Obstructive sleep apnea: The key for a better asthma control?

INTRODUCTION: Obstructive sleep apnea (OSA) is an important risk factor for poor asthma control. The objective of this study is to analyze the symptomatic control in asthmatic patients with OSA after using continuous positive airway pressure (CPAP). METHODS: Patients were collected in a monographic asthma consult and a polygraphy was performed due to clinical suspicion or poor disease control. Asthma associated pathologies, as well as clinical and patient-perceived asthma control parameters were evaluated before and after the initiation of CPAP. RESULTS: A hundred patients were included, 59% were women and 41% men. From them, 54% had severe OSA, 33% moderate OSA and 13% mild OSA, and 10% could not tolerate CPAP. Eighty four percent had a moderate or severe degree of asthma with fractional exhaled nitric oxide (FENO) 32 ± 24.6 ppm and an asthma control test (ACT) before CPAP of 19 ± 4. Asthma control before CPAP was good in 41% of patients, partial in 29%, and bad in 30%. After three or more months of CPAP, clinical asthma control was good in 70% (p < 0.001), perceived control by ACT after CPAP was 21 ± 4 (p < 0.001). When asked for their opinion, 51.5% referred clinical improvement after CPAP, no change in 46.5%. CONCLUSIONS: The use of CPAP in asthmatic patients with OSA improves both clinical and perceived asthma control in a statistically significant way. Most patients had good adaptation to CPAP (90%) and 51.5% had clinical improvement.

COVID-19 Course in Allergic Asthma Patients: A Spanish Cohort Analysis.

PURPOSE: The acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has had a high impact on patients with chronic diseases. In the literature, there are different perspectives on asthma as comorbidity or risk factor on COVID-19 severity. PATIENTS AND METHODS: The aim of this retrospective study across 13 allergy departments in Spain was to determine the severity of COVID-19 in asthmatic adults followed in allergy departments and its relationship with atopy, clinical and demographic characteristics, phenotypes and laboratory data. In addition, lung function test and asthma control test (ACT) before and after COVID-19 were analyzed. Data was obtained from electronic medical records from March 2020 to April 2021. RESULTS: Two hundred one asthmatic patients were diagnosed with COVID-19 infection by validated detection test. About 30% of the patients were admitted for bilateral pneumonia. Advanced age, elevated D-dimer, lower numbers of lymphocytes and eosinophils, heart diseases and hypertension were associated with severe COVID-19. Allergic and mixed allergic/eosinophilic phenotype and their biomarkers (total IgE, aeroallergens sensitizations, allergic rhinitis, and blood eosinophilia) were related to fewer hospital admissions. Poor control and lower forced expiratory volume in the first second (FEV1) were related to worse prognosis of COVID-19. CONCLUSION: Asthmatic patients with allergic and eosinophilic phenotype have a better evolution of COVID-19 and lower risk of admissions. Older patients, cardiovascular comorbidities, AERD and eosinopenia are related to severity COVID-19.

Occupational asthma induced by inhaled carmine among butchers.

BACKGROUND: Carmine is a natural coloring agent for food and cosmetics. There have been several reports of occupational asthma among employees at factories making natural dyes, however, there are no cases reported among butchers. OBJECTIVES: We report on two male patients who presented with a history of occupational asthma. Both patients are butchers and used a mixture of additives with carmine as dye in sausages. METHODS: Skin prick tests were performed with common aeroallergens, commercial mixture additives and separated compound of the additive mixture. Total IgE, metacholine test, specific inhalatory challenge tests with carmine and mites, SDS-PAGE and IgE-immunoblotting were carried out. RESULTS: Skin tests were positive to mites, additive mixture and carmine in both cases. Specific IgE to mites was positive only in patient one. Bronchial provocation tests were positive to metacholine and carmine and negative to Dermatophagoides pteronyssinus in both cases. IgE-immunoblot showed a specific IgE-binding band at 10 kDa and at a large number of bands along all molecular weights. No inhibition was achieved in carmine-IgE-specific bands with the D. pteronyssinus extract. CONCLUSIONS: We report on two butchers with occupational asthma due to an IgE-mediated sensitization to carmine. There are several proteins that may act as allergens, and these may be conditioned by the route of exposure and are not cross-reactive with mite proteins. Carmine may be considered to be an etiologic agent in butcher's asthma.