ObjectiveTo evaluate the efficacy and safety of dupilumab in the treatment of moderate-to-severe asthma. MethodsA retrospective study was conducted among patients with moderate-to-severe asthma who were treated with dupilumab and inhaled corticosteroids (ICS) combined with long acting beta-agonist (LABA) in Department of Respiratory, Beijing Chao-yang Hospital from May, 2021 to April, 2022. Paired t-test or Mann-Whitney U test was applied to compare the Asthma Control Test (ACT) scores, number of acute exacerbations per year, type 2 inflammatory biomarkers, blood total IgE and results of pulmonary function tests, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1 as percentage of predicted (FEV1%pred), FEV1/FVC, peak expiratory flow (PEF), maximal expiratory flows (MEF) at 75% (MEF75), 50% (MEF50) and 25% (MEF25) of the vital capacity PEF, and maximal mid-expiratory flow (MMEF) or FEF25%-75%, at the end of follow-up with those before treatment. Adverse reactions were recorded during the treatment. ResultsA total of 47 patients with moderate-to-severe asthma were included in the study, among them 17 and 30 received treatment with dupilumab or ICS/LABA. At the time of 12 months after treatment with dupilumab, the patients' ACT score and pulmonary function tests were significantly increased compared with those at the baseline. In contrast, patients' fractional exhaled nitric oxide (FeNO), blood total IgE, blood basophil counts and annual acute exacerbations were significantly decreased in comparison with those at the baseline. The doses of oral corticosteroids added by 7 patients at the baseline was gradually reduced and finally discontinued after treatment of dupilumab. There were 4, 2, 1 and 1 patients developed injection site reaction, pruritus, erythema and fatigue, respectively, which were mild and recovered without treatment. There was no serious adverse reaction observed, and only 1 case developed herpes zoster which was recovered after treatment. ConclusionDupilumab shows marked efficacy in the treatment of moderate-to-severe asthma with favorable safety.
ObjectiveTo investigate the medical knowledge and treatment compliance of parents of asthma children in Gaoming District, Foshan City. MethodOne hundred consecutive parents of asthma children who sought pediatric service in Gaoming People's Hospital from January to December in 2012 were surveyed by the use of Knowledge-Belief-Behavior Questionnaire developed by Capital Research Center of Pediatrics. ResultsNinety-five of the one hundred questionnaires provided useful data for analysis. Among these parents, 63.18% understood the nature of asthma being hyperactive inflammatory disease of the airways; 78.91% believed it to be controllable by regular treatment; only 21.05% of asthma children under parental guidance received inhaled corticosteroids on a regular basis; 14.74% considered their children fit for physical exercises when stabilized; 22.10% chose inhaled β2 agonists as "relievers" during attacks; 61.05% were concerned about the side effects on growth of inhaled corticosteroids and 48.42% discontinued its use against physician's instruction; 82.11% of asthma children had not been evaluated by Asthma Control Questionnaire. ConclusionsParents of asthma children in Gaoming District, Foshan City have weak links in the understanding of this condition. Though most believe it to be controllable under regular treatment, the overall compliance is unsatisfactory. Therefore, knowledge of asthma should be propagated at various public fronts in order to better improve the treatment compliance and consequently the disease control, of asthma children.
Objective To evaluate the efficacy and safety of meperizumab for patients with refractory asthma by means of meta-analysis. Methods PubMed, Web of Science, China National Knowledge Infrastructure and other databases were searched for literatures on randomized controlled trials of meperizumab for patients with refractory asthma published before October 30, 2021. The Endnote X9.2 software was used to summarize and eliminate duplicate studies. The literature was screened according to the pre-specified inclusion and exclusion criteria, and data extraction and quality evaluation were performed on the selected literature. Stata 16.0 was used for meta-analysis. Results A total of 632 related articles were detected, and 8 articles were included after screening, including 2438 subjects. Meta-analysis results showed that the patients with refractory asthma treated with meperizumab had a 22% reduction in the risk of exacerbation [relative risk (RR)=0.78, 95% confidence interval (CI) 0.70 to 0.88], forced expiratory volume in one second [weighted mean difference (WMD)=0.10, 95%CI 0.06 to 0.13] and asthma control questionnaire score (WMD=–0.32, 95%CI –0.47 to –0.17) were improved, blood eosinophil count (WMD=–0.23, 95%CI –0.37 to –0.09) and sputum eosinophil count (WMD=–6.37, 95%CI –9.68 to –3.06) were significantly decreased. The probability of serious adverse reactions was significantly reduced (RR=0.65, 95%CI 0.47 to 0.90). Conclusion Meperizumab can effectively reduce the risk of exacerbation for asthma, improve lung function and asthma control level, reduce blood eosinophil count and sputum eosinophil count, and reduce the incidence of serious adverse reactions in patients with refractory asthma.
This paper proposes a forced oscillation respiration resistance detector which has the characteristics of portable and friendly interface, with remote transmission function. STM32 is used to produce single frequency or complex frequency oscillation signal. In the experiments, the signal was magnified by the power amplifier to drive speaker to generate oscillates airflow into the subject's oral cavity. The analog to digital coverter of STM32 was used to measure the signals obtained by the pressure sensor and the flow sensor, and then the operation parameters were to be displayed on the TFT-LCD touch screen, and could also be transferred to the master computer. Simulated lung and volunteerism were used to verify the reliability of the detector. The test results showed that the system was reliable, and it achieved the significance in respiratory impedance detecting.
Objective To investigate the effects of a mixed bacterial lysate (OM-85 BV) on lung function and serum IgE in asthmatic mice under acute attack, and to explore the therapeutic effect of OM-85 BV on acute attack and the application value of OM-85 BV in non-acute attack. Methods A total of 30 SPF Kunming mice aged 4 to 6 weeks were randomly divided into 3 groups, namely a blank control group (Group A), an asthma model group (Group B), and an OM-85 BV intervention group (Group C). The mice in groups B and C were sensitized by intraperitoneal injection of ovalbumin on day 1, 8 and 15, respectively. From day 22, the asthma model was stimulated by inhalation of 5% ovalbumin every day for 30 min for 5 consecutive days. The mice in group C were treated with OM-85 BV dissolved in normal saline from day 1, and each mouse was gavaged continuously for 10 days. The intraperitoneal injection, intragastric administration and aerosol inhalation reagent of mice in group A were all replaced by normal saline, while the intragastric administration of mice in group B was replaced by normal saline. One hour after the last stimulation, the mice were anesthetized, their lung function was measured, blood was collected from the eyeballs and then they were sacrificed, and the blood was centrifuged and the serum was separated and stored. Hematoxylin and eosin staining was used for pathological examination. Serum IgE was determined by enzyme-linked immunosorbent assay. Results Compared with group A, forced vital capacity in 0.15 second (FEV0.15), FEV0.15/forced vital capacity (FVC) and peak expiratory flow (PEF) of mice in group B were significantly decreased. The lung function of group C was improved compared with group B. In group B, the pathological manifestations were dysplasia and collapse of bronchial epithelium, infiltration of inflammatory cells, mainly lymphocytes and eosinophils, a small amount of mucus and shed epithelial cells in the tracheal lumen, and significant thickening of airway wall. The asthma mouse model was well established. The pathological manifestations of airway in group C were less severe than those in group B, the thickness of airway wall was reduced, and the inflammatory cells were also significantly reduced. The serum IgE concentration in groups B and C increased, and the IgE level in group C decreased significantly compared with group B. The differences were statistically significant (all P<0.05). Conclusions Exogenous administration of OM-85 BV in asthmatic mice can effectively reduce the concentration of serum IgE, alleviate airway inflammation, reduce eosinophil infiltration, and improve the pulmonary function performance of asthmatic mice during acute attack, showing that FEV0.15/FVC, FEV0.15 and PEF indicators are significantly improved. OM-85 BV can alleviate the symptoms of bronchial asthma in the acute attack of mice, improve the physiological function of the lung during the acute attack, inhibit airway inflammation, and have certain application value in the stable asthma control.
Objection To investigate the changes of insulin and insulin receptor in asthma patients.Methods Forty asthma patients were allocated into two groups：20 newly diagnosed treatment–naiuml;ve mild-moderate asthma patients，20 mild-moderate persistent asthma patients treated with inhaled corticosteroid. 20 healthy volunteers were enrolled as normal control.Blood samples were obtained from 40 asthma patients and 20 healthy volunteers.Total and differential leukocyte counts,blood glucose concentration and serum insulin concentration were measured.The level of lymphocyte insulin receptor in peripheral blood were assayed by flow cytomertry.Pulmonary function were performed at the same time.Results The numbers of eosinophil in the two asthma groups were significantly higher than those in the normal control group [(4.04±2.57)% and (4.24±2.34)% vs (0.90±1.38)%，Plt;0.05)，the levels of insulin and insulin receptor in the treatment-naiuml;ve group were significantly higher than those in the control group [insulin：(13.00±5.20)mIU/L vs (10.08±3.79)mIU/L，Plt;0.05；insulin receptor：(2.59±3.11)% vs (0.99±0.62)%，Plt;0.05).Conclusion Insulin secretion and insulin receptor expression in asthma patients are increased in the presence of inflammation.
Objective To investigate the association between polymorphism of S2 locus allele in ADAM33 gene and bronchial asthma in Xinjiang Uygur population.Methods PCR-RFLP was used to determine polymorphismof S2 locus allele in ADAM33 gene in 131 Uygur patients with bronchial asthma ( asthma group) and 90 Uygur healthy individuals ( control group) .Results The comparison of three genotypes and allele frequency of the S2 in the ADAM33 gene had statistical significance in the asthma group and the control group ( X2 =6. 065, P lt;0. 05;X2=5. 255, P lt;0. 025) . The G allele of S2 site increased the risk of asthma( OR =1. 616, P lt;0. 05) . The CG genotype also increased the risk of asthma ( OR= 1. 351,P lt;0. 05) . The FEV1% pred and FVC% pred had significant difference between three genotypes of the S2 site in the ADAM33 gene in the asthma group ( F = 6. 248, P lt; 0. 01; F = 7. 067, P lt; 0. 01) .Conclusion The polymorphism of the S2 site in the ADAM33 gene has significant correlation with asthma in Xinjiang Uygur population, and can increase risk of asthma in the Uygur population.
Objective To analyze the causal relationship between gut microbiota and childhood asthma based on Mendelian randomization (MR). Methods The human gut microbiota dataset was downloaded from the MiBioGen database, and 196 known bacterial groups (9 phyla, 16 classes, 20 orders, 32 families, and 119 genera) were retained as exposure factors. Single nucleotide polymorphisms (SNPs) that were strongly correlated with exposure factors and independent of each other were selected as effective instrumental variables. A childhood asthma dataset with 3 025 patients and 135 449 controls was downloaded from the genome-wide association studies database as the outcome variable. Two-sample MR analysis was performed using inverse variance weighted, weighted median, MR-Egger, weighted model and simple model methods, respectively. The causal association between gut microbiota and childhood asthma was evaluated by odds ratio (OR). Sensitivity analysis was performed by leave-one-out method. Horizontal pleiotropy was tested by MR-Egger intercept test and MR-PRESSO global test, and Cochran’s Q test was used for heterogeneity. Results A total of 15 out of 196 gut microbiota groups were found to have a causal association (P<0.05) with the risk of childhood asthma, with a total of 181 SNPs included in the analysis. Inverse variance weighted analysis showed that Mollicutes [OR=1.42, 95% confidence interval (CI) (1.10, 1.83), P=0.007], Escherichia-Shigella [OR=1.39, 95%CI (1.02, 1.90), P=0.036], Oxalobacter [OR=1.30, 95%CI (1.10, 1.54), P=0.002], Ruminococcaceae UCG-009 [OR=1.34, 95%CI (1.09, 1.64), P=0.006] and Tenericutes [OR=1.42, 95%CI (1.10, 1.83), P=0.007] were significantly positively correlated with childhood asthma. Actinobacteria [OR=0.76, 95%CI (0.58, 0.99), P=0.042], Bifidobacteriaceae [OR=0.76, 95%CI (0.58, 0.98), P=0.035], Eubacterium nodatum group [OR=0.81, 95%CI (0.70, 0.94), P=0.007], Bifidobacterales [OR=0.76, 95%CI (0.58, 0.98), P=0.035] and Actinobacteria [OR=0.74, 95%CI (0.56, 0.99), P=0.040] were negatively correlated with childhood asthma. In addition, the results of leave-one-out sensitivity analysis were stable, MR-Egger intercept test and MR-PRESSO global test showed no horizontal pleiotropy, and Cochran’s Q test showed no heterogeneity. Conclusions There is a causal relationship between gut microbiota and childhood asthma. Mollicutes, Escherichia-Shigella, Oxalobacter, Ruminococcaceae UCG-009 and Tenericutes may increase the risk of childhood asthma. Actinobacteria, Bifidobacteriaceae, Eubacterium nodatum group, Bifidobacterales and Actinobacteria can reduce the risk of childhood asthma.
Objective To explore the inducing factors, the serum total immunoglobulin E (IgE) and specific IgE of bronchial asthma in Mianyang children, for better control of childhood asthma. Methods A total of 1 288 cases of asthma who were hospitalized in pediatric respiratory ward or asthma clinic from March 2013 to February 2016 were enrolled in the study. All cases complied with the diagnostic criteria for acute episode of childhood bronchial asthma revised in 2008 by the National Children’s Asthma Cooperative Group. The causes of asthma attack were asked by doctors, and the patient’s serum total IgE and specific IgE was tested. Results Respiratory tract infections were the most common cause (1 057 cases, 82.1%), which was followed by weather changes and exposure to cold air (694 cases, 53.9%), and then food (304, 23.6%). The risk of asthma induced by respiratory infections was highest in <2-year old group (358 cases, 97.5%), and lowest in 10-14-year old group (42 cases, 33.3%), with a decreasing trend with age (χ2trend=239.865, P<0.001). Food was also an important inducing factor, and seafood was the most frequent (121 cases, 39.8%). Total serum IgE was positive in 868 cases (67.4%). The positive rate in <2-year old group (52.6%) was the lowest, and the positive rate in 10-14-year old group (89.7%) was the highest, with an increasing trend with age (χ2trend=88.055, P<0.001). Serum specific IgE was positive in 733 cases (56.9%). The positive rate in <2-year old group (37.1%) was the lowest, and the positive rate in 10-14-year old group (92.6%) was the highest, with an increasing trend with age (χ2trend=150.361, P<0.001). The progressive rate of dust mites in inhalation and dietary allergens was highest (668 cases, 51.8%), which was followed by house dust (431 cases, 33.4%). Conclusions The most common inducing factor for bronchial asthma in Mianyang children is respiratory tract infection, followed by the weather changes and cold air exposure, and then food. Detection of serum total IgE and specific IgE is more valuable in elderly children with bronchial asthma.
Detection of the fraction of exhaled nitric oxide (FeNO) is a safe, simple and easy method to assess airway inflammation noninvasively. Thus, FeNO detection has been paid more attention to diagnosis and guide treatment of pulmonary diseases. The common feature of pneumonia, asthma, chronic obstructive pulmonary disease and chronic cough is the existence of varying degrees of airway inflammation. In this review, FeNO production and its potential pathologic and physiologic role in various pulmonary diseases were discussed.