Omalizumab versus Mepolizumab as add-on therapy in asthma patients not well controlled on at least an inhaled corticosteroid: A network meta-analysis

Irreversible airway obstruction (IAO) is a subtype of asthma and relates to poorer prognosis in some asthma patients. However, the prevalence and risk factors for IAO are unknown. A systematic review regarding controlled clinical studies (cohort, case-control studies) on IAO asthma in adult and/or children affected by asthma/early wheeze was performed. Eighteen papers were identified in this study. It was reported that the incidence of IAO at random effects or fixed effects in severe asthma and nonsevere asthma was 0.54 (95% CI: 0.45–0.62) and 0.16 (95% CI: 0.12–0.20), respectively. In IAO asthma, the pooled odds ratio (OR) related to smoking exposure was 2.22 (95% CI: 1.82–2.73), the OR for male, smoking, and fractional exhaled nitric oxide (FENO) was 2.22 (95% CI: 1.82–2.7), 1.79 (95% CI: 1.46–2.19), and 2.16 (95% CI: 1.05–4.43), respectively, suggesting these factors increase the risk of IAO. However, a decreased OR in IAO asthma was observed due to rhinitis (OR = 0.31, 95% CI: 0.24–0.40), atopy (OR = 0.584, 95% CI: 0.466–0.732), and atopic dermatitis (OR = 0.60, 95% CI: 0.42–0.85), indicating these factors are associated with reduced risk of IAO. IAO in asthma is associated with gender, smoking, FENO, rhinitis, atopy, and atopic dermatitis.

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Long-acting muscarinic antagonist + long-acting beta agonist versus long-acting beta agonist + inhaled corticosteroid for COPD: A systematic review and meta-analysis

Respirology ◽

10.1111/resp.12603 ◽

2015 ◽

Vol 20 (8) ◽

pp. 1153-1159 ◽

Cited By ~ 19

Author(s):

Nobuyuki Horita ◽

Naoki Miyazawa ◽

Koji Tomaru ◽

Miyo Inoue ◽

Takeshi Kaneko

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Beta Agonist ◽

Inhaled Corticosteroid ◽

Muscarinic Antagonist ◽

Long Acting

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Clinical verification in homeopathy and allergic conditions

Homeopathy ◽

10.1016/j.homp.2012.06.002 ◽

2013 ◽

Vol 102 (01) ◽

pp. 54-58 ◽

Cited By ~ 4

Author(s):

Michel Van Wassenhoven

Keyword(s):

Allergic Rhinitis ◽

Skin Diseases ◽

Meta Analysis ◽

Hay Fever ◽

Care Practice ◽

Homeopathic Medicine ◽

Asthma Patients ◽

Randomised Controlled ◽

Clinical Verification

Background: The literature on clinical research in allergic conditions treated with homeopathy includes a meta-analysis of randomised controlled trials (RCT) for hay fever with positive conclusions and two positive RCTs in asthma. Cohort surveys using validated Quality of Life questionnaires have shown improvement in asthma in children, general allergic conditions and skin diseases. Economic surveys have shown positive results in eczema, allergy, seasonal allergic rhinitis, asthma, food allergy and chronic allergic rhinitis. Aims: This paper reports clinical verification of homeopathic symptoms in all patients and especially in various allergic conditions in my own primary care practice. Results: For preventive treatments in hay fever patients, Arsenicum album was the most effective homeopathic medicine followed by Nux vomica, Pulsatilla pratensis, Gelsemium, Sarsaparilla, Silicea and Natrum muriaticum. For asthma patients, Arsenicum iodatum appeared most effective, followed by Lachesis, Calcarea arsenicosa, Carbo vegetabilis and Silicea. For eczema and urticaria, Mezereum was most effective, followed by Lycopodium, Sepia, Arsenicum iodatum, Calcarea carbonica and Psorinum. Conclusions: The choice of homeopathic medicine depends on the presence of other associated symptoms and ‘constitutional’ features. Repertories should be updated by including results of such clinical verifications of homeopathic prescribing symptoms.

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Meta-analysis of vitamin D and lung function in patients with asthma

Respiratory Research ◽

10.1186/s12931-019-1072-4 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 8

Author(s):

Jian Liu ◽

Yong-Quan Dong ◽

Jie Yin ◽

Jian Yao ◽

Jie Shen ◽

...

Keyword(s):

Vitamin D ◽

Lung Function ◽

Meta Analysis ◽

Serum Vitamin ◽

Forced Expiratory Volume ◽

Asthma Control Test ◽

Serum Vitamin D ◽

Vitamin D Levels ◽

Asthma Patients ◽

Sufficient Vitamin

Abstract Background There is growing literature suggesting a link between vitamin D and asthma lung function, but the results from systematic reviews are conflicting. We conducted this meta-analysis to investigate the relation between serum vitamin D and lung function in asthma patients. Methods Major databases, including OVID, MEDLINE, Web of Science and PUBMED, were searched until 10th October 2018. All published observational studies related to vitamin D and asthma were extracted. All meta-analyses were performed using Review Manager 5.3.5. Results This quantitative synthesis found that asthma patients with low vitamin D levels had lower forced expiratory volume In 1 s (FEV1) (mean difference (MD) = − 0.1, 95% CI = − 0.11 to − 0.08,p < 0.01;I2 = 49%, p = 0.12) and FEV1% (MD = − 10.02, 95% CI = − 11 to − 9.04, p < 0.01; I2 = 0%, p = 0.82) than those with sufficient vitamin D levels. A positive relation was found between vitamin D and FEV1 (r = 0.12, 95% CI = 0.04 to 0.2, p = 0.003; I2 = 59%,p = 0.01), FEV1% (r = 0.19, 95% CI = 0.13 to 0.26, p < 0.001; I2 = 42%, p = 0.11), forced vital capacity (FVC) (r = 0.17, 95% CI = 0.00 to 0.34, p = 0.05; I2 = 60%, p = 0.04), FEV1/FVC (r = 0.4, 95% CI = 0.3 to 0.51, p < 0.001; I2 = 48%, p = 0.07), and the asthma control test (ACT) (r = 0.33, 95% CI = 0.2 to 0.47, p < 0.001; I2 = 0%, p = 0.7). Subgroup analysis indicated that the positive correlation between vitamin D and lung function remained significant in both children and adults. Conclusions Our meta-analysis suggested that serum vitamin D levels may be positively correlated with lung function in asthma patients. Future comprehensive studies are required to confirm these relations and to elucidate potential mechanisms.

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2221. Chlamydia pneumoniae (Cpn) Induces IFN-γ Responses in Peripheral Blood Mononuclear Cells (PBMC) from Pediatric and Adult Asthma Patients: Effects of Age and Inhaled Corticosteroid Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1899 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S758-S758

Author(s):

Aviva Szigeti ◽

Margaret Hammerschlag ◽

Diana Weaver ◽

Tamar Smith-Norowitz ◽

Stephan Kohlhoff

Keyword(s):

Peripheral Blood Mononuclear Cells ◽

Peripheral Blood ◽

Chlamydia Pneumoniae ◽

Mononuclear Cells ◽

Inhaled Corticosteroid ◽

Peripheral Blood Mononuclear ◽

Blood Mononuclear Cells ◽

Asthma Patients ◽

Ifn Γ

Abstract Background Chlamydia pneumoniae (Cpn) is unique in its ability to cause chronic infections, potentially triggering asthma exacerbations as well as subsequent asthma development. Th1-mediated immunity and IFN-γ are critical for clearing chlamydial infections. Persistent or recent Cpn infection may be identified in vitro by detecting T-helper cytokine IFN-γ produced by peripheral blood mononuclear cells (PBMC) stimulated by Cpn. Inhaled corticosteroids (ICS) may have an inhibitory effect on IFN-γ. Prior studies have shown increased Th2 responses upon in vitro Cpn stimulation with increased age. Our aim was to determine whether age and inhaled corticosteroid (ICS) use affect Cpn-induced PBMC produced IFN-γ levels. Methods Pediatric and adult subjects with (n = 23) and without (n = 10) asthma were enrolled. PBMC obtained from all subjects were stimulated with Cpn (MOI = 0.1 x48h) in vitro. IFN-γ levels in culture supernatants were determined by ELISA and reported as pg/mL. Nasopharyngeal (NP) swabs were tested for Cpn using Real-Time PCR. Statistical analysis for continuous variables was performed using the Mann–Whitney U test. Results None of the subjects were positive for Cpn by PCR on NP swab. Levels of IFN-γ produced by PBMC stimulated by Cpn were similar between asthmatic vs. control subjects (41.7 vs. 68.8, respectively; P = 0.72) and between pediatric and adult subjects with asthma (IFN-γ 54 vs. 20.1 respectively, P = 0.95). Pediatric subjects with asthma who received ICS had lower IFN-γ levels than those who did not (median IFN-γ 25.5 vs. 209; P = 0.003). Conclusion Our finding of lower IFN-γ levels among asthma patients on ICS compared with those not on ICS suggests that ICS use may dampen the systemic inflammatory response. While we did not find a statistically significant difference between pediatric and adult age groups in this pilot study, there was a trend to higher Cpn-induced IFN-γ levels among younger pediatric subjects. Future prospective studies should further define predictors of diminished IFN-γ responses in patients with asthma. Disclosures All authors: No reported disclosures.

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Can We Identify Asthma Patients Who Can Safely Reduce Their Inhaled Corticosteroid Medication Without Suffering From A Loss Of Control?

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a3951 ◽

2012 ◽

Author(s):

Emma E. Wilson ◽

Bev Hargadon ◽

Maria Shelley ◽

Glenn Hearson ◽

Rebecca Simms ◽

...

Keyword(s):

Loss Of Control ◽

Inhaled Corticosteroid ◽

Asthma Patients

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Appropriate use of inhaled corticosteroid and long-acting ß2-adrenergic agonist combination therapy among asthma patients in a US commercially insured population

Current Medical Research and Opinion ◽

10.1185/03007990903155915 ◽

2009 ◽

Vol 25 (9) ◽

pp. 2251-2258 ◽

Cited By ~ 9

Author(s):

Xin Ye ◽

Benjamin Gutierrez ◽

Victoria Zarotsky ◽

Michael Nelson ◽

Christopher M. Blanchette

Keyword(s):

Combination Therapy ◽

Inhaled Corticosteroid ◽

Appropriate Use ◽

Adrenergic Agonist ◽

Asthma Patients ◽

Long Acting

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Association between IL-13 +1923C/T polymorphism and asthma risk: a meta-analysis based on 26 case-control studies

Bioscience Reports ◽

10.1042/bsr20160505 ◽

2017 ◽

Vol 37 (1) ◽

Cited By ~ 7

Author(s):

Yueli Xu ◽

Junjuan Li ◽

Zhaolei Ding ◽

Juan Li ◽

Bin Li ◽

...

Keyword(s):

Genetic Model ◽

Meta Analysis ◽

Age Groups ◽

Allergic Inflammation ◽

Case Control ◽

Respiratory Disorder ◽

Case Control Studies ◽

Increased Risk ◽

Asthma Patients ◽

Highly Correlated

Asthma is a serious and hereditary respiratory disorder affecting all age groups. Interleukin-13 (IL-13) is a central regulator of allergic inflammation. The purpose of the present study was to estimate the relationship between IL-13 +1923C/T polymorphism and asthma susceptibility. Relevant case-control studies published between January 2000 and July 2016 were searched in the online databases. Review Manage (RevMan) 5.3 was used to conduct the statistical analysis. The pooled odds ratio (OR) with its 95% confidence interval (CI) was employed to calculate the strength of association. A total of 26 articles were retrieved, including 17642 asthma patients and 42402 controls. Overall, our results found that IL-13 +1923C/T polymorphism was significantly associated with increased risk of asthma under each genetic model (P<0.00001). Subgroup analysis by ethnicity showed that alleles and genotypes of this variant correlated with asthma among Asians and Caucasians, but only TT genotype under the homozygote model in Africans. When stratified by age group, this variant highly correlated with asthma in children and moderately in adults. Furthermore, the TT, CT and CC genotypes in asthma group were all significantly associated with increased IgE levels in sera of asthma patients when compared with controls. Our results suggested that IL-13 +1923C/T polymorphism contributed to the development of asthma. Further case-control studies with more ethnicities are still needed.

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