Quality-of-life and asthma control with low-dose inhaled corticosteroids

Increasing violence-related distress over time was associated with worse lung function and worse asthma-related quality of life in youth with asthma despite treatment with low-dose inhaled corticosteroids.Exposure to violence has been associated with lower lung function in cross-sectional studies. We examined whether increasing violence-related distress over time is associated with worse lung function and worse asthma control or quality of life in a secondary analysis of a 48-week randomized clinical trial in 98 youth with asthma (ages 9–16 years) treated with low-dose inhaled corticosteroids (the Vitamin D Kids Asthma Study [VDKA]). We then replicated our findings for lung function in a prospective study of 232 Puerto Rican youth followed for an average of 5·4 years. Violence-related distress was assessed using the Checklist of Children's Distress Symptoms (CCDS) scale. Our outcomes of interest were percent predicted (%pred) lung function measures and (in VDKA only) asthma control (assessed using the Asthma Control Test) and asthma-related quality of life (assessed using the Pediatric Asthma Quality of Life questionnaire). In a multivariable analysis in VDKA, each 1-point increment in the CCDS score was associated with decrements of 3.27% in %predFEV1 (95% confidence interval [CI]=−6.44% to −0.22%, p=0.04) and a 2.65% decrement in percent predicted FVC (95% CI=−4.86% to −0.45%, p=0.02), and 0.30 points in the overall PAQLQ score (95% CI=−0.50 to −0.10, p<0.01). Similar findings for FEV1 and FVC were obtained in the prospective study of Puerto Rican youth. Our findings suggest that violence-related distress may worsen lung function and quality of life in youth with asthma (even those treated with low-dose inhaled corticosteroids) and further support policies to reduce exposure to violence among children in the U.S. and Puerto Rico.

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Effectiveness of inhaled corticosteroids in real life on clinical outcomes, sputum cells and systemic inflammation in asthmatics: a retrospective cohort study in a secondary care centre

BMJ Open ◽

10.1136/bmjopen-2017-018186 ◽

2017 ◽

Vol 7 (11) ◽

pp. e018186 ◽

Cited By ~ 18

Author(s):

Sophie F Demarche ◽

Florence N Schleich ◽

Monique A Henket ◽

Virginie A Paulus ◽

Thierry J Van Hees ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Outcomes ◽

Asthma Control ◽

Secondary Care ◽

Inhaled Corticosteroids ◽

Real Life ◽

Care Centre ◽

Eosinophilic Inflammation ◽

Sputum Eosinophils

ObjectivesThe impact of inhaled corticosteroids (ICS) on eosinophilic inflammation in asthma is well established, but their effect in a real-life setting has not been extensively studied. Our purpose was to investigate the effect of ICS on airway and systemic inflammation as well as on clinical outcomes in patients with asthma from clinical practice.Design, setting and participantsWe conducted a retrospective analysis on asthmatics from a secondary care centre in whom ICS were initiated/increased (n=101), stopped/decreased (n=60) or remained stable (n=63, used as a control group) between two visits with available sputum and blood cell counts.ResultsThe median time between both visits ranged from 1 to 2 years. Initiating or increasing ICS (median variation (IQR): 800 (400–1200) µg beclomethasone equivalent dose per day) reduced sputum eosinophils and fractional exhaled nitric oxide (P<0.0001) and to a lesser extent blood eosinophils (P<0.0001), while withdrawing or decreasing ICS (median variation (IQR): 900 (500–1200) µg beclomethasone equivalentdose per day) resulted in increased sputum eosinophils (P=0.008). No change was found in patients with a stable dose. The effectiveness of ICS in improving asthma control, quality of life, forced expiratory volume in 1 s (FEV1), bronchial hyper-responsiveness and exacerbation rate was only observed in the eosinophilic phenotype (sputum eosinophils ≥3%, n=79). In non-eosinophilic asthmatics, stepping-down ICS resulted in an improvement in asthma control and quality of life, without any significant change in FEV1(n=38).ConclusionsOur results confirm the effectiveness of ICS on eosinophilic inflammation in real life and demonstrate that their clinical benefit seems to be restricted to eosinophilic asthmatics. Our data also support a try for stepping-down ICS in non-eosinophilic asthmatics.

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Factors associated with quality of life in patients with severe asthma: the impact of pharmacotherapy

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562015000004545 ◽

2015 ◽

Vol 41 (6) ◽

pp. 496-501 ◽

Cited By ~ 1

Author(s):

Daiane Silva Souza ◽

Lúcia de Araújo Costa Beisl Noblat ◽

Pablo de Moura Santos

Keyword(s):

Quality Of Life ◽

Asthma Control ◽

Inhaled Corticosteroids ◽

Activity Limitation ◽

Dose Inhaler ◽

Life Questionnaire ◽

Asthma Control Questionnaire ◽

Cross Sectional ◽

The Impact

ABSTRACT OBJECTIVE: To identify, characterize, and quantify associations of various factors with quality of life (QoL) in patients with asthma, according to the pharmacotherapy employed. METHODS: This was a cross-sectional study involving 49 patients (≥ 18 years of age) with severe uncontrolled or refractory asthma treated at a specialized outpatient clinic of the Brazilian Unified Health Care System, regularly using high doses of inhaled corticosteroids (ICs) or other medications, and presenting comorbidities. At a single time point, QoL was assessed with the Asthma Quality of Life Questionnaire (AQLQ). The overall AQLQ score and those of its domains were correlated with demographic variables (gender and age); Asthma Control Questionnaire score; pharmacotherapy (initial IC dose, inhaler devices, and polytherapy); and comorbidities. RESULTS: Better AQLQ scores were associated with asthma control-overall (OR = 0.38; 95% CI: 0.004-0.341; p < 0.001), "symptoms" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001), and "emotional function" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001)-and with IC dose ≤ 800 µg-"activity limitation" domain (OR = 0.249; 95% CI: 0.070-0.885; p = 0.029). Worse AQLQ scores were associated with polytherapy-"activity limitation" domain (OR = 3.651; 95% CI: 1.061-12.561; p = 0.036)-and number of comorbidities ≤ 5-"environmental stimuli" domain (OR = 5.042; 95% CI: 1.316-19.317; p = 0.015). CONCLUSIONS: Our results, the importance of this issue, and the lack of studies taking pharmacotherapy into consideration warrant longitudinal studies to establish a causal relationship between the identified factors and QoL in asthma patients.

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Faculty Opinions recommendation of Effects of ultra-low-dose transdermal estradiol on cognition and health-related quality of life.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1050526.502432 ◽

2006 ◽

Author(s):

Oliver Wolf

Keyword(s):

Quality Of Life ◽

Low Dose ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Transdermal Estradiol

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Faculty Opinions recommendation of Does asthma control correlate with quality of life related to upper and lower airways? A real life study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1163994.624644 ◽

2009 ◽

Author(s):

Gianna Moscato ◽

Gianni Pala

Keyword(s):

Quality Of Life ◽

Asthma Control ◽

Real Life ◽

Life Study ◽

Lower Airways ◽

Real Life Study

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Bioactive Peptides Sensitize Cells to Anticancer Effects of Oxaliplatin in Human Colorectal Cancer Xenografts in Nude Mice

Protein and Peptide Letters ◽

10.2174/0929866526666190405124955 ◽

2019 ◽

Vol 26 (7) ◽

pp. 512-522

Author(s):

Xian Li ◽

Long Xia ◽

Xiaohui Ouyang ◽

Qimuge Suyila ◽

Liya Su ◽

...

Keyword(s):

Quality Of Life ◽

Colorectal Cancer ◽

Nude Mice ◽

Low Dose ◽

Bioactive Peptides ◽

Human Colorectal Cancer ◽

Short Term ◽

Hct 116

Background: Despite new agent development and short-term benefits in patients with Colorectal Cancer (CRC), metastatic CRC cure rates have not improved due to high rates of oxaliplatin resistance and toxicity. There is an urgent need for effective tools to prevent and treat CRC and reduce morbidity and mortality of CRC patients. Exploring the effects of bioactive peptides on the antitumor to CRC was of vital importance to the clinical application. Objective: This study aimed to investigate the therapeutic impact of Anticancer Bioactive Peptides (ACBP) on anticancer effect of oxaliplatin (LOHP) in human colorectal cancer xenografts models in nude mice. Methods: HCT-116 cells were cultured in vitro via CCK-8 assays and the absorbance was measured at 450 nm. Apoptosis and cell cycle were assessed by Flow Cytometry (FCM) in vitro. HCT-116 human colorectal cancer cells inoculated subcutaneously in nude mice of treatment with PBS (GG), ACBP, LOHP, ACBP+LOHP (A+L) in vivo. The quality of life was assessed by dietary amount of nude mice, the weight of nude mice, inhibition rates, tumor weight and tumor volume. Immunohistochemistry and RT-qPCR method was conducted to determine the levels of apoptosisregulating proteins/genes in transplanted tumors. Results: ACBP induced substantial reductions in viable cell numbers and apoptosis of HCT116 cells in combined with LOHP in vitro. Compared with the control GG group, ACBP combined low dose oxaliplatin (U) group demonstrated significantly different tumor volume, the rate of apoptosis, the expression levels of Cyt-C, caspase-3,8,9 proteins and corresponding RNAs (P<0.05). The expression of pro-apoptotic proteins in the cytoplasm around the nucleus was significantly enhanced by ACBP. Short term intermittent use of ACBP alone indicted a certain inhibitory effect on tumor growth, and improve the quality of life of tumor bearing nude mice. Conclusion: ACBP significantly increased the anti-cancer responses of low dose oxaliplatin (L-LOHP), thus, significantly improving the quality of life of tumor-bearing nude mice.

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