Prevelance of Undiagnosed Bronchiectasis in Patients Suffering from Severe Persistent Asthma

Introduction: Asthma is a clinical condition associated with recurring airway obstruction, airway hyperresponsiveness and airway inflammation. Asthma and bronchiectasis are separate illnesses. However, both disorders occur in some patients e.g., ABPA. Rare data exist for determining the impact of asthma aggravation by bronchiectasis. Present study aims to find such association. Objective: To determine the prevalence of undiagnosed bronchiectasis in patients suffering from severe persistent asthma. Study Design: Cross sectional/descriptive study Place and Duration of Study: Department of Pulmonology, Al-Aleem Medical College/Gulab Devi Teaching Hospital Lahore from 1st July 2020 to 31st December 2020. Methodology: One hundred and twenty five patients of severe persistent asthma were enrolled. Patients were aged between 20-75 years. Patients details demographics age, sex and body mass index were recorded after taking written consent. High-resolution computed tomography (HRCT) chest was done among complete patients to recognized undiagnosed bronchiectasis. Prevalence of undiagnosed bronchiectasis was assessed among cases. Results: Sixty five (54.17%) were females and the rest were males 55 (45.83%). Mean age of the patients were 40.26±9.55 years with mean BMI 25.16±8.66 kg/m2. 35 (28%) patients had smoking history. Majority of the patients 55 (44%) were aged between 45-75 years of age. Prevalence of undiagnosed bronchiectasis was found in 48 (38.4%) patients of severe persistent asthma. Conclusion: The prevalence of undiagnosed bronchiectasis was significantly high among patients of long disease duration suffering from persistent asthma. Keywords: Severe persistent, Asthma, Undiagnosed bronchiectasis

Overview of severe asthma, with emphasis on pediatric patients: a review for practitioners

Asthma is the most common life-threatening chronic disease in children. Although guidelines exist for the diagnosis and treatment of asthma, treatment of severe, pediatric asthma remains difficult. Limited studies in the pediatric population on new asthma therapies, complex issues with adolescence and adherence, health disparities, and unequal access to guideline-based care complicate the care of children with severe, persistent asthma. The purpose of this review is to provide an overview of asthma, including asthma subtypes, comorbidities, and risk factors, to discuss diagnostic considerations and pitfalls and existing treatments, and then present existing and emerging therapeutic approaches to asthma management. An improved understanding of asthma heterogeneity, clinical characteristics, inflammatory patterns, and pathobiology can help further guide the management of severe asthma in children. More studies are needed in the pediatric population to understand emerging therapeutics application in children. Effective multimodal strategies tailored to individual characteristics and a commitment to address risk factors, modifiers, and health disparities may help reduce the burden of asthma in the USA.

Combination Anti-IgE and Anti-IL5 Therapy in a Pediatric Patient With Severe Persistent Asthma

Biologic agents, including anti-immunoglobulin E (omalizumab) and anti-interleukin 5 (mepolizumab), target different mediators involved in the inflammatory process and may work synergistically to decrease symptoms in patients with severe asthma. Here we describe a 12-year-old female on 2 biologic agents, omalizumab and mepolizumab, to control severe persistent asthma. Omalizumab was started years earlier with an initial response; however, her asthma again became uncontrolled and mepolizumab was added. Both biologics were administered concomitantly for over 6 months with marked improvement of asthma symptoms without significant side effects. A combination of biologic agents may be a potential therapy for pediatric patients with severe persistent asthma that remains uncontrolled on a single agent.

Pilot study investigating diagnostic utility of serum MMP-1 and TGF-β1 in asthma in ‘real world’ clinical practice in India

AimsAt a tissue level, matrix metalloproteinase-1 (MMP-1) and transforming growth factor-beta 1 (TGF-β1) contribute to allergic airway inflammation, tissue remodelling and disease severity in asthma via different pathways. Their peripheral blood levels and role in diagnosis and therapeutic monitoring has not been adequately explored. We investigated the association between MMP-1 and TGF-β in moderate and severe persistent asthma and evaluated their performance characteristics by constructing receiver operating characteristic curves.MethodsSerum MMP-1 and TGF-β1 were measured using ELISA in 75 adults; moderate persistent asthma (n=25), severe persistent asthma (n=25) and healthy community controls (n=25). Severity of asthma was determined as per Global Initiative for Asthma guidelines. Subjects were followed up for 3 months and treatment responsiveness was assessed by spirometry and symptom response.ResultsSerum MMP-1 and TGF-β1 were significantly elevated in asthmatics compared with controls (p<0.0001 and p<0.01). While serum MMP-1 was elevated in severe asthma compared with moderate asthma (p<0.05), TGF-β1 was lower in severe asthma compared with moderate asthma (p<0.05). The performance characteristics of serum MMP-1 and TGF-β1 were promising in this cohort with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 82%, 100%, 100% and 99% and 62%, 100%, 100% and 97.8%, respectively; sensitivity of MMP-1 being superior.ConclusionThis pilot study showed that serum MMP-1 and TGF-β1 levels are elevated in chronic asthma and may serve as a useful adjunct in differentiating moderate from severe asthma. A large multicentre study in well characterised cohort of asthmatics is warranted to investigate their role in diagnosis and therapeutic monitoring.