Pulmonary function testing dataset of pressure and flow, dynamic circumference, heart rate, and aeration monitoring.

Respiratory data was collected from 20 subjects, with an even sex distribution, in the low-risk clinical unit at the University of Canterbury. Ethical consent for this trial was granted by the University of Canterbury Human Research Ethics Committee (Ref: HREC 2023/30/LR-PS). Respiratory data were collected, for each subject, over three tests consisting of: 1) increasing set PEEP from a starting point of ZEEP using a CPAP machine; 2) test 1 repeated with two simulated apnoea's (breath holds) at each set PEEP; and 3) three forced expiratory manoeuvres at ZEEP. Data were collected using a custom pressure and flow sensor device, ECG, PPG, Garmin HRM Dual heartrate belt, and a Dräeger PulmoVista 500 Electrical Impedance Tomography (EIT) machine. Subject demographic data was also collected prior to the trial, in a questionnaire, with measurement equipment available. These data aim to inform the development of pulmonary mechanics models and titration algorithms.

Navigating biologic therapies in elderly asthma.

The prevalence of asthma among the elderly population has witnessed a notable rise, presenting unique challenges in diagnosis and management. Biologic therapies, such as omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab, have demonstrated efficacy in targeting specific pathways associated with severe asthma in elderly individuals. However, a significant research gap exists in the application of these therapies in elderly asthma patients. Despite the considerable size of the elderly asthma population and the social and economic burden that this specific demographic imposes on society, the available body of research catering to this group is limited. Notably, no RCTs have been expressly designed for the elderly across all asthma biologic therapies. Moreover, most RCTs have set upper age cutoffs, commonly 75 years old, and exclusion criteria for common comorbidities in the elderly, thus marginalizing this group from pivotal research. This underscores the crucial need for intentional inclusion of elderly participants in separately designed clinical trials and more researches, aiming to augment the generalizability of findings and enhance therapeutic outcomes. Given the distinct physiological changes associated with aging, there may be a concern regarding the efficacy and safety of biologic therapies in the elderly compared to non-elderly adults, posing a barrier to their use in this population. However, observational studies have shown similar benefits of these therapies in elderly individuals as seen in non-elderly adults. Other anticipated challenges related to initiating biologic therapy in elderly people with asthma including dosing consideration and monitoring strategies, which are important areas of investigation for optimizing asthma management will be discussed in this review. In summary, this review navigates the current landscape of biologic therapies for elderly asthma, offering valuable insights for various stakeholders, including researchers, healthcare providers, and policymakers, to advance asthma care in this vulnerable population. We propose that future research should concentrate on tailored, evidence-based approaches to address the undertreatment of elderly asthma patients.

Spirometric Assessment of Pulmonary Function Tests in Asthma Patients.

BACKGROUND AND AIMS: Asthma is a chronic airway inflammatory disorder that imposes substantial morbidity and mortality. Spirometry is a significant tool for the objective measurement of obstruction among asthmatics. The present study was conducted to assess the pulmonary function test parameters among asthmatics and compare the observed and predicted values. MATERIALS AND METHODS: This cross-sectional research was performed on 120 asthmatic patients who attended a tertiary care healthcare center and underwent spirometry evaluation. The spirometry indices such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, peak expiratory flow rate (PEFR), and maximal voluntary ventilation (MVV) were recorded. Further, a gender-wise comparison of spirometry indices was also done. RESULTS: There was a substantial decrease in FVC (2.05 ± 0.12 vs. 2.75 ± 0.24 L/sec; p = 0.02), FEV1 (1.78 ± 0.16 vs. 2.38 ± 0.32 L/sec; p = 0.01), FEV1/FVC ratio (74 ± 4.38 vs. 83 ± 5.76 %; p = 0.01), PEFR (4.76 ± 0.42 vs. 5.82 ± 0.65 L/sec; p = 0.03), and MVV (78.65 ± 28.45 vs. 115.87 ± 32.15 L/min; p = 0.001) for observed and predicted values. Female asthmatic patients displayed a substantial decline in FVC (p = 0.001), FEV1 (p = 0.006), FEV1/FVC (p = 0.001), and MVV (p = 0.01) when compared to males. CONCLUSION: This study suggests that asthmatic individuals had impaired lung function upon initial assessment. Female asthmatic patients studied are at increased risk of asthma severity when compared to males.

Myasthenia Gravis Mimicking Status Asthmaticus: The Hidden Crisis.

Status asthmaticus is a severe form of aggravation of asthma, whereas myasthenia gravis (MG) is a rare neuromuscular condition characterised by exhaustion and muscle weakness. Myasthenic crisis can occasionally manifest with symptoms that resemble status asthmaticus, which can result in an incorrect diagnosis and ineffective therapy. In addition to discussing the therapeutic implications, this abstract attempts to draw attention to the difficulties in distinguishing between status asthmaticus and myasthenia crisis and the importance of diagnosing subtle signs of MG. In this case, we present a 55-year-old female, with a misdiagnosed case of bronchial asthma, who presented with shortness of breath at rest for two to three days and was suspected to have an acute exacerbating episode of asthma. She was later evaluated for non-respiratory causes of dyspnea on noticing subtle signs of ptosis and was found to have an active myasthenic crisis. Although this case presented typically as status asthmaticus, it did not respond to conventional treatment of it, and on the contrary, it worsened. Hence, it is necessary to look for subtle signs of MG and promptly differentiate it from other similar emergency events to help administer accurate treatment which can prove life-saving.

Respiratory monitoring dataset, with rapid expiratory occlusions, over increasing positive airway pressure ventilation.

Resting breathing data was collected from 80 smokers, vapers, asthmatics, and otherwise healthy people in the low-risk clinical unit at the University of Canterbury. Subjects were asked to breathe normally through a full-face mask connected to a Fisher and Paykel Healthcare SleepStyle SPSCAA CPAP device. PEEP (Positive End-Expiratory Pressure) support was increased from 4 to 12 cmH2O in 0.5 cmH2O increments. Data was also collected during resting breathing at ZEEP (0 cmH2O) before and after the PEEP trial. The trial was conducted under University of Canterbury Human Research Ethics Committee consent (Ref: HREC 2023/04/LR-PS). Data was collected by and Dräeger PulmoVista 500 EIT machine and a custom Venturi-based pressure and flow sensor device connected in series with the CPAP and full-face mask. The outlined dataset includes pressure, flow, volume, dynamic circumference (thoracic and abdominal, and cross-sectional aeration. Subject demographic data was self-reported using a questionnaire given prior to the trial.

Myasthenia Gravis Presenting with Myasthenic Crisis Mimicking Status Asthmatics.

A 23-year-old woman was transferred to our hospital due to exacerbating dyspnea with wheeze. After admission, we started mechanical ventilation immediately, and she was diagnosed with status asthmatics. On the following day, she was able to be weaned from the ventilator. However, she required re-intubation because of an unstable respiratory condition just after extubation. Detailed neurological investigations identified blepharoptosis and muscle weakness with easy fatigability. An edrophonium test was positive. Anti-acetylcholine receptor antibody was detected in her serum. She was finally diagnosed with myasthenia gravis and successfully treated with neostigmine and a low-dose corticosteroid.

A comparative study evaluating C-reactive protein, sputum eosinophils and forced expiratory volume in one second in obese and nonobese asthmatics.

ntroduction: Asthma and obesity are considered inflammatory disorders. Inflammatory markers - sputum eosinophils, C-reactive protein (CRP) and the forced expiratory volume in one second (FEV1) were analysed to find their association in obese asthmatics and compared with their asthma control test (ACT) to understand these parameters in this phenotype. MATERIAL AND METHODS: After completing the asthma control test (ACT), the CRP, FEV1 and sputum eosinophils of sixty asthmatics were compared to find the association of them in obese and nonobese asthmatics and contrasted with their ACT. The data were analysed using IBM SPSS V20.0, Mann-Whitney U test (non-parametric test), Pearson's correlation coefficient and Fisher's exact test. RESULTS: We found significant differences for CRP (P = 0.001) and sputum eosinophils (P = 0.001) between obese and nonobese asthmatics, both higher in obese asthmatics and with a significant association with body mass index (BMI) (P < 0.05). The FEV1 levels were independent of the BMI levels of asthmatics. There was a significant correlation between the CRP and sputum eosin-ophils (0.52, P = 0.001) for all asthmatics. There was no significant correlation between FEV1 and sputum eosinophils (nonobese P = 0.120, obese P = 0.388) and between FEV1 and CRP (obese P = 0.423, nonobese P = 0.358) in both obese and nonobese asthmatics. Obesity had an association (P = 0.001) with ACT scores (≤ 19). CONCLUSIONS: Sputum eosinophils and CRP were raised in obese asthmatics and had a positive association with BMI. Obese asthmatics had a poorer subjective asthma control than nonobese asthmatics despite FEV1 being independent of the BMI levels. Measuring the systemic inflammatory markers could help in additional interventions in reducing systemic inflammation and thus possibly facilitating better symptom control.

Eficacia de la tintura de ajo al 20% en pacientes asmáticos. Policlínico 13 de Marzo. 2018 -2019 / Efficacy of 20% garlic tincture in asthmatic patients. Polyclinic March 13. 2018 -2019 / Eficácia da tintura de alho a 20% em pacientes asmáticos. Policlínica, 13 de março. 2018-2019

RESUMEN Se realizó un estudio prospectivo, con modelo cuasi experimental en los pacientes asmáticos pertenecientes del Policlínico 13 de Marzo, con el objetivo de evaluar la eficacia de la tintura de ajo al 20% en el tratamiento intercrisis del Asma Bronquial, en el período comprendido de enero de 2018 a mayo de 2019. El Universo estuvo representado por 88 pacientes asmáticos entre 20-59 años de edad dispensarizados en el consultorio 25. La muestra quedó constituida por 84 pacientes que cumplieron con los criterios de inclusión y de exclusión. Los pacientes fueron distribuidos de forma aleatoria, en dos grupos control y experimental, utilizando la tabla de números aleatorios computarizados, en una proporción pareada de 1:1. Se empleó la prueba de diferencia de proporciones para muestras independientes y se trabajó con un nivel de significación p=0,05. Con este proyecto se contribuyó al desarrollo de la medicina natural y tradicional en nuestro país. Se demostró la eficacia de la tintura de ajo en el 97.6 % de los pacientes. Los hombres fueron los más afectados por las crisis y se reportaron 3 efectos adversos de forma leve.

ABSTRACT A prospective study was carried out, with a quasi-experimental model in asthmatic patients belonging to the 13 de Marzo Polyclinic, with the aim of evaluating the efficacy of the 20% garlic tincture in the inter-crisis treatment of Bronchial Asthma, in the period from January from 2018 to May 2019. El universo was represented by 88 asthmatic patients between 20-59 years of age dispensed in the office 25. The sample consisted of 84 patients who met the inclusion and exclusion criteria. The patients were randomized into two control and experimental groups, using the table of computerized random numbers, in a paired ratio of 1: 1. The difference of proportions test was used for independent samples and the level of significance was p = 0.05. This project contributed to the development of natural and traditional medicine in our country. The efficacy of garlic tincture was demonstrated in 97.6% of patients. Men were the most affected by the seizures and 3 mild adverse effects were reported.

RESUMO Foi realizado um estudo prospectivo, com modelo quase experimental em pacientes asmáticos pertencentes à Policlínica 13 de Marzo, com o objetivo de avaliar a eficácia da tintura de alho a 20% no tratamento intercrises da Asma Brônquica, no período de janeiro de 2018 a maio de 2019. O El Universo foi representado por 88 pacientes asmáticos entre 20 e 59 anos dispensados ​​em consultório 25. A amostra foi composta por 84 pacientes que atenderam aos critérios de inclusão e exclusão. Os pacientes foram randomizados em dois grupos controle e experimental, utilizando a tabela de números aleatórios computadorizados, na proporção pareada de 1: 1. O teste de diferença de proporções foi utilizado para amostras independentes e o nível de significância adotado foi p = 0,05. Este projeto contribuiu para o desenvolvimento da medicina natural e tradicional em nosso país. A eficácia da tintura de alho foi demonstrada em 97,6% dos pacientes. Os homens foram os mais afetados pelas convulsões e três efeitos adversos leves foram relatados.

Inhaled Corticosteroid-Containing Regimens Reduce Hospitalizations and Healthcare Costs among Elderly Asthmatics: Real-World Validation Using the National Health Insurance Claims Database.

The high rates of mortality and hospitalization among elderly asthmatics, as well as their increasing healthcare costs have become an important public health issue. It would be worthwhile to assess whether inhaled corticosteroid (ICS) can resolve these problems. To explore ICS prescription rates for elderly asthmatics and the factors influencing them and to investigate their association with hospitalization and healthcare costs, we analyzed data from the National Health Insurance Claims Database for the same time frame (December 1 to February 28) across three different periods (2011-2012; 2014-2015; and 2017-2018), from which we identified 6,619, 5,619, and 6,880 elderly individuals, respectively. The prescription rates of ICS increased (52.8%, 65.5% and 68.8%, in the first, second and third survey period, respectively) and inversely the hospital admission rates declined (3.7%, 3.2% and 2.5%, in the first, second and third survey period, respectively). The total healthcare costs per month were significantly lower for patients who received ICS-containing regimens than for those who did not. A multivariate analysis revealed that increasing age, rural residence, receiving a prescription from a clinic, hospital admission, and prescription of asthma medications other than ICS were associated with non-prescription of ICS, whereas cross-boundary treatment increased the ICS-prescription rate. Our study suggests that increases in the prescription rate of ICS are associated with reduced hospital admission rates and lower medical costs in the real-world. ICS prescription rates in rural areas and at clinics, which remain low, need to be increased.

Efficacy and Safety of Biologic Agents in Chronic Urticaria, Asthma and Atopic Dermatitis - A Real-life Experience.

INTRODUCTION: Several biologic agents have been approved for the treatment of asthma, chronic urticaria and atopic dermatitis. These therapeutic agents are especially useful for patients with severe or refractory symptoms. We present the real-life experience of four of the commonly used biologic agents in the United Arab Emirates. METHODS: In this retrospective observational study, we reviewed the demographic, clinical, laboratory and treatment parameters for all patients treated with biologic agents. RESULTS: 270 patients received biologics at our centre between May 2015 and December 2019 with a median age of 36.5 years. Omalizumab was the most prescribed agent (n=183, 67.8%) followed by dupilumab (n=54, 20%), benralizumab (n=22, 8.1%) and mepolizumab (n=11, 4.1%). Urticaria was the commonest treatment indication (n=148, 55%) followed by asthma (n=105, 39%) and atopic dermatitis (n=13, 5%). All chronic urticaria patients were treated with omalizumab and showed improvement in the mean urticaria control test score from 6.7±4.47 to 12.02±4.17, with a p-value of 0.001. Dupilumab was found to be the most commonly prescribed drug for asthma (37%), followed by omalizumab (32%), benralizumab (21%) and mepolizumab (10%). The mean Asthma control test score for all asthmatics combined increased from 17.06 ± 5.4 to 19.44 ± 5.6, with p-value 0.0012 with treatment; FeNO reduced from 60.02 ± 45.74 to 29.11 ± 27.92, with p-value 0.001 and mean FEV1 improved from 2.38L ± 0.8 to 2.67L ± 0.78, with p-value 0.045. Only 4 patients in the entire cohort reported adverse events. CONCLUSION: Our study demonstrated that biological agents are a safe and effective treatment for atopic asthma, chronic urticaria and atopic dermatitis.

Smoking and lung function among adults with newly onset asthma.

Introduction: Smoking increases the risk of asthma and reduces lung function among subjects with and without asthma. We assessed the effects of smoking on lung function reflecting both central and small airways among adults with newly onset asthma. Methods: In a population-based study, 521 (response rate 86%) working-aged adults with clinically defined newly diagnosed asthma answered a questionnaire on personal smoking and other factors potentially influencing lung function, and performed spirometry. We applied multiple linear regression analysis to estimate the relations between smoking and lung function adjusting for confounding. Results: Among asthmatics, FEV1 level was reduced significantly, on average 208 mL, related to regular smoking (adjusted effect estimate -0.208, 95% CI -0.355 to -0.061) and 245 mL in relation to former smoking, that is, among those who quit less than a year ago (-0.245, 95% CI -0.485 to -0.004). In contrast, FEV1 was not significantly related to occasional smoking or former smoking among those who quit over a year ago. Forced expiratory flow (FEF) levels (L/s) were also significantly reduced among regular smokers (FEF25-75%: -0.372, 95% CI -0.607 to -0.137; FEF50%: -0.476, 95% CI -0.750 to -0.202). An exposure-response pattern related to both daily smoking rate and lifetime cumulative smoking was seen both among men and women. Conclusions: This study provides new evidence that among working-aged adults with new asthma, regular smoking and former smoking reduce lung function levels with a dose-response pattern. The lung function parameters applied as outcomes reflect both larger and smaller airways.

A review of obesity and asthma across the life span.

OBJECTIVE: This literature review aims to compare obese-asthmatic adults and children, and to characterize differences and similarities between the two subgroups from epidemiological, demographical, phenotypical, and physiological perspectives. METHODS: Literature search was conducted using Pubmed database with "obesity," "asthma," "epidemiology," "cluster analysis," "demography," "mechanics," and ''FeNO'' as search terms. METHODS: Articles investigating epidemiological, demographic, phenotypical variation, and mechanical aspects of breathing specifically in obese asthmatics were identified. The studies were then divided according to age: children (<18 years of age) and adults (>18 years of age). RESULTS: Increase in asthma incidence and prevalence is observed in both obese-asthmatic children and adults. Asthma prevalence is greater in adult females regardless of ethnic background, and in men of African American and Hispanic ethnicities. Degree of weight gain and early onset of menarche appears to directly affect asthma severity in adolescent girls and females. Airway hyperresponsiveness and fractional exhaled nitric oxide do not have any positive correlation with high BMI in obese-asthmatic children and adults. Obesity also alters lung mechanics in asthmatics, but the impact is different for children and adults likely due to differential effect of obesity on central and peripheral airway. CONCLUSION: Existing literature suggests both similarities and differences in obese-asthmatic children and adults. The most pertinent differences are related to gender, ethnicity, and lung functions.

Effect of Montelukast 10 mg in Elderly Patients with Mild and Moderate Asthma Compared with Young Adults. Results of a Cohort Study.

BACKGROUND: The clinical characteristics and physio-pathogenic mechanisms of asthma in patients older than 60 years appear to differ from the behavior described for other age groups. Therefore, the effectiveness of medications for elderly patients with asthma should not be extrapolated from studies conducted on teenagers or young adults. OBJECTIVE: The study aimed to establish the clinical effect of montelukast 10 mg in elderly patients with mild and moderate asthma compared to its effect on young adults. METHOD: A prospective cohort study was conducted during 12 weeks of follow-up, which consecutively included the total population of adult patients attended by a group of 21 general practitioners, between July and December 2016. Young adults (18-59 years) and older adults were included (60 years or older) with mild or moderate asthma, which, according to the criteria of his treating physician, had been prescribed montelukast 10 mg/day. The variables of interest were: use of inhaled corticosteroids during the last month, use of inhaled beta-2 adrenergic agonists as a rescue in the last month, having attended the emergency service during the last month due to an asthma attack, presence of wheezing in the physical examination, the number of attacks in the last month and the number of days without symptoms in the last month. RESULTS: A total of 126 patients entered the cohort and 104 completed the follow-up, of which 29% were older adults. On admission, 65.4% of patients (68/104) had used rescue inhaled beta2 in the last month and had been using schemes with corticosteroids. After 12 weeks of follow-up, 58.1% (43/74) of the young adults required treatment schedules with corticosteroids, while in the elderly, only 36.7% of the patients (11/30) required this treatment scheme (p-value: 0.047). Regarding the use of rescue inhaled beta-2 at 12 weeks, 55% of young adults reported using them, compared to 33.3% of older adults (p-value: 0.041). CONCLUSION: In this cohort of patients, treated with montelukast 10 mg/day for 12 weeks, there was a reduction of broncho-obstructive symptoms and exacerbations of the disease. In older adults compared to young adults, a greater reduction in the use of beta2 agonists rescue medications and in the concomitant use of inhaled corticosteroid schemes was documented.

Soda consumption and hospital admissions among Californian adults with asthma.

INTRODUCTION: Asthma prevalence has been increasing consistently since 1995 in California. Recent studies have found that consuming soda and sugar-containing drinks may pose a risk for asthma. Research that examines the relationship between soda intake and asthma among adult asthmatics is limited. OBJECTIVE: This study investigated the relationship between sugar-sweetened soda consumption and asthma hospitalization among adult asthmatics in California. METHODS: This cross-sectional study was based on the 2011-2012 California Health Interview Survey (CHIS) data and included 3,784 adults who were diagnosed with asthma by a doctor and who currently reported either that they still had asthma, or that they had suffered from an asthma attack in the last 12 months. The analysis was survey weighted. The exposure variable was soda intake measured as the number of times soda was consumed in the last week. The health outcome measure was overnight hospital admission due to asthma. Logistic regression was used to examine the association between soda consumption and overnight hospital admission after adjusting for age, education, sex, race/ethnicity, weight status, smoking status, and self-rated health. RESULTS: Adults with asthma who drank soda three or more times per week reported higher odds of overnight hospitalization (adjusted odds ratio = 2.77, 95% CI: 1.51-5.10, p = 0.001). CONCLUSIONS: Our findings suggest that efforts designed to limit soda consumption would benefit asthma suffers by reducing hospital admissions. This, however, needs further research to confirm a direct causal association.

Molecularly targeted therapies for asthma: Current development, challenges and potential clinical translation.

Extensive research into the therapeutics of asthma has yielded numerous effective interventions over the past few decades. However, adverse effects and ineffectiveness of most of these medications especially in the management of steroid resistant severe asthma necessitate the development of better medications. Numerous drug targets with inherent airway smooth muscle tone modulatory role have been identified for asthma therapy. This article reviews the latest understanding of underlying molecular aetiology of asthma towards design and development of better antiasthma drugs. New drug candidates with their putative targets that have shown promising results in the preclinical and/or clinical trials are summarised. Examples of these interventions include restoration of Th1/Th2 balance by the use of newly developed immunomodulators such as toll-like receptor-9 activators (CYT003-QbG10 and QAX-935). Clinical trials revealed the safety and effectiveness of chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTH2) antagonists such as OC0000459, BI-671800 and ARRY-502 in the restoration of Th1/Th2 balance. Regulation of cytokine activity by the use of newly developed biologics such as benralizumab, reslizumab, mepolizumab, lebrikizumab, tralokinumab, dupilumab and brodalumab are at the stage of clinical development. Transcription factors are potential targets for asthma therapy, for example SB010, a GATA-3 DNAzyme is at its early stage of clinical trial. Other candidates such as inhibitors of Rho kinases (Fasudil and Y-27632), phosphodiesterase inhibitors (GSK256066, CHF 6001, roflumilast, RPL 554) and proteinase of activated receptor-2 (ENMD-1068) are also discussed. Preclinical results of blockade of calcium sensing receptor by the use of calcilytics such as calcitriol abrogates cardinal signs of asthma. Nevertheless, successful translation of promising preclinical data into clinically viable interventions remains a major challenge to the development of novel anti-asthmatics.

Low-flow veno-venous extracorporeal carbon dioxide removal in the management of severe status asthmatics: a case report.

Status asthmaticus is a life-threatening condition that requires intensive care management. Most of these patients have severe hypercapnic acidosis that requires lung protective mechanical ventilation. A small proportion of these patients do not respond to conventional lung protective mechanical ventilation or pharmacotherapy. Such patients have an increased mortality and morbidity. Successful use of extracorporeal membrane oxygenation (ECMO) is reported in such patients. However, the use of ECMO is invasive with its associated morbidity and is limited to specialised centres. In this report, we report the use of a novel, minimally invasive, low-flow extracorporeal carbon dioxide removal device in management of severe hypercapnic acidosis in a patient with life threatening status asthmaticus.

The level of submicron fungal fragments in homes with asthmatic children.

OBJECTIVES: Much scientific evidence indicates a positive association between moldy environments and respiratory illnesses and/or symptoms (e.g., asthma). Recently, submicron fungal fragments (<1.0 µm) have been suggested as a potential contributor to adverse health effects due to their biological composition (e.g., antigens, mycotoxins, and (1,3)-ß-D-glucan) as well as their small size. However, the contribution of exposure to fine fungal particles on adverse health outcomes has been poorly characterized, particularly in homes with asthmatic children. We characterized the airborne level of smaller-sized fungal particles between homes with and without asthmatic children. METHODS: We visited 29 homes with (n=15) and without (n=14) an asthmatic child and sampled submicron fungal fragments in a living room and child׳s bedroom, along with outdoor sampling, using the NIOSH two-stage sampler. (1,3)-ß-D-glucan of fungal fragments analyzed by Limulus Amebocyte lysate assay (LAL) was used for quantifying their exposure. RESULTS: Overall, the geometric mean (GM) concentration of (1,3)-ß-D-glucan in submicron fungal fragments in indoor air was two-fold higher in homes with asthmatic children (50.9 pg/m(3)) compared to homes with non-asthmatic children (26.7 pg/m(3)) (P<0.001). The GM concentration of these particles in child׳s bedroom in homes with an asthmatic child (66.1 pg/m(3)) was about three times higher than that in homes with non-asthmatic children (23.0 pg/m(3)) (P<0.001). The relative humidity had a negative correlation with the concentration of (1,3)-ß-D-glucan in submicron fungal fragments (Pearson coefficient=-0.257, P=0.046). CONCLUSIONS: Our findings indicate that homes with asthmatic children have a higher concentration of submicron fungal fragments compared to homes with non-asthmatic children. A greater exposure to smaller-sized fungal particles may occur in homes with an asthmatic child as relative humidity decreases. The very careful control of relative humidity in indoor air is necessary for reducing exposure to fine fungal particles and inhibiting the growth of microorganisms in homes with allergic diseases.

Metered dose inhaler technique among inner-city asthmatics and its association with asthma medication adherence.

INTRODUCTION: Inhaled medications, critical for asthma treatment, are self-administered through metered dose inhalers (MDI). Asthma self-management hinges on adherence to these medications and to proper MDI technique. OBJECTIVE: To assess predictors of proper MDI technique, and MDI technique as a tool to identify patients with low adherence to inhaled medications. METHODS: Prospective cohort of asthmatics from clinics in New York, NY and New Brunswick, NJ. MDI technique was assessed using a standardized checklist. Adherence to inhaled asthma controller medication was evaluated with the Medication Adherence Report Scale. Predictors of MDI technique were evaluated using regression analyses. The distribution of number of MDI technique steps missed was compared in adherent vs. non-adherent asthmatics. RESULTS: Overall, 326 patients were included (55% Hispanic, 27% Black). In adjusted analyses, age < 55 years was significantly associated with MDI technique (P = 0.03). Overall, 12%, 34%, 40% of asthmatics missed 5-6, 3-4, or 1-2 MDI steps; 16% received a perfect MDI technique score. Adherence rates were 20%, 39%, 48%, and 62% among those who missed 5-6, 3-4, 1-2, or none of the steps in the MDI technique checklist (P < 0.001). CONCLUSION: Poor MDI technique is common among inner-city patients with asthma and is associated with poor adherence to controller medications. Older patients with asthma are at higher risk of improper MDI technique. Assessment of MDI technique may be a simple clinical aid to identify patients with low adherence to controller medications.

Microbial biotransformation of beclomethasone dipropionate by Aspergillus niger

In the present research, the steroidal anti-asthmatic drug beclomethasone dipropionate was subjected to microbial biotransformation by Aspergillus niger. Beclomethasone dipropionate was transformed into various metabolites first time from microbial transformation. New drug metabolites produced can act as new potential drug molecules and can replace the old drugs in terms of safety, efficacy, and least resistance. They were purified by preparative thin layer chromatography technique, and their structures were elucidated using modern spectroscopic techniques, such as 13C NMR, 1H NMR, HMQC, HMQC, COSY, and NOESY, and mass spectrometry, such as EI-MS. Four metabolites were purified: (i) beclomethasone 17-monopropionate, (ii) beclomethasone 21-monopropionate, (iii) beclomethasone, and (iv) 9beta,11beta-epoxy-17,21-dihydroxy-16beta-methylpregna-1,4-diene-3,20-dione 21-propionate.

Na pesquisa presente o fármaco esteróide antiasmático dipropionato de beclometasona foi submetido à biotransformação microbiana pelo Aspergillus niger. O dipropionato de beclometasona foi transformado, pela primeira vez, em metabólitos variados por biotransformação microbiana. Novos metabólitos do fármaco produzidos podem agir como novas moléculas potenciais e podem substituir os fármacos antigos em questão de segurança, eficácia e mínima resistência. Eles foram purificados por cromatografia em camada delgada preparativa e as suas estruturas foram elucidadas usando técnicas espectroscópicas modernas, como 13C NMR, 1H NMR; HMQC; HMQC; COSY, NOESY e espectrometria de massas, por exemplo, EI-MS. Purificaram-se quatro metabólitos, denominados (i) 17-monopropionato de beclometasona; (ii) 21-monopropionato de beclometasona: (iii) beclometasona e (iv) 21-propionato de 9beta,11beta-epoxi-17,21-diidroxi-16beta-metilpregna-1,4-dieno-3,20-diona.