Pediatric obesity‐related asthma: A prototype of pediatric severe non‐T2 asthma

Childhood obesity contributes to many diseases, including asthma. There is literature to suggest that asthma developing as a consequence of obesity has a nonallergic or non‐T2 phenotype. In this review, obesity‐related asthma is utilized as a prototype of non‐T2 asthma in children to discuss several nonallergic mechanisms that underlie childhood asthma. Obesity‐related asthma is associated with systemic T helper (Th)1 polarization occurring with monocyte activation. These immune responses are mediated by insulin resistance and dyslipidemia, metabolic abnormalities associated with obesity, that are themselves associated with pulmonary function deficits in obese asthmatics. As in other multifactorial diseases, there is both a genetic and an environmental contribution to pediatric obesity‐related asthma. In addition to genetic susceptibility, differential DNA methylation is associated with non‐T2 immune responses in pediatric obesity‐related asthma. Initial investigations into the biology of non‐T2 immune responses have identified the upregulation of genes in the CDC42 pathway. CDC42 is a RhoGTPase that plays a key role in Th cell physiology, including preferential naïve Th cell differentiation to Th1 cells, and cytokine production and exocytosis. Although these novel pathways are promising findings to direct targeted therapy development for obesity‐related asthma to address the disease burden, there is evidence to suggest that dietary interventions, including diet modification, rather than caloric restriction alone, decrease disease burden. Adoption of a diet rich in micronutrients, including carotenoids and 25‐OH cholecalciferol, a vitamin D metabolite, may be beneficial since these are positively correlated with pulmonary function indices, while being protective against metabolic abnormalities associated with the obese asthma phenotype.     

They just don't take their medicines: Reframing medication adherence in asthma from frustration to opportunity

Assessing and addressing suboptimal adherence to asthma medications is a key component in the treatment of all children with asthma, particularly those with difficult‐to‐treat asthma. However, parents often overreport adherence to asthma medications. Increased medication adherence could lead to improved outcomes in the form of better asthma control and decreased asthma exacerbations, as well as decreased healthcare utilization costs. Yet there are many complex factors that affect medication adherence, and barriers are often different in each family. Social determinants of health, complex healthcare relationships, and patient‐related factors may all affect medication adherence. Multicomponent patient‐centered strategies, as well as strategies that utilize technology and habit formation strategies may be helpful in improving medication adherence. Further study is needed to reliably and sustainably improve medication adherence in children with asthma across the broader population; in some populations, alternate diagnoses, adjusting therapy, and other intervention may be required to improve asthma control and health.     

轻中度哮喘患者提高运动耐量可行性研究

目的 比较同等日常运动水平的轻、中度哮喘患者与健康志愿者的运动心肺功能;探讨静息深吸气量与大运动功率的关系。方法 轻、中度哮喘患者１９例和健康志愿者１９例接受了运动心肺功能试验。试验采用负荷递增运动方案,运动前测一秒钟用力呼气容积（ＦＥＶ１）、深吸气量（ＩＣ）,运动后监测ＦＥＶ１。运动中监测心率、氧耗量（ＶＯ２）、每分钟通气量（ＶＥ）、氧脉搏（Ｏ２－ｐｕｌｓｅ）、呼吸频率等。结果 哮喘患者运动后Ｆ     

The impact of combat deployment on asthma diagnosis and severity

Objectives: Environmental exposures during military deployments to Iraq and Afghanistan may lead to higher rates of respiratory complaints and diagnoses. This study investigates whether there is a relationship between rates of asthma diagnosis and severity associated with military deployment. Methods: Retrospective review of active duty Army personnel underwent fitness for duty evaluation (Medical Evaluation Board) for asthma. The electronic medical record was reviewed for onset of diagnosis (pre- or post-deployment), disease severity, screening spirometry, bronchodilator response and bronchoprovocation testing. We compared patients with and without a history of combat deployment to Operations Iraqi Freedom/Enduring Freedom. Results: Four hundred consecutive Army personnel with a clinical diagnosis of asthma were evaluated. Equal numbers of patients had deployed (48.5%) versus never deployed (51.5%). Of those who deployed, 98 (24.5%) were diagnosed post-deployment. The diagnosis of asthma was objectively confirmed in 74.8% of patients by obstructive screening spirometry, bronchodilator response, and/or methacholine challenge testing. There were no significant differences in spirometry between deployers and non-deployers or based on pre- and post-deployment diagnosis. Similarly, asthma severity classification did not differ between deployed and non-deployed service members, or by pre- and post-deployment diagnosis status. Conclusions: Among active duty military personnel with career limiting asthma, there is no significant relationship between rates of diagnosis or severity based on history of deployment to Southwest Asia.     

支气管舒张试验药物剂量与间隔时间的临床研究

目的 评价吸入沙丁胺醇的剂量及吸入后不同时间测定FEV1不同的阳性判断标准对支气管舒张试验结果的影响.方法 选择支气管哮喘(简称哮喘)患者30例,COPD患者29例,健康对照组30名,吸入200 μg或400μg沙丁胺醇,吸入后分别于15、20、30 min重复测定FEV1,计算舒张试验阳性率;次日吸入另一剂量的沙丁胺醇再进行支气管舒张试验.统计学处理用SPSS 10.0软件.不同剂量支气管舒张剂及不同时间后舒张试验阳性率比较采用卡方检验.结果 以FEV1改善率≥12%,且FEV1增加绝对值＞200 ml为舒张试验阳性标准,哮喘组吸入200 μg沙丁胺醇后15、20、30 min时的舒张试验阳性者均为28例(28/30,93.3%),哮喘组3个时点间比较差异无统计学意义(x2=0.00,P＞0.05);吸入400 μg沙丁胺醇后15、20、30 min时的舒张试验阳性者分别为28例(28/30,93.3%)、29例(29/30,96.7%)、27例(27/30,90.0%),哮喘组3个时点间比较差异无统计学意义(x2=1.07,P＞0.05);比较吸入200 μg与400 μg沙丁胺醇后的舒张试验阳性者,在3个时点比较差异均无统计学意义(x2值均为0.00,P均＞0.05).COPD组和健康对照组舒张试验阳性率与吸入沙丁胺醇的剂量和观察时间亦无关系.吸入200 μg沙丁胺醇15 min后重复测定FEV1(以FEV1改善率≥12%,且FEV1增加绝对值＞200 ml为舒张试验阳性标准),诊断哮喘的灵敏度可达93.3%,特异性可达98.3%.结论 吸入200 μg沙丁胺醇15 min后重复测定FEV1,既可保证舒张试验的效能,又可减少药物用量及其不良反应,是一种理想的选择;以FEV1改善率≥12%,且FEV1增加绝对值＞200 ml为舒张试验阳性标准,诊断哮喘的效能优于其他舒张试验阳性标准.     

The effect of 3‐year parental smoking on asthma status of their children

ObjectiveWhilst the prevalence and severity of asthma influenced by environmental factors, the effect of parental smoking on asthma status of their children was examined.Patients and MethodsNinety asthmatic children, 32 with smoker and 58 with non‐smoker parents (baseline age, 8.5 ± 3.5 and 8.2 ± 3.3 respectively) were studies in two sessions 3 years apart by evaluating respiratory symptoms (RS) prevalence and severity, various drugs used, and pulmonary function tests (PFT) including forced vital capacity; forced volume in the first second, peak expiratory flow; and maximum expiratory low at 75, 50 and 25% of vital capacity (FVC, FEV1, PEF, MEF75, MEF50 and MEF25, respectively).ResultsThe prevalence and severity of all RS were significantly increased in asthmatic children with smoking parents after 3 years except prevalence and severity of night wheeze and the prevalence of chest wheeze (p < 0.05 to p < 0.001), but the PFT values were non‐significantly reduced. In asthmatic children with non‐smoking parents, the prevalence and severity of RS were decreased after 3 years, which was significant for night and chest wheeze for prevalence and night cough and chest wheeze for severity (all, p < 0.05), and the PFT values were increased, which were statistically significant for FVC, FEV1, MEF50 and MEF25 (p < 0.05 to p < 0.01). Drugs used by the group with smoking parents were increased and were significantly higher than their reduction in the groups with non‐smoking parents at the end of the study (p < 0.05 for fluticasone propionate 125/salmeterol and budesonide160/formoterol).ConclusionLong‐term parental smoking increased prevalence and severity of RS and drug used but decreased PFT values of their asthmatic children.     

The effects of isothermic and hypothermic carbon dioxide pneumoperitoneum on respiratory function test results

Background/Purpose

This study investigated the effects of isothermic and hypothermic carbon dioxide, used for pneumoperitoneum during laparoscopic cholecystectomy, on respiratory function test results.

Methods

Thirty patients who underwent elective laparoscopic cholecystectomy were enrolled in this prospective randomized study. The patients were divided into two groups. Carbon dioxide at 37?°C (isothermic) was used in the isothermic group, and carbon dioxide at 21?°C (hypothermic) was used in the hypothermic group. Respiratory function tests were performed in the preoperative period and at 12?h after the operation.

Results

Mean forced vital capacity (FVC), forced expiratory volume (FEV1), maximum peak expiratory flow (PEF), and the FEV1/FVC ratio were significantly higher in the isothermic group than in the hypothermic group (P < 0.05).

Conclusions

Using isothermic carbon dioxide for pneumoperitoneum has fewer negative effects than hypothermic carbon dioxide on respiratory function tests results. Isothermic carbon dioxide may be preferable for patients with respiratory problems.     

The long‐term impact of severe acute respiratory syndrome on pulmonary function,exercise capacity and health status

Background and objective: Severe acute respiratory syndrome (SARS) emerged in 2003 and its long‐term sequelae remain largely unclear. This study examined the long‐term outcome of pulmonary function, exercise capacity, health and work status among SARS survivors. Methods: A prospective cohort study of SARS patients at the Prince of Wales Hospital, Hong Kong was conducted, with serial assessments of lung function, 6MWD and 36 item Short Form General Health Survey at 3, 6, 12, 18 and 24 months after disease onset. The work status was also recorded. Results: Serial assessments were completed by 55 of the 123 (39.9%) subjects, of whom 27 were health‐care workers (HCW). The mean age of the group was 44.4 (SD 13.2) years and 19 (34.5%) were males. At 24 months, 10 (18.2%), 9 (16.4%), 6 (10.9%) and 29 (52.7%) subjects had FEV₁, FVC, TLC and DL_CO < 80% of predicted values, respectively. The mean (SD) 6MWD increased significantly from 439.0 (89.1) m at 3 months to 460.1 (102.8) m at 6 months (P 0.016) and became steady after 6 months. However, 6MWD and 36 item Short Form General Health Survey scores were lower than the normal population throughout the study. Moreover, 29.6% of HCW and 7.1% of non‐HCW had not returned to work 2 years after illness onset. Conclusions: This 2‐year study of a selected population of SARS survivors, showed significant impairment of DL_CO, exercise capacity and health status persisted, with a more marked adverse impact among HCW.     

Social Media Responses to COVID-19: The PRONTO study: Clinical performance of ID NOW in individuals with compatible SARS-CoV-2 symptoms in walk-in centres—accelerated turnaround time for contact tracing

BackgroundThis PRONTO study investigated the clinical performance of the Abbott ID NOW^TM (IDN) COVID-19 diagnostic assay used at point of care and its impact on turnaround time for divulgation of test results.MethodsProspective study conducted from December 2020 to February 2021 in acute symptomatic participants presenting in three walk-in centres in the province of Québec.ResultsValid paired samples were obtained from 2,372 participants. A positive result on either the IDN or the standard-of-care nucleic acid amplification test (SOC-NAAT) was obtained in 423 participants (prevalence of 17.8%). Overall sensitivity of IDN and SOC-NAAT were 96.4% (95% CI: 94.2–98.0%) and 99.1% (95% CI: 97.6–99.8), respectively; negative predictive values were 99.2% (95% CI: 98.7–99.6%) and 99.8% (95% CI: 99.5–100%), respectively. Turnaround time for positive results was significantly faster on IDN.ConclusionIn our experience, IDN use in symptomatic individuals in walk-in centres is a reliable sensitive alternative to SOC-NAAT without the need for subsequent confirmation of negative results. Such deployment can accelerate contact tracing, reduce the burden on laboratories and increase access to testing.