2000. Participants completed the detailed European Community Respiratory Health Survey, which included specific questions about their asthma management. Participants were included in this analysis if they had a positive response to the question ‘Have you ever had asthma?’. This resulted in a total of 435 subjects. Results: Of the subjects with self‐reported asthma, over half of the participants reported that a doctor had ever measured their breathing (52.9%). However, only 10.1% of participants reported that they owned a peakflow meter (PFM) and only 13.3% reported that they had ever been given a written action plan. In comparison with data reported from 1993, doctor measurement of lung function has decreased significantly (P < 0.0001), as has PFM ownership (P < 0.0001) and, importantly, possession of a written action plan (P = 0.0004). Conclusions: Asthma management among adults still falls well short of NAC guidelines. The decline in some key features over recent years suggests that new management and dissemination strategies are required. (Intern Med J 2002; 32: 451?456)     

Serum Vitamin A and β-Carotene Levels in Children with Asthma

Background. Low serum levels of dietary antioxidants are associated with allergic diseases including asthma. Vitamin A and carotenoids are dietary antioxidants that are likely to play an important role against airway inflammation. Methods. This study included 433 asthmatic schoolchildren and 537 healthy control subjects, between 6 and 18 years of age. Serum β-carotene, vitamin A, cholesterol, and triglycerides levels were studied in all subjects. Results. Serum vitamin A concentration was significantly lower in asthmatic subjects than in healthy control subjects (19.4 ± 1.1 mg/dL vs. 28.9 ± 0.86 mg/dL) (p < 0.001). There were no significant differences in the levels of β-carotene, cholesterol, and triglycerides between the two groups. Conclusion. Reduction of vitamin A in asthmatic children may have etiological implications for the disease.     

Relationship between asthma control status, the Asthma Control Test™ and urgent health-care utilization in Asia

Background and objective: Accurate assessment of control is an integral part of asthma management. We investigated the relationship between control status derived from the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT) and urgent health‐care utilization. Methods: Asthma Insights and Reality in Asia‐Pacific Phase 2 (AIRIAP 2) was a cross‐sectional, community‐based survey of 4805 subjects with asthma from urban centres across Asia. A symptom control index was derived from the AIRIAP 2 questionnaire using the GINA control criteria for day‐ and night‐time symptoms, need for rescue medication, activity limitation and exacerbations; lung function was excluded. The main outcomes were asthma control, based on these GINA criteria and the ACT, and the relationship between control and self‐reported urgent health‐care utilization (hospitalization, emergency room visits or other unscheduled urgent visits) related to asthma over the previous 12 months. Results: Each of the symptom criteria was significantly associated with urgent health‐care utilization, with odds ratios (ORs) ranging from 2.25 (95% confidence interval (CI): 1.94–2.61) for daytime symptoms to 2.57 (95% CI: 2.29–2.90) for nocturnal awakening. Similarly, control status was significantly associated with urgent health‐care utilization, with ORs of 0.19 (95% CI: 0.13–0.28), 0.70 (95% CI: 0.65–0.76) and 1.00 for controlled, partly controlled and uncontrolled, respectively. The optimal ACT cut‐off score for identifying uncontrolled asthma was ≤19 for subjects aged ≥12 years. Urgent health‐care utilization was reported by 57.2% versus 28.7% of patients scoring ≤19 versus >19 (P < 0.001). Conclusions: The GINA control classification and the ACT are valid symptom‐based measures that are significantly associated with urgent health‐care utilization.     

Possible Maximal Change in the SF‐36 of Outpatients with Chronic Obstructive Pulmonary Disease and Asthma

The purpose of the present study was to investigate the responsiveness of the Short Form‐36 (SF‐36) in patients with chronic obstructive pulmonary disease (COPD) and asthma. We studied patients with COPD and asthma who attended our outpatient clinic. In the first cross‐sectional study, we compared the differences in the SF‐36 scores between pretreatment patients (152 with COPD and 174 with asthma) who visited the clinic for the first time and in‐treatment patients (123 with COPD and 151 with asthma) who had received treatment for > 6 months. The differences in each scale of the SF‐36 ranged from 6.9 to 14.4 in COPD patients and from 7.0 to 28.3 in asthma patients. In the second longitudinal study, patients who visited for the first time were enrolled, and the initial, and, 3‐, 6‐, and 12‐month evaluations of the SF‐36 were studied. A total of 136 COPD patients and 136 asthma patients were enrolled consecutively, and 100 patients with COPD and 66 patients with asthma completed the year‐long examinations. In COPD patients, except for bodily pain, the scores in all scales of the SF‐36 improved significantly during the first 3 or 6 months. In patients with asthma, all scale scores of the SF‐36 improved significantly during the first 3 months. Maximal changes in the SF‐36 scores were observed at 6 or 12 months. Longitudinal maximal changes in each scale approached or exceeded the possible maximal changes, which were derived from the differences in the scores between pretreatment patients and in‐treatment patients in the first cross‐sectional study. Improvements in the SF‐36 scores showed moderate to strong negative correlations with their baseline scores in patients with COPD and asthma. In conclusion, the SF‐36 shows sufficient responsiveness in the assessment of the health status of patients with COPD and asthma, but these responses are strongly influenced by their baseline values.     

Reliability,Validity, and Responsiveness of the Pediatric Quality of Life Inventory™ (PedsQL™) Generic Core Scales and Asthma Symptoms Scale in Vulnerable Children With Asthma

Background. Patient-reported outcomes such as health-related quality of life (HRQOL) are increasingly used as primary endpoints in clinical trials. The Pediatric Quality of Life Inventory? (PedsQL?) is widely used as a measure of HRQOL and may be a particularly suitable primary outcome in pediatric asthma clinical trials. Objectives. To examine the reliability, validity, and responsiveness to clinical change of the PedsQL? 4.0 Generic Core Scales and PedsQL? Asthma Module Asthma Symptoms Scale in a sample of vulnerable children with persistent asthma recruited from Federally Qualified Health Centers. Methods. Children (N = 252; ages 3 to 14 years) with persistent asthma (27% mild, 40.9% moderate, 32.1% severe) and their parents (93.7% mother, 83.3% Hispanic, 76.9% Spanish-speaking, 72.6% less than a high school diploma) enrolled in a clinical trial completed the PedsQL? 4.0 Generic Core Scales, the PedsQL? 3.0 Asthma Module Asthma Symptoms Scale, and a measure of asthma symptom frequency (used as an indicator of clinical change) at baseline and 3-month follow-up. Results. The PedsQL? demonstrated adequate internal consistency reliability and convergent and discriminative validity. Based on intra- and intersubject change, effect sizes, and standard errors of measurement, the PedsQL? demonstrated responsiveness to clinical change. Conclusions. For both child self-report and parent proxy-report, the PedsQL? Generic Core Scales Total Scale score and the PedsQL? Asthma Symptoms Scale are suitable for use as primary asthma clinical trial outcomes.     

Expression of Transforming Growth Factor β1 in Bronchial Biopsies in Asthma and COPD

The role of transforming growth factor β₁ (TGF β₁) in airway remodeling in asthma and chronic obstructive pulmonary disease (COPD) has not been fully described. To evaluate the possible pathogenetic role of TGF β₁ in asthma and COPD, immunohistochemical expression of TGF β₁ was described in bronchial biopsies from patients with asthma and COPD compared with healthy individuals. Twelve subjects with asthma, 13 subjects with COPD, and 10 healthy individuals enrolled in the study. Bronchial biopsies were stained with hematoxylin and eosin and anti‐TGF β₁ antibody. As a result, immunoreactive TGF β₁ was mainly localized in association with connective tissue in all groups. The staining intensity was not statistically different among the groups in bronchial epithelium, whereas it was significantly higher in the group of asthma in the submucosa. Because there is evidence showing a significant increase of staining intensity in the submucosa from asthmatics but not from subjects with COPD, we may conclude that TGF β₁ may play a significant role in pathogenesis of asthma but not in COPD.     

Physiotherapy in Asthma—Seeking Consensus

Objective. The evidence base for or against physiotherapy interventions in asthmatic adults remains ambiguous, and there are discrepancies between different clinical practice guidelines. We evaluated the level of agreement between the recommendations about physiotherapy for adults with asthma in two major clinical practice guidelines: the Global Initiative for Asthma (GINA 2011) and the British Thoracic Society and the Association of Chartered Physiotherapists in Respiratory Care (BTS/ACPRC 2009). Methods. We used the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument to assess the methodological rigor of the guideline development, the Assessment of Multiple Systematic Reviews (AMSTAR) tool and the Physiotherapy Evidence Database (PEDro) scale to assess the methodological quality of systematic reviews and clinical trials included in the analyzed documents. Additionally, we compared the reference lists of the analyzed sections to establish the overlap in included primary and secondary studies. Results. We observed no agreement between the two guidelines in the choice of source research articles. Only two studies out of 18 used in BTS guidelines were used in the GINA. The reason why GINA developers did not use the body of evidence included in BTS is that it is not clear. Three independent investigators indicated higher scores in all domains of the AGREE II in the BTS/ACPRC document in comparison with the GINA guidelines. Conclusions. The significant differences in the content and in the development processes of the examined sections of the two guidelines suggest the need for more frequent and careful updating or directing the readers of the GINA to the BTS/ACPRC, a guideline addressing specifically and more comprehensively physiotherapy interventions in asthma.     

Association of Tumor Necrosis Factor-α and Neutrophilic Inflammation in Severe Asthma

BackgroundThere is evidence that neutrophils are increased in the airway of severe disease or acute exacerbations of asthma. The mechanisms by which neutrophils are recruited to the airways and contribute to the pathophysiology of asthma remain to be elucidated. Tumor necrosis factor (TNF-α), which can induce both tissue accumulation and activation of neutrophils and eosinophils, has been shown to be increased in the airways of severe asthma. The objective of this study is to evaluate whether TNF-α is associated with neutrophilic inflammation in asthma.MethodsFollowing an inhalation of hypertonic saline, induced sputum was obtained from 9 healthy controls, 9 mild persistent asthma patients who were treated with low-dose inhaled corticosteroids; and 7 severe persistent asthma patients who were treated with combinations of drugs including high-dose inhaled corticosteroids, oral prednisolone, bronchodilators, and leukotriene receptor antagonist. After 0.1% dithiothreitol (DTT) homog- enization, they were examined for total cell count, cellular differentiation, and the concentrations of TNF-α and myeloperoxidase (MPO).ResultsThe concentration of TNF-α was not correlated with neutrophils in healthy controls or mild asthma patients. In sputum from severe asthma patients, however, the concentration of TNF-α is significantly correlated with both the percentage of neutrophils and the concentration of MPO. The concentration of TNF-α is not correlated with the percentage of eosinophils in healthy controls, mild asthma patients, or severe asthma patients.ConclusionsTNF-α may be a contributing molecule for both accumulation and activation of neutrophils in the airways of severe asthma.