Optimization of bronchial asthma treatment according to polymorphism in the leukotriene-C4 synthase gene

The aim of the study was to investigate the effectiveness of different schemes of basic asthma therapy depending on the polymorphism of the LTC4 gene. Materials and methods. 181 patients with asthma were recruited to participate in the study. All patients included in the study underwent a general clinical study, spirometry, the level of asthma control was determined by Asthma control questionnaire 5 (ACQ-5), by studying the polymorphism of the LTC4 gene, it was determined that patients belong to the A/A, A/C and C/C genotypes. Results. Allelic -444C polymorphism of the LTC4-S gene (rs 730012) had the following genotype frequency among asthma patients: A/A – 77 people (42.6 %), A/C – 73 people (40.3 %) and C/C – 31 people (17.1 %). In groups of patients with genotypes A/A and A/C, during treatment with a low dose of ICS and montelukast, there was a significant improvement in FEV1 and the score according to the ACQ-5 questionnaire (asthma control level). However, in the group of patients with the C/C genotype, there were no significant changes in FEV1 and the score according to the ACQ-5 questionnaire. In the groups of patients with genotypes A/A and C/C on the background of increasing the dose of ICS to medium in a fixed combination with LABA compared with the results of treatment with low-dose ICS and montelukast, there was a significant improvement in FEV1 and asthma control – ACQ- 5. At the same time, in the group of patients with genotype A/C, there were no reliable indicators of FEV1 and ACQ-5 score changes. Conclusions. The frequency of genotypes A/A, A/C and C/C for LTC4S polymorphism in the studied population are 42.6 %, 40.3 % and 17.1 %, respectively. Patients with genotypes A/A and C/C have a significant response to treatment with a low dose of ICS and montelukast in the form of an improvement in FEV1 and ACQ-5 score. Increasing the dose of ICS up to moderate in a fixed combination with β2-LABA in groups of patients with genotypes A/A and C/C leads to a significant improvement in the FEV1, as well as in the asthma control level - ACQ-5

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Assessment of disease control in patients with asthma

Medicina ◽

10.3390/medicina45120121 ◽

2009 ◽

Vol 45 (12) ◽

pp. 943 ◽

Cited By ~ 1

Author(s):

Guoda Pilkauskaitė ◽

Kęstutis Malakauskas ◽

Raimundas Sakalauskas

Keyword(s):

Lung Function ◽

Asthma Control ◽

Control Level ◽

Asthma Management ◽

Control Test ◽

Uncontrolled Asthma ◽

Asthma Control Test ◽

Inhaled Steroids ◽

Asthma Patients ◽

Β2 Agonists

International guidelines indicate that the main criterion of asthma management is asthma control level. The aim of this study was to assess asthma control and its relation with age, gender, and lung function. Material and methods. A total of 106 family physicians and 13 pulmonologists and allergists took part in this study. Each doctor had selected 10–15 asthma patients and had sent invitations to them by post. On the visit day, the patients themselves filled in the Asthma Control Test. The doctors interviewed the patients and filled in a special questionnaire. Pulmonologists and allergists also assessed lung function by performing spirometry. According to the results of the Asthma Control Test, the disease control level was indicated as “totally controlled” (25 points), “well controlled” (24–20 points), and “uncontrolled” (19 points or less). Results. A total of 876 asthma patients were examined. Uncontrolled asthma was diagnosed to 56.2% of the patients, 36.5% of patients had well controlled and 7.3% totally controlled asthma. There was no significant difference in asthma control level comparing men and women. A correlation between asthma control level and age was found revealing poorer asthma control in older patients. Ninety-five percent of patients were treated with inhaled steroids; most of them had used inhaled steroids in combination with long-acting β2 agonists. It was found that lung function correlated with clinical symptoms of asthma, the demand of shortacting β2 agonists, and asthma control level. Conclusion. The study showed that uncontrolled asthma was diagnosed to more than half of the patients, despite most of them used inhaled steroids. Asthma control was worsening with the age of patients with asthma and it correlated with lung function. We suggest that periodical assessment of asthma control should help to optimize asthma management.

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Effect of Hypnotherapy on Immune Response and Standard Therapy in Psychogenic Asthma Patients

Turkish Journal of Immunology ◽

10.5222/tji.2021.22931 ◽

2021 ◽

Author(s):

Yusup Subagio Sutanto ◽

Handono Kalim ◽

Kusworini Handono ◽

Aris Sudiyanto

Keyword(s):

Immune Response ◽

Asthma Control ◽

Standard Therapy ◽

Control Level ◽

Therapy Response ◽

Double Blind ◽

Long Run ◽

Asthma Patients ◽

Group B ◽

Stress Mediators

Objective: Asthma is a complex inflammatory disease. The therapy for asthma is usually pharmacotherapy but it can increase the side effects in the long run. Hypnosis has been used to clinically treat asthma. This study aimed to investigate the efficacy of hypnotherapy which will increase the standard of therapy in psychogenic asthma patients on immune response, stress mediators, and asthma control level. Materials and Methods: This research is a double-blind experimental randomized control trial group study with a crossover design conducted in the outpatient clinic of Dr. Moewardi Hospital, Surakarta, Indonesia. The Friedman test followed by the marginal homogeneity statistic test was used to assess variations in the levels of asthma control. The study subjects were 30 respondents who were divided randomly into groups A and B. Both groups had standard asthma therapy and hypnotherapy with a different sequence. Results: Hypnotherapy made a significant decrease in SCL 90 score within each group as follows: Group A (A1 vs A2; p=0.004) and Group B (B2 vs B3; p=0.001). Levels of asthma control improved significantly in both groups (A1 vs A2; p=0.001 and B2 vs B3; p=0.004). Hypnotherapy significantly improved the norepinephrine levels in both groups as well (A1 vs A2; p=0.001 and B2 vs B3; p=0.073). Hypnotherapy insignificantly reduced IL-13 (p=0.132) and IL-17 (p=0.149) levels. Conclusion: This study concluded that hypnotherapy applied to psychogenic asthma patients can improve their standard therapy response. This improved standard therapy response will affect the treatment, prevention, and management of uncontrolled asthma.

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Airway contribution to alveolar nitric oxide in healthy subjects and stable asthma patients

Journal of Applied Physiology ◽

10.1152/japplphysiol.01032.2007 ◽

2008 ◽

Vol 104 (4) ◽

pp. 918-924 ◽

Cited By ~ 68

Author(s):

Yannick Kerckx ◽

Alain Michils ◽

Alain Van Muylem

Keyword(s):

Nitric Oxide ◽

Asthma Control ◽

Healthy Subjects ◽

Molecular Diffusion ◽

Forced Expiratory Volume ◽

No Production ◽

Asthma Control Questionnaire ◽

Asthma Patients ◽

The Impact

Alveolar nitric oxide (NO) concentration (FaNO), increasingly considered in asthma, is currently interpreted as a reflection of NO production in the alveoli. Recent modeling studies showed that axial molecular diffusion brings NO molecules from the airways back into the alveolar compartment during exhalation (backdiffusion) and contributes to FaNO. Our objectives in this study were 1) to simulate the impact of backdiffusion on FaNO and to estimate the alveolar concentration actually due to in situ production (FaNO,prod); and 2) to determine actual alveolar production in stable asthma patients with a broad range of NO bronchial productions. A model incorporating convection and diffusion transport and NO sources was used to simulate FaNO and exhaled NO concentration at 50 ml/s expired flow (FeNO) for a range of alveolar and bronchial NO productions. FaNO and FeNO were measured in 10 healthy subjects (8 men; age 38 ± 14 yr) and in 21 asthma patients with stable asthma [16 men; age 33 ± 13 yr; forced expiratory volume during 1 s (FEV1) = 98.0 ± 11.9%predicted]. The Asthma Control Questionnaire (Juniper EF, Buist AS, Cox FM, Ferrie PJ, King DR. Chest 115: 1265–1270, 1999) assessed asthma control. Simulations predict that, because of backdiffusion, FaNO and FeNO are linearly related. Experimental results confirm this relationship. FaNO,prod may be derived by FaNO,prod = (FaNO − 0.08·FeNO)/0.92 ( Eq. 1 ). Based on Eq. 1 , FaNO,prod is similar in asthma patients and in healthy subjects. In conclusion, the backdiffusion mechanism is an important determinant of NO alveolar concentration. In stable and unobstructed asthma patients, even with increased bronchial NO production, alveolar production is normal when appropriately corrected for backdiffusion.

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Is ventilation heterogeneity related to asthma control?

European Respiratory Journal ◽

10.1183/13993003.00393-2016 ◽

2016 ◽

Vol 48 (2) ◽

pp. 370-379 ◽

Cited By ~ 33

Author(s):

Sarah Svenningsen ◽

Parameswaran Nair ◽

Fumin Guo ◽

David G. McCormack ◽

Grace Parraga

Keyword(s):

Quality Of Life ◽

Asthma Control ◽

Forced Expiratory Volume ◽

Life Questionnaire ◽

Strongly Correlated ◽

Asthma Control Questionnaire ◽

Asthma Patients ◽

Ventilation Heterogeneity ◽

Magnetic Resonance Imaging Mri

In asthma patients, magnetic resonance imaging (MRI) and the lung clearance index (LCI) have revealed persistent ventilation heterogeneity, although its relationship to asthma control is not well understood. Therefore, our goal was to explore the relationship of MRI ventilation defects and the LCI with asthma control and quality of life in patients with severe, poorly controlled asthma.18 patients with severe, poorly controlled asthma (mean±sd 46±12 years, six males/12 females) provided written informed consent to an ethics board approved protocol, and underwent spirometry, LCI and 3He MRI during a single 2-h visit. Asthma control and quality of life were evaluated using the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ). Ventilation heterogeneity was quantified using the LCI and 3He MRI ventilation defect percent (VDP).All participants reported poorly controlled disease (mean±sd ACQ score=2.3±0.9) and highly heterogeneous ventilation (mean±sd VDP=12±11% and LCI=10.5±3.0). While VDP and LCI were strongly correlated (r=0.86, p<0.0001), in a multivariate model that included forced expiratory volume in 1 s, VDP and LCI, VDP was the only independent predictor of asthma control (R2=0.38, p=0.01). There was also a significantly worse VDP, but not LCI in asthma patients with an ACQ score >2 (p=0.04) and AQLQ score <5 (p=0.04), and a trend towards worse VDP (p=0.053), but not LCI in asthma patients reporting ≥1 exacerbation in the past 6 months.In patients with poorly controlled, severe asthma MRI ventilation, but not LCI was significantly worse in those with worse ACQ and AQLQ.

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Changes in quantifiable breathing pattern components predict asthma control: an observational cross-sectional study

Asthma Research and Practice ◽

10.1186/s40733-021-00071-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Panagiotis Sakkatos ◽

Anne Bruton ◽

Anna Barney

Keyword(s):

Asthma Control ◽

Breathing Pattern ◽

Cross Sectional Study ◽

Uncontrolled Asthma ◽

Asthma Control Questionnaire ◽

Cross Sectional ◽

Mean Values ◽

Subject Variability ◽

Asthma Patients ◽

Within Subject Variability

Abstract Background Breathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components may provide additional useful information about asthma control. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control. Methods One hundred twenty-two asthma patients at STEP 2- STEP 5 GINA asthma medication were enrolled. Asthma control was determined by the Asthma Control Questionnaire (ACQ7-item) and patients divided into ‘well controlled’ or ‘uncontrolled’ groups. Breathing pattern components (respiratory rate (RR), ratio of inspiration duration to expiration duration (Ti/Te), ratio of ribcage amplitude over abdominal amplitude during expiration phase (RCampe/ABampe), were measured using Structured Light Plethysmography (SLP) in a sitting position for 5-min. Breath-by-breath analysis was performed to extract mean values and within-subject variability (measured by the Coefficient of Variance (CoV%). Binary multiple logistic regression was used to test whether breathing pattern components are predictive of asthma control. A post-hoc analysis determined the discriminant accuracy of any statistically significant predictive model. Results Fifty-nine out of 122 asthma patients had an ACQ7-item < 0.75 (well-controlled asthma) with the rest being uncontrolled (n = 63). The absolute mean values of breathing pattern components did not predict asthma control (R2 = 0.09) with only mean RR being a significant predictor (p < 0.01). The CoV% of the examined breathing components did predict asthma control (R2 = 0.45) with all predictors having significant odds ratios (p < 0.01). The ROC curve showed that cut-off points > 7.40% for the COV% of the RR, > 21.66% for the CoV% of Ti/Te and > 18.78% for the CoV% of RCampe/ABampe indicated uncontrolled asthma. Conclusion The within-subject variability of timing parameters and TA motion can be used to predict asthma control. Higher breathing pattern variability was associated with uncontrolled asthma suggesting that irregular resting breathing can be an indicator of poor asthma control.

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Relationship Between Psychosocial Stressor and Asthma Control in Adult Asthma Patients at Depok Hospital, West Java

Childhood Stunting, Wasting, and Obesity, as the Critical Global Health Issues: Forging Cross-Sectoral Solutions ◽

10.26911/the7thicph.05.31 ◽

2020 ◽

Author(s):

Hasnah Viviana ◽

◽

Erna Harfiani ◽

◽

Keyword(s):

Asthma Control ◽

Clinical Symptoms ◽

Control Level ◽

Airflow Obstruction ◽

Psychosocial Stressors ◽

Psychosocial Stressor ◽

West Java ◽

Cross Sectional ◽

Adult Asthma ◽

Asthma Patients

ABSTRACT Background: Asthma is a reversible airflow obstruction developed by genetic and environ-mental factors. Several studies revealed that stress could exacerbate the clinical symptoms in patients with asthma. This study aimed to determine the relationship between psychosocial stressors and the asthma control level in adult asthma patients at pulmonology polyclinic, Depok Hospital, West Java. Subjects and Method: This was a cross-sectional study conducted at pulmonology polyclinic, Depok Hospital, West Java in 2019. A total of 58 adult asthma patients was selected with consecutive sampling. The dependent variable was the asthma control. The independent variable was the level of the psychosocial stressor. The data were collected using asthma control questionnaires and the Holmes-Rahe Scale for calculating the score of stress events. Data were analyzed by chi-square. Results: The majority of adult asthma patients had moderate to severe psychosocial stressors (63.8%) and partial to fully controlled asthma (53.4%). Level of psychosocial stressor reduced the level of asthma control, and it was statistically significant (p <0.001). Conclusion: The level of psychosocial stressor reduces the level of asthma control. Keywords: bronchial asthma, psychosocial stressor, level of controlled Correspondence: Erna Harfiani. Department of Pharmacology, Faculty of Medicine, UPN Veteran Jakarta. Jl RS Fatmawati Pondok Labu Jakarta Selatan, 12450. Email: [email protected]. Mobile: +6281585042313. DOI: https://doi.org/10.26911/the7thicph.05.31

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The long-term effect of an exercise and diet intervention in asthma patients: a 1-year follow-up on a randomised controlled trial

ERJ Open Research ◽

10.1183/23120541.00032-2019 ◽

2019 ◽

Vol 5 (2) ◽

pp. 00032-2019 ◽

Cited By ~ 2

Author(s):

Adrian Koch Bentzon ◽

Linda Wolfgang Loehde ◽

Vibeke Backer ◽

Louise Toennesen

Keyword(s):

Asthma Control ◽

Controlled Trial ◽

Study Groups ◽

Exercise Group ◽

Diet Group ◽

Control Group ◽

Asthma Control Questionnaire ◽

Diet Intervention ◽

Asthma Patients

BackgroundIn the EFFORT (Effects of Exercise and Diet in Nonobese Asthma Patients – A Randomized Controlled Trial) study, maximum exercise capacity (V′O2max) increased significantly within a 2-month high-intensity spinning period. Furthermore, the study concluded that only the combined exercise and diet intervention improved asthma control, significantly. This study examined whether original improvements in V′O2max and asthma control were present 1 year after intervention completion.MethodIn the original trial, 149 patients were randomised into four study groups. Participants were assessed with an incremental cycle ergometer test and the Asthma Control Questionnaire (ACQ). Of the 149 patients, 66 accepted the follow-up invitation. Participants were distributed in their original groups: exercise group (n=18), diet group (n=117), combined diet and exercise group (n=115) and the control group (n=110). Patients were assessed with original procedures. Though, upon measuring V′O2max, the original four study groups were merged into one spinning group (n=127) and one nonspinning group (n=133).ResultsComparing the spinning and nonspinning group, there was no significant between-group difference in V′O2max, at 1-year follow-up (p=0.3). In addition, there was no significant between-group difference in ACQ score (p=0.6). Hence, in the combined group, the initial improvement in the ACQ score had regressed to pre-intervention values within 1 year from study completion.ConclusionThere were no measurable long-lasting effects on V′O2max 1 year after the intervention was completed. Furthermore, there was no long-lasting effect of the combined intervention on asthma control.

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Small Airway Dysfunction in Asthma Is Associated with Perceived Respiratory Symptoms, Non-Type 2 Airway Inflammation, and Poor Responses to Therapy

Respiration ◽

10.1159/000515328 ◽

2021 ◽

pp. 1-13

Author(s):

Ying Liu ◽

Li Zhang ◽

Hong Lin Li ◽

Bin Miao Liang ◽

Ji Wang ◽

...

Keyword(s):

Asthma Control ◽

Small Airway ◽

Chest Tightness ◽

Asthma Control Test ◽

Sputum Induction ◽

Asthma Control Questionnaire ◽

Asthma Patients ◽

Ifn Γ ◽

Treatment Responsiveness

Background: Emerging evidence has indicated that small airway dysfunction (SAD) contributes to the clinical expression of asthma. Objectives: The aim of the study was to explore the relationships of SAD assessed by forced expiratory flow between 25 and 75% (FEF25–75%), with clinical and inflammatory profile and treatment responsiveness in asthma. Method: In study I, dyspnea intensity (Borg scale), chest tightness, wheezing and cough (visual analog scales, VASs), and pre- and post-methacholine challenge testing (MCT) were analyzed in asthma patients with SAD and non-SAD. In study II, asthma subjects with SAD and non-SAD underwent sputum induction, and inflammatory mediators in sputum were detected. Asthma patients with SAD and non-SAD receiving fixed treatments were prospectively followed up for 4 weeks in study III. Spirometry, Asthma Control Questionnaire (ACQ), and Asthma Control Test (ACT) were carried out to define treatment responsiveness. Results: SAD subjects had more elevated ΔVAS for dyspnea (p = 0.027) and chest tightness (p = 0.032) after MCT. Asthma patients with SAD had significantly elevated interferon (IFN)-γ in sputum (p < 0.05), and Spearman partial correlation found FEF25–75% significantly related to IFN-γ and interleukin-8 (both having p < 0.05). Furthermore, multivariable regression analysis indicated SAD was significantly associated with worse treatment responses (decrease in ACQ ≥0.5 and increase in ACT ≥3) (p = 0.022 and p = 0.032). Conclusions: This study indicates that SAD in asthma predisposes patients to greater dyspnea intensity and chest tightness during bronchoconstriction. SAD patients with asthma are characterized by non-type 2 inflammation that may account for poor responsiveness to therapy.

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Quantifiable Breathing Pattern Components Can Predict Asthma Control: an Observational Cross-sectional Study

10.21203/rs.3.rs-152796/v1 ◽

2021 ◽

Author(s):

Panagiotis Sakkatos ◽

Anne Bruton ◽

Anna Barney

Keyword(s):

Asthma Control ◽

Breathing Pattern ◽

Cross Sectional Study ◽

Uncontrolled Asthma ◽

Asthma Control Questionnaire ◽

Cross Sectional ◽

Mean Values ◽

Subject Variability ◽

Asthma Patients ◽

Within Subject Variability

Abstract Background: Breathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components can provide additional useful information about asthma control. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control. Methods: 122 asthma patients at STEP 2- STEP 5 GINA asthma medication were enrolled. Asthma control was determined by the Asthma Control Questionnaire (ACQ7-item) and patients divided into ‘well controlled’ or ‘uncontrolled’ groups. Breathing pattern components (respiratory rate (RR), ratio of inspiration duration to expiration duration (Ti/Te), ratio of ribcage amplitude over abdominal amplitude during expiration phase (RCampe/ABampe), were measured using Structured Light Plethysmography (SLP) in a sitting position for 5-minutes. Breath-by-breath analysis was performed to extract mean values and within-subject variability (measured by the Coefficient of Variance (CoV%). Binary multiple logistic regression was used to test whether breathing pattern components are predictive of asthma control. A post-hoc analysis determined the discriminant accuracy of any statistically significant predictive model. Results: Fifty-nine out of 122 asthma patients had an ACQ7-item < 0.75 (well-controlled asthma) with the rest being uncontrolled (n= 63). The absolute mean values of breathing pattern components did not predict asthma control (R2 = 0.09) with only mean RR being a significant predictor (p < 0.01). The CoV% of the examined breathing components did predict asthma control (R2 = 0.45) with all predictors having significant odds ratios (p < 0.01). The ROC curve showed that cut-off points > 7.40% for the COV% of the RR, > 21.66% for the CoV% of Ti/Te and > 18.78% for the CoV% of RCampe/ABampe indicated uncontrolled asthma. Conclusion: The within-subject variability of timing parameters and TA motion can be used to predict asthma control. Higher breathing pattern variability was associated with uncontrolled asthma suggesting that irregular resting breathing is an indicator of poor asthma control.

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Utility of Asthma Control Questionnaire 7 in the assessment of asthma control

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132014000200011 ◽

2014 ◽

Vol 40 (2) ◽

pp. 171-174 ◽

Cited By ~ 3

Author(s):

Mariana Nadal Cardoso ◽

Herberto José Chong Neto ◽

Lêda Maria Rabelo ◽

Carlos Antônio Riedi ◽

Nelson Augusto Rosário

Keyword(s):

Correlation Coefficient ◽

Asthma Control ◽

Good Reproducibility ◽

Uncontrolled Asthma ◽

Asthma Control Questionnaire ◽

Global Initiative For Asthma ◽

Number Of Patients ◽

Asthma Patients ◽

Global Initiative

Our objective was to evaluate the reproducibility of Asthma Control Questionnaire 7 (ACQ-7) in asthma patients, comparing our results against those obtained with the Global Initiative for Asthma (GINA) criteria. We evaluated 52 patients. Patients completed the ACQ-7, underwent spirometry, and were clinically assessed to determine the level of asthma control according to the GINA criteria, in two visits, 15 days apart. The ACQ-7 cutoff for uncontrolled asthma was a score of 1.5. The ACQ-7 showed good reproducibility, with a correlation coefficient of 0.73. The ACQ-7 identified a greater number of patients with uncontrolled asthma than did the GINA criteria; according to the GINA criteria, 47 patients (90.4%) presented with partially controlled asthma.

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