scholarly journals The upper-airway microbiota and loss of asthma control among asthmatic children

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Yanjiao Zhou ◽  
Daniel Jackson ◽  
Leonard B. Bacharier ◽  
David Mauger ◽  
Homer Boushey ◽  
...  
Keyword(s):  
Asthma Control ◽  
Asthma Exacerbation ◽  
Upper Airway ◽  
Severe Exacerbation ◽  
Asthmatic Children ◽  
Time Points ◽  
Asthma Exacerbations ◽  
Severe Asthma Exacerbation ◽  
Airway Microbiome ◽  
One Year

AbstractThe airway microbiome has an important role in asthma pathophysiology. However, little is known on the relationships between the airway microbiome of asthmatic children, loss of asthma control, and severe exacerbations. Here we report that the microbiota’s dynamic patterns and compositions are related to asthma exacerbations. We collected nasal blow samples (n = 319) longitudinally during a clinical trial at 2 time-points within one year: randomization when asthma is under control, and at time of early loss of asthma control (yellow zone (YZ)). We report that participants whose microbiota was dominated by the commensal Corynebacterium + Dolosigranulum cluster at RD experience the lowest rates of YZs (p = 0.005) and have longer time to develop at least 2 episodes of YZ (p = 0.03). The airway microbiota have changed from randomization to YZ. A switch from the Corynebacterium + Dolosigranulum cluster at randomization to the Moraxella- cluster at YZ poses the highest risk of severe asthma exacerbation (p = 0.04). Corynebacterium’s relative abundance at YZ is inversely associated with severe exacerbation (p = 0.002).

scholarly journals Duration of the efficacy of omalizumab after treatment discontinuation in ‘real life’ severe asthma

Thorax ◽  
2017 ◽  
Vol 73 (8) ◽  
pp. 782-784 ◽  
Author(s):  
Maria del Carmen Vennera ◽  
Carlos Sabadell ◽  
Cesar Picado
Keyword(s):  
Prospective Study ◽  
Asthma Control ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Real Life ◽  
First Year ◽  
Severe Asthma Exacerbation ◽  
Optimal Duration ◽  
Open Prospective Study

Efficacy of omalizumab in severe asthma is well documented; however, the optimal duration of the treatment remains unclear. In an open prospective study, we sought to assess the persistence of response in subjects withdrawing from omalizumab treatment. We evaluated 49 patients who voluntarily accepted to discontinue omalizumab treatment after 6 years of therapy. Asthma relapse was defined as any severe asthma exacerbation associated with loss of asthma control. Twelve patients relapsed in the first year of follow-up, and 7 within 13 and 48 months. These results suggest that the effects of 6 years of omalizumab may persist after discontinuation of therapy in 60% of patients for at least 4 years.

scholarly journals Typical Antipsychotics Increase Risk of Severe Exacerbation in Asthma Patients– A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Chin-Wei Kuo ◽  
Szu-Chun Yang ◽  
Yu-Fen Shih ◽  
Xin-Min Liao ◽  
Sheng-Hsiang Lin
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
High Dose ◽  
Severe Exacerbation ◽  
Severe Asthma Exacerbation ◽  
Increased Risk ◽  
Asthma Patients ◽  
Ed Visits ◽  
Dose Dependent ◽  
Typical Antipsychotics

Abstract Background:Severe asthma exacerbation reduces patients’ life quality, results in visits to the emergency department (ED) and hospitalization, and incurs additional medical costs. Antipsychotics block receptors with bronchodilation function; however, the effects of antipsychotics use on severe asthma exacerbation are unknown. This study aimed to investigate the effects of antipsychotics on asthma-related ED visits and hospitalizations.Methods:This study used a case-crossover design. Using the 2003-2017 Taiwan National Health Insurance Reimbursement Database, we established a cohort of 18,657 adults with severe asthma exacerbation leading to ED visits or hospitalization. Univariate and multivariate conditional logistic regressions were conducted to explore the association of antipsychotics use with severe asthma exacerbation. Subgroup analyses of different classes, doses, receptor functions of antipsychotics and schizophrenia were also performed.Results:Antipsychotics use was associated with a higher risk of severe asthma exacerbation (adjusted odds ratio (OR): 1.27; 95% confidence interval (CI): 1.05-1.54; P = 0.013) compared with no use of antipsychotics. Use of typical antipsychotics increased the risk of severe asthma exacerbation (adjusted OR: 1.40, 95% CI: 1.10-1.79, P = 0.007), whereas use of atypical antipsychotics did not. There was a dose-dependent effect of antipsychotics (test for trend: P =0.025). Antipsychotics that block the M2 muscarinic or D2 dopaminergic receptor were associated with an increased risk of severe asthma exacerbation (adjusted OR: 1.39, 95% CI: 1.10-1.76, P = 0.007 and adjusted OR: 1.33, 95% CI: 1.08-1.63, P = 0.008, respectively).Conclusions: Use of typical antipsychotics is associated with a dose-dependent increased risk of severe asthma exacerbation. Physicians should thus weight the risk and benefit of prescribing high-dose typical antipsychotics for asthma patients.

scholarly journals Does the occurrence of a severe asthma exacerbation change the rate of subsequent events?

2021 ◽  
Author(s):  
Tae Yoon Lee ◽  
John Petkau ◽  
Mohsen Sadatsafavi
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Failure Time ◽  
Asthma Management ◽  
Frailty Model ◽  
Severe Exacerbation ◽  
Adult Group ◽  
Old Patients ◽  
Severe Asthma Exacerbation

Background: Severe exacerbations requiring hospitalization are an important component of the natural history of asthma and a major source of its burden. Whether the occurrence of a severe exacerbation affects the rate of subsequent events has far-reaching implications in asthma management. Methods: Using the centralized administrative health databases of British Columbia, Canada (1997/01/01-2016/03/31), we created an incidence cohort of patients with at least one severe asthma exacerbation, defined as an episode of hospitalization with asthma as the primary diagnosis. We used an accelerated failure time joint frailty model for the time intervals between severe asthma exacerbations. Analyses were conducted separately for pediatric (< 14 years old) and adult (≥14 years old) patients. Results: There were 3,039 patients (mean age at baseline 6.4, 35% female) in the pediatric group and 5,459 patients (mean age at baseline 50.8, 68% female) in the adult group, with 16% and 15%, respectively, experiencing at least one severe asthma exacerbation during follow-up. The first follow-up severe asthma exacerbation was associated with an increase of 79% (95% CI: 15% - 186%) in the rate of the subsequent events for the pediatric group. The corresponding value was 186% (95% CI: 85% - 355%) for the adult group. For both groups, the effects of subsequent severe exacerbations were not statistically significant. Conclusion: Our findings suggest that among patients who have experienced their first severe asthma exacerbation, preventing the next event can drastically change the course of the disease and reduce the burden of future exacerbations.

scholarly journals Childhood obesity in relation to poor asthma control and exacerbation: a meta-analysis

2016 ◽  
Vol 48 (4) ◽  
pp. 1063-1073 ◽  
Author(s):  
Fariba Ahmadizar ◽  
Susanne J.H. Vijverberg ◽  
Hubertus G.M. Arets ◽  
Anthonius de Boer ◽  
Jason E. Lang ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Asthma Control ◽  
Meta Analysis ◽  
Odds Ratios ◽  
Cross Sectional ◽  
Random Effects Models ◽  
Asthmatic Children ◽  
Asthma Exacerbations ◽  
Increased Risk ◽  
A Minor

To estimate the association between obesity and poor asthma control or risk of exacerbations in asthmatic children and adolescents, and to assess whether these associations are different by sex.A meta-analysis was performed on unpublished data from three North-European paediatric asthma cohorts (BREATHE, PACMAN (Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects) and PAGES (Pediatric Asthma Gene Environment Study)) and 11 previously published studies (cross-sectional and longitudinal studies). Outcomes were poor asthma control (based on asthma symptoms) and exacerbations rates (asthma-related visits to the emergency department, asthma-related hospitalisations or use of oral corticosteroids). Overall pooled estimates of the odds ratios were obtained using fixed- or random-effects models.In a meta-analysis of 46 070 asthmatic children and adolescents, obese children (body mass index ≥95th percentile) compared with non-obese peers had a small but significant increased risk of asthma exacerbations (OR 1.17, 95% CI 1.03–1.34; I2: 54.7%). However, there was no statistically significant association between obesity and poor asthma control (n=4973, OR 1.23, 95% CI 0.99–1.53; I2: 0.0%). After stratification for sex, the differences in odds ratios for girls and boys were similar, yet no longer statistically significant.In asthmatic children, obesity is associated with a minor increased risk of asthma exacerbations but not with poor asthma control. Sex does not appear to modify this risk.

scholarly journals MP9: SINO-NASAL 5 QUESTIONNAIRE PREDICTS POOR ASTHMA CONTROL IN CHILDREN WITH PERSISTENT ASTHMA

2016 ◽  
Vol 64 (3) ◽  
pp. 808.1-808
Author(s):  
G Phull ◽  
D Prue ◽  
C Martinez ◽  
K Scheffey ◽  
D Pillai
Keyword(s):  
Asthma Control ◽  
Persistent Asthma ◽  
Upper Airway ◽  
Asthma Severity ◽  
Life Questionnaire ◽  
Night Time ◽  
Time Activity ◽  
Asthmatic Children ◽  
Airway Symptoms ◽  
The Impact

Purpose of StudyUp to 80% of asthmatic children may experience upper airway symptoms, including rhinitis, often perceived as coming from lower airways. Asthma diagnosis, classification and assessment of control are defined by the National Asthma Education Prevention Program (NAEPP) 2007 guidelines, but may understate the impact of the upper airway. We explored associations between Sino-Nasal 5 (SN-5) quality of life questionnaire, validated in radiographic confirmed sinus disease, and NAEPP asthma impairment in children. We hypothesize that children with NAEPP defined uncontrolled asthma will have abnormal SN-5 scores.Methods UsedWe performed a retrospective chart review of children (1–21 yr) referred to a pediatric pulmonary clinic for persistent asthma. Data collected include age, gender, BMI%, NAEPP asthma severity, SN-5, asthma control (TRACK children <5 y, ACT children ≥5 y) and pulmonary function testing (PFT). The primary analysis was to identify associations between SN-5 scores and levels of NAEPP guideline impairment: daytime symptoms, night time awakenings, activity interference and PFTs. Significant SN-5 scoring was defined as ≥3.5 based on prior studies. PFT was performed in children ≥5 y. Statistical analysis with SPSS 22.Summary of Results76 children were evaluated; 38% female, mean age 6.9 y and mean BMI% 69%. Significant SN-5 score (≥3.5 vs. <3.5) was associated with decreased control of daytime symptoms (OR 0.16 [95% CI:0.06–0.44]), night time awakenings (OR 0.09 [0.03–0.29]), activity interference (OR 0.2 [0.06–0.68]) and asthma control (OR 0.32 [0.12–0.85]). Those with SN-5 ≥3.5 had poor asthma control based on TRACK (p<0.002) and ACT (p<0.001). Age, gender, BMI%, asthma severity and PFTs were not associated with SN-5.ConclusionsIn persistent asthmatic children, NAEPP defined daytime, night time, activity related impairment and poor asthma control were associated with a significant SN-5 score; PFTs and NAEPP asthma severity were not. This suggests that upper airways may play a larger role in lower airway associated symptoms, and that SN-5 may be beneficial in assessing asthma symptoms. Recognizing and treating upper airway symptoms, an understated area in asthma guidelines, might improve overall asthma control. A prospective analysis in a larger cohort is recommended to evaluate these findings.

scholarly journals Study of Clinical Characteristics and Cytokine Profiles of Asthmatic Children with Rhinovirus Infection during Acute Asthma Exacerbation at National Hospital of Pediatrics

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Thuy Nguyen-Thi-Dieu ◽  
Huong Le-Thi-Thu ◽  
Huong Le-Thi-Minh ◽  
An Pham-Nhat ◽  
Sy Duong-Quy
Keyword(s):  
Asthma Exacerbation ◽  
Acute Asthma ◽  
Cytokine Profile ◽  
Severe Exacerbation ◽  
Polymorphonuclear Leucocytes ◽  
Healthy Children ◽  
Asthmatic Children ◽  
Significant Difference ◽  
Children With Asthma ◽  
Acute Asthma Exacerbation

Background. In children with asthma, the viral infection of airways is usually a main cause of acute asthma exacerbation and hospitalization. However, few studies on clinical and biomolecular characteristics of asthmatic children in this field have been done, especially in emergent countries. Objective. This study described the clinical and biological characteristics of asthmatic children who had acute asthma exacerbation and rhinovirus (RV) infection. Methods. Children under 15 years of age hospitalized for acute asthma exacerbation were included. They underwent clinical examination and peripheral blood analyses for the cytokine profile. The severity of acute asthma exacerbation was evaluated by Pediatric Asthma Score (PAS). Healthy children under 15 years of age were also invited in this study. Results. One hundred fifteen asthmatic children were included in this study. There were 18.2% of mild PAS, 37.4% of moderate PAS, and 44.4% of severe PSA. Among them, 63/115 (54.8%) asthmatic children had positive RV infection (RV+). The percentages of asthmatic children with RV+ had increased polymorphonuclear leucocytes were significantly higher than asthmatic children with RV−. There were no significant differences of the concentrations of non-Th2-related cytokines in asthmatic children with RV− and RV+. The concentration of Th2-related cytokines (IL-5 and IL-13) in asthmatic children with RV+ was significantly higher than those with RV−. However, there was no significant difference for the cytokine profile between mild, moderate, and severe asthma. Conclusion. RV infection is a main cause of acute asthma exacerbation in children with asthma. The increase of Th2-related cytokines, especially IL-5 and IL-13, is a relevant biomarker for RV infection in asthmatic children with severe exacerbation.

scholarly journals Risk factors associated with severe asthma exacerbations in children attending Alexandria University Children’s Hospital, Egypt

2018 ◽  
Vol 5 (12) ◽  
pp. 5019
Author(s):  
Ihab H. El Sawy ◽  
Reham M. Wagdy ◽  
Afaf G. Ibrahim ◽  
Suzy W. Ibrahim
Keyword(s):  
Risk Factors ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Mild Asthma ◽  
Factors Associated ◽  
Children's Hospital ◽  
Asthma Exacerbations ◽  
Severe Asthma Exacerbation ◽  
Children’S Hospital ◽  
History Of

Background: Severe asthma exacerbation is one of the common pediatric medical emergencies that necessitates hospital visits. The study aimed to identify risk factors associated with pediatric severe asthma exacerbations that might have the potential to guide the parents for early medical consultations and physicians at primary health care centers for proper management.Methods: A case-control study was conducted on over 100 asthmatic children below 12 years attending the Emergency Department of Alexandria University Children’s Hospital in acute exacerbation. Based on a modified pulmonary index score, the patients were allocated into 2 groups; study group (50 patients with severe asthma exacerbation) and control group (50 patients with mild asthma exacerbations). Demographic data, history of illness, alarming clinical signs, medications, and outcome of all participants were recorded.Results: Severe asthma exacerbations were more encountered among males, older age, and with a longer duration of asthma (X±SD=28.4±15.9 months) with significant differences when compared to controls. Comparing the studied groups revealed higher risk for severe asthma exacerbations mainly with; history of sudden onset of severe respiratory distress (Odds ratio “OR”=30.13, 95% CI, 13.78-66.69) and chronic steroid-dependent asthma (OR=14.46, 95% CI, 3.97-52.65). Cyanosis, lethargy, and inability to talk were alarming signs in patients with severe asthma exacerbation when compared to those with mild asthma exacerbation (p<0.05).Conclusions: Severe asthma exacerbation in children is still associated with many risk factors that may alert the patients’ caregivers and physicians prospectively for early proper management. 

scholarly journals The Asthma Control Test (ACT) as Predictor of Asthma Exacerbation among Indonesian Hajj Pilgrims in 2018

2020 ◽  
Vol 4 (2) ◽  
pp. 128
Author(s):  
Saifuddin A ◽  
Zaini Nasir U ◽  
Rengganis I
Keyword(s):  
Asthma Control ◽  
Asthma Exacerbation ◽  
Area Under The Curve ◽  
Control Test ◽  
Act Scores ◽  
Asthma Control Test ◽  
Asthma Exacerbations ◽  
Acute Asthma Exacerbation ◽  
Act Assessment ◽  
Act Score

Objective: Every year, millions of Muslims from around the world gather in Saudi Arabia to perform Hajj. Before leaving for pilgrimage, Indonesian pilgrims go through various health examinations in Regional Primary Health Center (Pusat Kesehatan Masyarakat/ Puskesmas). Since there was no existing research on Asthma Control Test (ACT) assessment for pilgrims with bronchial asthma to predict asthma exacerbations during Hajj pilgrimage period, this cohort study was conducted to fill this gap.Methods: Pilgrims who suffered from asthma were recruited in Daerah Khusus Ibukota (DKI) Jakarta Province region in 2018. The degree classification of asthma in the ACT group was determined as uncontrolled, partially controlled, and fully controlled. ACT scores were calculated in Puskesmas and embarkation. Observation of asthma exacerbations in pilgrims while performing Hajj was performed by doctors. Data were analyzed with SPSS for Windows.Results: A total of 68 participants were included (46 female [67.6%]; 45 aged <60 years [66.2%]). At embarkation, the asthma classification based on the ACT was as follows: 36 (52.9%) and 13 (19.1%) pilgrims had partially controlled and uncontrolled asthma, and 17 (47.2%) and 8 (61.5%) of each group experienced exacerbation, respectively, with p = 0.006 for the ACT values at embarkation. The area under the curve value was 0.717 (95% CI; 0.596-0.838).Conclusion: There was increased asthma exacerbation incidence in the uncontrolled and partially controlled ACT groups at embarkation compared to the fully controlled ACT group. The ACT score was able to predict the occurrence of acute asthma exacerbation during Hajj period.International Journal of Human and Health Sciences Vol. 04 No. 02 April’20 Page : 128-135

scholarly journals Serum Vitamin D Levels and Vitamin D Supplement in Adult Patients with Asthma Exacerbation

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Tadech Boonpiyathad ◽  
Teerapol Chantveerawong ◽  
Panitan Pradubpongsa ◽  
Atik Sangasapaviliya
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Asthma Control ◽  
Asthma Exacerbation ◽  
Vitamin D2 ◽  
Vitamin D Status ◽  
Asthmatic Patients ◽  
Asthma Exacerbations ◽  
Vitamin D Levels ◽  
Act Score

Introduction. Vitamin D deficiency has been linked to an increased risk of asthma exacerbations. Objective. This study aimed to compare vitamin D status during the period of severe asthma exacerbations and investigate if vitamin D supplementation improves asthma control. Methods. A total of 47 asthmatic patients and 40 healthy subjects participated in this study. Serum 25-hydroxyvitamin D (25(OH)D), asthma control test (ACT) score, and % predicted peak expiratory flow rate were evaluated in the period with and without severe asthma exacerbations. After that, we provided vitamin D2 supplements to the patients with low vitamin D levels for 3 months. Results. At the period of asthma exacerbation, the prevalence of vitamin D deficiency and insufficiency was 38.29% and 34.04%. There was no significant difference in the levels of serum 25(OH)D with and without asthma exacerbations but the levels were significantly higher in the healthy group. Serum 25(OH)D levels significantly correlated with ACT score. Moreover, vitamin D2 supplementation improved asthma control in uncontrolled asthma group. Conclusions. Hypovitaminosis D was common in asthmatic patients but was not the leading cause of asthma exacerbations. Serum 25(OH)D levels correlated with the ability to control asthma. Improving vitamin D status might be a benefit in uncontrolled asthmatic patients.

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