Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24.956
Filtrar
1.
N Z Med J ; 133(1520): 61-72, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994594

RESUMO

AIM: In the PRACTICAL study, as-needed budesonide/formoterol reduced the rate of severe exacerbations compared with maintenance budesonide plus as-needed terbutaline. In a pre-specified analysis we analysed the efficacy in Maori and Pacific peoples, populations with worse asthma outcomes. METHOD: The PRACTICAL study was a 52-week, open-label, parallel group, randomised controlled trial of 890 adults with mild to moderate asthma, who were randomised to budesonide/formoterol Turbuhaler 200/6mcg one actuation as required or budesonide Turbuhaler 200mcg one actuation twice daily and terbutaline Turbuhaler 250mcg two actuations as required. The primary outcome was rate of severe exacerbations. The analysis strategy was to test an ethnicity-treatment interaction term for each outcome variable. RESULTS: Seventy-two participants (8%) identified as Maori, 36 participants (4%) as Pacific ethnicity. There was no evidence that ethnicity was an effect modifier for severe exacerbations (P interaction 0.70). CONCLUSION: The reduction in severe exacerbation risk with budesonide-formoterol reliever compared with maintenance budesonide was similar in Maori and Pacific adults compared with New Zealand European/Other.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Combinação Budesonida e Fumarato de Formoterol/uso terapêutico , Quimioterapia Combinada/métodos , Administração por Inalação , Adulto , Antiasmáticos/administração & dosagem , Asma/fisiopatologia , Broncodilatadores/administração & dosagem , Broncodilatadores/uso terapêutico , Budesonida/administração & dosagem , Budesonida/uso terapêutico , Combinação Budesonida e Fumarato de Formoterol/administração & dosagem , Estudos de Casos e Controles , Progressão da Doença , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores/normas , Nova Zelândia/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Terbutalina/administração & dosagem , Terbutalina/uso terapêutico , Resultado do Tratamento
2.
Respir Res ; 21(1): 252, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993656

RESUMO

SARS-CoV-2 is causing a pandemic with currently > 29 million confirmed cases and > 900,000 deaths worldwide. The locations and mechanisms of virus entry into the human respiratory tract are incompletely characterized. We analyzed publicly available RNA microarray datasets for SARS-CoV-2 entry receptors and cofactors ACE2, TMPRSS2, BSG (CD147) and FURIN. We found that ACE2 and TMPRSS2 are upregulated in the airways of smokers. In asthmatics, ACE2 tended to be downregulated in nasal epithelium, and TMPRSS2 was upregulated in the bronchi. Furthermore, respiratory epithelia were negative for ACE-2 and TMPRSS2 protein expression while positive for BSG and furin, suggesting a possible alternative entry route for SARS-CoV-2.


Assuntos
Asma/virologia , Infecções por Coronavirus/genética , Regulação da Expressão Gênica , Pneumonia Viral/genética , Serina Endopeptidases/genética , Síndrome Respiratória Aguda Grave/virologia , Fumar/epidemiologia , Asma/fisiopatologia , Bases de Dados Factuais , Humanos , Pandemias , Receptores Virais/genética , Valores de Referência , Sistema Respiratório/metabolismo , Sistema Respiratório/virologia , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/metabolismo , Fumar/fisiopatologia , Internalização do Vírus
3.
PLoS One ; 15(8): e0237769, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817718

RESUMO

Concerns exist that the positive association of physical activity with better lung function, which has been suggested in previous longitudinal studies in smokers, is due to reverse causation. To investigate this, we applied structural equation modeling (SEM), an exploratory approach, and marginal structural modeling (MSM), an approach from the causal inference framework that corrects for reverse causation and time-dependent confounding and estimates causal effects, on data from participants in the European Community Respiratory Health Survey (ECRHS, a multicentre European cohort study initiated in 1991-1993 with ECRHS I, and with two follow-ups: ECRHS II in 1999-2003, and ECRHS III in 2010-2014). 753 subjects who reported current smoking at ECRHS II, with repeated data on lung function at ECRHS I, II and III, physical activity at ECRHS II and III, and potential confounders at ECRHS I and II, were included in the analyses. SEM showed positive associations between physical activity and lung function in both directions. MSM suggested a protective causal effect of physical activity on lung function (overall difference in mean ß (95% CI), comparing active versus non-active individuals: 58 mL (21-95) for forced expiratory volume in one second and 83 mL (36-130) for forced vital capacity). Our results suggest bi-directional causation and support a true protective effect of physical activity on lung function in smokers, after accounting for reverse causation and time-dependent confounding.


Assuntos
Asma/terapia , Exercício Físico , Pulmão/fisiologia , Infecções Respiratórias/terapia , Adolescente , Adulto , Asma/etiologia , Asma/fisiopatologia , Peso Corporal/fisiologia , Dieta , Feminino , Volume Expiratório Forçado/fisiologia , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Fumantes , Fumar/efeitos adversos , Capacidade Vital/fisiologia , Adulto Jovem
4.
J Allergy Clin Immunol ; 146(2): 285-299, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32624257

RESUMO

The global pandemic caused by the newly described severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused worldwide suffering and death of unimaginable magnitude from coronavirus disease 2019 (COVID-19). The virus is transmitted through aerosol droplets, and causes severe acute respiratory syndrome. SARS-CoV-2 uses the receptor-binding domain of its spike protein S1 to attach to the host angiotensin-converting enzyme 2 receptor in lung and airway cells. Binding requires the help of another host protein, transmembrane protease serine S1 member 2. Several factors likely contribute to the efficient transmission of SARS-CoV-2. The receptor-binding domain of SARS-CoV-2 has a 10- to 20-fold higher receptor-binding capacity compared with previous pandemic coronaviruses. In addition, because asymptomatic persons infected with SARS-CoV-2 have high viral loads in their nasal secretions, they can silently and efficiently spread the disease. PCR-based tests have emerged as the criterion standard for the diagnosis of infection. Caution must be exercised in interpreting antibody-based tests because they have not yet been validated, and may give a false sense of security of being "immune" to SARS-CoV-2. We discuss how the development of some symptoms in allergic rhinitis can serve as clues for new-onset COVID-19. There are mixed reports that asthma is a risk factor for severe COVID-19, possibly due to differences in asthma endotypes. The rapid spread of COVID-19 has focused the efforts of scientists on repurposing existing Food and Drug Administration-approved drugs that inhibit viral entry, endocytosis, genome assembly, translation, and replication. Numerous clinical trials have been launched to identify effective treatments for COVID-19. Initial data from a placebo-controlled study suggest faster time to recovery in patients on remdesivir; it is now being evaluated in additional controlled studies. As discussed in this review, till effective vaccines and treatments emerge, it is important to understand the scientific rationale of pandemic-mitigation strategies such as wearing facemasks and social distancing, and implement them.


Assuntos
Asma/epidemiologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Distância Social , Glicoproteína da Espícula de Coronavírus/genética , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Fatores Etários , Alanina/análogos & derivados , Alanina/uso terapêutico , Antivirais/uso terapêutico , Asma/fisiopatologia , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Ensaios Clínicos como Assunto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/transmissão , Reposicionamento de Medicamentos , Humanos , Máscaras/provisão & distribução , Peptidil Dipeptidase A/genética , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/transmissão , Prevalência , Quarentena/organização & administração , Receptores Virais/genética , Receptores Virais/metabolismo , Índice de Gravidade de Doença , Glicoproteína da Espícula de Coronavírus/metabolismo
5.
J Allergy Clin Immunol Pract ; 8(8): 2600-2607, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32603901

RESUMO

BACKGROUND: Viral infections are known to exacerbate asthma in adults. Previous studies have found few patients with asthma among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia cases. However, the relationship between SARS-CoV-2 infection and severe asthma exacerbation is not known. OBJECTIVE: To assess the frequency of asthma exacerbation in patients with asthma hospitalized for SARS-CoV-2 pneumonia and compare symptoms and laboratory and radiological findings in patients with and without asthma with SARS-CoV-2 pneumonia. METHODS: We included 106 patients between March 4 and April 6, 2020, who were hospitalized in the Chest Diseases Department of Strasbourg University Hospital; 23 had asthma. To assess the patients' asthma status, 3 periods were defined: the last month before the onset of COVID-19 symptoms (p1), prehospitalization (p2), and during hospitalization (p3). Severe asthma exacerbations were defined according to Global INitiative for Asthma guidelines during p1 and p2. During p3, we defined severe asthma deterioration as the onset of breathlessness and wheezing requiring systemic corticosteroids and inhaled ß2 agonist. RESULTS: We found no significant difference between patients with and without asthma in terms of severity (length of stay, maximal oxygen flow needed, noninvasive ventilation requirement, and intensive care unit transfer); 52.2% of the patients with asthma had Global INitiative for Asthma step 1 asthma. One patient had a severe exacerbation during p1, 2 patients during p2, and 5 patients were treated with systemic corticosteroids and inhaled ß2 agonist during p3. CONCLUSIONS: Our results demonstrate that patients with asthma appeared not to be at risk for severe SARS-CoV-2 pneumonia. Moreover, SARS-CoV-2 pneumonia did not induce severe asthma exacerbation.


Assuntos
Asma/epidemiologia , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Agonistas Adrenérgicos beta/uso terapêutico , Idoso , Asma/tratamento farmacológico , Asma/fisiopatologia , Betacoronavirus , Comorbidade , Infecções por Coronavirus/fisiopatologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/fisiopatologia , Respiração Artificial , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos
6.
PLoS One ; 15(7): e0235069, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628682

RESUMO

BACKGROUND: Pneumonia is the leading cause of death among children and young people (CYP) with severe cerebral palsy (CP). Only a few studies used nomogram for assessing risk factors and the probability of pneumonia. Therefore, we aimed to identify risk factors and devise a nomogram for identifying the probability of severe pneumonia in CYP with severe CP. METHODS: This retrospective nationwide population-based cohort study examined CYP with newly diagnosed severe CP before 18 years old between January 1st, 1997 and December 31st, 2013 and followed them up through December 31st, 2013. The primary endpoint was defined as the occurrence of severe pneumonia with ≥ 5 days of hospitalization. Logistic regression analysis was used for determining demographic factors and comorbidities associated with severe pneumonia. These factors were assigned integer points to create a scoring system to identify children at high risk for severe pneumonia. RESULTS: Among 6,356 CYP with newly diagnosed severe CP, 2,135 (33.59%) had severe pneumonia. Multivariable logistic regression analysis revealed that seven independent predictive factors, namely age <3 years, male sex, and comorbidities of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications. A nomogram was devised by employing these seven significant predictive factors. The prediction model presented favorable discrimination performance. CONCLUSIONS: The nomogram revealed that age, male sex, history of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications were potential risk factors for severe pneumonia among CYP with severe CP.


Assuntos
Paralisia Cerebral/diagnóstico , Paralisia Cerebral/epidemiologia , Nomogramas , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/epidemiologia , Doença Aguda , Adolescente , Fatores Etários , Asma/diagnóstico , Asma/fisiopatologia , Paralisia Cerebral/complicações , Paralisia Cerebral/mortalidade , Criança , Pré-Escolar , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/mortalidade , Lesão por Pressão/diagnóstico , Lesão por Pressão/fisiopatologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Convulsões/diagnóstico , Convulsões/fisiopatologia , Fatores Sexuais , Análise de Sobrevida , Taiwan/epidemiologia
8.
Ann Allergy Asthma Immunol ; 125(4): 481-483, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32717301
9.
Allergol. immunopatol ; 48(3): 270-280, mayo-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-192030

RESUMO

INTRODUCTION: The first thousand days of life are a critical stage for the development of respiratory and immune systems. Many events in this period may be associated with wheezing in childhood. OBJECTIVE: This study aimed to investigate the association between early life determinants and wheezing in children aged 6-7 years. MATERIALS AND METHODS: Population-based case-control study using early-life related questions. We used the International Study of Asthma and Allergies in Childhood questionnaire to assess wheezing symptoms. Multiple logistic regressions were performed according to a hierarchical framework, considering the complex dynamic of wheezing/asthma and potential interaction between different levels of determination. RESULTS: A total of 820 children were included, from which 162 reported wheezing symptoms (19.7%). Multivariable analysis identified socioeconomic conditions (OR 2.08, 95% CI 1.08-4.00), family history of asthma (OR 2.28, 95% CI 1.37-3.75), vaginal discharge that required treatment during pregnancy (OR 1.68, 95% CI 1.00-2.83), neonatal hyperbilirubinemia (OR 2.00, 95% CI 1.17-3.42), anemia and intestinal parasitosis in the first two years (OR 2.28, 95% CI 1.22-4.25; OR 1.72, 95% CI 1.02-2.92, respectively) independently associated to wheezing at 6-7 years. Intended pregnancy was associated with reduced wheezing (OR 0.47, 95% CI 0.28-0.77). CONCLUSIONS: Several factors were associated with wheezing in childhood. Considering that intended pregnancy reduced wheezing and other associated exposures are considered modifiable, these findings may guide the planning of strategies to decrease the susceptibility to asthma symptoms in childhood


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Sons Respiratórios/fisiopatologia , Doenças Respiratórias/epidemiologia , Transtornos Respiratórios/fisiopatologia , Inquéritos e Questionários , Asma/fisiopatologia , Modelos Logísticos , Análise Multivariada
10.
J Allergy Clin Immunol ; 146(2): 307-314.e4, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32554082

RESUMO

BACKGROUND: The Centers for Disease Control and Prevention advises that patients with moderate to severe asthma belong to a high-risk group that is susceptible to severe coronavirus disease 2019 (COVID-19). However, the association between asthma and COVID-19 has not been well-established. OBJECTIVE: The primary objective was to determine the prevalence of asthma among patients with COVID-19 in a major US health system. We assessed the clinical characteristics and comorbidities in asthmatic and nonasthmatic patients with COVID-19. We also determined the risk of hospitalization associated with asthma and/or inhaled corticosteroid use. METHODS: Medical records of patients with COVID-19 were searched by a computer algorithm (March 1 to April 15, 2020), and chart review was used to validate the diagnosis of asthma and medications prescribed for asthma. All patients had PCR-confirmed COVID-19. Demographic and clinical features were characterized. Regression models were used to assess the associations between asthma and corticosteroid use and the risk of COVID-19-related hospitalization. RESULTS: Of 1526 patients identified with COVID-19, 220 (14%) were classified as having asthma. Asthma was not associated with an increased risk of hospitalization (relative risk, 0.96; 95% CI, 0.77-1.19) after adjusting for age, sex, and comorbidities. The ongoing use of inhaled corticosteroids did not increase the risk of hospitalization in a similar adjusted model (relative risk, 1.39; 95% CI, 0.90-2.15). CONCLUSIONS: Despite a substantial prevalence of asthma in our COVID-19 cohort, asthma was not associated with an increased risk of hospitalization. Similarly, the use of inhaled corticosteroids with or without systemic corticosteroids was not associated with COVID-19-related hospitalization.


Assuntos
Asma/epidemiologia , Betacoronavirus/patogenicidade , Doença da Artéria Coronariana/epidemiologia , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Pneumonia Viral/epidemiologia , Administração por Inalação , Corticosteroides/uso terapêutico , Adulto , Fatores Etários , Idoso , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/tratamento farmacológico , Asma/fisiopatologia , Técnicas de Laboratório Clínico/métodos , Comorbidade , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Illinois/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Obesidade/diagnóstico , Obesidade/fisiopatologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Prevalência , Estudos Retrospectivos , Fatores de Risco
11.
J Allergy Clin Immunol Pract ; 8(8): 2592-2599.e3, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32561497

RESUMO

BACKGROUND: It is unclear whether asthma may affect susceptibility or severity of coronavirus disease 2019 (COVID-19) in children and how pediatric asthma services worldwide have responded to the pandemic. OBJECTIVE: To describe the impact of the COVID-19 pandemic on pediatric asthma services and on disease burden in their patients. METHODS: An online survey was sent to members of the Pediatric Asthma in Real Life think tank and the World Allergy Organization Pediatric Asthma Committee. It included questions on service provision, disease burden, and the clinical course of confirmed cases of COVID-19 infection among children with asthma. RESULTS: Ninety-one respondents, caring for an estimated population of more than 133,000 children with asthma, completed the survey. COVID-19 significantly impacted pediatric asthma services: 39% ceased physical appointments, 47% stopped accepting new patients, and 75% limited patients' visits. Consultations were almost halved to a median of 20 (interquartile range, 10-25) patients per week. Virtual clinics and helplines were launched in most centers. Better than expected disease control was reported in 20% (10%-40%) of patients, whereas control was negatively affected in only 10% (7.5%-12.5%). Adherence also appeared to increase. Only 15 confirmed cases of COVID-19 were reported among the population; the estimated incidence is not apparently different from the reports of general pediatric cohorts. CONCLUSIONS: Children with asthma do not appear to be disproportionately affected by COVID-19. Outcomes may even have improved, possibly through increased adherence and/or reduced exposures. Clinical services have rapidly responded to the pandemic by limiting and replacing physical appointments with virtual encounters.


Assuntos
Asma/epidemiologia , Asma/fisiopatologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Agendamento de Consultas , Asma/terapia , Betacoronavirus , Criança , Saúde Global , Humanos , Adesão à Medicação , Pandemias , Índice de Gravidade de Doença , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Fatores de Tempo
13.
J Breath Res ; 14(4): 046003, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32512553

RESUMO

Measuring biomarkers (e.g. volatile organic compounds [VOCs]) in exhaled breath is an attractive approach to monitor airway inflammation in asthma and other lung diseases. Olfactive technology by electronic nose (e-Nose) has been applied to identify VOCs in exhaled breath. We compared e-Nose respiratory patterns in a pediatric cohort with asthma classificate children with different asthma control. This cross-sectional study involved 38 children: 28 with asthma and 10 healthy controls . The asthmatic patients were categorized as having controlled (AC), partially controlled (APC) or uncontrolled asthma (ANC) based on level of asthma symptom control according to Global Initiative for Asthma (GINA). Clinical exams, exhaled breath collection for generating e-Nose VOC profiles, and spirometry were performed. Exhaled breath samples were obtained using a commercial electronic nose (Cyranose 320; Smith Detections, Pasadena, CA, USA). The discriminative ability of breathprints were investigated by principal component analysis and penalized logistic regression. The e-Nose was able to discriminate between the CON (controls) + AC and the ANC + APC group with an area under the curve [AUC] of 0.85 (95% confidence interval [CI] 0.72 to 0.98) and a cross-validated AUC of 0.80 (95% CI 0.70 to 0.85). Sensitivity and specificity calculated using the Youden index were 0.79 and 0.84, respectively. Exhaled biomarker patterns were easy to obtain with the device and were able to differentiate children with uncontrolled symptomatic asthma from asymptomatic controls.


Assuntos
Asma/diagnóstico , Nariz Eletrônico , Área Sob a Curva , Asma/fisiopatologia , Biomarcadores/análise , Testes Respiratórios/instrumentação , Estudos de Casos e Controles , Criança , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Análise de Componente Principal , Compostos Orgânicos Voláteis/análise
14.
Medicine (Baltimore) ; 99(26): e20891, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590795

RESUMO

RATIONALE: The use of extra-positive end-expiratory pressure (PEEP) at a level of 80% intrinsic-PEEP (iPEEP) to improve ventilation in severe asthma patients with control ventilation remains controversial. Electrical impedance tomography (EIT) may provide regional information for determining the optimal extra-PEEP to overcome gas trapping and distribution. Moreover, the experience of using EIT to determine extra-PEEP in severe asthma patients with controlled ventilation is limited. PATIENTS CONCERNS: A severe asthma patient had 12-cmH2O iPEEP using the end-expiratory airway occlusion method at Zero positive end-expiratory pressures (ZEEP). How to titrate the extra-PEEP to against iPEEP at bedside? DIAGNOSES AND INTERVENTIONS: An incremental PEEP titration was performed in the severe asthma patient with mechanical ventilation. An occult pendelluft phenomenon of the ventral and dorsal regions was found during the early and late expiration periods when the extra-PEEP was set to <6 cmH2O. If the extra-PEEP was elevated from 4 to 6 cmH2O, a decrease in the end-expiratory lung impedance (EELI) and a disappearance of the pendelluft phenomenon were observed during the PEEP titration. Moreover, there was broad disagreement as to the "best" extra-PEEP settings according to the various EIT parameters. The regional ventilation delay had the lowest extra-PEEP value (10 cmH2O), whereas the value was 12 cmH2O for the lung collapse/overdistension index and 14 cmH2O for global inhomogeneity. OUTCOMES: The extra-PEEP was set at 6 cmH2O, and the severe whistling sound was improved. The patient's condition further became better under the integrated therapy. LESSONS: A broad literature review shows that this was the 3rd case of using EIT to titrate an extra-PEEP to against PEEPi. Importantly, the visualization of occult pendelluft and possible air release during incremental PEEP titration was documented for the first time during incremental PEEP titration in patients with severe asthma. Examining the presence of the occult pendelluft phenomenon and changes in the EELI by EIT might be an alternative means for determining an individual's extra-PEEP.


Assuntos
Asma/terapia , Impedância Elétrica/uso terapêutico , Respiração com Pressão Positiva/instrumentação , Radiologia Intervencionista/instrumentação , Idoso de 80 Anos ou mais , Asma/fisiopatologia , Feminino , Humanos , Respiração com Pressão Positiva/métodos , Radiologia Intervencionista/métodos , Respiração Artificial/métodos , Tomografia Computadorizada por Raios X/métodos
15.
Arerugi ; 69(3): 184-191, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32435019

RESUMO

BACKGROUND: In order to determine the optimal breathing method for childhood lung sound analyses, it is important to study the effect of airflow on the parameters of lung sounds. METHODS: Sixty-one well-controlled children with atopic asthma (median; 12 years) participated. After confirming that there was no wheezing or respiratory symptoms, the lung sound spectrums of the inspiratory flow before and after inhalation of a ß2 stimulant were analyzed. At the same time, their lung function was measured by a spirogram and the forced oscillation technique. RESULTS: Before ß2 agonist inhalation, the area under the entire curve (AT) and 99% frequency (F99) in the lung sound of inspiratory flow around 2.0L/s due to slightly strong breathing were significantly higher than the lung sound of inspiratory flow around 1.0L/s due to rest breathing. However, no marked differences were observed in the lung sound parameters based on the lung sound spectrum. The improvement in the lung sound parameters after ß2 agonist inhalation was clearer at an inspiratory flow around 1.0L/s than that around 2.0L/s. CONCLUSION: The present study showed that changes after ß2 agonist inhalation and the correlation with the lung function parameters were clear during resting breathing. This method may be used for the long-term montoring of children with asthma.


Assuntos
Asma/diagnóstico , Testes de Função Respiratória , Sons Respiratórios , Agonistas de Receptores Adrenérgicos beta 2 , Asma/fisiopatologia , Criança , Humanos , Pulmão/fisiopatologia
17.
Life Sci ; 255: 117835, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32450169

RESUMO

AIMS: Emerging findings demonstrate the critical roles of noncoding RNA (ncRNA) in asthma development. Nevertheless, the biological roles of circular RNA (circRNA) in airway remodeling are still elusive. Here, the present research focuses on the regulation of circRNA circHIPK3 in airway smooth muscle cells (ASMCs) proliferation and migration. MATERIALS AND METHODS: The sequence of circRNA was detected using Sanger sequencing. Cellular phenotypes were detected using CCK-8 assay, transwell and flow cytometer assay. The potential binding of miRNA and downstream and upstream targets was detected using dual-luciferase reporter assay. KEY FINDINGS: Results showed that circHIPK3 was significantly upregulated in platelet-derived growth factor (PDGF) induced ASMCs. Functional analysis using CCK-8, transwell migration assays and flow cytometry analysis showed that circHIPK3 knockdown repressed proliferation, migration and up-regulated the apoptosis in ASMCs. Mechanistic assays showed that circHIPK3 sponged miR-326 in the cytoplasm, thereby targeting stromal interaction molecule 1 (STIM1) to regulate ASMCs' proliferation, migration and apoptosis. SIGNIFICANCE: Collectively, the data elucidates that circHIPK3 functions as a regulator in the airway remodeling during the asthma development through miR-326/STIM1 axis, providing a novel insight for the therapeutic target.


Assuntos
Asma/fisiopatologia , Peptídeos e Proteínas de Sinalização Intracelular/genética , MicroRNAs/genética , Miócitos de Músculo Liso/citologia , Proteínas de Neoplasias/genética , Proteínas Serina-Treonina Quinases/genética , Molécula 1 de Interação Estromal/genética , Remodelação das Vias Aéreas/genética , Apoptose/efeitos dos fármacos , Asma/genética , Proliferação de Células/genética , Técnicas de Silenciamento de Genes , Humanos , Fator de Crescimento Derivado de Plaquetas/metabolismo , RNA Circular/genética , Sistema Respiratório/citologia
18.
Emerg Infect Dis ; 26(8): 1679-1685, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32407284

RESUMO

Limited data are available on the clinical presentation and outcomes of coronavirus disease (COVID-19) patients in the United States hospitalized under normal-caseload or nonsurge conditions. We retrospectively studied 72 consecutive adult patients hospitalized with COVID-19 in 2 hospitals in the San Francisco Bay area, California, USA, during March 13-April 11, 2020. The death rate for all hospitalized COVID-19 patients was 8.3%, and median length of hospitalization was 7.5 days. Of the 21 (29% of total) intensive care unit patients, 3 (14.3% died); median length of intensive care unit stay was 12 days. Of the 72 patients, 43 (59.7%) had underlying cardiovascular disease and 19 (26.4%) had underlying pulmonary disease. In this study, death rates were lower than those reported from regions of the United States experiencing a high volume of COVID-19 patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Alanina/análogos & derivados , Alanina/uso terapêutico , Asma/epidemiologia , Asma/fisiopatologia , Azitromicina/uso terapêutico , California/epidemiologia , Técnicas de Laboratório Clínico/métodos , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Hiperlipidemias/fisiopatologia , Hipertensão/fisiopatologia , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/mortalidade , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Índice de Gravidade de Doença , Análise de Sobrevida , Tomografia Computadorizada por Raios X
19.
Ann Allergy Asthma Immunol ; 125(3): 319-324, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32389780

RESUMO

BACKGROUND: Asthma contributes to considerable morbidity and health care utilization in adults. Insufficient and excessive sleep duration have known adverse effects on health. Little is known regarding the effect of sleep duration on health outcomes in adults with asthma. OBJECTIVE: To examine associations between sleep duration, patient-reported outcomes, and health care use in adults with asthma from the National Health and Nutrition Examination Survey. METHODS: Cross-sectional data from the 2007 to 2012 National Health and Nutrition Examination Survey were analyzed. Asthma was identified by self-report. Habitual hours of sleep duration were categorized as short (≤5), normal (6-8), and long (≥9). Multivariate regression analyses were used to examine the associations between sleep duration and patient-reported outcomes and health care use. RESULTS: Of the 1389 adults with asthma, 26% reported short sleep duration, 66% reported normal sleep duration, and 8% reported long sleep duration. Those with short sleep duration had increased asthma attacks (adjusted odds ratio [aOR] 1.58; 95% confidence interval [CI] 1.13-2.21), coughing (aOR 1.95; 95% CI 1.32-2.87), and overnight hospitalizations (aOR 2.14; 95% CI 1.37-3.36) compared with those having normal sleep duration. They also reported worse health-related quality of life, including days of poor physical health, mental health, and inactivity because of poor health (P values < .05). Those with long sleep had more activity limitations because of wheezing compared with those with normal sleep (aOR 1.82; 95% CI 1.13-2.91). CONCLUSION: Compared with adults having asthma and normal sleep duration, those having short sleep duration experience more frequent asthma attacks, increased health care use, and worse health-related quality of life, whereas those with long sleep duration experience more frequent activity limitation.


Assuntos
Sono/fisiologia , Adulto , Asma/fisiopatologia , Estudos Transversais , Assistência à Saúde/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Autorrelato
20.
Clin Sci (Lond) ; 134(9): 1063-1079, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32369100

RESUMO

Asthma is a chronic disease of the airways that has long been viewed predominately as an inflammatory condition. Accordingly, current therapeutic interventions focus primarily on resolving inflammation. However, the mainstay of asthma therapy neither fully improves lung function nor prevents disease exacerbations, suggesting involvement of other factors. An emerging concept now holds that airway remodeling, another major pathological feature of asthma, is as important as inflammation in asthma pathogenesis. Structural changes associated with asthma include disrupted epithelial integrity, subepithelial fibrosis, goblet cell hyperplasia/metaplasia, smooth muscle hypertrophy/hyperplasia, and enhanced vascularity. These alterations are hypothesized to contribute to airway hyperresponsiveness, airway obstruction, airflow limitation, and progressive decline of lung function in asthmatic individuals. Consequently, targeting inflammation alone does not suffice to provide optimal clinical benefits. Here we review asthmatic airway remodeling, focusing on airway epithelium, which is critical to maintaining a healthy respiratory system, and is the primary defense against inhaled irritants. In asthma, airway epithelium is both a mediator and target of inflammation, manifesting remodeling and resulting obstruction among its downstream effects. We also highlight the potential benefits of therapeutically targeting airway structural alterations. Since pathological tissue remodeling is likewise observed in other injury- and inflammation-prone tissues and organs, our discussion may have implications beyond asthma and lung disease.


Assuntos
Remodelação das Vias Aéreas/efeitos dos fármacos , Antiasmáticos/farmacologia , Asma/fisiopatologia , Inflamação/tratamento farmacológico , Animais , Asma/tratamento farmacológico , Epitélio/efeitos dos fármacos , Humanos , Inflamação/fisiopatologia , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA