Asthma Associated Cytokines Regulate the Expression of SARS-CoV-2 Receptor ACE2 in the Lung Tissue of Asthmatic Patients

It is still controversial whether chronic lung inflammation increases the risk for COVID-19. One of the risk factors for acquiring COVID-19 is the level of expression of SARS-CoV-2 entry receptors, ACE2 and TMPRSS2, in lung tissue. It is, however, not clear how lung tissue inflammation affects expression levels of these receptors. We hence aimed to determine the level of SARS-CoV-2 receptors in lung tissue of asthmatic relative to age, gender, and asthma severity, and to investigate the factors regulating that. Therefore, gene expression data sets of well-known asthmatic cohorts (SARP and U-BIOPRED) were used to evaluate the association of ACE2 and TMPRSS2 with age, gender of the asthmatic patients, and also the type of the underlying lung tissue inflammatory cytokines. Notably, ACE2 and to less extent TMPRSS2 expression were upregulated in the lung tissue of asthmatics compared to healthy controls. Although a differential expression of ACE2, but not TMPRSS2 was observed relative to age within the moderate and severe asthma groups, our data suggest that age may not be a key regulatory factor of its expression. The type of tissue inflammation, however, associated significantly with ACE2 and TMPRSS2 expression levels following adjusting with age, gender and oral corticosteroids use of the patient. Type I cytokine (IFN-γ), IL-8, and IL-19 were associated with increased expression, while Type II cytokines (IL-4 and IL-13) with lower expression of ACE2 in lung tissue (airway epithelium and/or lung biopsies) of moderate and severe asthmatic patients. Of note, IL-19 was associated with ACE2 expression while IL-17 was associated with TMPRSS2 expression in sputum of asthmatic subjects. In vitro treatment of bronchial fibroblasts with IL-17 and IL-19 cytokines confirmed the regulatory effect of these cytokines on SARS-CoV-2 entry receptors. Our results suggest that the type of inflammation may regulate ACE2 and TMPRSS2 expression in the lung tissue of asthmatics and may hence affect susceptibility to SARS-CoV-2 infection.

The Effect of Group Acceptance and Commitment Therapy on the Management of Asthma: A Randomized Clinical Trial

Background: Asthma is a common respiratory disorder that negatively affects quality of life (QOL) and mood status. Objectives: The purpose of this study was to investigate the efficacy of group acceptance and commitment therapy (ACT) on the symptom control, QOL, and mood status of asthmatic patients. Methods: This randomized clinical trial study was conducted on 32 asthmatic patients randomly allocated to the case group (underwent group ACT plus medical therapy; n = 15) and the control group (who were medically treated only in 2019; n = 17). The case group participated in 8 sessions of 90-minute group ACT. Spirometry was performed for both groups at baseline and at the end of the intervention. The Asthma Control Questionnaire (ACQ) to assess symptom control status, Hospital Anxiety and Depression Scale (HADS) to assess mood status, and Asthma Quality of Life Questionnaire (AQLQ) to assess QOL were filled out by the patients at baseline and at the end of the intervention. Results: The measurements regarding the trend of changes in the case group over the time were significant in all of the evaluated entities, including ACQ, depression and anxiety subscales of HADS, and AQLQ scores (P < 0.05), while nonsignificant alterations were observed in the controls (P > 0.05). The comparison of the 2 groups revealed significant differences in all the assessed entities (P > 0.05). The spirometry variables were statistically significant in the control group at baseline (P < 0.05), while the post-intervention assessments revealed a nonsignificant difference (P > 0.05). Conclusions: Group ACT can efficiently reduce the asthma symptoms in asthmatic patients, along with the remarkable improvement in mood and QOL. Further evaluations with a longer period of intervention are strongly recommended.

Food and Aeroallergen Sensitization in IgE -Mediated Asthma in Egypt

Purpose: Identifying the distribution of allergens is valuable to the effective diagnosis and treatment of allergic disease. So, our aim is to explore the sensitization of food and aeroallergens in Egyptian patients with atopic asthma. Methods: Cross-sectional study recruited 268 Egyptian patients with atopic asthma. Asthmatic patients were assessed by the enzyme allegro sorbent test (EAST) method for specific IgE to a panel of 19 common regional inhaled allergens and 15 food allergens. Results and Discussion: One hundred percent of the patients were sensitive to at least one allergen. Allergy to food allergens only was 2.9%; inhaled allergens only were 26.2% and both were70.9%. Fungi (62%) were the most frequent sensitizing aeroallergen amongst our asthmatic patients, followed by the pollen allergens (42.5%) and house dust mites (HDMs) (26%). Cows’ milk (30.5%) was the most frequent sensitizing food amongst our asthmatic patients, followed by eggs (22.4%) and fish (21.6%). Mono-sensitized patients accounted for 6.7% of all cases, while polysensitized was 93.3%. Moderate and severe asthma showed a significantly higher frequency of polysensitization compared to mild asthma. Conclusion: Fungi and cow's milk are the chief sensitizing allergens in Egyptian patients with atopic asthma. This study represents the first report of sensitization in atopic adult asthma using a large extract panel in Upper Egypt.

Аsthma

Asthma is one of the most common respiratory tract diseases (about 7% of adults and about 10% of adolescents and children suffer from asthma in the Russian Federation). Astma frequencies of occurrence dont depend from sex or age in population. Numbers of asthmatic patients in the world increase every year. The majority of patients suffering asthma well respond to conventional therapies and successful control disease, but 20-30% of the patients have severe phenotypes asthma resisting for known medicines, therefore they achieve control for asthma very rare. Patients with severe asthma frequently need hospitalizations (up to 30%) and intensive care (4-7%). The clinical asthma guideline has goals to optimize patient care, up-to-date information about the epidemiology, etiology and pathogenesis of the disease. The text contains actual data about asthma classification, its clinical signs, modern diagnostics (clinical, laboratory and instrumental) inclunded the differential diagnostics of astma. There are chapters about asthma treatment, rehabilitation and prevention in the guideline. Authors detailed describe existing healthcare options for asthmatic patients and the features of diasgnostics and care in partial groups of population (adolescents, pregnant or nursing women, persons with occupational or exercise-induced or severe phenotype asthma). The clinical guideline are recommended for medical doctors (independendently from qualification), under- and postgraduate students, universities tutors, residents and researchers.

Severe Asthma, Telemedicine, Self-Administered Therapy: Listening First to the Patient

Severe asthma patients are at increased risk of major exacerbations and they need to be monitored regularly. The COVID-19 pandemic has impressively impacted on the health care resources. The telemedicine approach applied to the follow-up of asthmatic patients has been proved to be effective in monitoring their disease and adherence to the therapy. The aim of our study was to investigate the satisfaction of severe asthma patients, before the activation of a telemedicine management complemented by a standard of care. An ad hoc questionnaire was developed and sent by e-mail to 180 severe asthma patients. Most of subjects (82%) were confident with the idea of doing self-measurements and self-managing their disease; 77% of subjects favoured to carry out virtual visit and telemedicine. 93% of patients considered easy the self-injection therapy. 94% of subjects felt safe and 93% were not worried while self-administering. Only mild adverse events were reported in 22% subjects after self-administration. Our results showed an agreement between what is considered necessary and practicable by healthcare personnel and what is perceived by the severe asthma patients, in terms of treatment and monitoring of the disease with Telehealth. Biologics have a safety profile and can be easily self-administred at home

COVID- 19 Infections with and without Co-morbidities and Clinical Outcome

Aim: To evaluate the clinical outcomes and severity of disease in COVID-19 patients presenting with and without comorbidities. Study Design: Cross-sectional study. Place and Duration: ICUs, wards of Jinnah Postgraduate Medical Center Karachi from March, to June 2021. Methodology: The enrolled patients diagnosed with COVID-19 ie according to the provisional directions given by WHO, were assessed for clinical outcomes. Comorbidities were determined based on patients self-report on admission. Results: Total 200 COVID patients were enrolled in the study, out of them 179 were with comorbidities like type 2 Diabetes mellitus, hypertension, cardiac disorders and asthma, while 21 COVID patients were with no co morbidity. In present study (n=200), 55.5% were belonging to the age group more than fifty five years old, there were 50.5% males and 29.5% patients came in the month of June 2021. There were 84% hypertensive, 54% were diabetic, 10% were Ischemic Heart Disease and 5% were Asthmatic patients. Clinical outcomes, i.e., pneumothorax, pulmonary embolism, Myocardial Infarction, septic shock, heart failure, Disseminated Intravascular Coagulation was compared regarding associated co-morbidities at the time of admission, p-value was <0.01 and x2=20.15 . Conclusion: COVID patients with comorbidities are more at risk of developing worst clinical outcomes.