Association of plasma soluble CD14 level with asthma severity in adults: a case control study in China

Juan Carlos Ivancevich Thursday, 21 February 2019 12:51
Research - Open Access
Ting ZhouXiji HuangJixuan MaYun ZhouYuewei LiuLili XiaoJing YuanJungang Xie and Weihong Chen Email author

Abstract

Background

Soluble CD14 (sCD14) shedding from CD14 could regulate T lymphocyte activation and function, which has implicated in the pathogenesis of bronchial asthma. The level of sCD14 expression is obviously increased in asthmatic patients during acute asthma attacks. The objective of this study was to investigate the association between plasma sCD14 level and asthma severity in adults.

Methods

The plasma sCD14 level in asthma patients (n = 910) and healthy controls (n = 881) was quantified by commercially available enzyme-linked immunosorbent assay (ELISA) kits. The asthma cases were subdivided into intermittent asthma (n = 537), mild (n = 246), moderate (n = 96) and severe (n = 31) persistent asthma patients. Association between plasma sCD14 level and asthma severity, lung function parameters as well as asthma symptoms and signs in adults were performed using multivariate logistic regression models.

Results

We observed significant relationships of plasma sCD14 level with asthma severity, lung function parameters as well as asthma symptoms and signs in adults. After adjusting for multiple potential confounders, each one-unit increase in log sCD14 was significantly associated with 67, 82, 79 and 85% reduced ORs for intermittent asthma, mild, moderate and severe persistent asthma, respectively (all P < 0.0001). Compared with the participants of FEV1/FVC ≥75%, each one-unit increase in log sCD14 was significantly associated with a 37% decreased OR of FEV1/FVC < 75% (P < 0.0001). However, the adjusted odds ratios (ORs) of severe dyspnea, wheeze and cyanosis in asthma patients were 1.88, 1.46 and 2.20 for each one-unit increase in log sCD14, respectively. In addition, compared with health controls, the adjusted area under the curve (AUC) of sCD14 was 0.814 at a cut-off points of 0.53, and the sensitivity and specificity were 71.0 and 76.8% for predicting asthma in adults. And the adjusted AUC of sCD14 reached 0.786, 0.847, 0.887 and 0.917 in predicting intermittent asthma, mild, moderate and severe persistent asthma, respectively.

Conclusions

Our results indicated that plasma sCD14 level is negatively associated with asthma severity, suggesting a protective role for sCD14 in the development of asthma in adults. And plasma sCD14 level might be a potential biomarker in prediction of asthma severity in adults.

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CME:Unlocking the Door to Asthma Control: Key Factors for Therapy Selection and Medication Management

Juan Carlos Ivancevich Monday, 18 February 2019 12:24

Intended Audience: Physicians, Pharmacists, Nurses, and Case Managers

Frequent asthma flare-ups lock patients out of their own lives by preventing them from fully participating in work/school, getting restful sleep, and engaging in social activities. In this CE accredited program, leading experts in asthma and managed care pharmacy will provide you with the keys to asthma control. Hear the latest evidence from recent conferences while discovering how novel therapies can tame and prevent flare-ups, reduce the impact of asthma-related comorbidities, and avoid the need for costly hospitalizations. Why leave those with severe asthma on the outside of life looking in when you can open the door?

Physicians completing this program will earn AMA PRA Category 1 Credit™ classified as Enduring material.

Pharmacists completing this program will earn Home Study credit in Disease State Mgmt/Drug therapy (H01).

 

Pharmacokinetics and pharmacodynamics of monoclonal antibodies for asthma treatment

Juan Carlos Ivancevich Monday, 11 February 2019 18:59

Review

Expert Opinion on Drug Metabolism & Toxicology, 15:2,113-120, DOI: 10.1080/17425255.2019.1568409
 

Introduction: Asthma is a chronic inflammatory airway disease. It occurs in a ‘severe’ form in about 8–10% of asthmatic patients. In the last decade, the development of biological drugs (e.g. monoclonal antibodies) allowed to efficiently approach severe asthma. The current therapeutic targets available are mainly those related to TH2 inflammation.

Areas covered: The main pharmacokinetic and pharmacodynamic characteristics of the monoclonal antibodies against IL-5, IL-5Ra, IL4-IL13, and IgE, that are currently marketed or understood for severe asthma are discussed in this paper.

Expert opinion: The currently available biological drugs represent an excellent therapeutic add-on to traditional drugs, especially in replacing systemic corticosteroid therapies. The different pharmacokinetic and pharmacodynamic characteristics of the drugs, despite sometime sharing the same target, would allow a better personalization of the therapy, tailoring the treatment to the characteristics of the patient.

The Electronic Asthma Management System (eAMS) Improves Primary Care Asthma Management

Juan Carlos Ivancevich Thursday, 14 February 2019 12:01

Samir GuptaCourtney PriceGina AgarwalDavid ChanSanjeev GoelLouis-Philippe BouletAlan G. KaplanGerald LebovicMuhammad MamdaniSharon E. Straus
 

Abstract

A high prevalence of suboptimal asthma control is attributable to known evidence-practice gaps. We developed a computerised clinical decision support system (the Electronic Asthma Management System – eAMS) to address major care gaps and sought to measure its impact on care in adults with asthma.

This was a 2-year interrupted time series study of usual care (year 1) versus eAMS (year 2) at 3 Canadian primary care sites. We included asthma patients aged ≥16 years receiving an asthma medication within the last 12 months. The eAMS consisted of a touch tablet patient questionnaire completed in the waiting room, with real-time data processing producing electronic medical record-integrated clinician decision support.

Action plan delivery (primary outcome) improved from 0/412 (0%) to 79/443 (17.8%) eligible patients [absolute increase 0.18 (0.14,0.22)]. Time series analysis indicated a 30.5% increase in physician visits with action plan delivery with the intervention (p<0.0001). Assessment of asthma control level increased from 173/3497 (4.9%) to 849/3062 (27.7%) eligible visits [adjusted OR 8.62 (5.14, 12.45)]. Clinicians escalated controller therapy in 108/3422 (3.2%) baseline visits versus126/3240 (3.9%) intervention visits (p=0.12). At baseline, a short-acting beta-agonist alone was added in 62 visits and a controller added in 54 visits; with the intervention, this occurred in 33 and 229 visits, respectively (p<0.001).

The eAMS improved asthma quality of care in real-world primary care settings. Strategies to further increase clinician uptake and a randomised controlled trial to assess impact on patient outcomes are now required.

Registration: ClinicalTrials.govNCT01070095

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Airway obstruction and bronchial reactivity from age 1 month until 13 years in children with asthma: A prospective birth cohort study

Juan Carlos Ivancevich Saturday, 09 February 2019 11:22

 

PLoS Med 16(1): e1002722. https://doi.org/10.1371/journal.pmed.1002722

Henrik Wegener Hallas, Bo Lund Chawes, Morten Arendt Rasmussen, Lambang Arianto, Jakob Stokholm, Klaus Bønnelykke, Hans Bisgaard

Investigators assessed 411 children from the at-risk COPSAC2000 birth cohort born to mothers with asthma to examine if low lung function and bronchial hyperreactivity are inherent features that increase the risk of developing airway inflammation and asthmatic symptoms. They observed that children who developed asthma had decreased lung function from 1 month of age throughout childhood as vs children without asthma. This lung function characteristic was evident prior to the development of airway inflammation and asthma, and did not worsen with prolonged duration of asthma symptoms. Findings, therefore, suggested that airway obstruction and bronchial hyperreactivity may be stable traits of childhood asthma, indicating that symptomatic disease may be a result of these traits but not their cause.

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Editor: Juan C. Ivancevich, MD

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