Lung function decline and variable airway inflammatory pattern: Longitudinal analysis of severe asthma

Newby, Christopher; Agbetile, Joshua; Hargadon, Beverley; Monteiro, W; Green, Ruth; Pavord, Ian D.; Brightling, Christopher E.; Siddiqui, Salman

doi:10.1016/j.jaci.2014.04.005

Cited by 63 publications

(65 citation statements)

References 35 publications

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“…Not only did we not observe the expected decline in FEV 1 over time that has been reported in patients with “eosinophilic severe asthma” [5, 15], but there was a modest improvement over the period of observation suggesting that the current symptom-based guideline therapies underestimate the control of airway inflammation. We analysed longitudinal data using three time points i.e.…”

Section: Discussionmentioning

confidence: 47%

“…The rate of change of FEV 1 was positive when the rate was computed from the baseline value to the point when the airway inflammation (or the sputum quantitative assay) became normal (Fig. 2), whereas the rate of change of FEV 1 thereafter, from the time sputum was normal to the time when the patient was last seen was a modest −14 ml/year which is clearly lesser than that reported in previous longitudinal asthma studies [6, 15–18]. The overall improvement in FEV 1 in this study is possibly driven by the fact that most patients had an improvement in lung function when sputum became normal after intensive anti-inflammatory therapy and that too within a short span of time resulting in high rates of improvement in FEV 1 with time.…”

Section: Discussionmentioning

confidence: 58%

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Sputum cell counts to manage prednisone-dependent asthma: effects on FEV1 and eosinophilic exacerbations

Aziz-Ur-Rehman

Dasgupta

Kjarsgaard

et al. 2017

Allergy Asthma Clin Immunol

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BackgroundPrednisone dependence in asthma is usually described based on clinical and spirometric characteristics. It is generally believed that these patients have frequent exacerbations and lose lung function rapidly because of uncontrolled airway eosinophilia.ObjectivesThe objectives of this study are to report the effect on asthma exacerbations and the change in lung function over time in prednisone-dependent asthma when severe asthma is managed using a protocol that aims to maintain normal sputum cell counts.MethodsA retrospective survey of patients prospectively assessed in a university tertiary care asthma clinic.Results52 patients (30 males, mean age 51 years, 64% non-atopic) were followed for a median period of 5.4 years (min–max: 0.2–35.2). Monitoring with the aim of keeping sputum eosinophils below 3% resulted in higher doses of corticosteroids (median daily dose of prednisone was 10 mg and for inhaled corticosteroids was 1500 μg of fluticasone equivalent) than at baseline and this was associated with predictable adverse effects. Despite the disease severity, 10 patients (19%) did not require LABA for symptom control. Most importantly, over the period of follow-up, there were only 0.3 eosinophilic exacerbations/patient/year. Overall, there was an increase in FEV1 over the period of follow-up (mean +84.6 ml/year) rather than an expected decline.ConclusionsMonitoring of eosinophils in sputum enables to maintain symptom control and preserve FEV1 in patients with severe prednisone-dependent asthma.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 58%

Sputum cell counts to manage prednisone-dependent asthma: effects on FEV1 and eosinophilic exacerbations

Aziz-Ur-Rehman

Dasgupta

Kjarsgaard

et al. 2017

Allergy Asthma Clin Immunol

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“…Finally, our patients were older (75 years vs. 69 years). It is believed that the impacts of allergy on lung function may be increasing with age [23].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Increased Serum IgE and Aspergillus Sensitization in Patients With COPD and Their Association With Symptoms and Lung Function

Jin

Liu

2016

Chest

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Background: Allergy and Aspergillus hypersensitivity (AH) were shown to be associated with severe symptoms or worse lung function in COPD patients. The prevalence of elevated total IgE (T-IgE) and its association with clinical symptoms and lung function in COPD have not been studied. The prevalence of AH and its correlation with clinical characteristics in a COPD cohort of larger sample size is also lacking. Methods: 273 patients with COPD were evaluated by respiratory symptoms, blood test, chest HRCT, lung function, serum detection of T-IgE and Aspergillus specific IgE. Patients with T-IgE ≥ 1000 KU/L were further investigated for allergic bronchopulmonary aspergillosis (ABPA). Results: The prevalence of elevated T-IgE and AH in patients with COPD was 47.3% and 15.0%, respectively. Eight patients (2.9%) met the diagnostic criteria for ABPA. Compared with the normal T-IgE group, patients with elevated T-IgE had a longer history of dyspnea (p < 0.01), an earlier onset of dyspnea after chronic cough/expectoration (p < 0.01), and were more likely to wheeze (p < 0.01). They also showed worse lung functions and more severe GOLD staging (p < 0.01). Analysis of the clinical data in male patients with smoking as the risk factor showed the same results. To evaluate the clinical characteristics of COPD with AH, patients with elevated T-IgE were further divided into subgroups with and without AH. When compared with the normal T-IgE group, both the two subgroups showed longer history of dyspnea (p < 0.01), an earlier onset of dyspnea (p < 0.01) and a worse status of lung function (p < 0.05). Correlation analysis demonstrated that T-IgE was correlated positively with the time length of dyspnea (r = 0.401, p < 0.001), and the ratio of duration of dyspnea to that of chronic cough/expectoration (r = 0.59, p < 0.001), but negatively with FEV1/ FVC% (r = −0.194, p = 0.001), and FEV1%predicted (r = −0.219, p < 0.001).

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“…(Hardin M et al, 2014; Martinez FD, 2009). Therefore, long duration of asthma, irrespective of the underlying etiology, is associated with poor asthma control (Pereira ED, Cavalcante AG, Pereira EN, Lucas P, & Holanda MA, 2011), poor quality of life (Pereira ED et al, 2011), and poorer lung function (Newby C et al, 2014) with irreversible loss in adults.…”

Section: Childhood Asthmamentioning

confidence: 99%

Health issues in Hispanic/Latino youth.

Isasi

Rastogi

Molina

2016

Journal of Latina/o Psychology

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This review focuses on obesity, asthma and mental health functioning as salient health issues affecting Hispanic youth. Burden of these conditions and consequences for adult health are also discussed. Hispanic youth are affected by obesity at an early age; the prevalence of obesity among Hispanic children 6–11 years old is twice as high as the prevalence for non-Hispanic White children of the same age, but among 2–5 years old is 4 times higher. Asthma disproportionally affects certain Hispanic groups, notably children of Puerto Rican ancestry, and the comorbidity of asthma and obesity is an emerging health issue. Another area of concern is the scant data on mental health functioning among Hispanic youth. Research on Hispanic youth mental health have reported high rates of depressive symptomatology and high rates of alcohol use among Hispanic adolescents but despite these findings, they have inadequate access to mental health services. This review highlights the need for better data to gain a better understanding of the health status of Hispanic youth and help develop preventive programs that addresses the need of this population. Improving access to health services, in particular mental health services, is also a crucial aspect.

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Lung function decline and variable airway inflammatory pattern: Longitudinal analysis of severe asthma

Cited by 63 publications

References 35 publications

Sputum cell counts to manage prednisone-dependent asthma: effects on FEV1 and eosinophilic exacerbations

Sputum cell counts to manage prednisone-dependent asthma: effects on FEV1 and eosinophilic exacerbations

The Prevalence of Increased Serum IgE and Aspergillus Sensitization in Patients With COPD and Their Association With Symptoms and Lung Function

Health issues in Hispanic/Latino youth.

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