scholarly journals Sputum metabolomic profiling revels metabolic pathways and signatures associated with inflammatory phenotypes in patients with asthma

2021 ◽  
Author(s):  
Ying Liu ◽  
Xin Zhang ◽  
Li Zhang ◽  
Brian Oliver ◽  
Hong Guang Wang ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Induced Sputum ◽  
Metabolic Profiles ◽  
Asthma Phenotypes ◽  
Pathway Topology ◽  
Severe Asthma Exacerbation ◽  
Validation Set ◽  
Inflammatory Phenotypes ◽  
Metabolic Signatures

Background: The molecular links between metabolism and inflammation that drive different inflammatory phenotypes in asthma are poorly understood. Objectives: To identify the metabolic signatures and underlying molecular pathways of different inflammatory asthma phenotypes. Method: In the discovery set (n=119), untargeted ultra-high performance liquid chromatography–mass spectrometry (UHPLC-MS) were applied to characterize the induced sputum metabolic profiles from asthmatic patients classified by different inflammatory phenotypes using orthogonal partial least-squares discriminant analysis (OPLS-DA) and pathway topology enrichment analysis. In the validation set (n = 114), differential metabolites were selected to perform targeted quantification. Correlations between targeted metabolites and clinical indexes in asthma patients were analyzed. Logistic and negative binomial regression models were established to assess the association between metabolites and severe asthma exacerbation. Results: 77 differential metabolites were identified in the discovery set. Pathway topology analysis uncovered that histidine metabolism, glycerophospholipid metabolism, nicotinate and nicotinamide metabolism, linoleic acid metabolism, phenylalanine, tyrosine and tryptophan biosynthesis were involved in the pathogenesis of different asthma phenotypes. In the validation set, 24 targeted quantification metabolites were significantly differentially expressed between asthma inflammatory phenotypes. Finally, adenosine 5’-monophosphate (RRadj = 1.000, 95%CI = [1.000, 1.000], P = 0.050), allantoin (RRadj = 1.000, 95%CI = [1.000, 1.000], P = 0.043) and nicotinamide (RRadj = 1.001, 95%CI = [1.000, 1.002], P = 0.021) were demonstrated to predict severe asthma exacerbation rate ratios. Conclusions: Different inflammatory asthma phenotypes have specific metabolic profiles in induced sputum. The potential metabolic signatures may serve as identification and therapeutic target in different inflammatory asthma phenotypes.

scholarly journals Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d’Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Philippe Le Conte ◽  
Nicolas Terzi ◽  
Guillaume Mortamet ◽  
Fekri Abroug ◽  
Guillaume Carteaux ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Intensive Care ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Extensive Literature ◽  
Level Of Evidence ◽  
Severe Asthma Exacerbation ◽  
Evidence Grade

Abstract Background The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients. Results The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/−) and 7 a low level of evidence (GRADE 2+/−). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines. Conclusion The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.

Emergency Management of Acute Severe Asthma Exacerbation in the Adult Population

2010 ◽  
Vol 1 (5) ◽  
pp. 174-179
Author(s):  
Sandra E. Marotta ◽  
Yuly Belchikov ◽  
Katherine Banker ◽  
Peter S. Marshall
Keyword(s):  
Emergency Management ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Adult Population ◽  
Acute Severe Asthma ◽  
Severe Asthma Exacerbation

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 Ketamine for Adults with Severe Asthma Exacerbation: A Systematic Review and Meta-analysis

2022 ◽  
Vol 2 (1) ◽  
pp. 91-97
Author(s):  
Fatimah AlShehri ◽  
Heetaf Aloqaily ◽  
Joud Enabi ◽  
Sharafaldeen Bin Nafisah
Keyword(s):  
Systematic Review ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Meta Analysis ◽  
World Health ◽  
Severe Asthma Exacerbation ◽  
Number Of Patients ◽  
Acute Asthma Exacerbation ◽  
Health Organization ◽  
Meta Analyses

BACKGROUND: Severe asthma mandates careful attention and timely management, and the benefit of ketamine in severe asthma exacerbations in adult patients require further exploration. METHODS: We conducted a systematic review and meta-analysis of the use of ketamine in cases of acute asthma exacerbation in adults. We searched PubMed, Google Scholar, Cochrane databases, and gray literature (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform); we also searched the reference lists of included articles and any systematic reviews and meta-analyses identified therein. Our search covered the period from 1963 to August 20, 2021. Search terms were “ketamine” AND “asthma”. RESULTS: Of 25 540 articles, two studies were included in the analysis. The total number of patients included in the studies was 136 (68 in the ketamine groups and 68 in the placebo group). The pooled effect size was 0.30 (95% CI: -0.04, 0.63) favouring ketamine over placebo, p=0.08, (I2=0%, p=0.39). A paired t-test revealed that ketamine improved the mean peak expiratory flow rate (PEFR) from 242.4 (SD=146.23) to 286.95 (SD=182.22), p=0.33, representing an 18.38% improvement. CONCLUSION: Ketamine can induce a 30% improvement in PEFR, representing a small positive effect in the treatment of acute severe asthma exacerbation in the emergency department (ED). The improvement was not statistically significant; nonetheless, since the improvement could be as great as 63% versus only a 4% possibility of no benefit/harm, the benefit appears to considerably outweigh any harm.

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