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1.
Otolaryngol Clin North Am ; 56(1): 181-195, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36410990

RESUMO

Unified airway disease describes the shared epidemiologic and pathophysiologic relationship among the chronic inflammatory diseases of the upper and lower airways including allergic rhinitis, chronic rhinosinusitis, asthma, and chronic otitis media. This concept proposes that these diseases are manifestations of a single inflammatory process and require an integrated diagnostic and therapeutic approach to achieve global disease control. Future directions to further establish this entity should focus on pathophysiology, diagnostic markers, flora microbes with particular emphasis on fungi, the role of type 3 inflammation, and targeted therapeutics including biologics, JAK inhibitors, and synthetic peptides.


Assuntos
Asma , Rinite Alérgica , Sinusite , Humanos , Sinusite/diagnóstico , Sinusite/terapia , Asma/diagnóstico , Asma/terapia , Sistema Respiratório , Inflamação , Doença Crônica
2.
Immunol Allergy Clin North Am ; 43(1): 199-208, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36411005

RESUMO

It is known that poor asthma control is common in pregnancy, and asthma in general disproportionally affects underserved communities. However, there is a paucity of data examining strategies to improve asthma control specifically among pregnant women from vulnerable populations. Identified barriers to optimal asthma care in other underserved groups include health literacy, financial constraints, cultural differences, and poor environmental controls. These deficiencies may also be targets for multimodal interventions geared toward improving asthma outcomes for underserved women during pregnancy.


Assuntos
Asma , Gravidez , Humanos , Feminino , Asma/diagnóstico , Asma/epidemiologia , Asma/terapia
3.
Immunol Allergy Clin North Am ; 43(1): 65-85, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36411009

RESUMO

Asthma is one of the most common potentially serious medical problems to complicate pregnancy. Optimal management of asthma during pregnancy is thus important for both mother and baby. Treating asthmatic women requires understanding the effects of pregnancy on the course of asthma, and, conversely, the effects of asthma on pregnancy outcomes. Successful management also requires an understanding the barriers to asthma control in this population of patients. Evidence has shown that it is essential that the allergist-immunologist, obstetrician, and patient work as a team during pregnancy to achieve optimal maternal and neonatal outcomes.


Assuntos
Asma , Doença Enxerto-Hospedeiro , Lactente , Recém-Nascido , Gravidez , Humanos , Feminino , Alergistas , Asma/diagnóstico , Asma/epidemiologia , Asma/terapia , Família
4.
Immunol Allergy Clin North Am ; 43(1): 87-102, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36411010

RESUMO

One-third of women with asthma have deterioration of their asthma during pregnancy, and one-fourth of pregnant women with asthma will experience severe exacerbations necessitating emergency department (ED) visits or hospitalizations. Early recognition of acute severe asthma, including life-threatening status asthmaticus, and aggressive medical interventions with ß2-agonists, anticholinergic agents, and systemic corticosteroids are necessary to treat maternal airway bronchoconstriction, support maternal and fetal oxygenation, and avoid adverse fetal outcomes. This review describes management of acute severe asthma in pregnancy, including status asthmaticus, in the ED and intensive care unit.


Assuntos
Asma , Estado Asmático , Gravidez , Feminino , Humanos , Estado Asmático/diagnóstico , Estado Asmático/terapia , Cuidados Críticos , Asma/diagnóstico , Asma/terapia , Família , Hospitalização
5.
Otolaryngol Clin North Am ; 56(1): 65-81, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36266106

RESUMO

The "unified airway" describes the concept that inflammation affects upper and lower airways by similar mechanisms; this often manifests as rhinitis, rhinosinusitis, and/or nasal polyposis in the upper airway with associated asthma or bronchial inflammation in the lower airways. The relationships between eosinophilic diseases of the upper and lower airways are highlighted by examining their prevalence and treatment regimens along with the synergistic effects of treatment on upper and lower airway symptoms. It is important to recognize the interrelatedness of upper and lower airway eosinophilic disease to assess and manage patients accurately and holistically.


Assuntos
Asma , Rinite , Sinusite , Humanos , Prevalência , Rinite/epidemiologia , Rinite/terapia , Asma/complicações , Asma/epidemiologia , Asma/terapia , Sinusite/epidemiologia , Sinusite/terapia , Sinusite/complicações , Inflamação/complicações
6.
Otolaryngol Clin North Am ; 56(1): 1-10, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36266105

RESUMO

Upper and lower airways diseases are very common, with population prevalence of 10% to 40%. The conditions are usually interlinked and referred to as "unified airway disease" or "the united airways." Especially in phenotypes with more severe disease, type 2 immunologic endotype is often noted. Comorbid upper and lower airway diseases are usually caused by similar underlying immunologic response. Any patient with rhinitis or rhinosinusitis should have their lower respiratory tract evaluated. A multidisciplinary approach in the diagnosis and treatment of airway disease is advised, especially, for more severe phenotypes.


Assuntos
Asma , Rinite , Sinusite , Humanos , Asma/diagnóstico , Asma/epidemiologia , Asma/terapia , Rinite/diagnóstico , Rinite/epidemiologia , Rinite/terapia , Sinusite/diagnóstico , Sinusite/epidemiologia , Sinusite/terapia , Sistema Respiratório , Comorbidade
7.
Otolaryngol Clin North Am ; 56(1): 157-168, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36266108

RESUMO

Concurrent chronic rhinosinusitis with nasal polyps (CRSwNP) in the upper airway, and asthma in the lower airway, often have a shared underlying pathophysiology, namely type 2 inflammation; hence, the term "unified airway disease." The combination of CRSwNP and asthma is associated with uncontrolled disease. The range of treatment of CRSwNP includes intranasal corticosteroids, nasal saline irrigation, oral corticosteroids, antibiotics, and biologics. A combined clinical algorithm for the management of the upper and lower airways in type 2 inflammation will be beneficial, especially for patients with uncontrolled disease who may benefit from biologics.


Assuntos
Asma , Produtos Biológicos , Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/tratamento farmacológico , Pólipos Nasais/terapia , Pólipos Nasais/complicações , Sinusite/complicações , Asma/terapia , Corticosteroides/uso terapêutico , Inflamação/complicações , Doença Crônica , Produtos Biológicos/uso terapêutico
8.
Allergol Immunopathol (Madr) ; 50(6): 47-52, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36335444

RESUMO

Although currently approved to treat severe asthma and chronic spontaneous urticaria, omalizumab has also been an effective and safe add-on treatment for other allergic diseases. Namely, omalizumab has been proposed to be used as add-on therapy in patients with allergic rhinitis and asthma and undergoing specific allergen immunotherapy (AIT). AIT is the only treatment that modifies the natural history of IgE-mediated diseases. This brief review summarizes the available evidence and controversies on the efficacy and safety of omalizumab combined with specific AIT.


Assuntos
Asma , Rinite Alérgica , Humanos , Criança , Omalizumab/uso terapêutico , Dessensibilização Imunológica , Rinite Alérgica/terapia , Asma/terapia , Alérgenos/uso terapêutico
9.
Sensors (Basel) ; 22(21)2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36366280

RESUMO

Asthma is a deadly disease that affects the lungs and air supply of the human body. Coronavirus and its variants also affect the airways of the lungs. Asthma patients approach hospitals mostly in a critical condition and require emergency treatment, which creates a burden on health institutions during pandemics. The similar symptoms of asthma and coronavirus create confusion for health workers during patient handling and treatment of disease. The unavailability of patient history to physicians causes complications in proper diagnostics and treatments. Many asthma patient deaths have been reported especially during pandemics, which necessitates an efficient framework for asthma patients. In this article, we have proposed a blockchain consortium healthcare framework for asthma patients. The proposed framework helps in managing asthma healthcare units, coronavirus patient records and vaccination centers, insurance companies, and government agencies, which are connected through the secure blockchain network. The proposed framework increases data security and scalability as it stores encrypted patient data on the Interplanetary File System (IPFS) and keeps data hash values on the blockchain. The patient data are traceable and accessible to physicians and stakeholders, which helps in accurate diagnostics, timely treatment, and the management of patients. The smart contract ensures the execution of all business rules. The patient profile generation mechanism is also discussed. The experiment results revealed that the proposed framework has better transaction throughput, query delay, and security than existing solutions.


Assuntos
Asma , Blockchain , Humanos , Pandemias , Segurança Computacional , Atenção à Saúde/métodos , Asma/diagnóstico , Asma/terapia
10.
Mol Cells ; 45(11): 833-845, 2022 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-36380733

RESUMO

Although asthma is a common chronic airway disease that responds well to anti-inflammatory agents, some patients with asthma are unresponsive to conventional treatment. Mesenchymal stem cells (MSCs) have therapeutic potential for the treatment of inflammatory diseases owing to their immunomodulatory properties. However, the target cells of MSCs are not yet clearly known. This study aimed to determine the effect of human umbilical cord-derived MSCs (hUC-MSCs) on asthmatic lungs by modulating innate immune cells and effector T cells using a murine asthmatic model. Intravenously administered hUC-MSCs reduced airway resistance, mucus production, and inflammation in the murine asthma model. hUC-MSCs attenuated not only T helper (Th) 2 cells and Th17 cells but also augmented regulatory T cells (Tregs). As for innate lymphoid cells (ILC), hUC-MSCs effectively suppressed ILC2s by downregulating master regulators of ILC2s, such as Gata3 and Tcf7. Finally, regarding lung macrophages, hUC-MSCs reduced the total number of macrophages, particularly the proportion of the enhanced monocyte-derived macrophage population. In a closer examination of monocyte-derived macrophages, hUC-MSCs reduced the M2a and M2c populations. In conclusion, hUC-MSCs can be considered as a potential anti- asthmatic treatment given their therapeutic effect on the asthmatic airway inflammation in a murine asthma model by modulating innate immune cells, such as ILC2s, M2a, and M2c macrophages, as well as affecting Tregs and effector T cells.


Assuntos
Asma , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Camundongos , Humanos , Animais , Imunidade Inata , Monócitos , Linfócitos , Células-Tronco Mesenquimais/fisiologia , Inflamação/terapia , Asma/terapia , Macrófagos , Cordão Umbilical
11.
Medicine (Baltimore) ; 101(45): e31737, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397327

RESUMO

Asthma is a chronic illness of the airways that affects approximately 300 million individuals worldwide. While it is commonly accepted that high ozone levels exacerbate asthma symptoms, the impact of low to moderate ozone levels on asthma symptoms has received little attention. The purpose of this research was to determine the relationship between hospital visits by asthma patients showing the severity of their symptoms and moderate ozone levels. Statistical analyses were performed on hospital visit big data for asthma patients in Seoul, Korea, collected between 2013 and 2017. The data set includes outpatient hospital visits (n = 17,787,982), hospital admissions (n = 215,696), and emergency department visits (n = 85,482). The frequency of hospital visits by asthma patients was evaluated in relation to low ozone levels (< 0.03 ppm) and moderate ozone levels (0.03-0.06 ppm) in the Seoul environment. In comparison to low ozone levels, moderate ozone levels resulted in a reduction in outpatient hospital visits (t = 7.052, P < .001). When ozone levels were low to moderate, there was a negative correlation between ozone levels and outpatient visits (r = -0.281, 95% CI: -0.331 to -0.228). Negative associations were also identified between ozone levels and new hospital admissions (t = 2.909, P < .01; r = -0.125, 95% CI: -0.179 to -0.070) and emergency treatments (t = 2.679, P < .01; r = -0.132, 95% CI: -0.186 to -0.076). Additionally, it was verified that moderate ozone levels one day before the visits resulted in a reduction in outpatient visits (t = 5.614, P < .001; r = -0.207, 95% CI: -0.259 to -0.153). A strong relationship was identified between moderate atmospheric ozone levels and a reduction in asthma patient hospital visits.


Assuntos
Asma , Ozônio , Humanos , Asma/epidemiologia , Asma/terapia , Hospitalização , Serviço Hospitalar de Emergência , Hospitais , Hiperplasia
13.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 44(5): 845-856, 2022 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-36325782

RESUMO

Asthma,a chronic inflammatory disease of respiratory system,is characterized by airway hyperresponsiveness,chronic airway inflammation,mucus secretion,and airway remodeling.Mesenchymal stem cell (MSC) are a kind of multifunctional stem cells,which have the ability of self-renewal and multi-directional differentiation.They are involved in a variety of physiological processes,such as immune response,antigen presentation,inflammatory response,and cell migration.MSCs plays a key role in the pathogenesis of bronchial asthma,while the underlying mechanism remains to be studied.MSC are a potential target for the treatment of bronchial asthma.This paper reviews the mechanism of MSC in the treatment of asthma.


Assuntos
Asma , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Humanos , Animais , Asma/terapia , Remodelação das Vias Aéreas , Diferenciação Celular , Modelos Animais de Doenças
14.
Ann Acad Med Singap ; 51(10): 637-647, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36317574

RESUMO

INTRODUCTION: This review aims to examine asthma management during the COVID-19 pandemic. METHOD: Relevant recommendations and articles were identified by respiratory professional societies and PubMed search using the terms "asthma" and "COVID-19", and examined for relevance and inclusion in this study. RESULTS: Recommendations for the management of asthma have remained similar but are now supported by new evidence between the years 2020 and 2022. Patients with well-controlled, mild-to-moderate asthma are unlikely to be at increased risk of acquiring COVID-19 or having worse outcomes from COVID-19. All asthma patients should receive COVID-19 vaccination. Spirometry can be performed with the usual strict infection control procedures unless there is a suspicion of COVID-19. Mask-wearing and other health measures remain important for asthma patients. CONCLUSION: While previous recommendations were largely based on expert opinion, the tremendous amount of literature published since the pandemic first emerged 2 years ago has helped guide respiratory professional bodies to update their recommendations. This study provides a timely review of the various recommendations and can be used to guide healthcare professionals in managing asthma patients, as the world prepares for a future with COVID-19 becoming endemic. The long-term consequences of COVID-19 infection in asthma patients and the ripple effects of COVID-19 remain uncertain and deserve ongoing study.


Assuntos
Asma , COVID-19 , Adulto , Humanos , Pandemias/prevenção & controle , Vacinas contra COVID-19 , Asma/terapia , Asma/epidemiologia , Controle de Infecções
16.
BMC Med Inform Decis Mak ; 22(1): 285, 2022 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333727

RESUMO

BACKGROUND: Asthma is a prevalent chronic disease that is difficult to manage and associated with marked disparities in outcomes. One promising approach to addressing disparities is shared decision making (SDM), a method by which the patient and provider cooperatively make a decision about asthma care. SDM is associated with improved outcomes for patients; however, time constraints and staff availability are noted implementation barriers. Use of health information technology (IT) solutions may facilitate the utilization of SDM. Coach McLungsSM is a collaborative web-based application that involves pediatric patients, their caregivers, and providers in a personalized experience while gathering patient-reported data. Background logic provides decision support so both audiences can develop a well-informed treatment plan together. The goal of this study is to evaluate the implementation of the Coach McLungsSM intervention into primary care. METHODS: Implementation will be evaluated using a stepped wedge randomized control study design at 21 pediatric and family medicine practices within a large, integrated, nonprofit healthcare system. We will measure changes in emergency department visits, hospitalizations, and oral steroid use, which serve as surrogate measures for patient-centered asthma outcomes. We will use a generalized linear mixed models with logit link to test the hypothesis for the reduction in exacerbation rates specifying the fixed effects of intervention and time and random effects for practice and practice*time. This design achieves 84% power to detect the hypothesized effect size difference of 10% in overall exacerbation between control (40%) and intervention (30%) periods (two-sided, p = 0.05). Implementation will be guided using the Expert Recommendations for Implementing Change (ERIC), a compilation of implementation strategies, and evaluated using the CFIR (Consolidated Framework for Implementation Research) and RE-AIM (Reach Effectiveness, Adoption, Implementation, Maintenance). DISCUSSION: We anticipate that a tailored implementation of Coach McLungsSM across diverse primary care practices will lead to a decrease in emergency department visits, hospitalizations, and oral steroid use for patients in the intervention group as compared to the control condition. TRIAL REGISTRATION: Clincaltrials.gov, NCT05059210. Registered 28 September 2021, https://www. CLINICALTRIALS: gov/ct2/show/NCT05059210.


Assuntos
Asma , Tomada de Decisão Compartilhada , Humanos , Criança , Asma/terapia , Doença Crônica , Avaliação de Resultados em Cuidados de Saúde , Atenção Primária à Saúde
17.
Allergol. immunopatol ; 50(6): 47-52, 01 nov. 2022. tab
Artigo em Inglês | IBECS | ID: ibc-211523

RESUMO

Although currently approved to treat severe asthma and chronic spontaneous urticaria, omalizumab has also been an effective and safe add-on treatment for other allergic diseases. Namely, omalizumab has been proposed to be used as add-on therapy in patients with allergic rhinitis and asthma and undergoing specific allergen immunotherapy (AIT). AIT is the only treatment that modifies the natural history of IgE-mediated diseases. This brief review summarizes the available evidence and controversies on the efficacy and safety of omalizumab combined with specific AIT (AU)


Assuntos
Humanos , Dessensibilização Imunológica/métodos , Antiasmáticos/uso terapêutico , Omalizumab/uso terapêutico , Alérgenos/uso terapêutico , Asma/terapia , Antialérgicos/uso terapêutico , Rinite Alérgica/terapia
19.
Semin Respir Crit Care Med ; 43(5): 684-708, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36220057

RESUMO

Racial inequities in asthma care are evolving as a recognized factor in long-standing inequities in asthma outcomes (e.g., hospitalization and mortality). Little research has been conducted regarding the presence or absence of racial inequities among patients seen in asthma specialist settings, this is an important area of future research given that asthma specialist care is recommended for patients experiencing the poor asthma outcomes disproportionately experienced by Black and Hispanic patients. This study provides a systematic review of racial asthma care inequities in asthma epidemiology, clinical assessment, medication prescription, and asthma specialist referral practices.


Assuntos
Asma , Asma/epidemiologia , Asma/terapia , Hospitalização , Humanos , Especialização
20.
Semin Respir Crit Care Med ; 43(5): 739-751, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36220058

RESUMO

The traditional one-size-fits all approach based on asthma severity is archaic. Asthma is a heterogenous syndrome rather than a single disease entity. Studies evaluating observable characteristics called phenotypes have elucidated this heterogeneity. Asthma clusters demonstrate overlapping features, are generally stable over time and are reproducible. What the identification of clusters may have failed to do, is move the needle of precision medicine meaningfully in asthma. This may be related to the lack of a straightforward and clinically meaningful way to apply what we have learned about asthma clusters. Clusters are based on both clinical factors and biomarkers. The use of biomarkers is slowly gaining popularity, but phenotyping based on biomarkers is generally greatly underutilized even in subspecialty care. Biomarkers are more often used to evaluate type 2 (T2) inflammatory signatures and eosinophils (sputum and blood), fractional exhaled nitric oxide (FeNO) and serum total and specific immunoglobulin (Ig) E reliably characterize the underlying inflammatory pathways. Biomarkers perform variably and clinicians must be familiar with their advantages and disadvantages to accurately apply them in clinical care. In addition, it is increasingly clear that clinical features are critical in understanding not only phenotypic characterization but in predicting response to therapy and future risk of poor outcomes. Strategies for asthma management will need to leverage our knowledge of biomarkers and clinical features to create composite scores and risk prediction tools that are clinically applicable. Despite significant progress, many questions remain, and more work is required to accurately identify non-T2 biomarkers. Adoption of phenotyping and more consistent use of biomarkers is needed, and we should continue to encourage this incorporation into practice.


Assuntos
Asma , Medicina de Precisão , Asma/tratamento farmacológico , Asma/terapia , Biomarcadores , Eosinófilos/metabolismo , Humanos , Imunoglobulina E , Óxido Nítrico/metabolismo , Óxido Nítrico/uso terapêutico
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