Detection of pathogens by real-time PCR in adult patients with acute exacerbation of bronchial asthma

Super User Thursday, 23 November 2017 11:39
 
Yutaka Yoshi, Kenichiro ShimizuMiyuki MorozumiNaoko ChibaKimiko UbukataHironori UrugaShigeo HanadaHiroshi WakuiShunsuke MinagawaHiromichi HaraTakanori NumataKeisuke SaitoJun ArayaKatsutoshi NakayamaKazuma Kishi and Kazuyoshi Kuwano

Abstract

Background

Respiratory tract infection is a major cause of acute exacerbation of bronchial asthma (AEBA). Although recent findings suggest that common bacteria are causally associated with AEBA, a comprehensive epidemiologic analysis of infectious pathogens including common/atypical bacteria and viruses in AEBA has not been performed. Accordingly, we attempted to detect pathogens during AEBA by using real-time polymerase chain reaction (PCR) in comparison to conventional methods.

Methods

We prospectively enroled adult patients with AEBA from August 2012 to March 2014. Infectious pathogens collected in nasopharyngeal swab and sputum samples were examined in each patient by conventional methods and real-time PCR, which can detect 6 bacterial and 11 viral pathogens. The causal association of these pathogens with AEBA severity and their frequency of monthly distribution were also examined.

Results

Among the 64 enroled patients, infectious pathogens were detected in 49 patients (76.6%) using real-time PCR and in 14 patients (21.9%) using conventional methods (p < 0.001). Real-time PCR detected bacteria in 29 patients (45.3%) and respiratory viruses in 28 patients (43.8%). Haemophilus influenzae was the most frequently detected microorganism (26.6%), followed by rhinovirus (15.6%). Influenza virus was the significant pathogen associated with severe AEBA. Moreover, AEBA occurred most frequently during November to January.

Conclusions

Real-time PCR was more useful than conventional methods to detect infectious pathogens in patients with AEBA. Accurate detection of pathogens with real-time PCR may enable the selection of appropriate anti-bacterial/viral agents as a part of the treatment for AEBA.

Download PDF

Asthma biomarkers in the age of biologics

Juan Carlos Ivancevich Saturday, 18 November 2017 10:37

Allergy, Asthma & Clinical Immunology

Harold Kim, Anne K. Ellis, David Fischer, Mary Noseworthy, Ron Olivenstein, Kenneth R. Chapman and Jason Lee

Allergy, Asthma & Clinical Immunology 2017, 13:48 | Published on: 17 November 2017

Abstract

The heterogeneous nature of asthma has been understood for decades, but the precise categorization of asthma has taken on new clinical importance in the era of specific biologic therapy. The simple categories of allergic and non-allergic asthma have given way to more precise phenotypes that hint at underlying biologic mechanisms of variable airflow limitation and airways inflammation. Understanding these mechanisms is of particular importance for the approximately 10% of patients with severe asthma. Biomarkers that aid in phenotyping allow physicians to “personalize” treatment with targeted biologic agents. Unfortunately, testing for these biomarkers is not routine in patients whose asthma is refractory to standard therapy. Scientific advances in the recognition of sensitive and specific biomarkers are steadily outpacing the clinical availability of reliable and non-invasive assessment methods designed for the prompt and specific diagnosis, classification, treatment, and monitoring of severe asthma patients. This article provides a practical overview of current biomarkers and testing methods for prompt, effective management of patients with severe asthma that is refractory to standard therapy.

Full Text | PDF

Response to case report: Airway autoimmune responses in severe eosinophilic asthma following low-dose Mepolizumab therapy

Juan Carlos Ivancevich Sunday, 05 November 2017 19:55

Allergy, Asthma & Clinical Immunology 2017, 13:45 | Published on: 3 November 2017

I. J. Pouliquen, P. Howarth, D. Austin, G. Gunn, E. Meyer, R. G. Price and E. Bradford

To the Editor,

We read with interest the case report and accompanying discussion published by Mukherjee et al. (AACI 2017;13:2) of a 62-year old woman diagnosed with severe eosinophilic asthma. This clinical case presents a patient with progressive deterioration in FEV1 function since 2011 with no improvement observed while receiving OCS, hydroxyurea or imatinib therapy. On this background of deterioration, the patient entered the double-blind placebo controlled clinical trial MEA115575 and received mepolizumab 100 mg s.c. every 4 weeks. Further deterioration in FEV1 coincided with the (protocol defined) reduction in prednisolone during the study, and neither intravenous solumedrol nor pre-study prednisolone doses improved FEV1 to pre-study values. During the open-label mepolizumab extension study MEA115661 the patient’s clinical status was unchanged. In January 2015, 9 months after their last dose of mepolizumab, the patient further deteriorated whilst receiving azathioprine immunosuppressive therapy. This clinical case presentation clearly underlines the aggressive nature...

 

Full Text | PDF

 

 

 

 

A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework

Juan Carlos Ivancevich Monday, 13 November 2017 23:32
 
George D. ThurstonHoward KipenIsabella Annesi-MaesanoJohn BalmesRobert D. BrookKevin CromarSara De MatteisFrancesco ForastiereBertil ForsbergMark W. FramptonJonathan GriggDick HeederikFrank J. KellyNino KuenzliRobert LaumbachAnnette PetersSanjay T. RajagopalanDavid RichBeate RitzJonathan M. SametThomas SandstromTorben SigsgaardJordi SunyerBert Brunekreef

Abstract

The American Thoracic Society has previously published statements on what constitutes an adverse effect on health of air pollution in 1985 and 2000. We set out to update and broaden these past statements that focused primarily on effects on the respiratory system. Since then, many studies have documented effects of air pollution on other organ systems, such as on the cardiovascular and central nervous systems. In addition, many new biomarkers of effects have been developed and applied in air pollution studies.

This current report seeks to integrate the latest science into a general framework for interpreting the adversity of the human health effects of air pollution. Rather than trying to provide a catalogue of what is and what is not an adverse effect of air pollution, we propose a set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health. These considerations are illustrated by the inclusion of examples for different types of health effects of air pollution.

 

Prognostic nomogram for inpatients with asthma exacerbation

Juan Carlos Ivancevich Thursday, 02 November 2017 11:25
Wakae Hasegawa,Yasuhiro Yamauchi Email author,Hideo Yasunaga,Hideyuki Takeshima,Yukiyo Sakamoto,Taisuke Jo,Yusuke Sasabuchi,Hiroki Matsui,Kiyohide Fushimi and Takahide Nagase

Abstract

Background

Asthma exacerbation may require a visit to the emergency room as well as hospitalization and can occasionally be fatal. However, there is limited information about the prognostic factors for asthma exacerbation requiring hospitalization, and no methods are available to predict an inpatient’s prognosis. We investigated the clinical features and factors affecting in-hospital mortality of patients with asthma exacerbation and generated a nomogram to predict in-hospital death using a national inpatient database in Japan.

Methods

We retrospectively collected data concerning hospitalization of adult patients with asthma exacerbation between July 2010 and March 2013 using the Japanese Diagnosis Procedure Combination database. We recorded patient characteristics and performed Cox proportional hazards regression analysis to assess the factors associated with all-cause in-hospital mortality. Then, we constructed a nomogram to predict in-hospital death.

Results

A total of 19,684 patients with asthma exacerbation were identified; their mean age was 58.8 years (standard deviation, 19.7 years) and median length of hospital stay was 8 days (interquartile range, 5–12 days). Among study patients, 118 died in the hospital (0.6%). Factors associated with higher in-hospital mortality included older age, male sex, reduced level of consciousness, pneumonia, and heart failure. A nomogram was generated to predict the in-hospital death based on the existence of seven variables at admission. The nomogram allowed us to estimate the probability of in-hospital death, and the calibration plot based on these results was well fitted to predict the in-hospital prognosis.

Conclusion

Our nomogram allows physicians to predict individual risk of in-hospital death in patients with asthma exacerbation.

Download PDF

Interasma on Twitter

Interasma RT @Aller_MD: Top story: Kaléo on Twitter: "Some bullies use words, others use food. Togeth… https://t.co/eOHOsmB43X, see more https://t.…
9hreplyretweetfavorite
Interasma RT @Aller_MD: “Epinephrine Nasal Spray for #Anaphylaxis Shows Promise as Potential Alternative to Auto-Injector” https://t.co/qVsbyMfDuL ht…
9hreplyretweetfavorite
Interasma RT @Aller_MD: “Stress-related disorders were significantly associated with risk of subsequent autoimmune disease” https://t.co/9YWUsJgHWp h…
9hreplyretweetfavorite
Interasma RT @Aller_MD: “A Teledermatology Scale-Up Framework and Roadmap for Sustainable Scaling: Evidence-Based Development” https://t.co/nqPSJpsyg
9hreplyretweetfavorite
Interasma RT @Aller_MD: “Tobacco Product Use Among Youths With and Without Lifetime #Asthmahttps://t.co/wnj8AyUM7Z https://t.co/ydFozighl5
9hreplyretweetfavorite

Editor: Juan C. Ivancevich, MD

Copyright © Interasma 2003-2017  •  Terms of Use  •  Privacy Policy  •  Contact Us  •  Sitemap

Powered by FREI SA

InterAsma