a b s t r a c tIn Russian population of Siberia asthma is usually concomitant with high sensitization to indoor allergens (cat, dog and house dust mites), overproduction of total immunoglobulin E (IgE) and airway hyperreactivity. Definition of genes that predispose to development of various sub-components of the asthma phenotype is important for understanding of etiology of this disease. To map genes predisposing to asthma, we tested 21 microsatellite markers from candidate chromosomal regions in 136 Russian nuclear families with asthma from Siberia. We performed non-parametric analysis for linkage with asthma, total IgE, specific IgE to cat, dog, and dust mites, and spirometric indices (FEV1 (%) -percentage of predicted forced expiratory volume in 1 s, FVC (%) -percentage of predicted forced vital capacity, and FEV1/FVC (%) -Tiffenau index). The most significant linkage was to the candidate region on chromosome 12. Locus controlling cat-specific IgE, which is the most abundant in asthma patients from Siberian population, mapped within the interval between 136 and 140 cM on chromosome 12q24.3, with the suggestive linkage at the marker D12S1611 (LOD = 2.23, P = 0.0007). Total IgE was also linked to this region (D12S1611 -LOD = 1.12, P = 0.012). FEV1 (%) exceeded LOD > 1 threshold for significance with the same locus 12q24.3, but with the peak at a more proximal region at 111.87 cM (D12S338 -LOD = 1.21, P = 0.009). Some evidence of linkage (LOD > 1.0) was also detected for asthma at 6p21.31 (D6S291) and total IgE at 13q14.2 (D13S165). These data indicate that the locus 12q24.3 is the most promising candidate for identification of asthma genes in Russian population of Siberia.
Bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases of the airways. Inhaled bronchodilators and corticosteroids are the cornerstone of pharmacological long-term treatment for asthma and COPD. The efficacy of any topical inhaled medication is dependent upon successful distribution of the drug to the site of disease. Targeting small airways inflammation in severe asthma and COPD are critically important as the combined surface area of small airways far exceeds the surface area that large central airways provide. Small airway dysfunction in BA is associated with increased asthma symptoms, worse asthma control and an increased number of exacerbations. Chronic inflammation in COPD causes structural alterations and narrowing of particularly the small airways. The extrafine combination of beclomethasone dipropionate/formoterol (BDP/F) enables drug delivery to both the large and small airways, and allows the clinical benefits to be achieved with a lower corticosteroid dose. The use of extrafine BDP/F is more effective in achievement asthma control and reduce COPD exacerbations. If it is necessary to continue ICS as part of a double or triple COPD therapy extrafine fixed combination of BDP/F can be considered as the drug of choice and optimal replacement of the ICS molecule.
Eosinophilic esophagitis (EE) is a chronic disease characterized by antigen-mediated eosinophilic inflammation leading to esophageal dysfunction. Food and pollen allergens are considered to be the main cause of EE. Indoor allergens can offend EE but not so often as food and pollen. Clinical case of EE associated with persistent allergic rhinitis with sensitization to house dust mites and cockroaches is presented in the article. Successful treatment with inhaled topical corticosteroids, taken orally, confirmed by endoscopy and biopsy is demonstrated.
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