The correlation between parental education and their knowledge of asthma

ObjectiveTo evaluate the impact of parental education on the success of Asthma Educational Intervention (AEI).MethodsAEI took place after the children's hospitalisation. Parental asthma knowledge was assessed at three time points: before AEI, immediately after, and 12 months later. The Intervention (I) group of parents (N = 231) received complete AEI. The Control (C) group of parents (N = 71) received instructions for proper use of asthma medications and the handbook.ResultsAsthma knowledge in I group increased immediately after the AEI (p < 0.01), and had not changed (p > 0.05) 12 months later. There were four subgroups in group I divided based on education level: elementary school, high school, college, and university degrees. Taking into account the parental education level, there were no differences in the baseline and final knowledge of asthma between subgroups (p > 0.05). The number of asthma exacerbations decreased after AEI (5.96:2.50, p < 0.01), regardless of the parental degree. Knowledge of asthma in group C did not improve during the study (p = 0.17). Final asthma knowledge was higher in group I compared to group C (p < 0.01).ConclusionThe parental education level did not influence the level of asthma knowledge after the AEI. The motivation and the type of asthma education had the greatest input on the final results.Practice implicationsAll parents should be educated about asthma regardless of their general education.     

Validación de un cuestionario en castellano sobre conocimientos de asma en profesores

ObjectiveTo evaluate the reliability and validity of the Spanish version of the NewCastle Asthma Knowledge Questionnaire (NAKQ) for determining asthma knowledge in teachers.MethodsDesign and sample: A cross-sectional observational study in educational centers of A Coruña providing preschool, primary school and/or compulsory secondary education. Centers were selected by random sampling, stratified by ownership and educational level (24 centers, 864 teachers). A total of 537 (62.1%) teachers responded (precision, ± 4%, confidence, 95%).MeasurementsAge, sex, academic training, teaching experience, personal/family history of asthma, NAKQ.AnalysisEvaluation of internal consistency (Cronbach's alpha). Concurrent validity was determined by comparing scores of asthmatic teachers or with asthmatic relatives with teachers with no contact with asthma. Test-retest reliability was evaluated in two randomly selected centers by the kappa index, Bland-Altman method and intraclass correlation coefficient.ResultsMean score on the NAKQ was 15.7 ± 5.3 (median 17), correctly answering 50.6% of items.Cronbach's alpha coefficient was 0.824 (95% CI: 0.802-0.845). NAKQ score was higher in asthmatic teachers or with close asthmatic relatives (17.7 ± 3.3) than in teachers with distant asthmatic relatives (16.1 ± 5.4) and teachers without close contact with asthma (15.1 ± 5.6; P < 0.001).In the test-retest analysis (kappa 0.33-1), there were no differences in NAKQ score between the first and second completion (mean difference, 0.3 ± 2.3; intraclass correlation coefficient, 0.863).ConclusionsScores obtained with the Spanish version of the NAKQ in teachers of Spanish school centers are reliable and valid to measure their degree of asthma knowledge.     

Factors affecting quality of life of asthma patients in Spain: The importance of patient education

ObjectivesAssessment of demographic and clinical factors that have an impact on the quality of life (QoL) of patients with asthma in Spain.Patients and methodsMulticenter, prospective, observational, cohort study, conducted in 40 Spanish Pneumology Units during a 12-month period. Data on sociodemographic, clinical variables, asthma treatment and QoL were collected in a case report form.Results536 patients (64.6% women, mean age: 54) were recruited. Reported QoL was better for patients from Northern and Central Spain as compared with those from the South and the East (p < 0.001), students and employed patients as compared with housewives and unemployed (p < 0.01), for those who had received asthma information (p < 0.01), for those with milder daytime symptoms (p < 0.01) and for patients with higher level of education (p < 0.05).ConclusionsAmong the factors that have a significant effect on patients’ QoL only symptom control and patient education on asthma control are modifiable. Therefore, all the strategies should be tailored to improve such factors when managing asthma patients.     

IFN-γ stimulation of dental follicle mesenchymal stem cells modulates immune response of CD4+ T lymphocytes in Der p1+ asthmatic patients in vitro

BackgroundHouse dust mite (Dermataphagoides pteronyssinus) is a widespread risk factor in the development of asthma. CD4⁺ T lymphocytes have an important role in the pathogenesis of allergic asthma by polarizing to Th2 cells.ObjectiveWe aimed to evaluate the immunoregulatory effects of dental follicle mesenchymal stem cells with and without IFN-γ stimulation on peripheral blood mononuclear cells of house dust mite sensitive asthmatic patients, and compared those with Dexamethasone as a systemic steroid.Material and methodsPBMC of asthmatic patients and healthy individuals separately cultured with or without DF-MSCs in the presence and absence of IFN-γ or Der p1 or Dexamethasone for 72 h. CD4⁺ T proliferation, cell viability, CD4⁺CD25⁺FoxP3⁺ Treg cell frequency and cytokine profiles of PBMC were evaluated via flow cytometry.ResultsDF-MSCs suppressed proliferation of CD4⁺ T lymphocytes (p_CDmix < 0.01, p_Derp1 < 0.01, p_IFN < 0.005) by increasing the number of FoxP3 expressing CD4⁺CD25⁺ T regulatory cells (p_CDmix < 0.005, p_Derp1 < 0.01, p_IFN < 0.001) and suppressed lymphocyte apoptosis (p_CDmix < 0.05, p_Derp1 < 0.05, p_IFN < 0.05), while Dexamethasone increased the apoptosis and decreased Treg cell frequency in asthmatic patients. IFN-γ stimulation increased the suppressive effect of DF-MSCs and also enhanced the frequency of FoxP3 expressing CD4⁺CD25⁺ T regulatory cells. The cytokine levels were regulated by DF-MSCs by reducing IL-4 cytokine levels (p_CDmix < 0.01, p_Derp1 < 0.05, p_IFN < 0.05) and upregulating IFN-γ levels (p_CDmix < 0.01, p_Derp1 < 0.05, p_IFN < 0.005) in asthmatic patients.ConclusionIFN-γ stimulated DF-MSCs were found to have a high modulatory effect on CD4⁺ T cell responses, while Dexamethasone had an apoptotic effect on CD4⁺ T cells in asthmatic patients. DF-MSCs may be a new cell-based therapy option for allergic diseases including asthma.     

Serum levels of adiponectin and leptin in asthmatic patients and its relation with asthma severity,lung function and BMI

IntroductionAsthma is one of the diseases which has a high prevalence in developed and developing countries. The relationship between asthma and obesity has always been focused by researchers. In this field, adipokines, especially adiponectin and leptin have highly attended by the scientist. The aim of this study was to determine the serum level of adiponectin, leptin and the leptin/adiponectin ratio in asthmatic patients and its relationship with disease severity, lung function and BMI (body mass index).MethodsIn this cross-sectional study, 90 asthmatic women admitted to the tertiary referral hospital in Kurdistan province – Iran, were examined. First, BMI was measured and then pulmonary function tests were performed in all asthmatics patient. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC, were measured. At the end, blood samples were collected and serum level of adiponectin and leptin were measured by ELISA method.ResultSerum leptin and leptin/adiponectin levels correlated positively with asthma severity and BMI (p = 0.0001), but there was no correlation between adiponectin level with asthma severity and BMI (p > 0.05), also serum leptin and leptin/adiponectin levels inversely correlated with FEV1 and FVC in patient (p = 0.0001).ConclusionAsthma is linked with obesity, and there is an association between asthma severity and BMI with serum leptin and leptin/adiponectin levels, but our results do not support a significant role of adiponectin in obesity or asthma.     

Asthma,allergic sensitization and lung function in sickle cell disease

BackgroundPulmonary disease is a frequent acute and chronic manifestation in sickle cell disease (SCD), presenting high morbidity and mortality.ObjectivesTo identify the prevalence and association of asthma, allergic sensitization and altered pulmonary function in patients with SCD (SS and Sβ^o).MethodsA single-center, cross-sectional study was conducted, in which 70 patients with SCD and 44 controls, aged six to 18 years, responded to the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), complemented with an anamnesis regarding the associated clinical outcomes. All patients underwent immediate hypersensitivity skin tests with aeroallergens and a pulmonary function evaluation (spirometry). Regarding the statistical analysis, parametric and non-parametric methods were used, depending on the variables studied. Tests were considered significant when p < 0.05.ResultsThere was no significant difference between the patients and controls regarding the prevalence of asthma and allergic sensitization (p > 0.05). The number of occurrences of acute chest syndrome per patient per year was significantly higher for asthmatic patients than for non-asthmatic patients (p = 0.04). Obstructive pulmonary function occurred in 30.9% of the patients and in 5.4% of the controls, and restrictive pulmonary function occurred in 5.5% of the patients and 5.4% of the controls. Asthma and wheezing in the last 12 months had significant associations with obstructive pulmonary function (p = 0.014 and p = 0.027, respectively).ConclusionsThe occurrence of asthma, allergic sensitization and alteration in lung function in patients with SCD reinforces the importance of routine monitoring of these diagnoses, which allows for early treatment and prevention of the evolution of pulmonary disease in adulthood.     

Elevated level of serum osteopontin in school-age children with asthma

BackgroundThe role of osteopontin (OPN) has not been elucidated in childhood asthma.ObjectiveOur purpose was to investigate whether OPN levels change due to allergic inflammation in pre-school and school-age children.MethodsIn this prospective, cross-sectional study, 42 healthy children and a total of 51 children with asthma were recruited. OPN levels and its association with clinical and laboratory parameters were investigated in the study population. The asthma group were divided into two groups with respect to age, ≤5-years (n = 23) and >5-years (n = 28), and labelled Asthma Group 1 and Asthma Group 2, respectively. OPN levels were compared between subgroups.ResultsSerum OPN levels were significantly higher in the asthma group when compared to the control group (p = 0.004). OPN levels were similar in Asthma Group 1 and control groups, whereas it was found to be higher in Asthma Group 2 (p > 0.025, p = 0.001, respectively). In the >5-years age asthmatic group, OPN levels of the patients with allergic rhinitis (n = 15) were higher than those of the patients (n = 13) without allergic rhinitis (p = 0.021).ConclusionThe study underscores the relationship between childhood asthma and OPN as the first study in the literature. In this study we found that OPN, which plays a role in Th2 mediated inflammation, may also play a role in childhood asthma. The fact that OPN levels do not increase in preschool-age children with asthma might be due to the transient wheezing in this group.     

Prevalence and clinical profile of difficult-to-control severe asthma in children: Results from pneumology and allergy hospital units in Spain

BackgroundSevere asthma is often poorly controlled and its prevalence in Spanish children is unknown. The aim was to determine the prevalence of difficult-to-control severe asthma in children, the agreement of asthma control between physicians and Spanish Guidelines for Asthma Management (GEMA), and the health-related quality of life (HRQoL) for children and parents.MethodsObservational, cross-sectional, two-phase, multicentre study. In the first phase, all children who attended pneumology and allergy units during a three-month period were classified according to physicians’ criteria as patients with: asthma, severe asthma, or difficult-to-control severe asthma. Patients aged 6–14 years with severe asthma (difficult-to-control or controlled) were included in the second phase.Results12,376 asthmatic children were screened in the first phase. According to physicians’ criteria, 8.8% (95% CI 8.3–9.3%) had severe asthma. Of these, 24.2% (95% CI, 21.7–26.8%) had difficult-to-control severe asthma. 207 patients with severe asthma (mean age 10.8 ± 2.3 years; 61.4% male; mean of 5.5 ± 3.4 years since asthma diagnosis) were included in the second phase. Compared to the patients with controlled asthma, children with difficult-to-control asthma had a higher number of exacerbations, emergency room or unscheduled primary care visits in the previous year (p < 0.0001, all) and poor HRQoL (p < 0.0001, both children and caregivers). 33.3% of patients with controlled asthma according to physicians’ criteria were poorly controlled according to GEMA.ConclusionsAround one in four asthmatic children with severe disease had difficult-to-control asthma, although one third was underestimated by physicians. Children with difficult-to-control severe asthma had a poor HRQoL that also affected their parents.     

Serum level of zinc in asthmatic patients: A case–control study

BackgroundHypozincemia could lead to a variety of defects in growth and the immune system, while it seems to be associated with increased rate of asthmatic attacks in children.MethodsThis study was performed to assess the serum zinc level in 100 paediatric asthmatic patients in comparison with a control group.ResultsMean serum level of zinc in the asthmatic patients was 70.5 ± 22.6 μg/dL, which was significantly lower than 80.9 ± 16.9 μg/dL in the control group (p < 0.001). Forty-two asthmatic patients (42%) had hypozincemia, while this rate was 12% in healthy children (p < 0.001). There was a significant association between the zinc level and severity of asthma (p < 0.001). However, no significant association was detected between the serum level of zinc and other factors, including control and treatment of the disease.ConclusionsAs for high rate of hypozincemia in the asthmatic children, evaluation of serum zinc level in asthmatic children could be suggested, while zinc substitution in the diet of those with hypozincemia could be recommended.     

Cough affects Quality of Life in asthmatic children aged 8-14 more than other asthma symptoms

BackgroundAsthma may influence children's health-related quality of life (QoL) differently by various symptoms, at different severity. The primary aim of this study was to evaluate the QoL in children with asthma and describe the impact of each asthma symptom on the child's well-being at different severity levels.Material and MethodsTwo hundred randomly selected children and one of their parents who consulted an outpatient asthma clinic, participated in the study. Qol was assessed with DISABKIDS-Smiley measure for children aged 4-7 years and with DISABKIDS DCGM-37 and Asthma Module for children 8-14 year old.ResultsMost of the children suffered from mild or moderate persistent asthma. Children with uncontrolled asthma stated lower QoL compared to partly controlled or controlled in both age groups (p < 0.05 in all domains). Cough appeared to affect QoL of 8-14 year olds more than other symptoms, especially in girls. In younger children, sex (boys, p = 0.039), age (p = 0.045), proxy sex (father, p = 0.048), frequency of doctor visits (4-6 months, p = 0.001), use of beta-2 agonists (p = 0.007) and father's smoking habits (p = 0.015) were associated with the QoL of coughing children but no correlation between cough and QoL was detected. In the 8-14 year age group coughers reported lower QoL compared to their counterparts; moreover, cough was found to affect QoL more than other symptoms (p < 0.05 in all domains).ConclusionsCough has a direct effect on asthmatic children's QoL but there is still an obvious need for research to reveal all the determinats of this effect.     

Asthma control affects school absence,achievement and quality of school life: a multicenter study

Introduction and ObjectivesAsthma may have a detrimental effect on school attendance and achievement. Friend relations, attendance to school activities, quality of life (QOL) of asthmatic children may be negatively affected. The aim of this study was to evaluate factors influencing school functioning for asthmatic school-age children.Materials and MethodsFrom January to May 2019, parents and school-age children who were followed by a diagnosis of asthma for more than one year, from seven pediatric allergy centers, were given a standard questionnaire including questions about child’s disease, school performance, absenteeism, home-family-school conditions. A pediatric QOL questionnaire was filled out by children. For evaluating control in the previous year, children who had more than two exacerbations and/or had any exacerbations needing systemic corticosteroids in the previous year were defined as inadequate control. School absence over nine days was taken into account as this has been shown to bring a risk for successful school life.Results507 patients were included. Asthma control status was found to be effective on school absence (p < 0.001), on school success (especially math scores) (p < 0.001), on friend relations (p = 0.033), QOL (p < 0.001), attendance to school activities (p < 0.001). Regular follow-up (p < 0.001), regular use of asthma medication (p = 0.014), tobacco smoke exposure (p < 0.001), heating with stove at home (p = 0.01) affected asthma control. School conditions such as crowdedness (p = 0.044), humidity of the class (p = 0.025), knowledge of teacher about child’s asthma (p = 0.012) were effective on asthma control independent of home conditions and asthma treatment parameters.ConclusionSchool interventions are important to improve asthma management.     

Prevalence of asthma in a Portuguese countryside town: repercussions on absenteeism and self-concept

BackgroundChildhood asthma represents an increasing health problem and is the leading cause of hospital admission and absenteeism in children with chronic disease. It also compromises quality of life, eventually contributing to disturbances in self-concept. Self-concept is a recent and global perspective of “the self” and relates to skills, self-image and self-esteem. Little information is available on this topic and there are no data from Portuguese countryside towns.ObjectiveThe aim of this study was to determine the prevalence of asthma among all school children in the 5th and 6th grades in a Portuguese countryside town and to establish its possible correlation with absenteeism and self-concept.MethodsIn April 2002, two questionnaires were administered in the presence of the researcher to a group of 950 children attending different schools. The children completed the internationally renowned questionnaires: ISAAC and the Self-Concept Scale by Susan Harter.ResultsOur sample (n = 818) had a mean age of 11 years (10-15 years) and a male-to-female ratio of 1/1. The cumulative prevalence of asthma was 11.9% and that of active asthma was 8.8 %; 63.9% of asthmatics were male and 36.1 % were female. The mean age of asthmatics was 11.34 years and 74 % had active symptoms. Comparison of this group of 97 asthmatic children with the remaining children revealed a statistically significant correlation between the presence of asthma and school absenteeism (global: p = 0.04; gymnastics: 0.05). Regarding the Self-Concept Scale a statistically significant association was found between the presence of asthma and school achievement (p = 0.027), physical appearance (p = 0.015), behavior (p < 0.000) and self-esteem (p < 0.000). No statistically significant correlations were found in social acceptance (p = 0.289) or athletic competence (p = 0.085). Asthmatic boys had higher self-concept scores than girls, except in the domain of behavior.ConclusionsTwelve percent of the population studied was asthmatic. In asthmatic children, absenteeism was higher and self-concept was lower for almost all domains, except social acceptance and athletic achievement, probably due to overprotection.     

Leptin and resistin in overweight patients with and without asthma

BackgroundExcess body mass increases the risk of development of asthmatic symptoms and their severity and decreases the treatment effectiveness. One of the hypotheses explaining the link between the two diseases concerns the adipokines, hormones produced by adipose tissue with a proinflammatory character. The aim of this study was to compare the levels of the adipokines (leptin and resistin) between overweight asthmatic patients, asthmatic patients with normal weight and overweight patients without asthma.Methods80 peripheral blood samples were collected from patients and blood serum extracted. Three groups were selected: overweight asthmatic patients (BMI ≥ 25), overweight patients without asthma and asthmatic patients with normal weight (BMI < 25). Waist circumference of the patients was measured (cut-off points were 80 cm for women and over 94 cm for men) and a skin prick test performed. Comparison of adipokine concentration between the 3 groups was made and association between these concentrations and the measurements was performed.ResultsAlthough the concentrations of both adipokines were slightly higher for overweight asthmatic patients compared to overweight healthy patients, these differences were not significant. A significant association was found between leptin concentration and both BMI (p < 0.01) and waist circumference (p < 0.01). A difference for this cytokine was also found between asthmatic and non-asthmatic female patients (p < 0.05).ConclusionsAs expected overweight patients with BMI ≥ 25 and patients with increased waist circumference showed higher leptin levels. We suggest that the studied cytokines, with a stronger indication for leptin, can elicit asthmatic inflammation in obese phenotype of asthma that affects more frequently women.     

Polymorphisms of TGFB1, TLE4 and MUC22 are associated with childhood asthma in Chinese population

ObjectiveTo investigate whether the genetic variants of TGFB1, TLE4, MUC22 and IKZF3 are associated with the development of asthma in Chinese children.Methods572 adolescent asthma patients and 590 age-matched healthy controls were included in this study. A total of four SNPs were genotyped, including rs2241715 of TGFB1, rs2378383 of TLE4, rs2523924 of MUC22, and rs907092 of IKZF3. Allele frequencies of the patients and the control group were compared by the Chi-square test. The Student t test was used to analyse the relationship between genotypes and clinical feature of the patients.ResultsPatients were found to have significantly different frequencies of allele A of rs2241715, allele G of rs2378383 and allele A of rs2523924 as compared with the controls (40.4% vs. 45.9%, p = 0.01 for rs2241715; 17.2% vs. 13.4%, p = 0.01 for rs2378383; 15.3% vs. 11.9%, p = 0.02 for rs2523924). For patients with severe asthma, those with genotype AA/AG of rs2241715 had remarkably higher FEV1% as compared with those with genotype GG (59.1 ± 4.3% vs. 55.4 ± 3.7%, p < 0.001). Moreover, those with genotype GG/GA of rs2378383 had remarkably lower FEV1% as compared with those with genotype AA (54.6 ± 2.9% vs. 58.6 ± 4.1%, p < 0.001).ConclusionsGenes TGFB1, TLE4 and MUC22 are associated with the risk of childhood asthma in Chinese population. Our results associating TGFB1 and TLE4 with clinical features of asthma suggest potential application of these parameters in the management of asthma children.     

Prevalence of asthma and associated factors in adolescents living in Belem (Amazon region), Para,Brazil

BackgroundThe prevalence of asthma in the Brazilian Amazon region is unknown. We studied the prevalence of asthma and associated factors in adolescents (13–14 years old) living in Belem, a large urban centre in this region.Methods3725 adolescents were evaluated according to the International Study of Asthma and Allergies in Childhood (ISAAC) protocol and a random sample of them (126 asthmatics and 254 non-asthmatics) were assessed for possible risk factors by a supplementary questionnaire (ISAAC Phase II) and skin prick tests with aeroallergens. The association between asthma and associated factors was determined by logistic regression analysis.Results3708 adolescents were enrolled, 48% were male. The prevalence of asthma in the last 12 months (identified as asthmatics) and the medical diagnosis of asthma were 20.7% and 29.3%, respectively. Risk factors significantly associated with asthma were: previous diagnosis of tuberculosis (odds ratio [OR] = 38.9; 95% confidence interval [95% CI]: 4.6–328.0) and measles (OR = 4.7; 95% CI: 2.3–9.8), breastfeeding for any length of time (OR = 4.2; 95% CI: 1.1–15.2), current rhinitis (OR = 3.2; 95% CI: 1.8–5.9), exposure to smokers (OR = 2.4; 95% CI: 1.2–4.5), moisture in home (OR = 1.8; 95% CI: 1.1–3.2) and rhinitis diagnosed by physician (OR = 1.7; 95% CI: 1.2–2.9). Sensitisation to at least one aeroallergen was significantly higher among asthmatic adolescents (86.5% vs. 32.4%; p < 0.0001).ConclusionsThe prevalence of asthma was similar to that observed in other Brazilian centres. Physician-diagnosed asthma was more frequent than the presence of symptoms suggestive of asthma. Infectious diseases, nutritional and environmental factors, as well as concomitant allergic rhinitis, were the main risk factors associated with the development of asthma in these adolescents.     

Relación entre la expresión de IL-2 e IL-4 y sus polimorfismos y los riesgos de padecer infección por Mycoplasma pneumoniae y asma en niños

IntroductionAsthma is an inflammatory disorder of the airways and the symptoms of asthma could be exacerbated by Mycoplasma pneumoniae infection. Interleukin-2 and interleukin-4 have been implicated in immune and inflammatory reactions. We examined the associations of IL2 and IL4 polymorphisms and expression with the risks of asthma and M. pneumoniae infection in children.Methods392 asthmatic children and 849 controls were recruited into the study. Eight polymorphisms in IL2 and IL4 were genotyped with Sequenom MassARRAY platform. M. pneumoniae infection and copy number was determined with fluorescence PCR. IL-2 and IL-4 serum expression levels were determined by using ELISA.ResultsWe found a significant association of IL2 rs6534349 polymorphism with increased asthma risk (heterozygotes, P = .029; homozygous variants; P = .013) and of IL4 rs2227284 polymorphism with reduced asthma risk (heterozygotes, P = .026; homozygous variants; P = .001). Besides, the association of other polymorphisms, except rs2070874 polymorphism, became apparent when the asthmatic children were grouped according to GINA classification of asthma control and severity. In addition, IL-2 and IL-4 serum expression levels were significantly higher in M. pneumoniae negative (P = .038) and positive (P = .011) subjects respectively. This observation holds true among asthmatic patients (P = .016 for IL-2 and P = .042 for IL-4), but only the IL-4 observation remained correct among non-asthmatic controls (P = .032). We also observed that the rs6534349 GG genotype was significantly associated with increased odds of getting high load M. pneumoniae infection (P = .0376).ConclusionsIL2 and IL4 could be important biomarkers for estimating the risks of asthma and M. pneumoniae infection in children.     

Relationship between exhaled leukotriene and 8-isoprostane levels and asthma severity,asthma control level,and asthma control test score

ObjectiveExhaled breath condensate (EBC) is a completely non-invasive method for the collection of airway secretions to measure intense inflammation in the airways of asthmatics. It has been shown that the childhood asthma control test (c-ACT) is a good tool for use in the evaluation of asthmatics. Whether the c-ACT score and asthma control level correlate with the airway inflammation is not well known. We aimed to evaluate the relationship between exhaled cysteinyl leukotrienes (Cys-LTs) and 8-isoprostane levels and asthma severity, asthma control level and c-ACT score in asthmatic children.MethodsThirty asthmatic children were evaluated with c-ACT score and pulmonary function tests. Asthma severity and asthma control level were assessed according to GINA. EBC was collected and Cys-LTs and 8-isoprostane concentrations were determined using a specific immunoassay kit.ResultsExhaled 8-isoprostane level in patients with moderate persistent asthma [114 (55–146) pg/ml] was higher than in the mild persistent group [52 (21–91) pg/ml] (p = 0.05, Mann–Whitney U [MWU]). EBC 8-isoprostane in children with 1–4 asthma exacerbations/year [52 (16–80) pg/ml] was significantly lower than in children with >4 asthma exacerbations/year [114 (57–129) pg/ml] (p < 0.05, MWU). No significant relation was determined between exhaled 8-isoprostane and Cys-LTs levels and c-ACT score and asthma control level. Exhaled 8-isoprostane correlated negatively with bronchodilator response (p = 0.015, r = −0.45).ConclusionsExhaled 8-isoprostane, as an oxidative stress specifier, was found to be increased in relation with asthma exacerbation frequency and oxidative stress increases with the severity of asthma. In contrast to asthma severity level, c-ACT score and asthma control level may not reflect airway inflammation.     

The relationship between hs-CRP and asthma control test in asthmatic patients

BackgroundHigh sensitive C-reactive protein (hs-CRP) has been shown to be associated with asthma in recent studies. However, the relationship between hs-CRP and the control of asthma has not been clearly identified yet.ObjectiveTo investigate the association of hs-CRP with asthma control test (ACT), which reveals the degree of asthma control, and to compare hs-CRP in adults with mild and moderate asthma in chronic, stable asthmatic patients.MethodsThirty patients with physician-diagnosed asthma (11 mild, 19 moderate), and 30 healthy patients were enrolled in the study. In addition to medical history and physical examination, asthma was assessed according to GINA guideline. Respiratory function tests (RFT) and ACT were performed. The serum hs-CRP levels of all cases patients were measured.ResultsThe levels of hs-CRP in asthmatic patients were significantly higher than those in the control cases (p = 0.002). The serum hs-CRP levels in the moderate asthmatics were significantly higher than those in the mild asthmatic ones (p = 0.04). When asthmatic cases were divided into two groups according to ACTs; the levels of hs-CRP in the groups of ACT ≤ 20 (uncontrolled groups) were significantly higher than the groups of ACT ≥ 20 (controlled groups) (p = 0.02). The hs-CRP levels showed significant correlations with ACT (p = 0.00, r = ?0.91) and asthma severity (p = 0.04, r = 038) in asthmatic patients.ConclusionIn conclusion it was shown that hs-CRP is related with asthma severity and ACT, and hs-CRP is a potential sensitive marker which reveals the severity and the control of asthma.     

Searching for Inflammatory and Oxidative Stress Markers Capable of Clustering Severe Asthma

ObjectiveAsthma inflammation may feature an imbalance between oxidative stress and antioxidant defenses. Oxidative stress induces propagation of airways inflammation and corticosteroid insensitivity contributing to poor asthma control, and frequent severe acute exacerbations. This study assessed inflammation and oxidative stress in severe asthmatic subjects and evaluated the possible correlations between inflammatory and oxidative stress markers investigated and asthma severity.Material and methodFifty-three patients with severe asthma, 11 patients with mild-moderate asthma and 12 healthy subjects were enrolled and underwent fractional exhaled nitric oxide (FENO) analysis and blood and sputum count cell collection. The content of mitochondrial DNA (MtDNA) and nuclear DNA (nDNA) was measured in exhaled breath condensate (EBC) by Real Time PCR and the ratio between MtDNA/nDNA was calculated. We detected MtDNA/nDNA in the EBC of severe asthmatics.ResultsWe found higher exhaled MtDNA/nDNA in severe asthmatics respectively compared to mild-moderate ones and to healthy controls (10.4 ± 2.2 vs 7.9 ± 2.5, p < 0.05 and 10.4 ± 2.2 vs 6.51 ± 0.21, p < 0.05). The level of exhaled MtDNA/nDNA was significantly higher in Non-T2 endotype severe asthmatics than T2 (14.07 ± 10. 8 vs 6.5 ± 5.5, p < 0.05).ConclusionOxidative stress marker (MtDNA/nDNA) is increased significantly with asthma severity and may be useful for endotyping severe asthma.     

Interleukin-33 in children with asthma: A systematic review and meta-analysis

BackgroundPrevious studies have shown that serum interleukin 33 serving as an “alarmin” is increased in children with asthma. The objective of this study was to assess the validity of serum IL33 test for early diagnosis of childhood asthma.MethodsA literature search was performed in June 2016 using PubMed, Embase, the Cochrane Library and other Chinese Medical Databases to identify studies. The search terms used were “cytokine”, “interleukin-33“, “asthma” and “children”. The meta-analysis was performed using Review Manager 5.3 software. Random-effects model was used to estimate the standardized mean differences (SMDs) with 95% confidence intervals (CIs).ResultsA total of eight studies were included into this meta-analysis, involving 330 asthmatic children and 248 healthy children. The meta-analysis results revealed that the serum IL33 level was higher in asthmatic children compared to that in healthy children (SMD = 1.29, 95%CI = 0.53–2.05, P = 0.0009), with significant heterogeneity across studies (I² = 94% and P < 0.00001).ConclusionsThe meta-analysis showed that serum IL33 is a helpful biomarker for early diagnosis of childhood asthma. However, owing to lack of enough data, the increased serum concentration of IL33 cannot be an indicator for the asthma severity.