02
Sep.
2010
Journal: THORAX
Author: Daan Caudri, Alet H Wijga, Maarten O Hoekstra, Marjan Kerkhof, Gerard H Koppelman, Bert Brunekreef, Henriette A Smit, Johan C de Jongste
Prediction of asthma in symptomatic preschool children using exhaled nitric oxide, Rint and specific IgE
Rationale: For clinicians it remains very difficult to predict whether preschool children with symptoms suggestive of asthma will develop asthma in later childhood.
Objective: To investigate whether measurement of fraction of exhaled nitric oxide (FENO), interrupter resistance (Rint) or specific immunoglobulin E (IgE) in 4-year-old children with suggestive symptoms can predict asthma symptoms up to age 8 years.
Methods: Children were recruited from the PIAMA birth cohort. All children with symptoms suggestive of asthma at age 3 or 4 years, who were invited for medical examination at age 4 (n=848), were eligible. Associations of FENO (n=308), Rint (n=482) and specific IgE (n=380) at 4 years with wheezing and asthma at the ages of 5–8 years were assessed using repeated measurement analyses. The added predictive value of these objective tests was then investigated by including parameters for clinical history in the model.
Results: FENO and specific IgE measured at 4 years were associated with wheezing and asthma at 8 years. Both tests also remained significant predictors after mutual adjustment and adjustment for clinical history: OR on wheezing at 8 years for FENO(10log-scale, per IQR) 1.6 (95% CI 1.1 to 2.2) and for specific IgE 2.8 (95% CI 1.9 to 4.1). Rint was significantly associated with wheezing at age 6, but not at 7 and 8 years.
Conclusions: In preschool children with symptoms suggestive of asthma, both FENO and specific IgE measured at age 4, but not Rint, improved the prediction of asthma symptoms until the age of 8 years, independent of clinical history.
02
Sep.
2010
Journal: The Journal of Allergy and Clinical Immunology
Author: Claus Bachert, Nan Zhang, Gabriele Holtappels, Lizzy De Lobel, Paul van Cauwenberge, Shixi Liu, Ping Lin, Jean Bousquet, Kristel Van Steen
Presence of IL-5 protein and IgE antibodies to staphylococcal enterotoxins in nasal polyps is associated with comorbid asthma
Background: Nasal polyps often are associated with asthma. The phenotype of these patients is unknown.
Objective: To identify the mucosal factors associated with asthma comorbidity, we analyzed the inflammatory patterns of nasal polyps.
Methods: Nasal polyps from 70 Belgian patients, 34% with asthma, were analyzed for type of inflammation, T-cell cytokines, and IgE antibodies to Staphylococcus aureus enterotoxins. The same investigations were repeated in 93 Chinese patients with polyps, a group with a low asthma comorbidity rate (8%).
Results: In Belgian patients with polyps, 54% of samples showed eosinophilic inflammation. A classification tree evaluation identified IL-5 as the main positive determinant. Enterotoxin IgE in tissue (37%) was associated with significantly increased total IgE and eosinophil cationic protein concentrations. Expression of enterotoxin IgE, total IgE at greater than 1,442 kU/L, and eosinophil cationic protein at greater than 17,109 μg/L in samples with a total IgE concentration of greater than 246 kU/L significantly predicted asthma (odds ratio, 5.8-13). Only 7.5% of the samples from Chinese patients with polyps showed eosinophilic inflammation. IL-5 was confirmed as a positive determinant of eosinophilic inflammation, and enterotoxin IgE in tissue (17% of patients) was associated with significantly increased total IgE and eosinophil cationic protein concentrations. The expression of IL-5 or total IgE at greater than 790 kU/L in samples with an IL-5 concentration of greater than 194 pg/mL significantly predicted comorbid asthma (odds ratio, 17.2-96).
Conclusion: Mucosal inflammation in nasal polyps orchestrated by TH2 cytokines and amplified by S aureus enterotoxins is characterized by an increased eosinophilic inflammation and formation of IgE antibodies. This phenotype is associated with comorbid asthma in white and Asian patients with nasal polyps.
30
Aug.
2010
Journal: Respiratory Medicine
Author: Louis-Philippe Boulet, Hollie Devlin, Denis E. O’Donnell
The Physicians’ Practice Assessment Questionnaire on asthma and COPD
We describe a new tool, the Physicians’ Practice Assessment Questionnaire (PPAQ), designed for the global self-assessment of implementation of asthma and COPD guidelines, as determined by the percentage of patients in whom physicians estimate that they implement guidelines key recommendations. Some of its properties were assessed by a group of 47 general practitioners (GPs), and test–retest data were obtained in repeating the questionnaire at a 5-week interval without intervention in a sub-group of 28 practitioners. Answers to the various questions were globally reproducible. The lowest scores (recommendations implemented in less than 50% of their patients) were: 1) for both asthma and COPD: referral for patient education, provision of a written action plan and regular assessment of inhaler technique, 2) for asthma: referral to a specialist for difficult to control asthma or uncertain diagnosis, and 3) for COPD: assessment of lung function and disability according to specific criteria and referral to a rehabilitation program. The analysis showed sufficient internal consistency for both questionnaires (Cronbach alphas 0.7617 for asthma and 0.8317 for COPD). Pearson’s correlations indicated good test–retest (r = 0.6421, p = 0.0002 for asthma; r = 0.6801, p < 0.0001 for COPD). In conclusion, the PPAQ is a new tool to assess implementation of asthma and COPD guidelines; it has the potential to identify care gaps that can be specifically targeted for intervention.
30
Aug.
2010
Journal: Respiratory Medicine
Author: Christoph Schäper, Sven Gläser, Stephan B. Felix, Annette Gogolka, Beate Koch, Matthias Krüll, Ralf Ewert, Oliver Noga
Omalizumab treatment and exercise capacity in severe asthmatics – Results from a pilot study
Background: In patients with moderate to severe allergic asthma, clinical effectiveness of omalizumab, an approved anti-IgE-reacting substance, is usually assessed by pulmonary function testing (PFT), symptom scores and physicians judgement.
Aims: We postulate that cardiopulmonary exercise testing (CPET) may provide an additional option to verify symptomatic changes in patients with allergic asthma.
Methods: Ten consecutive patients with allergic asthma were treated with omalizumab. Prior to and after 16 weeks of treatment all patients underwent PFT and symptom-limited CPET. Results were compared to 10 asthmatic controls without omalizumab medication. Symptoms were assessed according to investigators judgement (IGETE).
Results: All 20 patients showed a significantly impaired exercise capacity at baseline [peak oxygen uptake (VO2) 71 ± 16% predicted]. In patients with omalizumab, peakVO2 increased from 13.8 (8.4–21.4) to 16.8 (11.2–23.9) ml/kg/min (p < 0.05), VO2 at anaerobic threshold increased by 22% [9.8 (3.3–15.2) to 12.3 (6.7–14.4) ml/kg/min (p < 0.05)]. There was no improvement in the controls. The increase in VO2 was significantly correlated to the improvement in symptoms. All patients revealed dynamic hyperinflation under exercise with a decreasing extent with omalizumab treatment.
Conclusion: This study suggests that CPET may provide additional and useful tools to assess and verify the individual clinical response to omalizumab treatment. An improvement in exercise capacity can reliably mirror changes in quality of life and IGETE. Patients with omalizumab experience significant improvements in their initially impaired exercise capacity. CPET can be safely accomplished in patients with severe asthma.
25
Aug.
2010
Journal: International Archives of Allergy and Immunology
Author: Jonas Eriksson, Linda Ekerljung, Teet Pullerits, Kenneth Holmberg, Eva Rönmark, Jan Lötvall, Bo Lundbäck
Prevalence of Chronic Nasal Symptoms in West Sweden: Risk Factors and Relation to Self-Reported Allergic Rhinitis and Lower Respiratory Symptoms
Background: There are few population-based studies on chronic nasal symptoms and little is known about their prevalence and determinants, or their association with allergic rhinitis and asthma.
Methods: A questionnaire focused on respiratory symptoms and conditions was mailed in 2008 to 30,000 randomly selected subjects aged 16–75 years in West Sweden, 29,218 could be traced and 18,087 (62%) responded. The questionnaire included questions on self-reported allergic rhinitis, asthma, lower respiratory and nasal symptoms and possible determinants.
Results: Nasal congestion was reported by 14.9% and runny nose by 13.1% of subjects. In total, 19.8% had chronic nasal symptoms. Subjects with chronic nasal symptoms had considerably more symptoms from the lower airways compared with nonrhinitic subjects and vice versa. Forty-seven percent of the subjects with chronic nasal symptoms had concurrent self-reported allergic rhinitis. Several hereditary and environmental factors were associated with chronic rhinitis, including family history of asthma [odds ratio (OR) 1.27; 95% confidence interval 1.07–1.50], family history of allergy (OR 1.74; 1.57–1.92) and current smoking (OR 1.39; 1.25–1.54). Further, chronic nasal symptoms were increasingly prevalent with an increasing degree of urbanization.
Conclusion: The prevalence of chronic nasal symptoms in West Sweden was found to be high and strongly associated both with self-reported allergic rhinitis and symptoms from the lower airways. Moreover, several risk factors were identified for chronic nasal symptoms, including family history of allergy and asthma and smoking.