Benralizumab affects NK cell maturation and proliferation in severe asthmatic patients.

INTRODUCTION: The mechanism of action of benralizumab is determined by its afucosylated constant fragment that binds CD16a receptors on the membrane of natural killer cells. Here we analysed changes in Natural Killer and T-cells in Severe asthmatic patients, before and after benralizumab. METHODS: Natural Killer and T-cell subsets were detected through multiparametric flow cytometry. The concentrations of serum cytokines levels were detected through multiplex assay. Functional proliferation assay was performed in follow-up samples in severe asthmatic patients. RESULTS: At baseline, severe asthmatic patients showed higher percentages of immature Natural Killer cells when compared with healthy controls. We demonstrate the proliferative capacity of these cells and their activation after benralizumab administration. Benralizumab shifted Natural Killer cell phenotypes towards maturity. Correlation between the Natural Killer cells and functional parameters and with steroid-sparing was observed. CONCLUSION: Together this data contributes to our understanding of the mechanisms of action of benralizumab in the resolution of inflammation in severe asthma patients.

Factors associated with uncontrolled asthma among adult asthmatic patients in eastern Ethiopia: A multicenter study.

Objective: Asthma is a major public health problem worldwide. Despite various attempts, it is still uncontrolled in most parts of the world. Moreover, it is contributing to the national and global burden of non-communicable diseases. Studying factors associated with uncontrolled asthma in different parts of Ethiopia is crucial to control the disease and improving the quality of life of asthmatic patients. Thus, this study aimed to determine the factors associated with uncontrolled asthma among adult asthmatic patients in Eastern Ethiopia. Methods: Facility-based cross-sectional study was employed from 1st October 2020 to 30th January 2021. A total of 416 adult asthmatic patients participated in the study from six hospitals follow-up clinics. Asthma control test was used to assess the participants level of asthma control and a score of ⩽19 were regarded to have uncontrolled asthma. Data were analyzed using SPSS version 24. Bivariable and multivariable analyses were carried out to identify factors associated with uncontrolled asthma and variables with a p value of less than 0.05 were considered statistically significant. Result: The prevalence of uncontrolled asthma was 66.1 % (95% confidence interval: 61.5-70.4). Not attending scheduled medical follow-up (adjusted odds ratio: 2.54; 95% confidence interval: 1.28-4.99), poor knowledge about asthma (adjusted odds ratio = 4.59; 95% confidence interval: 2.01-10.51), negative attitude toward asthma (adjusted odds ratio = 3.72; 95% confidence interval: 1.83-7.59), and poor adherence to medications (adjusted odds ratio = 2.53; 95% confidence interval: 1.25-5.13) were significantly associated with uncontrolled asthma. Conclusion: In this study, the prevalence of uncontrolled asthma was considerably high. Not attending scheduled medical follow-up, poor knowledge about asthma, negative attitude toward asthma, and poor adherence to anti-asthma medications were associated with uncontrolled asthma. Therefore, it is crucial to focus on increasing the patients' level of awareness about asthma control, improving medication adherence, and avoiding triggering factors.

Assessing the use of MDI among asthmatic patients in Saudi Arabia.

Background: Asthma is an important public health problem worldwide on account of its prevalence. Education of asthmatic patients about appropriate using of MDIs would be more effective medications. Objectives: To assess the appropriateness of using MDIs among asthmatic patients and to determine the factors significantly associated with correct use of MDI. Method: A descriptive study was conducted on 399 asthmatic patients on internet on Google from 28th October to 28th November 2015. A questionnaire was filled out and SPSS version 21 was used for data analysis. Standard method was used to obtain descriptive statistic comprising means, percentage and standard deviations in order to describe demographic variables. Analysis of variance (ANOVA) test was used to compare means of contentious and categorical variables of demographic characteristics and medical background with using MDIs and find association between them. P-value of 0.05 and less were regarded as statistically significant. Results: In the studied sample, 87% were age less than 45 years, 74% of cases were females. About 92% of cases were higher and above level of education. More than half of subjects had asthma for more than five years. There were 36% of patients using MDI. Only a few patients (12%) had the correct all skills using MDIs. There were significant association between using MDIs with age and duration of asthma (p=<0.001). Conclusions: Despite the well-known fact that a good MDI technique is of greatest importance, Majority of asthmatic patients have poor skills of MDI appropriate use. Incorrect MDIs technique is common among asthma patients. Health care professional must be focused on training on use MDI among the younger and newly diagnosis asthmatic patients. This indicating the need for regular formal training programmes on inhaler techniques so as to decipher correct practices in inhalation therapy.

Assessing the use of MDI among Asthmatic Patients in Saudi Arabia

Background: Asthma is an important public health problem worldwide on account of its prevalence. Education of asthmatic patients about appropriate using of MDIs would be more effective medications. Objectives: To assess the appropriateness of using MDIs among asthmatic patients and to determine the factors significantly associated with correct use of MDI. Method: A descriptive study was conducted on 399 asthmatic patients on internet on Google from 28th October to 28th November 2015. A questionnaire was filled out and SPSS version 21 was used for data analysis. Standard method was used to obtain descriptive statistic comprising means, percentage and standard deviations in order to describe demographic variables. Analysis of variance (ANOVA) test was used to compare means of contentious and categorical variables of demographic characteristics and medical background with using MDIs and find association between them. P-value of 0.05 and less were regarded as statistically significant. Results: In the studied sample, 87% were age less than 45 years, 74% of cases were females. About 92% of cases were higher and above level of education. More than half of subjects had asthma for more than five years. There were 36% of patients using MDI. Only a few patients (12%) had the correct all skills using MDIs. There were significant association between using MDIs with age and duration of asthma (p=<0.001). Conclusions: Despite the well-known fact that a good MDI technique is of greatest importance, Majority of asthmatic patients have poor skills of MDI appropriate use. Incorrect MDIs technique is common among asthma patients. Health care professional must be focused on training on use MDI among the younger and newly diagnosis asthmatic patients. This indicating the need for regular formal training programmes on inhaler techniques so as to decipher correct practices in inhalation therapy. (AU)

Correlation between fractional exhaled nitric oxide level and clinical outcomes among childhood asthmatic patients: community hospital-based perspective.

A fractional exhaled nitric oxide (FeNO) device has been developed for the evaluation of clinical control in asthmatic patients, instead of for uses in only analyzing clinical data and spirometry. The implementation of the FeNO device in daily practice has demonstrated both positive and negative results. Community hospital settings in Thailand have never used this method for the evaluation of disease control in asthmatics. The aim of this study was to assess the correlation between FeNO levels and asthma control, as determined by physicians. We recruited asthmatic patients aged from 4-15-years-old (after informed consent approval was obtained from their guardians) from May 15, 2018, to July 20, 2019. All of the patients had already been diagnosed as having asthma by physicians and had been prescribed inhaled corticosteroid medications. After routine visits, skin prick tests with 8 aeroallergens were performed. If a positive result was shown for at least 1 allergen, then the FeNO device was applied for the assessment of the level of inflammation. Data were analyzed by using SPSS Statistics version 21.0. Agreement index and Kruskal Wallis tests were used to measure the correlations. From 178 asthmatic patients, the mean age was 94.9 ± 36.75 months, and 59% of them were male. The educational levels of the guardians of the patients mostly consisted of primary school, and the household income was less than 333 US dollars per month. Inhaled corticosteroids were prescribed among the patients for disease control. The correlation between the FeNO level and the control level demonstrated a high agreement (accuracy index: 91.57%). The medians of the mean wheal diameters of Dermatophagoids pteronyssinus, Dermatophagoids farinae and Cladosporium spp. were significantly related to the FeNO level (with p-values of 0.024, 0.003 and 0.045, respectively). Conversely, a number of positive skin responses to aeroallergens were not related with the FeNO level. In conclusion, a lower level of FeNO correlates with good asthma control level in pediatric allergic asthma. The medians of the mean wheal diameters of Dermatophagoids pteronyssinus, Dermatophagoids farinae and Cladosporium spp. correlated with higher FeNO levels. A device assessing FeNO seems beneficial for evaluating the level of disease control among childhood asthmatic patients in a primary care setting.

Perceived Asthma Control Care and Health Care Participation in Patients with Asthma.

BACKGROUND: Asthma is one of the most severe and life-threatening health problems, the better control of which is one of the main goals in asthma management to be achieved by patients' balanced participation in the treatment process. This study aimed to investigate asthma control, perceived care, and health care participation in patients with asthma. MATERIALS AND METHODS: This descriptive-analytical study included 221 asthmatic patients, who were selected using the convenience sampling method from those referring to pulmonary clinics in Kerman, Iran. The required data were collected using three questionnaires including Asthma Control Test (ACT), Perceived Care of Asthma Questionnaire (PCAQ), and Partners in Health Scale (PIH). The linear regression test was used to analyze the collected data with SPSS software version 21. RESULTS: In this study, 14.31, 42.22, and 87.33% of the patients had a favorable condition in asthma control, perceived asthma care, health participation, respectively. The disease duration was significantly associated with the level of perceived asthma care. Moreover, perceived asthma care had a significant relationship only with occupation. From another perspective, the relationship between marital status, level of education, city of residence, disease duration, and occupation with health care participation was significant. CONCLUSION: Patients would have more control over asthma if there were training programs underpinned by disease-based strategies and educational content regarding the risk factors of the disease, and the patients' experience and knowledge of the disease were promoted. Furthermore, reinforcing self-control and perceived asthma care skills and involving patients in healthcare process would also enhance the disease control.

Estudio del estado clínico-funcional en pacientes asmáticos / Study of the clinical and functional conditions of asthmatic patients

Introducción: Las principales alteraciones funcionales del asma bronquial son la obstrucción del flujo aéreo, su reversibilidad, variabilidad y la hiperrespuesta bronquial. Objetivo: Determinar el estado clínico-funcional en pacientes con asma que asisten por primera vez a consulta de neumología. Material y Métodos: Se realizó un estudio descriptivo transversal con 110 pacientes que asistieron por primera vez y fueron atendidos por asma en la consulta externa del Hospital Neumológico Benéfico Jurídico (HNBJ) en el año 2014-2015, se comprobó por la clínica y la espirometría la severidad de la enfermedad. Entre las variables de estudio están: edad, sexo, antecedentes patológicos familiares de asma o alergia, índice de masa corporal, gravedad o severidad del asma. Resultados: Predominó el asma de mayor gravedad entre los pacientes comprendidos entre los 40-59 años, con riesgo 4,4 veces superior en mayores de 40 años. El sexo femenino presentó 2,1 veces más riesgo. El 75,5 por ciento de pacientes tenía antecedentes patológicos familiares (APF) de asma o alergia y riesgo 3,4 veces superior de mayor gravedad. Más de la mitad presentó antecedentes patológicos personales (APP) de otras enfermedades y mayor proporción de asma de mayor gravedad. El 53.6 por ciento presentó sobrepeso u obesidad y 4,1 veces más riesgo de mayor gravedad. La mayoría de los pacientes no presentó adicción tabáquica. Conclusiones: Los pacientes mayores de 40 años, sexo femenino y con APF de asma o alergia, presentan asma de mayor gravedad. La obesidad es frecuente en pacientes asmáticos y constituye un riesgo importante de padecer asma más grave. Existe bajo porcentaje de asmáticos fumadores aunque esta condición favorece a padecer un asma más grave(AU)

Introduction: The main functional alterations in bronchial asthma are the obstruction of the air flow, its reversibility, variability, and bronchial hyper- responsiveness. Objective: To determine the clinical and functional conditions in patients with asthma who go to the outpatient pneumology service for the first time. Material and Methods: A cross-sectional descriptive study was conducted in 110 patients with asthma that were treated for the first time in the outpatient department of the Pneumology Service at the "Benéfico Jurídico" Teaching Hospital in Havana from June 1st,2014 to June 31st,2015. The severity of asthma was confirmed by clinical diagnosis and spirometric tests. The variables consisted of age, sex, family pathological antecedents of asthma or allergy, body mass index, and seriousness or severity of asthma. Results: The most serious asthma prevailed in patients aged 40 to 59 years, and the patients 40 years old and older presented 4.4 times higher risks. The female sex exhibited 2.1 times higher risks. 75.5 percent of patients with family pathological antecedents (FPA) of asthma or allergy showed 3.4 times higher risk levels for more serious conditions. More than half of patients presented personal pathological antecedents (PPA) of other diseases and a more serious asthma. 53.6 percent were overweight or obese who were 4.1 times at higher risks of suffering from more serious conditions. Most patients did not report smoking addiction. Conclusions: Asthmatic patients over 40 years showed a more serious asthma during their first visit to the outpatient pneumology service, and the female sex prevailed. Asthma or allergy, FPA and PPA were the risk factors for suffering from both asthma and more serious conditions. There is a low percentage of smoking asthmatics although this condition provokes more serious symptoms(AU)

Prevalence of specific immunoglobulin E and G against Aspergillus fumigatus in patients with asthma.

BACKGROUND AND PURPOSE: Aspergillus fumigatus as a ubiquitous fungus can be found in the respiratory tract of the asthmatic and healthy people. The inhalation of Aspergillus spores leads to an immune response in individuals with asthma and results in the aggravation of the clinical symptoms. The present study aimed to investigate the prevalence of specific immunoglobulin E and G (IgE and IgG) against A.fumigatus in asthmatic patients. MATERIALS AND METHODS: This study was conducted on 200 consecutive patients with moderate to severe asthma referring to Masih Daneshvari hospital Tehran, Iran, from January 2016 to February 2018. Skin prick test (SPT) was performed in all subjects with Aspergillus allergens. Moreover, all patients underwent specific IgE testing for Aspergillus using Hycor method. Enzyme immune assay was applied to measure total IgE and Aspergillus-specific IgG. RESULTS: According to the results, the mean age of the patients was 45.8 years (age range: 18-78 years). The mean levels of total IgE and Aspergillus specific IgE in asthmatic patients were obtained as 316.3 (range: 6-1300 IU/ml) and 1.5 (range: 0.1-61.3 IU/ml), respectively. Out of 200 patients, 27 (13.5%), 65 (32.5%), 22 (11.0%), and 86 (43.0%) cases had positive Aspergillus SPT, total IgE of > 417 IU/ml, Aspergillus -specific IgE, and IgG, respectively. The level of these variables in patients with severe asthma were 16 (16.5%), 36 (37.1%), 15 (15.5%), and 46 (47.4%), respectively. CONCLUSION: As the findings indicated, reactivity to Aspergillus is a remarkable phenomenon in asthmatic patients. It is also emphasised that the climatic condition may affect the positive rate of hypersensitivity to Aspergillus.

The mediating effects of cognitive emotion regulation strategies on the relationship between alexithymia and physical symptoms: Evidence from Iranian asthmatic patients.

Asthma is a chronic and episodic psychosomatic disease whose symptoms include coughing, wheezing, chest tightness, and shortness of breath. The present study aimed to investigate the effects of cognitive emotion regulation strategies (CERS) as mediators on the relationships between alexithymia subscales and physical symptoms (PS). 300 asthmatic patients (males=42.7%, females=57.3%, age range=16-65, mean age=29.40) and 100 normal controls participated in the study and completed the demographic questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), the Persian version of the Toronto Alexithymia Scale (FTAS-20), and the Powell & Enright Physical Symptoms Inventory (PSI). Asthmatic patients showed higher scores on all three alexithymia subscales including difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT) as well as non-adaptive CERS than normal controls. On the other hand, normal controls earned higher means in adaptive CERS. Results revealed that each of the three alexithymia subscales had indirect effects on PS through the non-adaptive cognitive emotion regulation strategy of catastrophizing. It is concluded that alexithymia can intensify PS through catastrophizing in asthmatic patients.

Effects of zafirlukast on the function of humanpolymorphonuclear neutrophil leukocytes in asthmatic patients: A prospective, controlled, in vitro study.

BACKGROUND: Reactive oxygen species (ROSS) play an important role in the pathogenesis of asthma, and oxidative stress contributes to the initiation and worsening of inflammatory respiratory disorders (eg, asthma). Thus, antioxidant drugs may have a role in reducing or preventing damage in asthma. OBJECTIVE: The aim of the study was to investigate the antioxidant effect of zafirlukast, a leukotriene receptor antagonist, in asthma. METHODS: This prospective, controlled, in vitro study was conducted at KingKhalid University Hospital, Riyadh, Saudi Arabia. The generation of ROSS by polymorphonuclear neutrophil leukocytes (PMNs) in patients with mild to moderate asthma (forced expiratory volume in 1 second [FEVI], >70% of the predicted value) and healthy volunteers was assessed using chemiluminescence (CL) with phorbol 12-myristate 13-acetate (PMA) and opsonized zymosan (OPZ) in the presence of different concentrations of zafirlukast (1.25-60 µg/mL). The xanthine/xanthine oxidase (X-XOD) reaction was used to test the scavenging effect of the drug. RESULTS: Six asthmatic patients (4 women, 2 men; mean age, 30.8 years; meanFEVI, 82.5% of the predicted value) and 8 healthy volunteers (4 women, 4 men; mean age, 28.8 years) were enrolled. A dose-dependent inhibition of the CL response was observed in both groups. However, patients with asthma required higher concentrations of zafirlukast to achieve an inhibitory effect similar to that in healthy controls. This difference was significant at concentrations of 20 to 60 µg/mL (all, P ≤ 0.05). When PMNs were challenged with OPZ, inhibition was also dose dependent in controls at all concentrations (all, P ≤ 0.05), but the inhibitory effect was not significant in the asthmatic patients at any concentration. The difference in the inhibitory effect between the 2 groups was significant at 30, 40, and 60 µg/mL (P < 0.02, <0.01, and <0.01, respectively). The mean (SEM) viability of the PMNs in the healthy controls was significantly affected only at the highest concentration compared with the control saline dose (86.5% [5.8%] vs 97.0% [8.%]; P < 0.05). No scavenging effect of zafirlukast was found using the X XOD system. Incubating PMA-stimulated cells with zafirlukast (5 and 10 µg/mL) for 10 minutes to 1 hour significantly increased the inhibitory effect of the drug by 15% to 46% (all, P < 0.001). When zafirlukast was tested for reversibility of its inhibitory effect on ROS production, its action was found to be irreversible at a concentration of 30 µg/mL (P < 0.001) and partially reversible at 60 µg/mL compared with the baseline saline control. CONCLUSIONS: Zafirlukast inhibited ROS generation by PMNs in a dose-dependentmanner in asthmatic patients and healthy subjects. However, asthmatic patients required much higher concentrations compared with controls. The incubation of the stimulated cells with zafirlukast increased the inhibitory effect. This finding suggests that the therapeutic effect of zafirlukast in asthma may be in part related to its antioxidant action.

Tratamiento intercrisis en pacientes asmáticos / Iintercrisis treatment in asthmatic patients

Se realizó estudio descriptivo transversal para caracterizar el tratamiento intercrisis de los pacientes asmáticos en el Policlínico Comunitario Docente "Carlos J. Finlay" de Camagüey, en el año 1998. La muestra fue de 298 pacientes utilizándose el método bietápico. Se escogieron los, pacientes en forma aleatoria de 10 consultorios y la historia clínica familiar fue la fuente de datos. El cumplimiento de las medidas generales fue directamente proporcional a la intesidad del asma, sustentándose el tratamiento farmacológico en el uso de beta adrenérgicos y expectorantes fundamentalmente. Hubo poca utilización de los estabilizadores de membrana corticoides y de la medicina natural y tradicional. Aproximadamente uno de cada 10 asmáticos moderados o severos, habían utilizado en el último año antihistamínicos de primera generación como parte del tratamiento intercrisis.

A descriptive, cross-sectional study was performed for characterizing intercrisis treatment in asthmatic patients in "Carlos J. Finlay" Polyclinic of Camagüey in 1998. The sample comprised 298 patients using the bietapic. Patients were ramdornly selected from 10 family physician health clinics source. The fulfillment of general measures was directly proportional to asthma intensity, supporting the pharmacologic treatment in the use of beta -adrenergic and expectorant mainly. There was poor use of membrane stabilizers, corticoids and of the natural and traditional Medicine Aproximately 1 out of 10 moderate or severe asthmatic had used in the last year antihistaminic of firts generation as part of the intercrisis treatment.

Survey on negative impact of chironomid midges (Diptera) on bronchial asthmatic patients in a hyper-eutrophic lake area in Japan.

Chironomid midges have been revealed to be a hazardous inhalant antigen of bronchial asthma. To determine the awareness of the negative impact of chironomid midges (Chironomus plumosus and Propsilocerus akamusi) among patients, a questionnaire survey of 118 patients in the Lake Suwa area and in the Matsumoto area was conducted from early September to mid-November of 1993. The life style was almost the same among the asthmatic patients in the Lake Suwa area and in the Matsumoto area, but the reactions to the nuisance differed significantly from each other. Although "Flight density" was higher in the Lake Suwa area (p < 0.01) than that in the Matsumoto area, 25.5% of the patients in the Lake Suwa area and 9.1% of those in the Matsumoto area answered "Endurable" (p < 0.01). Further follow-up studies including prick tests, intradermal tests and provocation tests should be conducted for patients who complained a strong allergic reaction.