Showing posts with label ASTHMA. Show all posts
Showing posts with label ASTHMA. Show all posts

Statins in Asthma COPD overlap may bring down the risk of CAD and stroke risk

By Dr Deepu

Recently published study in atherosclerosis journal has found that the risk for CAD was lower in all statin-treated patients with ACOS. Whereas the risk for ischemic stroke was lower only in long-term statin users with ACOS. There was no link  between risk for hemorrhagic stroke and  statin use.
A retrospective cohort study was conducted using data from the Longitudinal Health Insurance Database, which included 1 million enrollees in the Taiwan National Health Insurance program from January 1, 2000, through December 31, 2011.
Patients ≥20 years of age with ACOS who were treated with statins (n=916) and those who did not receive statin therapy (n=6338) were enrolled in the study. Investigators examined the cumulative incidence of CAD and stroke (both ischemic and hemorrhagic) with the use of time-dependent Cox proportional regression. Following adjustments for age, sex, inhaled corticosteroid use, oral steroid use, and comorbidities, adjusted hazard ratios (aHRs) and 95% CIs for CAD or stroke in statin users (long-term statin use: >600 days; short-term statin use: ≤600 days) were compared with these values in statin nonusers.
In statin users, the aHRs for CAD and stroke were 0.50 (95% CI, 0.41-0.62) and 0.83 (95% CI, 0.63-1.09), respectively. Furthermore, aHRs for ischemic and hemorrhagic stroke were 0.30 (95% CI, 0.09-0.99) and 0.90 (95% CI, 0.68-1.20), respectively. In addition, in long-term statin users, aHRs for CAD and stroke were 0.23 (95% CI, 0.13-0.41) and 0.42 (95% CI, 0.19-0.89), respectively. In short-term statin users, aHRs for CAD and stroke were 0.58 (95% CI, 0.47-0.71) and 0.93 (95% CI, 0.70-1.23), respectively.
A major limitation of the current study is that lipid levels were not taken into account. Moreover, although a new-user study design was employed, with propensity score matching and a time-dependent model for analysis, results were not as accurate as those derived from randomized controlled trials.

The study was published in atherosclerosis journal

Exercise Training May Improve Daily Life For Obese Individuals With Asthma, Study Suggests

By Dr Deepu

Obese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated.
The objective of the study was assess the effects of exercise on DLPA, asthma symptoms and psychosocial comorbidities in obese adults with asthma. The study included  Fifty-five grade II obese adults with asthma, the study subjects were randomly assigned to either a weight-loss program+exercise program (WL+E group, n=28) or a weight loss program +sham (WL+S group, n=27). The WL+E group incorporated aerobic and resistance muscle training into the weight-loss program (nutrition and psychological therapies), while the WL+S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality and anxiety and  depression  symptoms were quantified before and after treatment.
The results obtained after 3 months were positive, the WL+E group presented a significant increase in daily step counts (3,068 ± 2,325 vs. 729 ± 1,118 steps/day) and the number of asthma-symptom-free days (14.5 ± 9.6 vs. 8.6 ± 11.4 d/mo) compared with the WL+S group. The proportion of participants with improvements in depression symptoms (76.4 vs. 16.6 %) and a lower risk of developing obstructive sleepapnea (56.5 vs. 16.3%) was greater in the WL+E group than in the WL+S group (P<0.05). Significant improvements in sleep efficiency (6.6 ± 5.1 vs. 1.3 ± 4.7%) and latency (-3.7 ± 5.9 vs. 0.2 ± 5.6 min) were also observed in the WL+E group.
The authors concluded that exercise training plus a weight loss program improves DLPA, sleep efficiency and depressionand asthma symptoms in obese adults with asthma.
The three-month program targeted both weight loss and exercise through aerobic and resistance training, the study authors wrote in the journal Medicine and Science in Sports and Exercise.
When contacted over the email Dr Celso R F Carvalho gave the following insights into the study "In my opinion, the more important results of our study are the fact that exercise reduced the comorbidities of the obese asthmatic patients. I am not aware of any other non-pharmacological intervention that has presented such strong impact (bariatric surgery or diet support).

This is important because, in our clinical practice, most patients complain about having problems sleeping, lack of energy (sedentarism) and lower self-esteem (maybe due to the depression symptoms).

It is also important to reinforce that the effect in our study is compared with patients having an important support (nutritional and psychological). Then, the exercise had, on average, a 3-fold effect size compared with the "control group".

At last, I consider that the association we evaluated (Figures 4A-D) also suggest (or explain) how improvement in daily steps and depression symptoms are explained."

Read the findings of the study here.

FDA approves Injectable drug for uncontrolled Asthma

By Dr Deepu
The Food and Drug Administration approved Teva Pharmaceutical Industries Ltd.’s Cinqair (reslizumab) to adults who have treat severe asthma attacks despite taking other medication.It can be used with other asthma medicines for the maintenance treatment of severe asthma in patients aged 18 years and older.
        The drug is “given by injection every four weeks” and works by “reducing blood levels of eosinophils, a white blood cell that contributes to asthma”.
Cinqair is administered once every four weeks via intravenous infusion by a health care professional in a clinical setting prepared to manage anaphylaxis. Cinqair is a humanized interleukin-5 antagonist monoclonal antibody produced by recombinant DNA technology in murine myeloma non-secreting 0 (NS0) cells. Cinqair reduces severe asthma attacks by reducing the levels of blood eosinophils, a type of white blood cell that contributes to the development of asthma.

The safety and efficacy of Cinqair were established in four double-blind, randomized, placebo‑controlled trials in patients with severe asthma on currently available therapies. Cinqair or a placebo was administered to patients every four weeks as an add-on asthma treatment. Compared with placebo, patients with severe asthma receiving Cinqair had fewer asthma attacks, and a longer time to the first attack. In addition, treatment with Cinqair resulted in a significant improvement in lung function, as measured by the volume of air exhaled by patients in one second.

Cinqair can cause serious side effects including allergic (hypersensitivity) reactions. These reactions can be life-threatening. The most common side effects in clinical trials for Cinqair included anaphylaxis, cancer, and muscle pain.

Exposure to high levels of certain traffic air pollutants may increase risk of preterm birth for pregnant women with asthma.

By Dr Deepu

    Exposure to high levels of certain traffic air pollutants may increase the risk of preterm birth in pregnant women with asthma.

   Researchers analyzed data from over 223,000 single-child births and found this was especially true when women were exposed to pollutants just before conceiving, in early pregnancy and the last six weeks of pregnancy.

The analysis revealed that  preterm births occurred in 11.7% of singleton deliveries across the entire study population and 33.6% of these deliveries were early preterm births. The significant  asthma interactions were  sporadic before 30 weeks gestation, but more common during weeks 34 to 36, with risk highest among women with asthma exposed to NOx, CO and SO2.
 The findings were published online March 1 in the Journal of Allergy and ClinicalImmunology.

Asthma Patients Treated With Bronchial Thermoplasty May Have Decreased Airway Smooth Muscle Mass And Type-1 Collagen Deposition Underneath Basement Membrane

By Dr Deepu

Healio (9/22) reports that research indicated that individuals “with asthma treated with bronchial thermoplasty demonstrated decreased airway smooth muscle mass and type-1 collagen deposition underneath the basement membrane.” The findings were published in the Annals of the American Thoracic Society.

Lung CD200 Receptor Activation Abrogates Airway Hyperresponsiveness in Experimental Asthma

By Dr Deepu

The August issue of AJRCMB,study by Lauzon-Joset and colleagues demonstrate, in an experimental model of asthma, that local administration of CD200 inhibits airway hyperresponsiveness and lung accumulation of T helper type 2 cells, in addition to modulating the cytokine milieu within the lung. The authors note that "Given that airway hyperresponsiveness and inflammation are the root causes of asthma, these results pave the way to further investigations conducive to improved treatment."

Chloride Channel 3 Channels in the Activation and Migration of Human Blood Eosinophils in Allergic Asthma

By Dr Deepu
In the August issue of AJRCMB, Gaurav and colleagues report, for the first timein their study, a critical role for chloride channel 3 (CLC3) channels in the migration and activation of human blood eosinophils. The researchers also report, in addition to the known presence of nicotinamide adenine dinucleotide phosphate oxidase (NOX) 2, the existence of subtypes of NOX, including NOX1, NOX3, NOX5, dual oxidase (DUOX) 1, and DUOX2, albeit at low levels, in human blood eosinophils. Very high levels of NOX2 messenger RNA transcripts were found in the eosinophils of subjects with moderate to severe asthma compared with subjects with mild to moderate asthma and healthy subjects, suggesting a positive correlation between the expression of NOX2 messenger RNA transcripts and disease severity. The authors conclude that their findings provide a novel target in regulating eosinophil infiltration and activation in allergic airway inflammation in asthma.


By Dr Deepu
BTS/SIGN Asthma Guideline 2014  BTS/SIGN British Guideline on the Management of Asthma, October 2014
Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology (January 2005)
Diagnosis and Management of Work-Related Asthma: ACCP Consensus Statement (September 2008)
Guidelines for the management of work-related asthma ERS task Force Report 2012Eur Respir J 2012; 39: 529-545

Monitoring asthma in children  ERS statement 2015 Eur Respir J 2015; 45: 906–925

FDA approves new drug STIOLTO for airway diseases.

By Dr Deepu
Patients with COPD and asthma have yet another medicinal option as Stiolto was approved in May  2015 by the U.S. Food and Drug Administration (US FDA). The medicine should now be available in pharmacies around the U.S. and few other countries.

The medicine is in the list of ever growing combination medicines approved for asthma and COPD. 

Stiolto contains:
  • Tiotropium bromide (Spiriva), a long acting anticholinergic (LAAC)
  • Olodaterol (Striverdi), a long acting beta adrenergic (LABA)
Studies showed Spiriva by itself improved lung function. another study has showed that Spiriva used in combination with Symbicort, a medicine that contains both a LABA and an inhaled corticosteroid, improves lung function by as much as 62 percent.

Before concluding I want to emphasise the fact that, approved medicine might benefit in people who are not relieved with other medicines. They are class of ultra long acting drugs so the dosage frequency is decreased which on a long run may decrease the treatment cost and also need for rescue medicines.
Time has to tell whether this medicine combination with satisfy the end user I.e the patient himself has to decide whether it works or not.
Further reading:

Asthma Treatments May Be Less Likely To Work For Older Individuals

Pulmonary Medicine Blog By Dr Deepu

HealthDay (6/13, Preidt) reported that research indicates that “asthma treatments, especially inhaled corticosteroids, are less likely to work for older” individuals. Investigators “looked at 1,200 patients with mild-to-moderate asthma, and found that treatment failure occurred in” approximately “17 percent of those aged 30 and older, compared with about 10 percent of those younger than 30.” The study indicated that “lower lung function and having asthma for a longer time were” linked to “a higher risk of treatment failure.”


Pulmonary Medicine Blog By Dr Deepu

Scientists discover asthma's potential root cause and a novel treatment
Cardiff scientists have for the first time identified the potential root cause of asthma and an existing drug that offers a new treatment.

Published today in Science Translational Medicine journal, University researchers, working in collaboration with scientists at King's College London and the Mayo Clinic (USA), describe the previously unproven role of the calcium sensing receptor (CaSR) in causing asthma, a disease which affects 300 million people worldwide.

The team used mouse models of asthma and human airway tissue from asthmatic and non-asthmatic people to reach their findings.

Crucially, the paper highlights the effectiveness of a class of drugs known as calcilytics in manipulating CaSR to reverse all symptoms associated with the condition. These symptoms include airway narrowing, airway twitchiness and inflammation - all of which contribute to increased breathing difficulty.

"Our findings are incredibly exciting," said the principal investigator, Professor Daniela Riccardi, from the School of Biosciences. "For the first time we have found a link airways inflammation, which can be caused by environmental triggers - such as allergens, cigarette smoke and car fumes – and airways twitchiness in allergic asthma.

"Our paper shows how these triggers release chemicals that activate CaSR in airway tissue and drive asthma symptoms like airway twitchiness, inflammation, and narrowing. Using calcilytics, nebulized directly into the lungs, we show that it is possible to deactivate CaSR and prevent all of these symptoms."

Dr Samantha Walker, Director of Research and Policy at Asthma UK, who helped fund the research, said:

"This hugely exciting discovery enables us, for the first time, to tackle the underlying causes of asthma symptoms. Five per cent of people with asthma don't respond to current treatments so research breakthroughs could be life changing for hundreds of thousands of people.

"If this research proves successful we may be just a few years away from a new treatment for asthma, and we urgently need further investment to take it further through clinical trials. Asthma research is chronically underfunded; there have only been a handful of new treatments developed in the last 50 years so the importance of investment in research like this is absolutely essential."
While asthma is well controlled in some people, around one-in-twelve patients respond poorly to current treatments. This significant minority accounts for around 90% of healthcare costs associated with the condition.

According to Cardiff Professor Paul Kemp, who co-authored the study, the identification of CaSR in airway tissue means that the potential for treatment of other inflammatory lung diseases beyond asthma is immense. These include chronic obstructive pulmonary disease (COPD) and chronic bronchitis, for which currently there exists no cure. It is predicted that by 2020 these diseases will be the third biggest killers worldwide.Professor Riccardi and her collaborators are now seeking funding to determine the efficacy of calcilytic drugs in treating asthmas that are especially difficult to treat, particularly steroid-resistant and influenza-exacerbated asthma, and to test these drugs in patients with asthma.
Calcilytics were first developed for the treatment of osteoporosis around 15 years ago with the aim of strengthening deteriorating bone by targeting CaSR to induce the release of an anabolic hormone. Although clinically safe and well tolerated in people, calcilytics proved unsuccessful in treating osteoporosis.
But this latest breakthrough has provided researchers with the unique opportunity to re-purpose these drugs, potentially accelerating the time it takes for them to be approved for use asthma patients. Once funding has been secured, the group aim to be trialling the drugs on humans within two years.
"If we can prove that calcilytics are safe when administered directly to the lung in people, then in five years we could be in a position to treat patients and potentially stop asthma from happening in the first place," added Professor Riccardi.
The study was part-funded by Asthma UK, the Cardiff Partnership Fund and a BBSRC 'Sparking Impact' award.

ECG changes in Acute severe Asthma

Pulmonary Medicine Blog By Dr Deepu

Reversible ECG changes in Acute severe Asthma

Dear Friends I got a call from the emergency department to treat a patient who was gasping for air, the intern at the ER department informed me that the patient had RAD, RBBB and P pulmonale, After examining the patient and taking proper history from the attendants we came to know that the patient is an asthmatic and this was an acute asthmatic attack. Then the intern was baffled by the ECG changes, he thought the event to be a acute cardiac event, I then explained him the ECG changes which are seen in acute asthma. I thought to share the same with you
Here are the ECG changes in Acute Severe Asthma
1.     Sinus tachycardia
2.      Right axis deviation
3.      P pulmonale 
4.      Precordial leads -  voltage of the "p" wave is reduced
5.      Poor progression of the R wave in the precordial leads and marked persistence of the S wave in the left precordial leads
6.      Right bundle branch block
7.      Ventricular premature complexes
8.     Atrial enlargement
9.     Transient ST-segment depression or elevation     in inferior leads ; T-wave abnormalities
10.                        Ventricular repolarization shows a lowered J point with an upward oblique ST segment in the peripheral leads
The mechanism of these electrocardiographic changes appears to depend on the vertical position of the heart caused by over expansion of the lungs and pulmonary arterial hypertension
What are the causes of ECG changes???
1.     Adrenergic stimulation
2.     Hyperventilation
3.     Hyperinflation
4.     Primary or secondary coronary insufficiency
5.     Severity of ECG signs correlates with the degree of airway obstruction.

So, Various ECG changes can occur in acute severe asthma which are nonspecific and these may mimic an acute cardiac event and can cause diagnostic dilemma, most of these changes are reversible usually within 10 days of treatment


Textbooks, Review Articles and Other Resources

The list below includes free online textbooks and review articles in Allergy and Immunology. The files represent external links and are not hosted on this website.

Practice Parameters for Allergy and Immunology, AAAAI, ACAAI, JCAAI.
Practical guide for allergy and immunology - open access review articles. CSACI, 2011.
Conferences On-Line Allergy (COLA) - free video lectures on allergy and immunology topics, alsoavailable on YouTube. ACAAI.
Care pathways for children with allergies. Royal College of Paediatrics, Archives of Disease in Childhood, 2011.
WAO Position Papers and Statements
Fellows-in-Training: Review Corner Archive, 2002-2009. ACAAI.
Ask the Expert series by AAAAI
Program Directors' Core Curriculum and Reading List (PDF). AAAAI, 2009.
A/I MKSAP by AAAAI, 2003 (PDF, 29 MB) (some parts are outdated).
Free textbooks from (requires registration): Middleton's Allergy: Principles and Practice.
Allergy and Asthma Proceedings. Northwestern University Allergy-Immunology Syllabus.
Immunology; Allergic Disorders in Merck Manual.
Allergy and Immunology in eMedicine Medical Textbooks.
Allergy resources by Medical Matrix

Free Lectures and Podcasts in Allergy and Immunology

Conferences On-Line Allergy (COLA) 

Conferences On-Line Allergy (COLA) consists of the bi-weekly presentations at the Children's Mercy Hospitals & Clinics Section of Allergy, Asthma & Immunology. The lectures are very comprehensive and cover most of the spectrum of allergy and immunology. The project could be the video analog of the textbook Middleton's Allergy: Principles and Practice one day.

It is a good idea to download all video files (if allowed by the copyright holder) since many of the webmasters remove them after a certain period of the time. The download cane be done manually or throughiTunes by choosing the "Get all" option from the podcast menu.

Conferences On-Line Allergy (COLA) - free video lectures on allergy and immunology topics by ACAAI, YouTube channel

Allergy and Immunology Lectures at the University of South Florida

USF (University of South Florida, USA) Allergy & Immunology Lecture Series. The 55-minute lectures are recorded in wma format and are best viewed by using Windows Media Player software.

Podcasts by Journal of Allergy and Clinical Immunology (JACI)

JACI Podcasts highlight recent publications in selected areas, and feature discussions with the authors, editors and other experts:

WAO Podcasts

The World Allergy Organization (WAO) Journal has a podcast section: Chief Editor Interviews.

Conversations with allergy experts are available as free MP3 files by the World Allergy Organization (WAO). You can subscribe to the RSS feed here:

ACAAI Conferences

ACAAI Podcast and Vodcast Library is limited in scope but covers the latest advances in clinical allergy and immunology.


The best resource seems to be the immunology course of the University of South Carolina. The lectures can be watched online or downloaded to aniPod/iPhone. Currently, there are 2 courses available -- from the year 2007 and 2008:

Immunology 2007

Immunology 2008

Archive of the Immunology Courses from University of South Carolina

Video Lectures in Immunology,

Immunology, University of Cambridge

Immunology I & II, MIT OpenCourseWare

Immunology: Lecture Series, Howard Hughes Medical Institute


Allergic Rhinitis & Asthma. David Lang, MD. Drexel University College of Medicine Grand Rounds, 2003.
Severe Asthma: Clinical and Pathophysiologic Factors. Sally Wenzel, M.D. Drexel University College of Medicine Grand Rounds, 1999.
Asthma. Podcasts by the supplier of continuing medical education activities PeerView Press.

Allergic Rhinitis

Allergic Rhinitis. Podcasts by the supplier of continuing medical education activities PeerView Press.

Related Resources

Webinar Archives of World Allergy Organization (WAO) 
Podcasts in Allergy and Immunology. Allergy Notes, 01/2008.
Immunology Resources: Audio and Video Lectures, PowerPoint Presentations, Q&A 
Fellows-in-Training: Review Corner Archive, 2002-2008 by ACAAI

Audio and Video

Choosing Wisely Videos by AAAAI
Immunology Course for Medical Students, 2008, University of South Carolina
Archive of the Immunology Courses from University of South Carolina
Video Lectures in Immunology,
Immunology, University of Cambridge
Immunology I & II, MIT OpenCourseWare
Immunology: Lecture Series, Howard Hughes Medical Institute
Allergy and Immunology Lectures at the University of South Florida. USF (University of South Florida, USA) Allergy & Immunology Lecture Series. The 55-minute lectures are recorded in wma format and are best viewed by using Windows Media Player software. 

PowerPoint Presentations

Medical Immunology Syllabus. Columbia University.

Questions & Answers

FIT corner: Cellular and Molecular Immunology, edited by Abul K. Abbas and Andrew H. Lichtman.
Quiz 1, University of South Carolina
Quiz 2, University of South Carolina

Related Resources

Fellows-in-Training: Review Corner Archive, 2002-2008 by ACAAI
Webinar Archives of World Allergy Organization (WAO) 

Omalizumab may have anti-inflammatory effects on small airways and reverse airway remodeling

Omalizumab, a humanized anti-IgE monoclonal antibody, is an effective treatment for severe allergic asthma. This prospective, single-arm observational study, evaluated its effects on small airways and airway remodeling, in 26 adult patients with severe refractory asthma (48 weeks of omalizumab treatment). 

Asthma Quality of Life Questionnaire scores and peak expiratory flow improved. Asthma exacerbations requiring systemic corticosteroids, fractional exhaled nitric oxide at 50 mL/s and alveolar nitric oxide levels, sputum eosinophil proportions, and airway-wall thickness as assessed by computed tomography also decreased.

Omalizumab may have anti-inflammatory effects on small airways and reverse airway remodeling.


Comprehensive efficacy of omalizumab for severe refractory asthma: a time-series observational study. Tajiri T et al. Ann Allergy Asthma Immunol. 2014 Jul 1. pii: S1081-1206(14)00405-0. doi: 10.1016/j.anai.2014.06.004. [Epub ahead of print]


ABPA is a disease state induced by arthus reaction to colonizing aspergillus in the bronchi in patients with bronchial asthma.
Clinical Picture
  • ABPA should be suspected whenever asthma is refractory and is associated with fever, cough and black or grey sputum.
  • Chest x-ray often reveals evanescent pulmonary infiltrates.
  • Marked eosinophilia and elevated IgE are noted.
  • Aspergillus colonizes in the bronchi in asthmatics because of thick secretions. A precipitating antibody is produced. A type III immunological reaction follows. Complement is activated. An inflammatory response occurs with damage to the bronchial wall and the bronchi get plugged with secretion. Segmental infiltrates and atelectasis follows.
  • Aspergillus precipitating antibody is detected in serum.
  • IgE levels and eosinophiles are elevated.
  • Central bronchiectasis can be demonstrated by CT scan.

  • ABPA responds to systemic steroids.
  • Dose and duration of steroids can be adjusted by following serum IgE levels.