Asthma Control and Sputum Eosinophils: A Longitudinal Study in Daily Practice

Juan Carlos Ivancevich Wednesday, 12 April 2017 12:24

Articles in Press

Sophie F. Demarche,  Florence N. Schleich, MD, PhD, Virginie A. Paulus, MLT, Monique A. Henket, MLT, Thierry J. Van Hees, MPharm, PhD, Renaud E. Louis, MD, PhD

Abstract

Background

Longitudinal trials have suggested that asthma control may be influenced by fluctuations in eosinophilic inflammation. This association has however never been confirmed in daily practice.

Objective

To investigate the relationship between asthma control and sputum eosinophils in clinical practice.

Methods

A retrospective longitudinal study was conducted on 187 patients with asthma with at least 2 successful sputum inductions at our Asthma Clinic. Linear mixed models were used to assess the relationship between asthma control and individual changes in sputum eosinophils. Receiver-operating characteristic curves were constructed to define minimal important differences (MIDs) of sputum eosinophils associated with a change of at least 0.5 in Asthma Control Questionnaire (ACQ) score. Then, a validation cohort of 79 patients with asthma was recruited to reassess this relationship and the accuracy of the MID values.

Results

A multivariate analysis showed that asthma control was independently associated with individual fluctuations in sputum eosinophil count (P < .001). In patients with intermittent/persistently eosinophilic asthma, we calculated a minimal important decrease of 4.3% in the percentage of sputum eosinophils (area under the curve [AUC], 0.69; P < .001) or 3.4-fold (AUC, 0.65; P = .003) for a significant improvement in asthma control and a minimal important increase of 3.5% (AUC, 0.67; P = .004) or 1.8-fold (AUC, 0.63; P = .02) for a significant worsening in asthma control. The association between asthma control and sputum eosinophils and the accuracy of the MIDs of sputum eosinophils were confirmed in the validation cohort.

Conclusions

At the individual level, asthma control was associated with fluctuations in sputum eosinophil count over time.

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Effectiveness of bronchial thermoplasty in patients with severe refractory asthma: clinical and histopathological correlations

Juan Carlos Ivancevich Tuesday, 11 April 2017 13:19

JACI Journal Club

Asthma is a disease in which the airways of the lung become very sensitive to certain triggers, leading to spasms, in turn causing shortness of breath, coughing and wheezing.  The ultimate cause of asthma is unclear, but it has been shown in previous studies that there is remodeling of the airways in severe asthma. Airway smooth muscle (ASM) increases, along with fibrosis, infiltration of new blood vessels, and growth of cells that line the airways.   Recently, a procedure called bronchial thermoplasty (BT) has been developed, in which an endoscope is inserted into the airways.  This endoscope then delivers a temperature-controlled radio frequency to the airway wall.  In this month’s issue of JACI, Pretolani and colleagues look at bronchial thermoplasty and its effect on various clinical and histopathological findings (J Allergy Clin Immunol 2017; 139(4): 1176-1185).
In order to do this, they recruited 15 patients with severe uncontrolled asthma that did not respond to medications.  They looked at the symptoms through the Asthma Control Test (ACT) and the Asthma Quality of Life Questionnaire (AQLQ), as well as breathing patterns via spirometry and biopsy samples.  Bronchial thermoplasty was then performed.  At 3 and 12 months, the clinical and airway effects were examined.
What they found is that asthma control and quality of life increased considerably.  Exacerbations requiring oral steroids, emergency room visits, and hospitalizations were also decreased by approximately 90%.  Biopsy samples from 3 months showed a decrease in ASM size, as well as nerve fibers and neuroendocrine cells.
Based on these results, Pretolani and colleagues conclude that bronchial thermoplasty is an option for severe, uncontrolled, treatment refractory asthma.  Bronchial thermoplasty seems to affect the structure of airways, especially muscle size and nerve connections.  Targeting these structures, through thermoplasty or other means may be an effective way to help control these difficult-to-control cases.
 

Social media use for occupational lung disease

Juan Carlos Ivancevich Wednesday, 29 March 2017 13:53

Harber, Philip; Leroy, Gondy

OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli
 
Editor&apos;s Choice

INTRODUCTION

The Internet and the World Wide Web (WWW) revolutionized information and data availability. The early WWW was one-directional; information spread from one website to a multitude of readers. Following this ‘static’ phase, Web 2.0 added user-generated content and social interaction. Social media both increase the scope of available data and provide new channels for sharing information. Facebook, Instagram, Twitter, and blogs are examples with impact on all aspects of modern personal life (e.g. Meetups and online dating) and business (e.g. Amazon) in both developed and developing countries. They create global awareness and interaction.

In medicine, the paternalistic patient–physician relationship has changed as patients inform themselves using information from many online sources including other patients. Health professionals themselves use the WWW to interact with their patients and with their peers. The WWW increasingly accumulates information from and about the public. Using electronic rather than print media, these methods very rapidly disseminate information from a single source to many persons. They are a platform for peer-to-peer (many-to-many) communication and a rich source of data for monitoring population health. Social media support research in two ways – analysis of publicly available WWW information not primarily intended for research and, second, through direct interaction, surveys, and experiments between the public and the researchers.

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Association between rhinovirus wheezing illness and the development of childhood asthma: a meta-analysis

Juan Carlos Ivancevich Monday, 10 April 2017 13:31
Lu LiuYilin PanYanting ZhuYang SongXiaofan SuLan Yang, Manxiang Li

Author affiliations: 

Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'an, PR China
Correspondence to Dr Manxiang Li; This email address is being protected from spambots. You need JavaScript enabled to view it.
 

Abstract

Objective The relation between early-life rhinovirus (RV) wheezing illness and later onset of wheezing/asthma remains a subject of debate. Therefore, we conducted this meta-analysis to evaluate the association between RV wheezing illness in the first 3 years of life and the subsequent development of wheezing/asthma.

Design Systematic review and meta-analysis.

Methods The PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases were systematically searched for studies published between 1988 and February 2017, and additional studies were found by searching reference lists of relevant articles. 2 reviewers independently extracted data and assessed the quality of each study. Results were pooled using fixed-effect models or random-effects models as appropriate.

Results The meta-analysis included 15 original articles which met the criteria, while 10 articles reported the results of 4 longitudinal cohort studies with different follow-up periods. RV wheezing illness in the first 3 years of life was associated with an increased risk of wheezing/asthma in later life (relative risk (RR)=2.00, 95% CI 1.62 to 2.49, p<0.001). In subgroup analysis by age at follow-up, the association still remained significant in <10 years (RR=2.02, 95% CI 1.70 to 2.39, p<0.001) and ≥10 years (RR=1.92, 95% CI 1.36 to 2.72, p<0.001).

Conclusions The meta-analysis suggests an association between RV-induced wheezing in the first 3 years of life and the subsequent development of wheezing/asthma. Large-scale and well-designed studies that adequately address concerns for potential confounding factors are required to validate the risk identified in the current meta-analysis.

Obstructive sleep apnoea accelerates FEV1 decline in asthmatic patients

Juan Carlos Ivancevich Monday, 27 March 2017 16:33
 
BMC Pulmonary Medicine
BMC series – open, inclusive and trusted 201717:55

DOI: 10.1186/s12890-017-0398-2

Tsai-Yu Wang, Yu-Lun Lo, Shu-Min Lin et al. 

 

Abstract

Background

Although the prevalence of both obstructive sleep apnoea (OSA) and asthma are both increasing, little is known about the impact of OSA on the natural history of lung function in asthmatic patients.

Methods

A total of 466 patients from our sleep laboratory were retrospectively enrolled. Of them, 77 patients (16.5%) had asthma with regular follow-up for more than 5 years. Their clinical characteristics, pulmonary function, emergency room visits, and results of polysomnography results were analysed.

Results

The patients were divided into three groups according to the severity of the apnoea-hypopnea index (AHI). The decline in FEV1 among asthma patients with severe OSA (AHI > 30/h) was 72.4 ± 61.7 ml/year (N = 34), as compared to 41.9 ± 45.3 ml/year (N = 33, P = 0.020) in those with mild to moderate OSA (5 < AHI ≤ 30) and 24.3 ± 27.5 ml/year (N = 10, P = 0.016) in those without OSA (AHI ≤ 5). For those patients with severe OSA, the decline of FEV1 significantly decreased after continuous positive airway pressure (CPAP) treatment. After multivariate stepwise linear regression analysis, only AHI was remained independent factor for the decline of FEV1 decline.

Conclusions

Asthmatic patients with OSA had substantially greater declines in FEV1 than those without OSA. Moreover, CPAP treatment alleviated the decline of FEV1 in asthma patients with severe OSA.

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Editor: Juan C. Ivancevich, MD

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