Momordica charantia L. improves airway hyperresponsiveness and suppresses inflammation in a murine model of allergic asthma

Objective To evaluate the effect of a hydroethanolic extract of Momordica charantia L. (“bitter melon”, Cucurbitaceae) leaves (MCHA) on ovalbumin (OVA)-induced asthma model. Balb/c mice were sensitized twice and challenged for 4 alternate days with OVA and then treated with MCHA (500 mg/kg) for 7 consecutive days.Methods Control groups received treatment with normal saline or dexamethasone (2 mg/kg) on the same day. We assessed in vivo bronchial hyperresponsiveness and ex-vivo inflammation and mucus production in bronchoalveolar lavage (BAL), lung homogenates, and lung tissue.Results MCHA significantly improved airway hyperresponsiveness near baseline levels. MCHA administration significantly improved airway and lung inflammation, demonstrated by decreased total and inflammatory cells in BAL, lower levels of IL-5 and IL-13 in lung homogenate, and fewer inflammatory cells in lung tissue. Additionally, MCHA significantly diminished goblet cells in lung tissue.Conclusions Administration of a hydroethanolic extract of M. charantia leaves was effective in treating OVA-induced asthma in an animal model (AU)

Survey of immunopharmacological effects of botulinum toxin in cell signaling of bronchial smooth muscle cells in allergic asthma

Background Asthma is a lung disease that has influenced more than 350 million people worldwide. Airway smooth muscle (ASM) spasm leads to airway hyperresponsiveness (AHR) and bronchial obstruction, which are clinical manifestations of an asthma attack. Botulinum toxin (BTX) is a bacteria toxin that acts as muscle relaxant and may have therapeutic effects on AHR and asthma.Objective In this study, the effect of BTX on AHR and related gene expressions was evaluated.Material and Methods An asthma mice model was developed which was treated with BTX in two ways: intranasally (IN) and via nebulization (N) (0.01, 0.1, and 1 U/mL and 10 U/mL, respectively) on days 25, 27 and 29. AHR was evaluated on days 24, 26, 28, and 30, and gene expressions were evaluated for TrkA, TrkB, M1–M5, α7nAChR, TNF-α, and extracellular signal-regulated kinase 2 (ERK2) proteins. For histopathology of the lungs, perivascular and peribronchial inflammation, production of mucus, and goblet cell hyperplasia were studied.Results On day 24, treatment with BTX (for all doses) had no significant effect on AHR, but on days 26 and 28, AHR was decreased and this continued up to day 30 for all treated groups. Treatment with BTX had no significant effect on the gene expressions of TrkA, TrkB, M1–M5, α7nAChR, TNF-α, and ERK2 proteins, perivascular inflammation, peribronchial inflammation, hyperplasia of the goblet cell and production of mucus. Besides, mice administered with 10 mg/mL BTX perished. The BTX therapy controlled asthma attacks by decreasing AHR and relaxation of ASMs.Conclusion However, BTX had no significant effect on airway inflammation and production of mucus. While using BTX, it is necessary to prescribe safe doses in order to prevent adverse reactions (AU)

El manejo del asma como enfermedad inflamatoria crónica y problema sanitario global: documento de posicionamiento de las sociedades científicas / The management of asthma as a chronic inflammatory disease and global health problem: a position paper from the scientific societies

El asma es la enfermedad respiratoria más prevalente en el mundo; puede afectar a personas de todas las edades y es potencialmente mortal. En la actualidad, contamos con tratamientos de mantenimiento que son efectivos en la mayoría de los pacientes con asma y, sin embargo, una proporción importante no tiene bien controlada su enfermedad a pesar de los medios disponibles. En este documento, con el respaldo de las sociedades de los médicos que tratan el asma en España, se quiere llamar la atención de la sociedad y los profesionales sobre este problema en nuestro país. Se pone el foco sobre los aspectos clínicos, diagnósticos y terapéuticos del asma y se plantean algunas acciones de mejora en el ámbito de los pacientes y en el profesional sanitario que, en vista de los resultados actuales derivados de la falta de control del asma, podrían ser beneficiosas tanto en los resultados clínicos para los pacientes como en los de salud pública

Asthma is the most prevalent respiratory disease worldwide and it can affect people of all ages and is potentially fatal. Today, maintenance treatments are available that are effective in most patients, yet a significant proportion have poorly controlled disease, despite the resources on offer. This document, endorsed by members of the Spanish medical societies involved in the treatment of asthma, is intended to draw the attention of society and professionals to this problem in Spain. It focuses on the clinical, diagnostic and therapeutic aspects of asthma, and proposes some actions for improvement as regards patients and healthcare professionals which, in view of the current results arising from inadequate asthma control, might be beneficial to improve outcomes for both patients and public health

Asthma diagnosis and lung testing: Where is the boundary of asthma?

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Displasia broncopulmonar: importancia del ejercicio físico / Bronchopulmonary Dysplasia: The Importance Of Physical Exercise

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Early life origins of asthma: a review of potential effectors

There is growing evidence that events occurring early in life, both before and after birth, are significantly associated with the risk of asthma, chronic obstructive pulmonary disease, and diminished lung function later in life. In fact, from conception to death, a series of continuous, dynamic gene-environment interactions determine 2 fundamental biological processes, namely, lung development and lung aging. Over 130 birth cohorts have been initiated in the last 30 years. Data from these cohorts have improved our understanding of the inception, progression, and persistency of asthma. In this review, we summarize the main data for the early life events proven to determine later development and persistence of asthma, such as maternal atopy and smoking, preterm birth/bronchopulmonary dysplasia, infections, nutrition, obesity, smoking, and other environmental exposures in childhood and adolescence. While some of these factors are obviously impossible to prevent or eliminate, others have been proven to have a protective role, and current research is aimed optimizing them. Available prophylactic measures are also reviewed. In the case of environmental pollution, large scale political interventions successfully managed to decrease contamination levels, leading to improved lung function and lower asthma prevalence in the respective geographical areas. Future research should focus on better understanding these complex interactions in order to develop and enhance effective preventive therapeutic measures

Existe evidencia de que eventos que ocurren en fases tempranas de la vida, tanto antes como después del nacimiento, se asocian significativamente con el aumento del riesgo futuro de asma, enfermedad pulmonar obstructiva crónica y deterioro de la función pulmonar. En efecto, desde el momento de la concepción hasta la muerte, una serie de interacciones dinámicas y continuas genético-ambientales determinan dos procesos biológicos fundamentales, el desarrollo pulmonar y el envejecimiento pulmonar. En los últimos 30 años se han comenzado más de 130 cohortes de nacimiento. Los datos de estas cohortes han mejorado nuestra comprensión del inicio, la progresión y la persistencia del asma. En esta revisión, resumimos los datos principales de los eventos de la vida temprana probados que determinan el desarrollo y la persistencia posteriores del asma, como atopia materna y tabaquismo, parto prematuro/displasia broncopulmonar, infecciones, nutrición, obesidad, tabaquismo y otras exposiciones ambientales en la infancia y la adolescencia. Si bien algunos de estos factores son obviamente imposibles de prevenir o eliminar, se ha demostrado que otros tienen un papel protector, y la investigación actual apunta a optimizarlos. También se revisan las medidas profilácticas disponibles. En el caso de la contaminación ambiental, las intervenciones políticas a gran escala lograron disminuir los niveles de contaminación, lo que mejoró la función pulmonar y disminuyó la prevalencia de asma en las respectivas áreas geográficas. Las investigaciones futuras deberían centrarse en comprender mejor estas interacciones complejas para desarrollar y mejorar las medidas terapéuticas preventivas eficaces

From rhinitis to asthma: Is small airway disfunction the clue?

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Multispecies probiotics combination prevents ovalbumin-induced airway hyperreactivity in mice

BACKGROUND: Probiotics could be beneficial to health and some of them have shown to modulate immune responses. AIM: The aim of this study is to investigate if the probiotic strains including Lactobacillus and Pediococcus strains are able to alleviate allergic reactions in an ovalbumin-induced airway allergy model. METHODS: Lactobacillus multi-species preparation (LMP) was gavaged to BALB/c for total six weeks and BALB/c was challenged with ovalbumin in the last two weeks. A barometric whole-body plethysmography was used to assess enhanced pause (Penh) of airway hyperreactivity (AHR). Immunoglobulins (Ig) such as IgE, IgG1, IgG2a and cytokines such as IL-12, IFN-gamma, IL-4, IL-5, TNF-alfa and IL-13 in bronchoalveolar lavage fluid were assayed using ELISA kits. RESULTS: The results showed this LMP significantly reduced Th2 cytokines and enhanced Th1 cytokines production. OVA-specific IgE and IgG1 was lower in the probiotics-treated mice whereas IgG2a was increased. Most importantly, this murine model showed LMP supplementation significantly reduced AHR. CONCLUSIONS: Overall, this Lactobacillus multi-species preparation seemed to suppress OVA-sensitized airway hyperreactivity, thus serving as a possible candidate for therapeutic uses for allergic airway symptoms

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Sensibilidad Química Múltiple: análisis de un caso registrado en un Hospital de referencia / Multiple Chemical Sensitivity: analysis of a case registered in a reference hospital

Introducción: La contaminación y la exposición a productos químicos han condicionado un aumento de la prevalencia de enfermedades crónicas no sólo explicables por la genética o susceptibilidad individual. La Sensibilidad Química Múltiple (SQM) es un ejemplo de estas afecciones. Se trata de un trastorno adquirido, crónico y caracterizado por la aparición de síntomas recurrentes como respuesta a la exposición a compuestos químicos en concentraciones que no se consideran tóxicas para la población general. Su etiología es incierta y multifactorial, su diagnóstico clínico y su abordaje multidisciplinar. En ocasiones está vinculada a la exposición ocupacional, aunque la diversidad de sustancias que pueden desencadenarla la convierten en impredecible. Objetivo: La finalidad de este trabajo es aportar una visión general sobre esta patología con el objetivo de analizar la situación derivada de dicha afección tras la revisión de un caso de SQM. Metodología: Revisión bibliográfica del SQM mediante la búsqueda de literatura científica durante el mes de septiembre de 2017 utilizando los términos Mesh «Multiple Chemical Sensitivity.» Se presenta un caso clínico con diagnóstico de SQM vinculado a exposición ocupacional y se analiza la situación derivada de esta afección. Resultados: Se describe el caso clínico de una trabajadora de 45 años de edad, técnico de laboratorio en un hospital de referencia que tras el diagnóstico de hiperreactividad bronquial probablemente relacionado con la exposición a determinados reactivos comienza un periodo de incapacidad temporal con adaptaciones, cambios de puesto de trabajo y múltiples valoraciones por distintos especialistas hasta llegar al diagnóstico de SQM. Se analiza el informe médico de valoración y el expediente administrativo derivado de esta afección poniendo de manifiesto la dificultad que entraña la valoración de este tipo de patologías. Conclusión: Las peculiaridades del SQM en cuanto etiología, diagnóstico y tratamiento obligan a individualizar cada caso. La subjetividad que rodea el SQM lo convierte en una afección muy difícil de valorar. Uno de los grandes desafíos en la actualidad es continuar investigando para facilitar el abordaje multidisciplinar que requiere esta dolencia

Introduction: Pollution and exposure to chemical products has conditioned an increase in the prevalence of chronic diseases not only explained by genetics or individual susceptibility. The Multiple Chemical Sensitivity (MCS) is an example of these conditions. It is an acquired, chronic disorder identified by recurrent symptoms in response to exposure to chemical compounds at concentrations that are not considered toxic for the general population. Its etiology is uncertain and multifactorial; its diagnosis is clinical and must be multidisciplinary approached. It is sometimes linked to occupational exposure, being unpredictable most of the times due to the diversity of the categories that may trigger it. Objective: The purpose of this work is to provide a general overview of this pathology with the aim of analize the situation derived from this condition reviewing a case of MCS. Methodology: Literature review of the MCS through the search of scientific literature in the month of September 2017 using the terms Mesh «Multiple Chemical Sensitivity». A clinical case with a MCS diagnosis linked to an occupational exposure is presented and the consequences of the condition are analyzed. Results: The clinical case of a 45-year-old female laboratory technician in a reference hospital is described. After the diagnosis of bronchial hyperreactivity, probably related to certain reagents exposure, she begins a period of temporary disability with adaptations, changes in workplace and several valuations by specialized doctors ending with the diagnosis of MCS. The analysis of the medical assessment report and administrative record highlights the difficulty to assess this type of pathologies. Conclusion: The peculiarities of MCS in terms of etiology, diagnosis and treatment make it necessary to individualize each single case. The subjectivity surrounding the SQM makes it a very difficult condition to assess. One of the great challenges nowadays is to continue researching to facilitate the multidisciplinary approach that this ailment requires

Low dose treatment of mice with bacterial extract (OM-85) for attenuation of experimental atopic asthma in mice - Reply

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Exposición al aire contaminado por humo del tabaco en niños de una consulta de Neumología pediátrica / Exposition to contaminated air due to tobacco smoke in children of an office of pediatric pneumology

Objetivo: El objetivo principal es analizar el porcentaje de niños que acuden a la consulta de Neumología pediátrica que están expuestos al aire contaminado por humo del tabaco (ACHT). Pacientes y método: Se seleccionó una muestra de 201 niños entre 0 y 14 años que acudían a una consulta de Neumología pediátrica. El progenitor que acudía a la consulta respondía un cuestionario y el resto de la información se obtuvo de la historia clínica del niño. Se realizó una intervención breve sobre todos los progenitores. Resultados: El 39% de los niños estaban expuestos al ACHT. Un 19,4% de las madres reconocieron haber fumado en presencia de su hijo y un 18,4% de los padres. Pidieron cita para la consulta de tabaco el 20% de las madres y el 23,9% de los padres fumadores. Tanto en el grupo de niños expuestos como no expuestos la patología más frecuente fue el asma o hiperreactividad bronquial. Conclusiones: El 39% de los niños estaban expuestos al ACHT. Pocos padres muestran su deseo de dejar de fumar. La prohibición de fumar en domicilio no siempre es cumplida. No encontramos diferencias en cuanto a enfermedades entre el grupo de expuestos y no expuestos al ACHT. Desde la consulta de pediatría se puede informar y motivar a todos los padres fumadores para el abandono del tabaco

Objetive: To analyze the percentage of children who are exposed to smoke tobacco pollution in respiratory pediatric practice.Patients and methods. 201 children between 0 and 14 years were selected from respiratory pediatric practice. The information was obtained from a questionnaire answered by the parents who go to the clinic and from the medical history of the child. A brief intervention was carried out with all parents. Results: 39% of children were exposed to tobacco smoke pollution. 19.4% of mothers and 18.4% of fathers recognized smoking next to their children. 20% smoker mothers and 23.9% smoker fathers booked a date for quit smoking. The most frequent respiratory disease among children, both exposed and no tobacco pollution exposed, was asthma and bronchial hyperreactivity. Conclusions: 39% of children were exposed to tobacco smoke pollution. Only few parents want to quit smoking. A ban on smoking in the home is not obey in all cases. There were no differences found between diseases in both groups of exposed and no tobacco exposed. The pediatric practice is an opportunity to inform and motivate smoke cessation in parents

Una variante rara del síndrome de la cimitarra / Uncommon Variant of Scimitar Syndrome

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Post-bronchodilator Reversibility of FEV1 and Eosinophilic Airway Inflammation in COPD / Reversibilidad del FEV1 postbroncodilatador e inflamación eosinofílica de la vía aérea en la EPOC

Introduction: The relationship between bronchodilator responsiveness and eosinophilic airway inflammation has not been well documented in COPD. It has been investigated in this retrospective study. This issue has grown in importance due to increasing interest in the asthma-COPD overlap syndrome. Methods: 264 stable COPD patients with no past history of asthma were retrospectively analyzed. Correlation analyses between FEV1 reversibility and sputum eosinophil levels were conducted. Sputum eosinophil levels were dichotomized using FEV1 reversibility cut-off points (>0.4 L and >15% vs. >0.2L and >12%) and compared. The effectiveness of FEV1 reversibility to predict sputum eosinophilia (>3%) was analyzed with a logistic regression and a ROC analysis. Results: 82 (31.1%) patients with higher FEV1 reversibility values (0.14 vs. 0.11 L, P = .01) presented sputum eosinophilia. FEV1 reversibility was weakly correlated with the sputum eosinophil level (r = 0.162, P = .008). Patients with FEV1 > 0.4 L and >15% increment had higher sputum eosinophil levels (6.11 vs. 1.02%, P = .049) whereas the level did not differ when dichotomized by FEV1 increment >0.2 L and >12%. Very positive FEV1 reversibility (>0.4L and >15%) predicted sputum eosinophilia after adjustment forage, baseline FEV1 and FVC (OR: 4.262, P = .029). In the ROC analysis, the AUC was 0.58 (P = .034), and FEV1 increment>0.4L and >15% had a positive predictive value of 63.6% and an overall accuracy of 70.1%. Conclusions: FEV1 reversibility was weakly correlated with sputum eosinophil levels in COPD. Positive FEV1 reversibility (> 0.4 L and >15%) is moderately successful in predicting sputum eosinophilia (> 3%)

La relación entre la reactividad al broncodilatador y la inflamación eosinofílica de la vía aérea no está bien documentada en la EPOC y se ha investigado en este estudio retrospectivo. Esta cuestión ha adquirido mayor importancia debido al creciente interés que despierta el fenotipo mixto asma-EPOC. Métodos: Se analizó retrospectivamente a 264 pacientes con EPOC estable y sin antecedentes de asma. Se efectuaron análisis de correlación entre la reversibilidad del FEV1 y las concentraciones de eosinófilos en esputo, que se compararon una vez dicotomizadas en función de diferentes puntos de corte de la reversibilidad del FEV1 (> 0,4 l y > 15% vs. > 0,2 l y > 12%). La utilidad de la reversibilidad del FEV1 para predecir la eosinofilia del esputo (> 3%) se evaluó mediante una regresión logística y un análisis de la curva ROC. Resultados: En los 82 pacientes (31,1%) que presentaban eosinofilia del esputo, la reversibilidad del FEV1 fue mayor (0,14 vs. 0., 1 l, p = 0,01). La reversibilidad del FEV1 se correlacionó débilmente con la concentración de eosinófilos en esputo (r = 0,162, p = 0,008). Los pacientes con incrementos del FEV1 > 0,4 l y > 15% mostraron mayores concentraciones de eosinófilos en el esputo (6,11 vs. 1,02%, p = 0,049), aunque las concentraciones no difirieron tras dicotomizarlas de acuerdo a un incremento del FEV1 > 0,2 l y > 12%. Tras ajustarla en función de la edad, el FEV1 inicial y la FVC, la reversibilidad del FEV1 muy alta (> 0,4 l y > 15%) continuó siendo significativa para predecir la eosinofilia del esputo (OR: 4,262, p=0,029). El análisis de la curva ROC mostró que el valor predictivo positivo de un AUC de 0,58 (p=0,034) y un incremento del FEV1 > 0,4 l y > 15% es del 63,6%, con una precisión total del 70,1%. Conclusiones: En pacientes con EPOC, la reversibilidad del FEV1 se correlacionó débilmente con las concentraciones de eosinófilos en esputo. Una reversibilidad del FEV1 muy alta (> 0,4l y > 15%) puede predecir la eosinofilia del esputo (> 3%), pero su rendimiento es modesto

Evidencias en el uso de la vitamina D, la azitromicina y los corticoides para la hiperreactividad bronquial / Evidence on vitamin D, azithromycin and corticosteroids use for bronchial hyperreactivity

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Infectious and noninfectious pulmonary complications in patients with primary immunodeficiency disorders

Primary immunodeficiency disorders (PIDs) are caused by 1 or more defects of the immune system. Patients are more likely to experience recurrent and/or severe infections and tend to develop a wide range of complications. Respiratory diseases are the main and initial manifestation in most cases and the most common complication. Pulmonary complications cause significant morbidity and mortality in patients with PIDs. Early diagnosis and appropriate treatment can prevent or at least slow the development of respiratory complications. Since the spectrum of pulmonary complications in PIDs is broad, we divided pulmonary complications into upper respiratory complications (eg, sinusitis, otitis media, and laryngeal angioedema) and lower respiratory complications (eg, pneumonia, bronchitis, bronchiectasis, interstitial lung diseases, organizing pneumonia, pulmonary adenopathies and malignancies, hyperreactive airway diseases, pulmonary dysgenesis, and adverse reactions to treatment). This review covers the main respiratory manifestations in patients with PIDs (AU)

Las inmunodeficiencias primarias (PIDs) son enfermedades causadas por uno o más defectos del sistema inmunológico. Estos pacientes presentan con frecuencia infecciones recidivantes y/o severas así como otro tipo de complicaciones. Las patologías respiratorias son la principal y más frecuente manifestación y complicación de las PIDs. Las complicaciones de estas patologías pulmonares constituyen una de las principales causas de morbimortalidad entre los pacientes que sufren PIDs. El diagnóstico temprano y el tratamiento adecuado pueden prevenir, o al menos retrasar, la aparición de las complicaciones respiratorias en estos pacientes. Dado que el espectro de las enfermedades pulmonares es muy amplio, hemos dividido estas complicaciones entre aquellas que afectan a las vías aéreas superiores (sinusitis, otitis media y angioedema laríngeo, etc.) y las que afectan a las vías aéreas bajas (neumonía, bronquitis, bronquiectasias, enfermedades pulmonares intersticiales, neumonía organizada, adenopatías pulmonares y neoplasias, hiperreactividad bronquial, disgenesia pulmonar y las debidas a los efectos secundarios del tratamiento instaurado). Este artículo revisa las manifestaciones respiratorias que se observan más frecuentemente en los pacientes con PIDs (AU)

Lung sound analysis is useful for monitoring therapy in patients with bronchial asthma

Background: Lung sound analysis (LSA) has been reported to be useful for predicting airway obstruction and inflammation in patients with bronchial asthma. Objectives: We examined whether the exhalation-to-inhalation sound pressure ratio in the middle frequency range (200-400 Hz) (E/I MF) is useful for monitoring therapy in patients with asthma. Methods: The study population comprised 84 patients with mild to moderate asthma whose LSA data were available before and after 1 year of daily treatment with (budesonide 800 μg). We analyzed whether the E/I MF before and after treatment was associated with the fractional exhaled nitric oxide (FeNO) level, sputum eosinophil percentage, respiratory function, and airway hyperresponsiveness. Results: Prior to treatment with budesonide, the E/I MF was significantly correlated with respiratory function, airway hyperresponsiveness, FeNO, and sputum eosinophil percentage. The cutoff values for the E/I MF to detect the abnormalities of respiratory function, FeNO, and sputum eosinophil percentage were 0.367, 0.358, and 0.363, respectively. With respect to the reference value, the E/I MF improved significantly in patients whose respiratory function and FeNO benefited from therapy with budesonide compared with patients whose respiratory function did not benefit from budesonide (odds ratios of 6.39 and 4.78, respectively). According to the multivariate analysis, patients whose E/I MF did not improve had a longer history of smoking (P=.038), poorer posttreatment respiratory function (P=.028), and higher posttreatment FeNO (P=.0095). Conclusion: Similar to respiratory function and FeNO, E/I MF based on LSA is a useful indicator for monitoring the efficacy of therapy in asthmatic patients (AU)

Introducción: El análisis de los sonidos pulmonares ha demostrado ser una prueba de utilidad para objetivar la presencia de obstrucción e inflamación en las vías respiratorias de pacientes con asma bronquial. Objetivos: Hemos evaluado si el cociente sonido inspiración-espiración por presión en el rango de frecuencias medias, de 200 a 400 Hz, (E/I MF) tenía utilidad en la evaluación de la respuesta al tratamiento en pacientes con asma bronquial. Métodos: El estudio incluyó 84 pacientes con asma leve o moderada que tuvieran registros de LSA antes y tras un año de tratamiento con 800 μg de budesonida inhalada. Analizamos si los cambios en E/I MF tras el tratamiento se correlacionaban con los cambios en los niveles de óxido nítrico en aire exhalado (FeNO), el porcentaje de eosinófilos en muestras de esputo inducido, la función pulmonar y la hiperreactividad bronquial. Resultados: Antes de iniciar el tratamiento con budesonida inhalada, el cociente E/I MF se correlacionaba significativamente con la función pulmonar, la hiperreactividad bronquial, los niveles de FeNO y el porcentaje de eosinófilos en las muestras de esputo. Los puntos de corte del cociente E/I MF para detectar valores anómalos en la función pulmonar, los niveles de FeNO, y el porcentaje de eosinófilos en esputo eran 0,367, 0,358 y 0,363 respectivamente. El cociente E/I MF mejoraba significativamente en el grupo de pacientes en los que la budesonida inhalada inducía cambios significativos en la función pulmonar o en los niveles, con respecto a los valores de referencia apropiados comparados con los de los grupos de pacientes que no presentaban mejoría en estos parámetros (odds ratios de 6,39 y 4,78, respectivamente). En un análisis multivariante los pacientes que no presentaban mejoras significativas en el cociente E/I MF presentaban una historia de tabaquismo activo significativamente más larga (p=,038), unos niveles de función pulmonar tras tratamiento significativamente más bajos (p=,028), y paralelamente unos niveles de FeNO, tras tratamiento, más elevados (p=,0095). Conclusiones: Al igual que la función pulmonar y los niveles de FeNO, el cociente E/I MF obtenido mediante el LSA es un indicador útil para evaluar la eficacia del tratamiento en pacientes con asma bronquial (AU)

Mediterranean diet and childhood asthma

BACKGROUND: The incidence of bronchial hyperreactivity has increased to one-third of the population in developed countries, which requires the adoption of preventive and therapeutic measures. The objective of the present study was to assess the effects of a traditional Mediterranean diet on patients diagnosed with childhood asthma and determine if there is a beneficial effect from this dietary intervention. METHODS: Prospective before-after comparison study of 50 girls and 54 boys aged 1-5 years, who were enrolled in the 1-year programme "Learning to Eat from the Mediterranean", designed to promote the adoption of a traditional Mediterranean diet. We studied the clinical and therapeutic variables and anthropometric measurements. RESULTS: All studied symptomatic indicators (number and intensity of asthmatic attack, infections and hospital admissions) showed a positive and statistically significant evolution of bronchial hyperreactivity from the first weeks of the intervention onwards. Throughout the treatment, 32.2% of patients remained free of crisis, 35.3% of the patients only had one attack throughout the year and 24.9% had two episodes, compared to 4.73 episodes on average in the previous year. The use of inhaled corticosteroids markedly decreased from 3.92 ± 1.61 to 1.11 ± 1.09 times per patient per year (P < 0.001) and that of inhaled bronchodilators decreased from 4.14 ± 1.61 to 1.12 ± 1.40 (P < 0.001). As a result, the families involved in the programme reported a high level of satisfaction. CONCLUSIONS: The adoption of a traditional Mediterranean diet could contribute significantly to the improvement of patients diagnosed with childhood asthma

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Effect of once-daily generic ciclesonide on exhaled nitric oxide in atopic children with persistent asthma

BACKGROUND: Ciclesonide (CIC) is an effective inhaled corticosteroid for treating asthmatic children. However, its effect on airway inflammation assessed by the fraction of exhaled nitric oxide (FENO) in children with persistent asthma is virtually unknown. We aimed to assess the effect of once-daily generic CIC, 80 or 160 μg, on FENO, lung function, asthma control and bronchial hyperresponsiveness, in atopic children with persistent asthma. METHODS: This was a 12-week, randomised, double-blind, parallel-group study. Sixty children with mild-to-moderate persistent asthma were recruited. Changes in FENO, asthma control score, lung function (FEV1) and bronchial hyperresponsiveness to methacholine (BHR) were used to assess the effects of both CIC doses. Non-normally distributed variables were log-transformed to approximate normality, and parametric tests were used for comparisons within and between groups at baseline and after 12 weeks of treatment. RESULTS: In the CIC 80 μg group, FENO decreased from 45.0 ppb (95% CI 37.8-53.7) to 32.7 ppb (95% CI 21.0-47.3) at the end of study (P = 0.021), whereas in the CIC 160 μg group, FENO decreased from 47.3 ppb (95% CI 40.4-55.3) to 30.5 ppb (95% CI 24.1-38.7) (P < 0.001). The difference between groups in FENO at the end of study was not significant (P = 0.693). There was a significant improvement of asthma control with both CIC doses but there was no significant change in BHR or FEV1 in either group. CONCLUSION: Once-daily generic ciclesonide (80 μg or 160 μg), for 12 weeks, is effective to improve airway inflammation and asthma control in atopic children with persistent asthma

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