Associations between serum 25(OH)D concentrations and prevalent asthma among children living in communities with differing levels of urbanization: a cross-sectional study

Juan Carlos Ivancevich Saturday, 03 June 2017 16:01
Suzanne L. Pollard, John J. Lima, Karina Romero, Carla Tarazona-Meza, Edward Mougey, Katherine Tomaino, Gary Malpartida-Guzmán, Nadia N. Hansel, William Checkley and GASP Study Investigators

Abstract

Background

Prior evidence suggests that vitamin D deficiency may increase the risk of asthma and atopy and impair pulmonary function in children.

Methods

In this cross-sectional analysis nested in a case-control study, we analyzed serum 25(OH)D concentrations in 413 children with asthma and 471 children without asthma living in two geographically adjacent study communities (Pampas and Villa El Salvador). We measured total and antigen-specific IgE levels, pulmonary function, asthma control, and exhaled nitric oxide.

Results

Mean 25(OH)D concentrations were 25.2 ng/mL (SD 10.1) in children with asthma and 26.1 ng/mL (SD 13.7) in children without asthma (p = 0.28). Vitamin D deficiency (25(OH)D < 20 ng/ml) was more common in Pampas than in Villa El Salvador (52.7% vs. 10.5%; p < 0.001). In the overall study population, a 10 ng/ml decrease in serum 25(OH)D concentrations was not significantly associated with odds of asthma (OR 1.09, 95% CI: 0.94 to 1.25). However, vitamin D deficiency was associated with a 1.6-fold increase in odds of asthma in the overall cohort (95% CI: 1.14 to 2.25). After stratifying by site, a 10 ng/mL decrease in serum 25(OH)D concentrations was associated with 18% higher odds of having asthma in Pampas (OR = 1.18, 95% CI 1.02 to 1.38), whereas there was no significant association between 25(OH)D concentrations and asthma in Villa El Salvador (OR = 0.95, 95% CI 0.87 to 1.05). Combined data from these geographically adjacent populations suggests a possible threshold for the relationship between 25(OH)D levels and asthma at approximately 27.5 ng/ml. Serum 25(OH)D concentrations were not clearly associated with asthma control, total serum IgE, atopy, or airway inflammation.

Conclusion

Serum 25(OH)D concentrations were inversely associated with asthma in one study community with a high prevalence of deficiency. Studies are needed to investigate a possible threshold 25(OH)D concentration after which higher vitamin D levels show no further benefit for asthma.

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Asthma: epidemiology of disease control in Latin America – short review

Juan Carlos Ivancevich Friday, 12 May 2017 16:47
Dirceu Solé, Carolina Sanchez Aranda and Gustavo Falbo Wandalsen
 

Abstract

Asthma is reported as one of the most common chronic diseases in childhood, impairing the quality of life of patients and their families and incurring high costs to the healthcare system and society. Despite the development of new drugs and the availability of international treatment guidelines, asthma is still poorly controlled, especially in Latin America. Original and review articles on asthma control or epidemiology with high levels of evidence have been selected for analysis among those published in PubMed referenced journals during the last 20 years, using the following keywords: “asthma control” combined with “Latin America”, ” epidemiology”, “prevalence”, “burden”, “mortality”, “treatment and unmet needs”, “children”, “adolescents”, and “infants”. There was a high prevalence and severity of asthma during the period analyzed, especially in children and adolescents. Wheezing in infants was a significant reason for seeking medical care in Latin American health centers. Moreover, the frequent use of quick-relief bronchodilators and oral corticosteroids by these patients indicates the lack of a policy for providing better care for asthmatic patients, as well as poor asthma control. Among adults, studies document poor treatment and control of the disease, as revealed by low adherence to routine anti-inflammatory medications and high rates of emergency care visits and hospitalization. In conclusion, although rare, studies on asthma control in Latin America repeatedly show that patients are inadequately controlled and frequently overestimate their degree of asthma control according to the criteria used by international asthma treatment guidelines. Additional education for doctors and patients is essential for adequate control of this illness, and therefore also for reduction of the individual and social burden of asthma.

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Asthma in the elderly: a double-blind, placebo-controlled study of the effect of montelukast

Juan Carlos Ivancevich Tuesday, 18 April 2017 12:10
Michele Columbo

Published: 17 April 2017

Abstract

Background

Little is known about asthma in the elderly as most studies of this condition have not included this patient group. It is unclear whether leukotriene antagonists benefit older asthmatics. We studied the effect of adding montelukast to the asthma treatment of elderly subjects.

Methods

Twenty-five subjects 65 years old and older with asthma were evaluated at week 0, 1, 5, 9, 13, and 17. Each subject received montelukast 10 mg and placebo each for 8 weeks in a cross-over design.

Results

Montelukast for 4 or 8 weeks did not significantly affect ACT, daily symptom scores, number of puffs of albuterol, spirometric values, peripheral blood eosinophils, or serum IgE vs. baseline or placebo. Similar results were obtained when analyzing subgroups of patients with lower ACT, lower FEV1, and higher eosinophils.

Conclusions

In this study of elderly asthmatics, montelukast had no effect on asthma symptoms, number of puffs of albuterol, spirometric values, peripheral blood eosinophils or serum IgE. These results will require confirmation in larger patient cohorts and in patients with uncontrolled asthmatic symptoms.

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Asthma Research and Practice - Submission guidelines

Juan Carlos Ivancevich Thursday, 09 March 2017 12:14

Submission guidelines

Our 3-step submission process

 

 

  1.  Before you submit

    Now you’ve identified a journal to submit to, there are a few things you should be familiar with before you submit.

  2.  Ready to submit

    To give your manuscript the best chance of publication, follow these policies and formatting guidelines.

  3.  Submit and promote

    After acceptance, we provide support so your article gains maximum impact in the scientific community and beyond.

Submit your manuscript in Editorial Manager

Gender-specific determinants of asthma among U.S. adults

Juan Carlos Ivancevich Thursday, 02 February 2017 13:56
Rebecca Greenblatt, Omar Mansour, Edward Zhao, Michelle Ross and Blanca E Himes This email address is being protected from spambots. You need JavaScript enabled to view it.
 

Abstract

Background

Asthma, a chronic respiratory disease affecting over 18.7 million American adults, has marked disparities by gender, race/ethnicity and socioeconomic status. Our goal was to identify gender-specific demographic and socioeconomic determinants of asthma prevalence among U.S. adults using data from the Behavioral Risk Factors Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES).

Methods

Gender-specific regression analyses were performed to model the relationship between asthma prevalence with age, race/ethnicity, income, education level, smoking status, and body mass index (BMI), while taking into account the study designs.

Results

Based on BRFSS data from 1,003,894 respondents, weighted asthma prevalence was 6.2% in males and 10.6% in females. Asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese women was 2.5 and 3.5 times higher, respectively, while that in men was 1.7 and 2.4 times higher; asthma prevalence among current vs. never smoker women was 1.4 times higher, while that in men was 1.1 times higher. Similar results were obtained with NHANES data from 13,364 respondents: asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese respondents was 2.0 and 3.3 times higher for women, though there was no significant difference for men; asthma prevalence among current vs. never smokers was 1.8 times higher for women and not significantly different in men. Asthma prevalence by race/ethnicity and income levels did not differ considerably between men and women.

Conclusions

Our results underscore the importance of obesity and smoking as modifiable asthma risk factors that most strongly affect women.

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Asthma costs and social impact

Juan Carlos Ivancevich Wednesday, 01 February 2017 13:12
 
Carlos Nunes, Ana Margarida Pereira and Mário Morais-Almeida

Abstract

In recent decades, both asthma prevalence and incidence have been increasing worldwide, not only due to the genetic background, but mainly because of the effect of a wide number of environmental and lifestyle risk factors.

In many countries noncommunicable diseases, like asthma, are not yet considered a healthcare priority. This review will analyze and discuss disparities in asthma management in several countries and regions, such as access to healthcare human resources and medications, due to limited financial capacity to develop strategies to control and prevent this chronic disease.

This review tries to explore the social and economic burden of asthma impact on society. Although asthma is generally accepted as a costly illness, the total costs to society (direct, indirect and intangible asthma costs) are difficult to estimate, mainly due to different disease definitions and characterizations but also to the use of different methodologies to assess the asthma socio-economic impact in different societies.

The asthma costs are very variables from country to country, however we can estimate that a mean cost per patient per year, including all asthmatics (intermittent, mild, moderate and severe asthma) in Europe is $USD 1,900, which seems lower than USA, estimated mean $USD 3,100.

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Happy New Year 2017!!!

Juan Carlos Ivancevich Saturday, 31 December 2016 13:54

Preacutionary labelling of cross-reactive foods: The case of rapeseed

Juan Carlos Ivancevich Tuesday, 08 November 2016 13:17

Asthma Research and Practice

Alessandro Fiocchi, Lamia Dahdah, Carla Riccardi, Oscar Mazzina and Vincenzo Fierro

Abstract

Food allergic individuals are exposed to unnecessary dietary restrictions due to precautionary food allergy labelling (PFAL). Two forms of PFAL exist: type I identifies the possible presence of allergenic contaminaion in foods (‘may content…’), type II indicates as potentially dangerous ingredients or contaminants that do no belong to official list of food allergens. PFAL type II is based on the fear of cross-reactivity with foods belonging to that list. PFAL type II is less known, but may be tempting for the legal offices of food companies, for clinicians in a ‘defensive medicine’ key, and even for legislators. We identify here a case of PFAL type II, allergy to rapeseed (belonging to the family of Brassicaceae). Increasingly used for their nutritional and nutraceutic value in asthma prevention, rapeseed has been indicated by regulatory authorities in Canada and Europe as potential cross-reactor with mustard. In this review, we provide the elements for a risk assessment of cross-reactivity of rapeseed/mustard allergy in the general population both clinically and from the point of view of the molecular allergy. Three findings emerge:

1. Allergic reactions to rapeseed are exceptional

2. The allergens identified in rapeseed and mustard are similar, but not identical

3. Reactions to rapeseed have never been described in mustard-allergic patients.

On the ground of existing evidence, a precautionary labeling for rapeseed as potentially dangerous for patients allergic to mustard is not justified. In the interest of patients with multiple food allergy, PFAL type II must be avoided.

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Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (

Juan Carlos Ivancevich Monday, 31 October 2016 15:19
F. Braido, N. Scichilone, F. Lavorini, O. S. Usmani, L. Dubuske, L. P. Boulet, R. Mosges, C. Nunes, M. Sánchez-Borges, I. J. Ansotegui, M. Ebisawa, F. Levi-Schaffer, L. J Rosenwasser, J. Bousquet, T. Zuberbier, G. Walter CanonicaEmail author, for the Interasma Executive Board, WAO Board of Directors, ARIA and GA²LEN

Abstract

Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases.

Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change.

The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction.

In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant.

Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy.

This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.

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Asthma Research and Practice - Submission guidelines

Juan Carlos Ivancevich Friday, 14 October 2016 22:36

Asthma Research and Practice

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The official journal of Interasma

Submission guidelines

Our 3-step submission process

Before you submit

Now you’ve identified a journal to submit to, there are a few things you should be familiar with before you submit.

 Ready to submit

To give your manuscript the best chance of publication, follow these policies and formatting guidelines.

Asthma Research and Practice publishes the following article types:

Click the relevant link to find style and formatting information for the article you are going to submit.

Submit and promote

After acceptance, we provide support so your article gains maximum impact in the scientific community and beyond.

Submit your manuscript in Editorial Manager

 

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