The impact of parental history on children's risk of asthma: a study based on the National Health and Nutrition Examination Survey-III

Juan Carlos Ivancevich Tuesday, 02 June 2015 13:54

Authors Xu R, DeMauro SB, Feng R

Published Date May 2015  Journal of Asthma and Allergy » Volume 8 2015 Pages 51—61

DOI http://dx.doi.org/10.2147/JAA.S80245

Rengyi Xu,1 Sara B DeMauro,2 Rui Feng1

1Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; 2Division of Neonatology, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, PA, USA

Purpose: This study aimed to examine the separate effects of maternal and paternal history on the onset of asthma in children and evaluate the relationship between age of asthma onset in parents and risk of asthma in their children.
Methods: We used data from the third National Health and Nutrition Examination Survey. We developed new continuous standardized scores for survey data to quantify parental history that incorporated both the occurrence of asthma and the age at onset, and associated these scores with asthma risk in the children. The association analysis was adjusted for sex and obesity status.
Results: Children with maternal history have elevated asthma risk (hazard ratio of 3.71, 95% CI: 1.19–11.60) than those without, and those whose mothers had earlier age of onset have increased risk of asthma compared to those whose mothers had later age of onset. On the contrary, paternal history had a relatively smaller effect that may be only detectable in larger samples (hazard ratio of 2.17, 95% CI: 0.69–6.79).
Conclusion: Maternal asthma history was strongly associated with the onset of asthma in the second generation, and children whose mother had an earlier age of onset had an increased risk of 3.71. For an approximately 10-year decrease in mother’s age at onset of asthma, the risk of asthma for the offspring increased by 1.37-fold. Using our new risk scores led to smaller standard errors and thus more precise estimates than using a binary indicator.

Keywords: parental history, asthma risk, maternal history, survey, family data

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Linking And Clustering Multiscale Structural And Functional Variables In Asthmatic Populations

Juan Carlos Ivancevich Saturday, 30 May 2015 14:02

Sanghun Choi Ph.D. 1 2 Kun Chen Ph.D. 3 Eric A. Hoffman PhD 4 Sally E. Wenzel MD 5 Mario Castro MD, MPH 6 Sean B. Fain PhD 7 Nizar N. Jarjour MD 7 Mark L. Schiebler M.D. 7 Ching Long Lin PhD 1 ,

Publication Date: 2015
Free first page
 
 




Read More: http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2015.191.1_MeetingAbstracts.A2464

Managing Severe Asthma in Adults: Lessons From the ERS/ATS Guidelines

Juan Carlos Ivancevich Saturday, 23 May 2015 22:42


Abstract

Purpose of review To review the latest guidelines on severe asthma.

Recent findings An updated definition of severe asthma is provided together with the evaluation steps necessary to reach a diagnosis of severe asthma. The importance of phenotyping is emphasized, and recommendations are provided for therapies specifically directed for severe asthma.

Summary Severe asthma is widely recognized as a major unmet need. It is defined as asthma that requires treatment with high-dose inhaled corticosteroids and a second controller and/or systemic corticosteroid to prevent it from becoming 'uncontrolled' or that remains 'uncontrolled' despite this therapy. Severe asthma is a heterogeneous condition that consists of phenotypes such as eosinophilic asthma. More phenotypes need to be defined. Evaluation of the patient referred to as having severe or difficult-to-control asthma must take into account adherence to treatment, comorbidities and associated factors including side effects from therapies. These need to be addressed. Recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy are presented. Treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty is reviewed and recommendations made. Research efforts into phenotyping of severe asthma will provide both biomarker-driven approaches and newer effective therapies to severe asthma management.

Full text on Medscape

 

Pidotimod: the state of art

Juan Carlos Ivancevich Tuesday, 26 May 2015 13:30
 
 
Open Access
 
Review

Beatrice E FerrarioSilvia GarutiFulvio Braido and Giorgio W Canonica

Abstract

Despite the use of antibiotics and vaccines, the frequency of respiratory tract infections is still high and these infections interest a wide range of patients, from children to aged people, including in particular these extreme categories because of the deficiency of their immune system, due to immaturity in the former case and to “immunosenescence” in the latter. For that reason immunostimulant drugs are getting more important to prevent and to attenuate infections. Pidotimod (3-L-pyroglutamyl-L-thiazolidine-4carboxylic acid) is a synthetic dipeptide with immunomodulatory properties. We reviewed studies conducted on different categories of patients, with particular attention on children and senile patients suffering from recurrent respiratory tract infections, associated, or not, with asthma or COPD. The outcomes considered are both clinical and laboratory parameters. The common end-point of these studies is that Pidotimod has an immunomodulatory activity which is able both to improve the clinical conditions of patients and to enhance and stimulate their immunity cells (lymphocytes but not only) functions acting on adaptive and innate immunity. Pidotimod is also able to increase the concentration of salivary IgA directed against bacteria; furthermore, it can modulate airway epithelial cells functions up-regulating the expression of toll-like receptors and acting on adhesion molecules. According to studies conducted on patients with atopic asthma, it seems that Pidotimod could affect T-lymphocytes balance with a possible addictional anti-allergic activity. Furthermore, it has been demonstrated an improvement of FEV1 and PEF in asthmatic patients treated with Pidotimod. Main clinical outcomes are the reduction of the number of infectious episodes, lesser severity of signs and symptoms and, consequently, a reduction in use of antibiotics and symptomatic drugs, less working and school days lost, less mortality and morbidity. The studies considered give positive results, confirming Pidotimod’s efficacy. Furthermore, many studies show a good safety profile of the drug, without recording serious adverse events and mutagenic potential, and a very low incidence of side effects. Pidotimod is also a more safe solution in patients subjected to vaccination, if compared to lyophilized polibacterial, which can’t be administered for thirty days before vaccination.

Keywords: 

Pidotimod; natural immunity 

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Lebrikizumab in moderate-to-severe asthma: pooled data from two randomised placebo-controlled studies

Juan Carlos Ivancevich Saturday, 23 May 2015 03:52

Thorax doi:10.1136/thoraxjnl-2014-206719

  • Respiratory research
  • Original article
Open Access
  1. Nicola A Hanania1
  2. Michael Noonan2
  3. Jonathan Corren3
  4. Phillip Korenblat4
  5. Yanan Zheng5,
  6. Saloumeh K Fischer5
  7. Melissa Cheu5
  8. Wendy S Putnam5
  9. Elaine Murray5,
  10. Heleen Scheerens5
  11. Cecile TJ Holweg5
  12. Romeo Maciuca5
  13. Sarah Gray5
  14. Ramona Doyle5,
  15. Dana McClintock5
  16. Julie Olsson5
  17. John G Matthews5
  18. Karl Yen5

+Author Affiliations

  1. 1Section of Pulmonary and Critical Care MedicineBaylor College of MedicineHouston, Texas, USA
  2. 2Allergy Associates ResearchPortland, Oregon, USA
  3. 3Asthma and Allergy Research FoundationLos Angeles, California, USA
  4. 4Clinical Research Center LLCSt. Louis, Missouri, USA
  5. 5Genentech Inc. (a Member of the Roche Group)South San Francisco, California, USA
  1. Correspondence toDr Karl Yen, Genentech Inc, 1 DNA Drive, South San Francisco, CA 94080-4990, USA;This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

Introduction In a subset of patients with asthma, standard-of-care treatment does not achieve disease control, highlighting the need for novel therapeutic approaches. Lebrikizumab is a humanised, monoclonal antibody that binds to and blocks interleukin-13 activity.

Methods LUTE and VERSE were replicate, randomised, double-blind, placebo-controlled studies, evaluating multiple doses of lebrikizumab in patients with uncontrolled asthma despite the use of medium-to-high-dose inhaled corticosteroid and a second controller. Patients received lebrikizumab 37.5, 125, 250 mg or placebo subcutaneously every four weeks. The primary endpoint was the rate of asthma exacerbations during the placebo-controlled period. Analyses were performed on prespecified subgroups based on baseline serum periostin levels. Following the discovery of a host-cell impurity in the study drug material, protocols were amended to convert from phase III to phase IIb. Subsequently, dosing of study medication was discontinued early as a precautionary measure. The data collected for analysis were from a placebo-controlled period of variable duration and pooled across both studies.

Results The median duration of treatment was approximately 24 weeks. Treatment with lebrikizumab reduced the rate of asthma exacerbations, which was more pronounced in the periostin-high patients (all doses: 60% reduction) than in the periostin-low patients (all doses: 5% reduction); no dose–response was evident. Lung function also improved following lebrikizumab treatment, with greatest increase in FEV1 in periostin-high patients (all doses: 9.1% placebo-adjusted improvement) compared with periostin-low patients (all doses: 2.6% placebo-adjusted improvement). Lebrikizumab was well tolerated and no clinically important safety signals were observed.

Conclusions These data are consistent with, and extend, previously published results demonstrating the efficacy of lebrikizumab in improving rate of asthma exacerbations and lung function in patients with moderate-to-severe asthma who remain uncontrolled despite current standard-of-care treatment.

Trial registration numbers The LUTE study was registered under NCT01545440 and the VERSE study under NCT01545453 at http://www.clinicaltrials.gov

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Editor: Juan C. Ivancevich, MD

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