Longitudinal changes in sputum and blood inflammatory mediators during FeNO suppression testing.

To explore whether fractional exhaled nitric oxide (FeNO) non-suppression identifies corticosteroid resistance, we analysed inflammatory mediator changes during a FeNO suppression test with monitored high-intensity corticosteroid therapy. In linear mixed-effects models analysed over time, the 15 clinically distinct 'suppressors' (ie, ≥42% FeNO suppression) normalised Asthma Control Questionnaire scores (mean±SD, start to end of test: 2.8±1.4 to 1.4±0.9, p<0.0001) and sputum eosinophil counts (median (IQR), start to end of test: 29% (6%-41%) to 1% (1%-5%), p=0.0003) while significantly decreasing sputum prostaglandin D2 (254 (89-894) to 93 (49-209) pg/mL, p=0.004) and numerically decreasing other type-2 cytokine, chemokine and alarmin levels. In comparison, the 19 non-suppressors had persistent sputum eosinophilia (10% (1%-67%) despite high-intensity therapy) with raised end-test inflammatory mediator levels (1.9 (0.9-2.8)-fold greater than suppressors). FeNO non-suppression during monitored treatment implies biological corticosteroid resistance.

Intermetatarsal Coalition: Case Report, Literature Review, and Imaging Findings of an Underrecognized and Underdiagnosed Cause of Foot Pain.

Coalition is defined as abnormal bridging between two bones, and the connection can be osseous or nonosseous. Most coalitions in the foot involve the hindfoot. Intermetatarsal coalition is thought to be much rarer than the more common hindfoot coalitions and has only been reported sporadically in the orthopedic literature. We present two patients with nonosseous intermetatarsal coalition presenting with nonspecific dorsolateral foot pain and describe the imaging findings of intermetatarsal coalition with different modalities. We suspect that whilst rarely described, intermetatarsal coalition is quite likely a more common underrecognized entity than a rare entity. This report is aimed at increasing the awareness of coalition in this location, in the radiology community, particularly the nonosseous ones, given that this condition can be debilitating but treatable.

Exploring temporal self-regulation theory to predict sugar-sweetened beverage consumption.

Sugar-sweetened beverage (SSB) consumption is a high-risk dietary behaviour and represents a pressing public health concern.Objective: The present research aimed to utilize temporal self-regulation theory to explore the intention-behaviour gap in SSB consumption in adults.Design: A prospective correlational design (two data collection points) was used.Main outcome measures: A convenience sample of 387 Australian adults completed online questionnaires measuring intention, habit strength, environmental cues, past behaviour and self-control. One week later, 292 participants (76% female), aged 17 to 72 years (M = 24.72, SD = 7.98) completed a self-report measure of SSB intake over the previous week (attrition 23.8%).Results: Hierarchical multiple regression analysis revealed partial support for temporal self-regulation theory, with the model predicting 32.9% of the variance in consumption, and a large effect size (f2 = 0.53). Intention accounted for 17.9% (ΔR2 = .19, p < .001) variance in behaviour. Habit and environmental cues together accounted for an additional 13.8% (ΔR2 = .32, p < .001). Self-control did not predict consumption, and no interaction effects were found on the intention-behaviour relationship.Conclusion: Reflective and automatic processes were both important predictors of consumption. Intention, habit, and environmental cues may be suitable intervention targets to reduce consumption.

Anti-IL-4/IL-13 for the treatment of asthma: the story so far.

Introduction: Severe asthma is a global health concern with high morbidity and mortality. Understanding of its complex pathophysiology continues to increase, providing specific immune targets for therapeutic intervention.Areas covered: In this review, we focus on the role of IL-4 and IL-13 in severe asthma and on the biologic therapies developed to target them, particularly dupilumab, a monoclonal antibody against the IL-4 receptor α subunit and IL-4/IL-13 receptor complex. A literature search was undertaken for all studies of monoclonal antibodies against IL-4 and IL-13.Expert Opinion: Dupilumab decreases the rate of severe asthma exacerbations and improves symptoms, lung function, and quality of life. Importantly, these effects are also observed during reduction of maintenance oral corticosteroid doses. Those with the highest T2 biomarkers derive the greatest benefit and the presence of atopic dermatitis or chronic rhinosinusitis with or without nasal polyposis may recommend dupilumab as the preferred biologic treatment for a patient.

Is higher population-level use of ICS/LABA combination associated with better asthma outcomes? Cross-sectional surveys of nationally representative populations in New Zealand and Australia.

BACKGROUND AND OBJECTIVE: New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal public health systems, but different criteria for subsidized medicines. We explored differences in asthma management and asthma-related outcomes between these countries. METHODS: A web-based survey was administered in AU (2012) and NZ (2013) to individuals aged ≥16 years with current asthma, drawn randomly from web-based panels, stratified by national population proportions. Symptom control was assessed with the Asthma Control Test (ACT). Healthcare utilization was assessed from reported urgent doctor/hospital visits in the previous year. RESULTS: NZ (n = 537) and Australian (n = 2686) participants had similar age and gender distribution. More NZ than Australian participants used inhaled corticosteroid (ICS)-containing medication (68.8% vs 60.9%; P = 0.006) but ICS/long-acting ß2 -agonist (LABA) constituted 44.4% of NZ and 81.5% of Australian total ICS use (P < 0.0001). Adherence was higher with ICS/LABA than ICS-alone (P < 0.0001), and higher in NZ than in AU (P < 0.0001). ACT scores were similar (P = 0.41), with symptoms well controlled in 58.6% and 54.4% participants, respectively. More NZ participants reported non-urgent asthma reviews (56.6% vs 50.4%; P = 0.009). Similar proportions had urgent asthma visits (27.9% and 28.6%, respectively, P = 0.75). CONCLUSION: This comparison, which included the first nationally representative data for asthma control in NZ, showed that poorly controlled asthma is common in both NZ and AU, despite subsidized ICS-containing medications. The greater use of ICS-alone in NZ relative to ICS/LABA does not appear to have compromised population-level asthma outcomes, perhaps due to better adherence in NZ. Different ICS/LABA subsidy criteria and different patient copayments may also have contributed to these findings.