Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
1.
Ther Adv Respir Dis ; 16: 17534666221091183, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35430944

RESUMEN

BACKGROUND: Severe asthma increases the risk of severe COVID-19 outcomes such as hospitalization and death. However, more studies are needed to understand the association between asthma and severe COVID-19. METHODS: A cohort of 150,430 adult asthma patients were identified in the Swedish National Airway Register (SNAR) from 2013 to December 2020. Data on body mass index, smoking habits, lung function, and asthma control test (ACT) were obtained from SNAR, and uncontrolled asthma was defined as ACT ⩽19. Patients with severe COVID-19 were identified following hospitalization or in death certificates based on ICD-10 codes U07.1 and U07.2. The Swedish Prescribed Drug register was used to identify comorbidities and data from Statistics Sweden for educational level. Multivariate logistic regression analyses were used to estimate associations with severe COVID-19. RESULTS: Severe COVID-19 was identified in 1067 patients (0.7%). Older age (OR = 1.04, 95% CI = 1.03-1.04), male sex (1.42, 1.25-1.61), overweight (1.56, 1.27-1.91), obesity (2.12, 1.73-2.60), high-dose inhaled corticosteroids in combination with long-acting ß-agonists (1.40, 1.22-1.60), dispensed oral corticosteroids ⩾2 (1.48, 1.25-1.75), uncontrolled asthma (1.64, 1.35-2.00), cardiovascular disease (1.20, 1.03-1.40), depression (1.47, 1.28-1.68), and diabetes (1.52, 1.29-1.78) were associated with severe COVID-19, while current smoking was inversely associated (0.63, 0.47-0.85). When comparing patients who died from COVID-19 with those discharged alive from hospital until 31 December 2020, older age, male sex, and current smoking were associated with COVID-19 death. CONCLUSION: Patients with uncontrolled asthma and high disease burden, including increased asthma medication intensity, should be identified as risk patients for severe COVID-19. Furthermore, current smoking is strongly associated with COVID-19 death in asthma.


Asunto(s)
Asma , COVID-19 , Corticoesteroides/uso terapéutico , Adulto , Asma/complicaciones , Asma/tratamiento farmacológico , Asma/epidemiología , Hospitalización , Humanos , Masculino , Suecia/epidemiología
3.
Acta Paediatr ; 103(8): 856-61, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24766450

RESUMEN

AIM: This study evaluated risk factors for acute wheeze in preschool children and investigated whether subnormal levels of vitamin D were associated with increased risk for acute wheeze, atopy or viral/bacterial respiratory infections. METHODS: We recruited 130 children with acute wheeze, aged 6 months to 4 years, from paediatric emergency departments in Stockholm, Sweden, and 101 age-matched controls with no history of wheeze or sensitisation to airborne allergens. Parents answered standardised questionnaires, and blood samples were analysed for specific IgE to airborne and food allergens and levels of 25 hydroxyvitamin D (25(OH)D). Nasopharyngeal virus samples were collected during the emergency department visit in the group of children with wheeze, and a subset were also tested for bacteria. RESULTS: Vitamin D insufficiency (25(OH)D < 75 nmol/L (30 ng/mL)) was associated with an odds ratio of 2.7 (95% confidence interval 1.1-6.2) for acute wheeze. However, no association was found between vitamin D insufficiency and atopy, presence of virus or bacteria or recurrent infections. Children older than 24 months were particularly at risk of subnormal vitamin D levels, irrespective of wheezing history. CONCLUSION: Our findings support the hypothesis that subnormal levels of vitamin D are associated with acute wheeze in young children.


Asunto(s)
Hipersensibilidad Respiratoria/etiología , Ruidos Respiratorios/etiología , Vitamina D/análogos & derivados , Estudios de Casos y Controles , Preescolar , Femenino , Humanos , Lactante , Estilo de Vida , Modelos Logísticos , Masculino , Recurrencia , Hipersensibilidad Respiratoria/sangre , Infecciones del Sistema Respiratorio/sangre , Infecciones del Sistema Respiratorio/virología , Vitamina D/sangre
4.
Eur Respir J ; 42(1): 65-78, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23222870

RESUMEN

The causes of severe childhood asthma are poorly understood. Our aim was to define global patterns of gene expression in children with severe therapy-resistant and controlled asthma. White blood cells were isolated and the global transcriptome profile was characterised using the Affymetrix Human Gene ST 1.0 chip in children with severe, therapy-resistant asthma (n=17), controlled asthma (n=19) and healthy controls (n=18). Receptor expression was studied in separated leukocyte fractions from asthmatic adults (n=12). Overall, 1378 genes were differentially expressed between children with severe/controlled asthma and controls. Three significantly enriched Kyoto Encyclopedia of Genes and Genomes pathways were represented: natural killer cell-mediated cytotoxicity (upregulated in controlled asthma); N-glycan biosynthesis (downregulated in severe asthma); and bitter taste transduction receptors (TAS2Rs) (upregulated in severe asthma). Quantitative PCR experiments confirmed upregulation of TAS2Rs in severe asthmatics. TAS2R expression was replicated in leukocytes from adult asthmatics, in which TAS2R agonists also inhibited LPS-induced cytokine release. Significant correlations between expression of TAS2Rs and clinical markers of asthma severity were found in both adults and children. In conclusion, specific gene expression patterns were observed in children with severe, therapy-resistant asthma. The increased expression of bronchodilatory TAS2Rs suggests a new target for the treatment of asthma.


Asunto(s)
Asma/metabolismo , Receptores Acoplados a Proteínas G/metabolismo , Gusto/genética , Transcriptoma , Regulación hacia Arriba , Adolescente , Adulto , Asma/genética , Hiperreactividad Bronquial/metabolismo , Estudios de Casos y Controles , Niño , Preescolar , Análisis por Conglomerados , Estudios de Cohortes , Femenino , Perfilación de la Expresión Génica , Regulación de la Expresión Génica , Humanos , Leucocitos/citología , Masculino , Óxido Nítrico/metabolismo , Análisis de Secuencia por Matrices de Oligonucleótidos , Receptores Acoplados a Proteínas G/genética , Suecia
5.
Thorax ; 67(3): 215-21, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22131290

RESUMEN

OBJECTIVE: To determine whether environmental control using nocturnal temperature controlled laminar airflow (TLA) treatment could improve the quality of life of patients with persistent atopic asthma. DESIGN: Randomised, double-blind, placebo-controlled, parallel-group trial. Setting Nineteen European asthma clinics. PARTICIPANTS: 312 patients aged 7-70 with inadequately controlled persistent atopic asthma. MAIN OUTCOME MEASURE: Proportion of patients with an increase of ≥0.5 points in asthma quality of life score after 1 year of treatment. RESULTS: TLA devices were successfully installed in the bedrooms of 282 (90%) patients included in the primary efficacy analysis. There was a difference in treatment response rate between active (143 of 189, 76%) and placebo (56 of 92, 61%) groups, difference 14.8% (95% CI 3.1 to 26.5, p=0.02).3 In patients aged ≥12, on whom the study was powered, the difference in response rate was similar-active 106 of 143 (74%), placebo 42 of 70 (60%), difference 14.1% (0.6 to 27.7, p=0.059). There was a difference between groups in fractional exhaled nitric oxide change of -7.1 ppb (-13.6 to -0.7, p=0.03). Active treatment was associated with less increase in cat-specific IgE than placebo. There was no difference in adverse event rates between treatment groups. CONCLUSION: Inhalant exposure reduction with TLA improves quality of life, airway inflammation and systemic allergy in patients with persistent atopic asthma. TLA may be a treatment option for patients with inadequately controlled persistent atopic asthma. Trial registration number Clinical Trials NCT00986323.


Asunto(s)
Asma/terapia , Ambiente Controlado , Adolescente , Adulto , Anciano , Movimientos del Aire , Alérgenos/efectos adversos , Alérgenos/análisis , Antiasmáticos/administración & dosificación , Asma/etiología , Asma/fisiopatología , Niño , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Inmunoglobulina E/biosíntesis , Exposición por Inhalación/efectos adversos , Exposición por Inhalación/prevención & control , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Calidad de Vida , Sueño/fisiología , Temperatura , Resultado del Tratamiento , Adulto Joven
6.
Pediatr Allergy Immunol ; 22(1 Pt 1): 9-18, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20880352

RESUMEN

Children with problematic severe asthma (PA) are either difficult to treat because of the presence of aggravating factors or else severely resistant to therapy. We investigated a cohort of school-aged children with PA and compared these children to age-matched peers with controlled persistent asthma (CA). The aims were to characterize features of children suffering from PA and identify children who were severely resistant to therapy. In this cross-sectional, multicenter comparison of children with different manifestations of persistent asthma, PA was defined as insufficient asthma control despite level 4 treatment, according to GINA. The protocol included questionnaires, spirometry, methacholine provocation, measurement of fraction of nitric oxide in exhaled (FE(NO) ) and nasal air, blood sampling for inflammatory biomarkers and atopy, and computerized tomography of sinuses and lungs (in the PA group only). Of the 54 children with PA, 61% had therapy-resistant asthma, with the remaining being difficult to treat because of identified aggravating factors. Children with PA more often had parents with asthma (p=0.003), came from families with a lower socioeconomic status (p=0.01), were less physically active (p=0.04), and had more comorbidity with rhinoconjunctivitis (p=0.01) than did the 39 children with CA. The former also exhibited lower FEV(1) values (p=0.02) and increased bronchial hyper-responsiveness (p=0.01), but there were no differences in atopy (p=0.81) or FE(NO) (p=0.16). A non-invasive protocol, involving a standardized and detailed clinical characterization, revealed distinguishing features of children with PA and enabled the identification of children with therapy-resistant asthma.


Asunto(s)
Asma/tratamiento farmacológico , Asma/fisiopatología , Rinitis/complicaciones , Índice de Severidad de la Enfermedad , Adolescente , Asma/diagnóstico , Asma/genética , Hiperreactividad Bronquial , Pruebas de Provocación Bronquial , Niño , Estudios Transversales , Espiración , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/fisiología , Masculino , Cloruro de Metacolina/uso terapéutico , Óxido Nítrico/metabolismo , Pruebas de Función Respiratoria , Espirometría , Encuestas y Cuestionarios
7.
J Pediatr Psychol ; 34(2): 205-16, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18573809

RESUMEN

OBJECTIVE: To examine whether a distressing medical procedure leaves lasting impressions in young children's memories. METHODS: Children 12- to 78-weeks old (N = 172) received inhalation treatment through a face mask or underwent other interventions at a pediatric emergency department. They were randomized to be presented with neutral cues and cues from the inhalation 1 week or 6 months after the target event. Children's reactions at cue presentation were scored from videotapes. RESULTS: Across the age span tested, children treated with inhalation showed higher distress than controls when presented with cues from inhalation 1 week, but not 6 months after target treatment. CONCLUSIONS: Stress during medical procedures in preverbal children may develop as a result of prior experience of such procedures. These memories typically seem to fade within 6 months.


Asunto(s)
Niño Hospitalizado , Unidades de Cuidados Intensivos/estadística & datos numéricos , Memoria , Estrés Psicológico/epidemiología , Estrés Psicológico/psicología , Preescolar , Femenino , Humanos , Lactante , Masculino , Grabación de Cinta de Video
8.
Pediatr Allergy Immunol ; 19(3): 219-26, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18399898

RESUMEN

Rhinitis is common in asthmatic schoolchildren who are allergic to animal dander and constantly and indirectly exposed to these allergens in their everyday environment. As a patho-physiological linkage between nasal and bronchial inflammation has been proposed to exist, the primary objective of this study was to determine whether nasal administration of mometasone furoate (MSNF) can reduce bronchial inflammation, as reflected in the level of exhaled nitric oxide (F(E)NO) in asthmatic schoolchildren with dander allergy and mild-to-moderate rhinitis. Forty such children were assigned randomly to be treated for 4 wk with MSNF or placebo, employing a double-blind procedure. F(E)NO was the primary end-point measured and secondary end-points were nasal levels of NO, the concentration of eosinophilic cationic protein (ECP) in nasal lavage, the relative numbers of eosinophils in blood, forced expiratory volume in 1 s (FEV(1)), peak expiratory flow (PEF) and scoring of symptoms. There was no significant difference in the F(E)NO values of the treated and control groups at any time-point, whereas the nasal level of ECP was lower in the treated group compared with placebo (p = 0.05) on both days 7 and 28, and compared with baseline for the treated group (p = 0.06 on day 7, p = 0.02 on day 28). Furthermore, the mean blood eosinophil count decreased in the treated group, which also demonstrated lower scores for nasal symptoms compared with placebo, but neither of these differences were statistically significant. FEV(1), PEF and nasal levels of NO remained unchanged in both groups. Four weeks of nasal treatment with MSNF had no effect on bronchial inflammation, as reflected by exhaled NO, whereas signs of nasal and systemic eosinophil activation were reduced. Thus, nasal administration of a steroid as a strategy to reduce asthmatic inflammation remains questionable in mild-to-moderately severe cases of perennial rhinitis and asthma.


Asunto(s)
Antialérgicos/administración & dosificación , Antiinflamatorios/administración & dosificación , Asma/tratamiento farmacológico , Óxido Nítrico/análisis , Pregnadienodioles/administración & dosificación , Rinitis Alérgica Perenne/tratamiento farmacológico , Adolescente , Antialérgicos/uso terapéutico , Antiinflamatorios/uso terapéutico , Asma/inmunología , Asma/fisiopatología , Pruebas Respiratorias , Método Doble Ciego , Proteína Catiónica del Eosinófilo/sangre , Eosinófilos/inmunología , Espiración , Femenino , Humanos , Recuento de Leucocitos , Masculino , Furoato de Mometasona , Pregnadienodioles/uso terapéutico , Ventilación Pulmonar , Rinitis Alérgica Perenne/inmunología , Rinitis Alérgica Perenne/fisiopatología
9.
Pediatr Allergy Immunol ; 16(1): 59-64, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15693913

RESUMEN

Epidemiological data suggest a comorbidity link between nasal and bronchial allergic disease. Exhaled nitric oxide (FENO) is a sensitive marker of bronchial inflammation and increases after bronchial allergen provocation. We studied FENO in 19 children and adolescents with allergic asthma and 10 controls before and 2, 6 and 24 h after a single nasal allergen challenge. The correlation between FENO and other markers of allergic inflammation, such as eosinophils in blood and eosinophil cationic protein (ECP) in serum and nasal lavage was also assessed. FENO remained unchanged 24 h post-challenge in both steroid and steroid-naive patients. At 6 h post-challenge, FENO decreased in both asthmatics and controls. The asthmatic subjects showed a positive correlation between FENO and blood eosinophils before (r=0.71, p=0.001) and after the challenge, and between FENO and ECP in nasal lavage (r=0.62, p=0.02) 2 h after the challenge. Mean ECP in nasal lavage increased post-challenge but not significantly. We conclude that a single nasal allergen challenge does not augment bronchial inflammation although FENO, is related to blood eosinophil count and to the nasal inflammatory response. Our data do not support the theory of a direct transmission of the nasal inflammation to the lower airways.


Asunto(s)
Alérgenos , Asma/metabolismo , Hiperreactividad Bronquial/complicaciones , Pruebas de Provocación Nasal/métodos , Óxido Nítrico/metabolismo , Adolescente , Análisis de Varianza , Asma/complicaciones , Asma/inmunología , Biomarcadores/metabolismo , Hiperreactividad Bronquial/diagnóstico , Hiperreactividad Bronquial/inmunología , Niño , Proteína Catiónica del Eosinófilo/inmunología , Eosinófilos/inmunología , Espiración/fisiología , Femenino , Citometría de Flujo/métodos , Humanos , Mediadores de Inflamación/análisis , Mediadores de Inflamación/metabolismo , Masculino , Óxido Nítrico/análisis , Factores de Tiempo
10.
Br J Clin Pharmacol ; 58(4): 411-8, 2004 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-15373934

RESUMEN

OBJECTIVES: To evaluate high dose tolerability and relative systemic dose potency between inhaled clinically equipotent dose increments of formoterol and terbutaline in children. METHODS: Twenty boys and girls (6-11 years-old) with asthma and normal ECGs were studied. Ten doses of formoterol (Oxis) 4.5 microg (F4.5) or terbutaline (Bricanyl) 500 microg (T500) were inhaled cumulatively via a dry powder inhaler (Turbuhaler) over 1 h (three patients) or 2.5 h (17 patients) and compared to a day of no treatment, in a randomised, double-blind (active treatments only), crossover trial. Blood pressure (BP), ECG, plasma potassium, glucose, lactate, and adverse events were monitored up to 10 h to assess tolerability and relative systemic dose potency. RESULTS: Formoterol and terbutaline had significant beta2-adrenergic effects on most outcomes. Apart from the effect on systolic BP, QRS duration and PR interval, the systemic effects were significantly more pronounced with terbutaline than with formoterol. Thus, mean minimum plasma potassium, was suppressed from 3.56 (95% confidence interval, CI: 3.48-3.65) mmol l(-1) on the day of no treatment to 2.98 (CI: 2.90-3.08) after 10 x F4.5 and 2.70 (CI: 2.61-2.78) mmol l(-1) after 10 x T500, and maximum Q-Tc (heart rate corrected Q-T interval [Bazett's formula]) was prolonged from 429 (CI: 422-435) ms on the day of no treatment, to 455 (CI: 448-462) ms after 10 x F4.5 and 470 (CI: 463-476) ms after 10 x T500. Estimates of relative dose potency indicated that F4.5 microg had the same systemic activity as the clinically less effective dose of 250 microg terbutaline. The duration of systemic effects differed marginally between treatments. Spontaneously reported adverse events (most frequently tremor) were fewer with formoterol (78% of the children) than with terbutaline (95%). A serious adverse event occurred after inhalation of 45 microg formoterol over the 1 h dosing time, that prompted the extension of dosing time to 2.5 h. CONCLUSIONS: Multiple inhalations over 2.5 h of formoterol (4.5 microg) via Turbuhaler) are at least as safe as and associated with less systemic effects than multiple inhalations of the clinically equipotent dose of terbutaline (500 microg) in children with asthma.


Asunto(s)
Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Etanolaminas/administración & dosificación , Terbutalina/administración & dosificación , Administración por Inhalación , Presión Sanguínea/efectos de los fármacos , Niño , Estudios Cruzados , Método Doble Ciego , Femenino , Fumarato de Formoterol , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino
11.
Pediatr Res ; 54(4): 496-501, 2003 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12840159

RESUMEN

Asthmatic patients show increased concentrations of nitric oxide (NO) in exhaled air (Feno). The diffusing capacity of NO in the airways (Dawno), the NO concentrations in the alveoli and the airway wall, and the maximal airway NO diffusion rate have previously been estimated noninvasively by measuring Feno at different exhalation flow rates in adults. We investigated these variables in 15 asthmatic schoolchildren (8-18 y) and 15 age-matched control subjects, with focus on their relation to exhaled NO at the recommended exhalation flow rate of 0.05 L/s (Feno0.05), age, and volume of the respiratory anatomic dead space. NO was measured on-line by chemiluminescence according to the European Respiratory Society's guidelines, and the NO plateau values at three different exhalation flow rates (11, 99, and 382 mL/s) were incorporated in a two-compartment model for NO diffusion. The NO concentration in the airway wall (p < 0.001), Dawno (p < 0.01), and the maximal airway NO diffusion rate (p < 0.001) were all higher in the asthmatic children than in control children. In contrast, there was no difference in the NO concentration in the alveoli (p = 0.13) between the groups. A positive correlation was seen between the volume of the respiratory anatomic dead space and Feno0.05 (r = 0.68, p < 0.01), the maximal airway NO diffusion rate (r = 0.71, p < 0.01), and Dawno (r = 0.56, p < 0.01) in control children, but not in asthmatic children. Feno0.05 correlated better with Dawno in asthmatic children (r = 0.65, p < 0.01) and with the NO concentration in the airway wall in control subjects (r < 0.77, p < 0.001) than vice versa. We conclude that Feno0.05 increases with increasing volume of the respiratory anatomic dead space in healthy children, suggesting that normal values for Feno0.05 should be related to age or body weight in this age group. Furthermore, the elevated Feno0.05 seen in asthmatic children is related to an increase in both Dawno and NO concentration in the airway wall. Because Dawno correlates with the volume of the respiratory anatomic dead space in control subjects and Feno0.05 correlates with Dawno in asthmatic children, we suggest that Dawno partly reflects the total NO-producing surface area and that a larger part of the bronchial tree produces NO in asthmatic children than in control children.


Asunto(s)
Asma/metabolismo , Óxido Nítrico/metabolismo , Adolescente , Adulto , Hiperreactividad Bronquial , Niño , Difusión , Femenino , Humanos , Masculino , Pruebas de Función Respiratoria , Fenómenos Fisiológicos Respiratorios , Sistema Respiratorio/anatomía & histología , Estadística como Asunto
12.
Pediatr Res ; 52(3): 393-8, 2002 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12193674

RESUMEN

Nitric oxide (NO) in exhaled air is believed to reflect allergic inflammation in the airways. Measured levels of exhaled NO vary with the exhaled flow rate, which therefore must be standardized. The aim of this study was to estimate the optimal exhalation flow rate when measuring NO in exhaled air. We studied 15 asthmatic children (8-18 y) with elevated NO levels and 15 age-matched controls and focused on how the quality of the NO curve profile, the discriminatory power, and the reproducibility were influenced by the exhalation flow rate. We used an on-line system for NO measurements at six different exhalation flow rates in the interval of 11-382 mL/s. The fraction of exhaled nitric oxide (FENO) was highly flow-dependent as was expected. Intermediate flow rates yielded a flat and stable NO plateau and were considerably easier to interpret than those obtained at the highest and lowest flow rates. The ratio of FENO between asthmatics and controls was lower at higher flow rates and a considerable overlap in NO values was demonstrated at all flow rates except 50 mL/s. The reproducibility was much lower at more extreme flow rates and was best at 50 mL/s. We conclude that a target exhalation flow rate of approximately 50 mL/s is to be preferred using the single-breath method for on-line NO measurements in schoolchildren.


Asunto(s)
Asma/fisiopatología , Pruebas Respiratorias , Óxido Nítrico , Ventilación Pulmonar , Adolescente , Niño , Femenino , Humanos , Hipersensibilidad Inmediata , Masculino , Estándares de Referencia , Reproducibilidad de los Resultados , Suecia
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...