Search

Farmers constitute a large professional group worldwide. In developed countries farms tend to become larger, with a concentration of farm operations. Animal farming has been associated with negative respiratory effects such as work-related asthma and rhinitis. However, being born and raised or working on a farm reduces the risk of atopic asthma and rhinitis later in life. A risk of chronic bronchitis and bronchial obstruction/COPD has been reported in confinement buildings and livestock farmers. This position paper reviews the literature linking exposure information to intensive animal farming and the risk of work-related respiratory diseases and focuses on prevention. Animal farming is associated with exposure to organic dust containing allergens and microbial matter including alive microorganisms and viruses, endotoxins and other factors like irritant gases such as ammonia and disinfectants. These exposures have been identified as specific agents/risk factors of asthma, rhinitis, chronic bronchitis, COPD and reduced FEV1. Published studies on dust and endotoxin exposure in livestock farmers do not show a downward trend in exposure over the last 30 years, suggesting that the workforce in these industries is still overexposed and at risk of developing respiratory disease. In cases of occupational asthma and rhinitis, avoidance of further exposure to causal agents is recommended, but it may not be obtainable in agriculture, mainly due to socio-economic considerations. Hence, there is an urgent need for focus on farming exposure in order to protect farmers and others at work in these and related industries from developing respiratory diseases and allergy. [ABSTRACT FROM AUTHOR]

Farmers constitute a large professional group worldwide. In developed countries farms tend to become larger, with a concentration of farm operations. Animal farming has been associated with negative respiratory effects such as work‐related asthma and rhinitis. However, being born and raised or working on a farm reduces the risk of atopic asthma and rhinitis later in life. A risk of chronic bronchitis and bronchial obstruction/COPD has been reported in confinement buildings and livestock farmers. This position paper reviews the literature linking exposure information to intensive animal farming and the risk of work‐related respiratory diseases and focuses on prevention. Animal farming is associated with exposure to organic dust containing allergens and microbial matter including alive microorganisms and viruses, endotoxins and other factors like irritant gases such as ammonia and disinfectants. These exposures have been identified as specific agents/risk factors of asthma, rhinitis, chronic bronchitis, COPD and reduced FEV1. Published studies on dust and endotoxin exposure in livestock farmers do not show a downward trend in exposure over the last 30 years, suggesting that the workforce in these industries is still overexposed and at risk of developing respiratory disease. In cases of occupational asthma and rhinitis, avoidance of further exposure to causal agents is recommended, but it may not be obtainable in agriculture, mainly due to socio‐economic considerations. Hence, there is an urgent need for focus on farming exposure in order to protect farmers and others at work in these and related industries from developing respiratory diseases and allergy. [ABSTRACT FROM AUTHOR]

The Internet has become an inevitable tool for collecting health and health behavior questionnaires. This study compared the feasibility, presence of score differences, and subjective evaluations by children between Internet and identical paper (asthma/fruit) questionnaires in elementary schools. A randomized crossover design was applied, with children starting with one administration mode before completing (5 minutes later) the other mode. Ten Dutch elementary schools with 270 school children (fifth grade, 10-12 years) were approached to participate. Response was 92%. The Internet mode had significantly less missing/nonunique answers than the paper mode (p < .01). The completion times did not differ significantly between the Internet and the paper mode. Except for perceived self-efficacy to eat sufficient fruit (p < .05), no differences in the asthma and fruit scores were found when comparing between the 2 modes. All variables showed strong intraclass correlation coefficients (166 ≥ 0.64) between modes. Most items had good to very good agreement (kappa 0.61-0.95). The percentages for global and exact agreement ranged per item from 61.3 to 100. Most children preferred the Internet mode on “general preference” and “ease of use” aspects but rated no preference on “understandability.” The majority rated the evaluation aspects of the Internet mode positively. Thus, Internet administration of a health and health behavior questionnaire is feasible at elementary schools, gives comparable responses, and is well accepted and preferred by children compared to the paper version. Therefore, it is recommended to use Internet as a tool in health and health behavior research among children. (J Sch Health. 2006;76(2):80-86) [ABSTRACT FROM AUTHOR]

Aim: To identify the latent profiles and predictors of family management styles for children with asthma. Design: This is a secondary data analysis. The demographic data of 506 primary caregivers of children with asthma and their scores of the Family Management Scale in a cross‐sectional study were used. Latent profile analysis and multiple logistic regression analyses were employed. Results: Three family management styles were identified: Thriving (Profile 1), Accommodating (Profile 2), and Enduring (Profile 3) Family Management Style. The child's age, gender, mother's education level, family structure, influence of illness on parents' work and family life, whether they had follow‐up plans and whether their parents had read disease and health knowledge pamphlets were found to be the predictors of different styles. Conclusion: Three distinct family management styles exist for children with asthma. Future interventions designed to enhance family management for children with asthma should be based on their demographic characteristics and family management styles. Implications for the Profession and Patient Care: The precise classification of family management styles in this study can serve as a guide to form multi‐disciplinary teams of physicians and nurses to provide individualized care and conduct in‐depth research to explore the mechanisms of biomedicine and the social psychology of asthma in the future. Impact: This paper aims to identify the latent profiles and predictors of family management styles of children with asthma.Thriving, accommodating, and enduring family management styles were identified in this paper. Child's characteristics, family and organizational factors were the predictors of different family management styles.Findings of this paper provide guidance for physicians and nurses to offer individualized care and conduct in‐depth research to explore the mechanisms of biomedicine and the social psychology of asthma in the future. Reporting Method: The article was reported according to the STROBE Checklist. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

One of the hottest topics in biomedical research is to decipher the functional implications of the Gasdermin (GSDM) protein family in human pathologies. These proteins are the key effectors of a lytic and pro‐inflammatory cell death type termed pyroptosis (also known as "Gasdermin‐mediated programmed cell death"). However, ever‐growing evidence showed that GSDMs can play multiple and complex roles in a context‐dependent manner. In this sense, Gasdermin‐B (GSDMB; the only GSDM gene absent in mice and rats) has been implicated in antibacterial defense, numerous inflammatory pathologies (e.g., asthma, ulcerative colitis), and cancer, but both cell death‐dependent and ‐independent functions have been reported in these diseases, fueling the debate on whether GSDMB has genuine pyroptotic capacity. Recently, a series of seminal papers cast light on the GSDMB multitasking capacity by showing that different GSDMB transcriptional isoforms have distinct biological activities. Nonetheless, there are still obscure areas to be clarified on the precise functional involvement of GSDMB translated variants in physiological and pathological conditions. In this viewpoint, we critically discuss the most recent and exciting data on this topic and propose a series of relevant challenges that need to be overcome before GSDMB‐driven biomedical applications (as a biomarker of disease risk/progression/outcome or as specific therapeutic target) become a reality in clinical settings. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic forced health care systems globally to adapt quickly to remote modes of health care delivery, including for routine asthma reviews. A core component of asthma care is supporting self‐management, a guideline‐recommended intervention that reduces the risk of acute attacks, and improves asthma control and quality of life. Objective: We aimed to explore context and mechanisms for the outcomes of clinical effectiveness, acceptability and safety of supported self‐management delivery within remote asthma consultations. Design: The review followed standard methodology for rapid realist reviews. An External Reference Group (ERG) provided expert advice and guidance throughout the study. We systematically searched four electronic databases and, with ERG advice, selected 18 papers that explored self‐management delivery during routine asthma reviews. Setting, Participants and Intervention: Health care professional delivery of supported self‐management for asthma patients during remote (specifically including telephone and video) consultations. Main Outcome Measures: Data were extracted using Context‐Mechanism‐Outcome (C‐M‐O) configurations and synthesised into overarching themes using the PRISMS taxonomy of supported self‐management as a framework to structure the findings. Results: The review findings identified how support for self‐management delivered remotely was acceptable (often more acceptable than in‐person consultations), and was a safe and effective alternative to face‐to‐face reviews. In addition, remote delivery of supported self‐management was associated with; increased patient convenience, improved access to and attendance at remote reviews, and offered continuity of care. Discussion: Remote delivery of supported self‐management for asthma was generally found to be clinically effective, acceptable, and safe with the added advantage of increasing accessibility. Remote reviews could provide the core content of an asthma review, including remote completion of asthma action plans. Conclusion: Our findings support the option of remote delivery of routine asthma care for those who have this preference, and offer healthcare professionals guidance on embedding supported self‐management into remote asthma reviews. Patient and Public Contribution: Patient and public contribution was provided by a representative of the Asthma UK Centre for Applied Research (AUKCAR) patient and public involvement (PPI) group. The PPI representative reviewed the findings, and feedback and comments were considered. This lead to further interpretations of the data which were included in the final manuscript. [ABSTRACT FROM AUTHOR]

Medication non-adherence, defined as any deviation from the regimen recommended by their healthcare provider, can increase morbidity, mortality and side effects, while reducing effectiveness. Through studying two respiratory conditions, asthma and tuberculosis (TB), we thoroughly review the current understanding of the measurement and reporting of medication adherence. In this paper, we identify major methodological issues in the standard ways that adherence has been conceptualised, defined and studied in asthma and TB. Between and within the two diseases there are substantial variations in adherence reporting, linked to differences in dosing intervals and treatment duration. Critically, the communicable nature of TB has resulted in dose-by-dose monitoring becoming a recommended treatment standard. Through the lens of these similarities and contrasts, we highlight contemporary shortcomings in the generalised conceptualisation of medication adherence. Furthermore, we outline elements in which knowledge could be directly transferred from one condition to the other, such as the application of large-scale cost-effective monitoring methods in TB to resource-poor settings in asthma. To develop a more robust evidence-based approach, we recommend the use of standard taxonomies detailed in the ABC taxonomy when measuring and discussing adherence. Regimen and intervention development and use should be based on sufficient evidence of the commonality and type of adherence behaviours displayed by patients with the relevant condition. A systematic approach to the measurement and reporting of adherence could improve the value and generalisability of research across all health conditions., (© 2020 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)

Background: Asthma is routinely treated with inhaled corticosteroids (ICS). Asthma patients on ICS are at increased risk of adrenal suppression, a potentially serious effect of long‐term glucocorticoid exposure; however, this relationship is poorly understood. Therefore, this study aims to identify metabolite biomarkers related to adrenal suppression in asthma patients taking ICS. Methods: A total of 571 urine metabolites from 200 children with asthma on ICS in the Pharmacogenetics of Adrenal Suppression with Inhaled Steroids (PASS) cohort were profiled. Samples were grouped by peak plasma cortisol measurement as adrenal sufficient (>350 nmol/L) or insufficient (≤350 nmol/L) (outcome). Regression and discriminant‐based statistical models combined with network analyses were utilized to assess relationships between metabolites and the outcome. Finally, prioritized metabolites were validated using data from an ancillary study of the Childhood Asthma Management (CAMP) cohort with similar characteristics to PASS. Results: Ninety metabolites were significantly associated with adrenal suppression, of which 57 also could discriminate adrenal status. While 26 metabolites (primarily steroids) were present at lower levels in the adrenal insufficient patients, 14 were significantly elevated in this group; the top metabolite, mannitol/sorbitol, was previously associated with asthma exacerbations. Network analyses identified unique clusters of metabolites related to steroids, fatty acid oxidation, and nucleoside metabolism, respectively. Four metabolites including urocanic acid, acetylcarnitine, uracil, and sorbitol were validated in CAMP cohort for adrenal suppression. Conclusions: Urinary metabolites differ among asthma patients on ICS, by adrenal status. While steroid metabolites were reduced in patients with poor adrenal function, our findings also implicate previously unreported metabolites involved in amino acid, lipid, and nucleoside metabolism. [ABSTRACT FROM AUTHOR]

Background: Evidence from observational comparative effectiveness research (CER) is ranked below that from randomized controlled trials in traditional evidence hierarchies. However, asthma observational CER studies represent an important complementary evidence source answering different research questions and are particularly valuable in guiding clinical decision making in real‐life patient and practice settings. Tools are required to assist in quality appraisal of observational CER to enable identification of and confidence in high‐quality CER evidence to inform guideline development. Methods: The REal Life EVidence AssessmeNt Tool (RELEVANT) was developed through a step‐wise approach. We conducted an iterative refinement of the tool based on Task Force member expertise and feedback from pilot testing the tool until reaching adequate inter‐rater agreement percentages. Two distinct pilots were conducted—the first involving six members of the Respiratory Effectiveness Group (REG) and European Academy of Allergy and Clinical Immunology (EAACI) joint Task Force for quality appraisal of observational asthma CER; the second involving 22 members of REG and EAACI membership. The final tool consists of 21 quality sub‐items distributed across seven methodology domains: Background, Design, Measures, Analysis, Results, Discussion/Interpretation, and Conflict of Interest. Eleven of these sub‐items are considered critical and named "primary sub‐items". Results: Following the second pilot, RELEVANT showed inter‐rater agreement ≥ 70% for 94% of all primary and 93% for all secondary sub‐items tested across three rater groups. For observational CER to be classified as sufficiently high quality for future guideline consideration, all RELEVANT primary sub‐items must be fulfilled. The ten secondary sub‐items further qualify the relative strengths and weaknesses of the published CER evidence. RELEVANT could also be applicable to general quality appraisal of observational CER across other medical specialties. Conclusions: RELEVANT is the first quality checklist to assist in the appraisal of published observational CER developed through iterative feedback derived from pilot implementation and inter‐rater agreement evaluation. Developed for a REG‐EAACI Task Force quality appraisal of recent asthma CER, RELEVANT also has wider utility to support appraisal of CER literature in general (including pre‐publication). It may also assist in manuscript development and in educating relevant stakeholders about key quality markers in observational CER. [ABSTRACT FROM AUTHOR]

The European Academy of Allergy and Clinical Immunology (EAACI) owns three journals: Allergy, Pediatric Allergy and Immunology and Clinical and Translational Allergy. One of the major goals of EAACI is to support health promotion in which prevention of allergy and asthma plays a critical role and to disseminate the knowledge of allergy to all stakeholders including the EAACI junior members. There was substantial progress in 2017 in the identification of basic mechanisms of allergic and respiratory disease and the translation of these mechanisms into clinics. Better understanding of molecular and cellular mechanisms, efforts for the development of biomarkers for disease prediction, novel prevention and intervention studies, elucidation of mechanisms of multimorbidies, entrance of new drugs in the clinics as well as recently completed phase three clinical studies and publication of a large number of allergen immunotherapy studies and metaanalyses have been the highlights of the last year. [ABSTRACT FROM AUTHOR]

mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. However, it may be disruptive and results achieved are not always reaching the goals. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline using the best evidence‐based approach to care pathways suited to real‐life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity. Patients largely use over‐the‐counter medications dispensed in pharmacies. Shared decision making centered around the patient and based on self‐management should be the norm. Mobile Airways Sentinel networK (MASK), the Phase 3 ARIA initiative, is based on the freely available MASK app (the Allergy Diary, Android and iOS platforms). MASK is available in 16 languages and deployed in 23 countries. The present paper provides an overview of the methods used in MASK and the key results obtained to date. These include a novel phenotypic characterization of the patients, confirmation of the impact of allergic rhinitis on work productivity and treatment patterns in real life. Most patients appear to self‐medicate, are often non‐adherent and do not follow guidelines. Moreover, the Allergy Diary is able to distinguish between AR medications. The potential usefulness of MASK will be further explored by POLLAR (Impact of Air Pollution on Asthma and Rhinitis), a new Horizon 2020 project using the Allergy Diary. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is impacted by allergens and air pollution but interactions between air pollution, sleep and allergic diseases are insufficiently understood. POLLAR (Impact of air POLLution on sleep, Asthma and Rhinitis) is a project of the European Institute of Innovation and Technology (EIT Health). It will use a freely‐existing application for AR monitoring that has been tested in 23 countries (the Allergy Diary, iOS and Android, 17,000 users, TLR8). The Allergy Diary will be combined with a new tool allowing queries on allergen, pollen (TLR2), sleep quality and disorders (TRL2) as well as existing longitudinal and geolocalized pollution data. Machine learning will be used to assess the relationship between air pollution, sleep and AR comparing polluted and non‐polluted areas in 6 EU countries. Data generated in 2018 will be confirmed in 2019 and extended by the individual prospective assessment of pollution (portable sensor, TLR7) in AR. Sleep apnea patients will be used as a demonstrator of sleep disorder that can be modulated in terms of symptoms and severity by air pollution and AR. The geographic information system GIS will map the results. Consequences on quality of life (EQ‐5D), asthma, school, work and sleep will be monitored and disseminated towards the population. The impacts of POLLAR will be (1) to propose novel care pathways integrating pollution, sleep and patients' literacy, (2) to study sleep consequences of pollution and its impact on frequent chronic diseases, (3) to improve work productivity, (4) to propose the basis for a sentinel network at the EU level for pollution and allergy, (5) to assess the societal implications of the interaction. MASK paper N°32. [ABSTRACT FROM AUTHOR]

Recommendations for or against the use of interventions need to consider both desirable and undesirable effects as well as patients' values and preferences (V&P). In the decision‐making context, patients' V&P represent the relative importance people place on the outcomes resulting from a decision. Therefore, the balance between desirable and undesirable effects from an intervention should depend not only on the difference between benefits and harms but also on the value that patients place on them. V&P are therefore one of the criteria to be considered when formulating guideline recommendations in the Evidence‐to‐Decision framework developed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Working Group. Patients' V&P may be quantified through utilities, which can be elicited using direct methods (e.g., standard gamble or time trade‐off) or indirect methods (using validated instruments to measure health‐related quality of life, such as EQ‐5D). The GRADE approach recommends conducting systematic reviews to summarise all the available evidence and assess the degree of certainty on V&P. In this article, we discuss the importance of considering patients' V&P and provide examples of how they are considered in the 2024 person‐centred Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. [ABSTRACT FROM AUTHOR]

Rationale: It is unclear how each individual asthma symptom is associated with asthma diagnosis or control. Objectives: To assess the performance of individual asthma symptoms in the identification of patients with asthma and their association with asthma control. Methods: In this cross‐sectional study, we assessed real‐world data using the MASK‐air® app. We compared the frequency of occurrence of five asthma symptoms (dyspnea, wheezing, chest tightness, fatigue and night symptoms, as assessed by the Control of Allergic Rhinitis and Asthma Test [CARAT] questionnaire) in patients with probable, possible or no current asthma. We calculated the sensitivity, specificity and predictive values of each symptom, and assessed the association between each symptom and asthma control (measured using the e‐DASTHMA score). Results were validated in a sample of patients with a physician‐established diagnosis of asthma. Measurement and Main Results: We included 951 patients (2153 CARAT assessments), with 468 having probable asthma, 166 possible asthma and 317 no evidence of asthma. Wheezing displayed the highest specificity (90.5%) and positive predictive value (90.8%). In patients with probable asthma, dyspnea and chest tightness were more strongly associated with asthma control than other symptoms. Dyspnea was the symptom with the highest sensitivity (76.1%) and the one consistently associated with the control of asthma as assessed by e‐DASTHMA. Consistent results were observed when assessing patients with a physician‐made diagnosis of asthma. Conclusions: Wheezing and chest tightness were the asthma symptoms with the highest specificity for asthma diagnosis, while dyspnea displayed the highest sensitivity and strongest association with asthma control. [ABSTRACT FROM AUTHOR]

Objective: Asthma, a chronic inflammatory disease with diverse pathomechanisms, presents challenges in developing personalized diagnostic and therapeutic approaches. This review aims to provide a comprehensive overview of the role of exosomes, small extracellular vesicles, in asthma pathophysiology and explores their potential as diagnostic biomarkers and therapeutic tools. Methods: A literature search was conducted to identify recent studies investigating the involvement of exosomes in asthma. The retrieved articles were analyzed to extract relevant information on the role of exosomes in maintaining lung microenvironment homeostasis, regulating inflammatory responses, and their diagnostic and therapeutic potential for asthma. Results: Exosomes secreted by various cell types, have emerged as crucial mediators of intercellular communication in healthy and diseased conditions. Evidence suggest that exosomes play a significant role in maintaining lung microenvironment homeostasis and contribute to asthma pathogenesis by regulating inflammatory responses. Differential exosomal content between healthy individuals and asthmatics holds promise for the development of novel asthma biomarkers. Furthermore, exosomes secreted by immune and nonimmune cells, as well as those detected in biofluids, demonstrate potential in promoting or regulating immune responses, making them attractive candidates for designing new treatment strategies for inflammatory conditions such as asthma. Conclusion: Exosomes, with their ability to modulate immune responses and deliver therapeutic cargo, offer potential as targeted therapeutic tools in asthma management. Further research and clinical trials are required to fully understand the mechanisms underlying exosome‐mediated effects and translate these findings into effective diagnostic and therapeutic strategies for asthma patients. [ABSTRACT FROM AUTHOR]

Background: An innovation to better manage cat‐allergic patients utilises anti‐Fel d 1 IgY antibodies to neutralise Fel d 1 after its production by the cat. However, there is no published study showing its clinical efficacy in humans in a home setting. A longitudinal, open‐label, proof‐of‐concept study was carried out to approach clinical efficacy of the cat food in cat‐allergic patients. Methods: After a baseline evaluation, the cats ate only the cat food for the following 4 months. Daily evaluation of efficacy was performed for 2 weeks at baseline and after 1, 2 and 3 months of intervention for periods of 2 weeks. The MASK‐air app was used daily to assess symptoms, work productivity and medications. Results: Of the 49 patients screened, 42 were followed up and 33 (78.5%) reported MASK‐air data at all 3 evaluation periods. The primary end point (visual analogue scale [VAS] for global allergy symptoms) was significantly improved (p < 0.0001). All symptoms (VAS nose, eye, and asthma), VAS work and the combined symptom‐medication score significantly improved after 1 month. The percentage of uncontrolled days (VAS>20/100) decreased from 64% at baseline to 35% at 1 month (p < 0.0001) and 14% at 3 months. A sensitivity analysis in patients with uncontrolled disease at baseline found similar results. Discussion: A cat diet containing anti‐Fel d 1 antibodies was able to (i) show decreased allergic symptoms and related outcomes, (ii) inform the design and feasibility of future studies with a control arm and (iii) estimate the sample size of the study. Study registration number: clinicaltrials.gov: NCT05656482. [ABSTRACT FROM AUTHOR]

Trichospira verticillata is an annual herb that belongs to the family Asteraceae. Trichospira verticillata extract (TVE) elicits anti‐plasmodial activity; however, there has been no detailed report about its anti‐inflammatory effects and molecular mechanisms. In addition, herbal plants exhibit anti‐inflammatory effects by suppressing the NLRP3 inflammasome. Therefore, the primary goal of this study was to examine the effects of TVE on NLRP3 inflammasome activation by measuring interleukin‐1β (IL‐1β) secretion. We treated lipopolysaccharides (LPS)‐primed J774A.1 and THP‐1 cells with TVE, which attenuated NLRP3 inflammasome activation. Notably, TVE did not affect nuclear factor‐kappa B (NF‐κB) signalling or intracellular reactive oxygen species (ROS) production and potassium efflux, suggesting that it inactivates the NLRP3 inflammasome via other mechanisms. Moreover, TVE suppressed the formation of apoptosis‐associated speck‐like protein (ASC) speck and oligomerization. Immunoprecipitation data revealed that TVE reduced the binding of NLRP3 to NIMA‐related kinase 7 (NEK7), resulting in reduced ASC oligomerization and speck formation. Moreover, TVE alleviated neutrophilic asthma (NA) symptoms in mice. This study demonstrates that TVE modulates the binding of NLPR3 to NEK7, thereby reporting novel insights into the mechanism by which TVE inhibits NLRP3 inflammasome. These findings suggest TVE as a potential therapeutic of NLRP3 inflammasome‐mediated diseases, particularly NA. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and paranasal sinuses lasting ≥12 weeks. CRS may exist with (CRSwNP) or without (CRSsNP) nasal polyps. The aim was to evaluate conditions associated with CRS in a randomized hospital cohort. We hypothesized that comorbidities and surgical procedures differ between pediatric and adult patients. Methods: This study consisted of hospital registry data of a random sample of rhinosinusitis patients (age range 0–89 years) with the diagnosis of J32 or J33, correspondingly, registered during outpatient visits from 2005 to 2019 (n = 1461). The covariates of interest were collected from electronic health records based on ICD‐10 codes and keyword searches. Results: Among pediatric patients (n = 104), the relative proportions of CRSsNP and CRSwNP were 86% and 14% respectively. The relative proportions of adult patients (n = 1357) with CRSsNP and CRSwNP were 60% and 40%, respectively. The following comorbidities significantly differed (p < 0.05) between pediatric and adult populations: allergy, chronic otitis media, and tonsillar diseases. In total, 41 % of the children and 46% of the adults underwent baseline endoscopic sinus surgery (ESS). Additional surgeries of the ear, nose and pharynx were significantly more common among children compared with adults. Risk of revision after baseline ESS was associated (p < 0.05) with allergy, asthma, eosinophilia, CRSwNP, immunodeficiency or its suspicion, non‐steroidal anti‐inflammatory drug exacerbated respiratory disease, and number of any diseases ≥2. Conclusions: Our study showed that comorbidities differ between pediatric and adult rhinosinusitis patients, as allergy, asthma and allergy, chronic otitis media, mental health disorders, and tonsils disease were significantly more prevalent among pediatric patients. Children and adults were equally treated with ESS. Notably, children underwent additional surgery on adenoids and tonsils more frequently. The effectiveness of ESS in multimorbid adults should be assessed at an individual level. [ABSTRACT FROM AUTHOR]

Objectives: To identify, describe and synthesise the views and experiences of adults living with asthma regarding shared decision‐making (SDM) in the existing qualitative literature Methods: We conducted a comprehensive search of 10 databases (list databases) from inception until September 2023. Screening was performed according to inclusion criteria. Tools from the Joanna Briggs lnstitute were utilised for the purposes of data extraction and synthesis in this study. The data extraction process in this study employed the Capability, Opportunity and Motivation Model of Behaviour (COM‐B model) as a framework, and a pragmatic meta‐aggregative approach was employed to synthesise the collected results. Results: Nineteen studies were included in the metasynthesis. Three synthesised themes were identified: the capability of people living with asthma, the opportunities of people living with asthma in SDM, and the motivation of the people living with asthma in SDM. Conclusions: We have identified specific factors influencing people living with asthma engaging in SDM. The findings of this study can serve as a basis for the implementation of SDM in people living with asthma and provide insights for the development of their SDM training programs. The ConQual score for the synthesised findings was rated as low. To enhance confidence, future studies should address dependability and credibility factors. Practice Implications: This review contemplates the implementation of SDM from the perspective of people living with asthma, with the aim of providing patient‐centred services for them. The results of this review can benefit the implementation of SDM and facilitate information sharing. It offers guidance for SDM skills training among adults living with asthma, fosters a better doctor–patient relationship and facilitates consensus in treatment decisions, thereby enabling personalised and tailored medical care. Patient or Public Contribution: Three nursing graduate students participated in the data extraction and integration process, with two students having extensive clinical experience that provided valuable insights for the integration. [ABSTRACT FROM AUTHOR]

Background: Young people (YP) with long‐term conditions (LTCs) are at greater risk of psychological distress than those without LTCs. Despite this, there is a scarcity of quality digital interventions designed to help improve mental wellbeing in this population. The aim of this study was to determine what YP, parents and health professionals preferred for future interventions. Methods: Twenty‐six YP with asthma, diabetes and/or epilepsy (the three most common LTCs in YP), 23 parents of YP with LTCs and 10 health professionals mainly in paediatric specialisms (total n = 59) took part in an online Delphi study to gain consensus (set at 75% agreement) on four questions across three rounds. Participants ordered psychological themes that may be experienced by YP with LTCs by importance and ranked digital intervention types and delivery modes by importance or usefulness. The most common results were reported if no consensus was reached by round 3. Results: Participants preferred a mobile phone app (73% agreement) and a mixture of one‐on‐one and group support for an intervention (75% agreement). The two highest ranked psychological themes were anxiety (44%) and wanting to appear 'normal' (38%), and the top intervention type was 'general counselling' (54% agreement). Conclusion: There was a clear desire for an app to help with the psychological aspects of living with LTCs and for a combination of one‐to‐one and group intervention elements. Anxiety and wanting to appear 'normal' might be two closely linked psychological challenges that could be addressed by a single intervention. Implications: The results will be important to consider for a future intervention, although further consultation will be needed for app development. Patient or Public Contribution: Two YP with a LTC provided feedback on the study protocol including the aims and procedures of the project. Another six YP with LTCs were consulted on an early draft of the study questionnaire (the four questions), which was subsequently revised. Once the project began, a patient and public involvement group consisting of two YP with LTCs and one parent of a YP with an LTC gave feedback on the research process, lay report of the results and dissemination plan. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is characterized by preventable morbidity, cost, and inequity. We sought to build an Asthma Learning Health System (ALHS) to coordinate regional pediatric asthma improvement activities. Methods: We generated quantitative and qualitative insights pertinent to a better, more equitable care delivery system. We used electronic health record data to calculate asthma hospitalization rates for youth in our region. We completed an "environmental scan" to catalog the breadth of asthma-related efforts occurring in our children's hospital and across the region. We supplemented the scan with grouplevel assessments and focus groups with parents, clinicians, and community partners. We used insights from this descriptive epidemiology to inform the definition of shared aims, drivers, measures, and prototype interventions. Results: Greater Cincinnati's youth are hospitalized for asthma at a rate three times greater than the U.S. average. Black youth are hospitalized at a rate five times greater than non-Black youth. Certain neighborhoods bear the disproportionate burden of asthma morbidity. Across Cincinnati, there are many asthma-relevant activities that seek to confront this morbidity; however, efforts are largely disconnected. Qualitative insights highlighted the importance of cross-sector coordination, evidence-based acute and preventive care, healthy homes and neighborhoods, and accountability. These insights also led to a shared, regional aim: to equitably reduce asthma-related hospitalizations. Early interventions have included population-level pattern recognition, multidisciplinary asthma action huddles, and enhanced social needs screening and response. Conclusion: Learning health system methods are uniquely suited to asthma's complexity. Our nascent ALHS provides a scaffold atop which we can pursue better, more equitable regional asthma outcomes. [ABSTRACT FROM AUTHOR]

Conclusion: Education, but not occupation, was differentially associated with adult asthma phenotypes in the general population. Further research into socioeconomic status variation in various asthma phenotypes is warranted. [ABSTRACT FROM AUTHOR]

Background There is a lack of information on annual healthcare expenditures both per person and for the U.S. population associated with trauma, as identified by International Classification of Disease Ninth Revision, Clinical Modification ( ICD-9- CM) codes. Methods This paper employed a two-part model to estimate the unadjusted and adjusted annual per individual expenditures and population burden of trauma exposure for the U.S. population, using a nationally representative survey of medical care expenditures. In addition, we estimated a logit model to examine the demographic and comorbidity factors associated with the likelihood of experiencing trauma. Results Approximately 18.2% of U.S. adults were found to have trauma exposure during the survey year of 2011. The most frequent trauma ICD-9- CM code was injury not elsewhere classified/not otherwise specified. Adjusted likelihood of trauma was higher among individuals under the age of 65; males; non-Hispanic whites; nonmarried or never married; and individuals living with comorbidities of stroke, joint pain, arthritis, and asthma. The most expensive of the top 10 ICD-9- CM trauma codes was dislocation of the knee. Significant differences in expenditure categories were found for office-based, outpatient, emergency department ( ED), dental, and other medical care. After adjustment for comorbidities and demographics, the adjusted per-person burden of trauma was estimated to be $1,689 (95% confidence interval [ CI] = $1,006 to $2,372), with an incremental burden on the U.S. population of $60.8 billion per year. Conclusions Trauma results in a significant healthcare expenditure burden, both per person and on the U.S. population. Clinicians should be aware that individuals in the U.S. population with certain comorbidities such as stroke, joint pain, arthritis, and asthma are more likely to have trauma and that differences exist in expenditures for office-based, outpatient, dental, and the ED. [ABSTRACT FROM AUTHOR]

Background: The impact of non‐pharmacological interventions (NPIs) on asthma prevention and management is insufficiently examined. We aim to comprehensively evaluate and synthesize existing evidence regarding the effectiveness of various NPIs throughout the life course. Methods: We conducted a systematic search and screening of reviews that examined the effectiveness of various NPIs on asthma prevention and control in the Cochrane Library, PubMed, Embase, and Ovid databases. Data extraction was performed by considering the type of NPIs and the life course stages of the target population. Recommendations were provided by considering the quality of review assessed using the AMSTAR2 tool and the consistency of findings across reviews. Results: We identified 145 reviews and mapped the evidence on the impact of 25 subtypes of NPIs on asthma prevention and control based on five stages of life course. Reviews indicated a shift of focus and various impacts of major NPIs on asthma prevention and control across life courses, while a few types of NPIs, such as physical exercise, appeared to be beneficial in children, adolescents and adults. Consistent and high‐level evidence was observed only for psychological intervention on asthma control and quality of life among adults and older adults. Potential benefit with high‐level evidence was reported on certain NPIs, such as vitamin D in reducing risk of developing asthma in offsprings in the prenatal stage, digital health interventions in improving asthma control from childhood to older adulthood, and breathing exercise in improving quality of life, asthma‐related symptoms and lung function in adulthood and older adulthood. Conclusion: This study emphasizes the significance of delivering NPIs to improve asthma prevention and management and highlights the heterogeneity regarding the impact of NPIs across life courses. High‐quality research is urgently needed to further strengthen the evidence base of NPIs and tailored interventions should be considered in guideline development. [ABSTRACT FROM AUTHOR]

Background: Acute asthma exacerbation in children is often caused by respiratory infections. In this study, a coordinated national surveillance system for acute asthma hospitalizations and causative respiratory infections was established. We herein report recent trends in pediatric acute asthma hospitalizations since the COVID‐19 pandemic in Japan. Methods: Thirty‐three sentinel hospitals in Japan registered all of their hospitalized pediatric asthma patients and their causal pathogens. The changes in acute asthma hospitalization in children before and after the onset of the COVID‐19 pandemic and whether or not COVID‐19 caused acute asthma exacerbation were investigated. Results: From fiscal years 2010–2019, the median number of acute asthma hospitalizations per year was 3524 (2462–4570), but in fiscal years 2020, 2021, and 2022, the numbers were 820, 1,001, and 1,026, respectively (the fiscal year in Japan is April to March). This decrease was observed in all age groups with the exception of the 3‐ to 6‐year group. SARS‐CoV‐2 was evaluated in 2094 patients from fiscal years 2020–2022, but the first positive case was not detected until February 2022. Since then, only 36 of them have been identified with SARS‐CoV‐2, none of which required mechanical ventilation. Influenza, RS virus, and human metapneumovirus infections also decreased in FY 2020. In contrast, 24% of patients had not been receiving long‐term control medications before admission despite the severity of bronchial asthma. Conclusion: SARS‐CoV‐2 was hardly detected in children with acute asthma hospitalization during the COVID‐19 pandemic. This result indicated that SARS‐CoV‐2 did not induce acute asthma exacerbation in children. Rather, infection control measures implemented against the pandemic may have consequently reduced other respiratory virus infections and thus acute asthma hospitalizations during this period. However, the fact that many hospitalized patients have not been receiving appropriate long‐term control medications is a major problem that should be addressed. [ABSTRACT FROM AUTHOR]

Background: Allergic bronchopulmonary mycosis (ABPM) is an allergic disease caused by type I and type III hypersensitivity to environmental fungi. Schizophyllum commune, a basidiomycete fungus, is one of the most common fungi that causes non‐Aspergillus ABPM. Objective: Herein, we attempted to clarify the clinical characteristics of ABPM caused by S. commune (ABPM‐Sc) compared with those of allergic bronchopulmonary aspergillosis (ABPA). Methods: Patients with ABPM‐Sc or ABPA were recruited from a nationwide survey in Japan, a multicenter cohort, and a fungal database at the Medical Mycology Research Center of Chiba University. The definition of culture‐positive ABPM‐Sc/ABPA is as follows: (1) fulfills five or more of the 10 diagnostic criteria for ABPM proposed by Asano et al., and (2) positive culture of S. commune/Aspergillus spp. in sputum, bronchial lavage fluid, or mucus plugs in the bronchi. Results: Thirty patients with ABPM‐Sc and 46 with ABPA were recruited. Patients with ABPM‐Sc exhibited less severe asthma and presented with better pulmonary function than those with ABPA (p = 0.008–0.03). Central bronchiectasis was more common in ABPM‐Sc than that in ABPA, whereas peripheral lung lesions, including infiltrates/ground‐glass opacities or fibrotic/cystic changes, were less frequent in ABPM‐Sc. Aspergillus fumigatus‐specific immunoglobulin (Ig)E was negative in 10 patients (34%) with ABPM‐Sc, who demonstrated a lower prevalence of asthma and levels of total serum IgE than those with ABPM‐Sc positive for A. fumigatus‐specific IgE or ABPA. Conclusions: Clinical characteristics of ABPM‐Sc, especially those negative for A. fumigatus‐specific IgE, differed from those of ABPA. [ABSTRACT FROM AUTHOR]

A young woman with historically mild asthma experienced worsening breathlessness and cough with competitive ice skating. Despite optimizing and escalating treatment for her eosinophilic asthma, and addressing known exacerbating factors, her symptoms remained uncontrolled and refractory to bronchodilators and oral corticosteroids. Objective testing suggested her presentation was out of keeping with asthma alone, and she was suspected to have comorbid dysfunctional breathing and/or inducible laryngeal obstruction. Evidence was required to confirm the diagnoses, assess each condition's contribution to her symptom burden, and guide therapy. As exercise was a predominant trigger, she proceeded to cardiopulmonary exercise test with continuous laryngoscopy during exercise (CPET‐CLE). Testing confirmed the presence of two forms of inducible laryngeal obstruction and evidence of hyperventilation predominant dysfunctional breathing. This case highlights the importance of identifying coexisting conditions in difficult‐to‐treat asthma, and the value of structured multidisciplinary assessment in referral centres for such individuals.This case highlights three key points in managing difficult‐to‐control asthma; the importance of identifying and acting upon a discrepancy between symptom severity and objective evidence, the benefits of a structured multidisciplinary approach in improving outcomes, and the pivotal role of complex testing in the hospital outpatient setting. [ABSTRACT FROM AUTHOR]

The efficacy and safety of the combination of biologic therapies remain unclear with an ineffective and insufficient single biologic for managing asthma. Herein, we report two cases using dual biologics for severe asthma and atopic dermatitis. A 52-year-old male patient who received dupilumab and mepolizumab, benralizumab, or tezepelumab, followed by bronchial thermoplasty, and a 41-year-old male patient who received dupilumab and omalizumab, both experienced improved asthma and atopic dermatitis. To date, 38 cases are using dual biologics for severe asthma. The success rate was 84%, with no major adverse effects. We report the first case of severe asthma receiving dual biologics with tezepelumab and furthermore bronchial thermoplasty, and comprehensive literature review on dual biologics. Dual biologics may be an effective treatment method for severe asthma, requiring further investigation. [ABSTRACT FROM AUTHOR]

Allergic diseases often occur early in life and persist throughout life. This life‐course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Santé). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing. [ABSTRACT FROM AUTHOR]

This article discusses the use of respiratory medications in Finland from 1990 to 2021 and their association with reduced disease burden. The study analyzes the consumption of medication for asthma, chronic obstructive pulmonary disease (COPD), rhinitis, cough, and cold, as well as the overall costs of asthma and severe COPD. The findings show that medication consumption has increased over time, but the overall burden and costs of respiratory diseases have decreased. The study also highlights the importance of systematic public health interventions in improving diagnostics, early treatment, and awareness of these diseases. [Extracted from the article]

The European Academy of Allergy and Clinical Immunology (EAACI) owns three journals: Allergy, Pediatric Allergy and Immunology and Clinical and Translational Allergy. One of the major goals of EAACI is to support health promotion in which prevention of allergy and asthma plays a critical role and to disseminate the knowledge of allergy to all stakeholders including the EAACI junior members. There was substantial progress in 2019 in the identification of basic mechanisms of allergic and respiratory disease and the translation of these mechanisms into clinics. Better understanding of molecular and cellular mechanisms, efforts for the development of biomarkers for disease prediction, novel prevention and intervention studies, elucidation of mechanisms of multimorbidities, entrance of new drugs in the clinics as well as recently completed phase three clinical studies and publication of a large number of allergen immunotherapy studies and meta‐analyses have been the highlights of the last year. [ABSTRACT FROM AUTHOR]

Exercise‐induced bronchoconstriction (EIB) is usually assessed by changes in forced expiratory volume in 1 s (FEV1) which is effort dependent. The purpose of this study was to determine whether the diaphragm electromyogram (EMGdi) recorded from chest wall surface electrodes could be used to reflect changes in airway resistance during an exercise challenge test and to distinguish patients with EIB from those without EIB. Ninety participants with or without asthma history were included in the study. FEV1 was recorded before and 5, 10, 15, and 20 min after exercise. EIB was defined as an FEV1 decline greater than 10% after exercise. A ratio of root mean square of EMGdi to tidal volume (EMGdi/VT) was used to assess changes in airway resistance. Based on changes in FEV1, 25 of 90 participants exhibited EIB; the remainder were defined as non‐EIB participants. EMGdi/VT in EIB increased by 124% (19%–478%) which was significantly higher than that of 21% (−39% to 134%) in non‐EIB participants (p < 0.001). At the optimal cutoff point (54% in EMGdi/VT), the area under the ROC curve (AUC) for detection of a positive test was 0.92 (p < 0.001) with sensitivity 92% and specificity 88%. EMGdi/VT can be used to assess changes in airway resistance after exercise and could be used to distinguish participants with EIB from those without EIB. [ABSTRACT FROM AUTHOR]

Several inefficiencies in drug development trial implementation may be improved by moving data collection from the clinic to mobile, allowing for more frequent measurements and therefore increased statistical power while aligning to a patient‐centric approach to trial design. Sensor‐based digital health technologies such as mobile spirometry (mSpirometry) are comparable to clinic spirometry for capturing outcomes, such as forced expiratory volume in 1 s (FEV1); however, the impact of remote spirometry measurements on the detection of treatment effect has not been investigated. A protocol for a multicenter, single‐arm, open‐label interventional trial of long‐acting beta agonist (LABA) therapy among 60 participants with uncontrolled moderate asthma is described. Participants will complete twice‐daily mSpirometry at home and clinic spirometry during weekly visits, alongside continuous use of a wrist‐worn wearable and regular completion of several diaries capturing asthma symptoms as well as participant‐ and site‐reported satisfaction and ease of use of mSpirometry. The co‐primary objectives of this study are (A) to quantify the treatment effect of LABA therapy among participants with moderate asthma, using both clinical spirometry (FEV1c) and mSpirometry (FEV1m); and (B) to investigate whether FEV1m is as accurate as FEV1c in detecting the treatment effect using a mixed‐effect model for repeated measures. Study results will help inform whether the deployment of mSpirometry and a wrist‐worn wearable for remote data collection are feasible in a multicenter setting among participants with moderate asthma, which may then be generalizable to other populations with respiratory disease. [ABSTRACT FROM AUTHOR]

Background: Maintenance doses for allergen immunotherapy (AIT) have been recommended for at least 3 years but little data on long‐term efficacy is available depending on AIT duration. To show sustained efficacy 10 years after completion of treatment with depigmented‐polymerized house dust mite (dpg‐pol HDM) allergen extract in adults with asthma and/or rhinoconjunctivitis. Methods: Patients included in a double‐blind placebo‐controlled AIT study with dpg‐pol HDM allergen extract were reviewed at completion of the perennial treatment and 10‐year follow‐up (10y‐FU). Change in symptom and rescue medication score was the primary objective. Visual analog scale (VAS), asthma control test (ACT), and degree of disease control were the secondary objectives. A comparative analysis between patients who underwent AIT treatment for <3 years and ≥3 years was performed. Results: Data from 31 patients (mean age 38 years) were available at 10y‐FU. All had asthma and 29 had rhinoconjunctivitis at baseline. Twenty‐three patients were treated ≥3 years and 8 for <3 years. Seventeen (55%) patients were asymptomatic at completion of AIT, with significant differences for nasal, conjunctival, and bronchial symptoms (p <.0001) compared with baseline only in those patients treated ≥3 years. Nine (52.9%) patients remained completely asymptomatic at 10y‐FU, all were treated for ≥3 years. Moreover, significant reduction in the number of patients with rhinitis (p =.0117), conjunctivitis (p <.0001), and bronchial (p =.0005) symptoms was observed at 10y‐FU compared with baseline only in the ≥3 years treated. Ten (32.3%) patients did not require any rescue medication at 10y‐FU, all had been treated for ≥3 years. ACT at 10y‐FU showed a good control of asthma (median 23.5; 95% IC[22.0, 25.0]). No significant differences were observed between VAS at end of treatment compared with VAS at 10y‐FU. Conclusions: Sustained clinical efficacy is achieved 10 years after completion of depigmented‐polymerized HDM, however, these findings were observed only if patients are treated for at least 3 years. Key Messages: A minimum of 3 years AIT treatment is required to obtain a sustained long‐term effectiveness.Dpg‐pol HDM is able to remove allergic rhinitis and asthma symptoms completely.Three‐year treatment with dpg‐pol HDM is able to maintain effectiveness 10 years after treatment. [ABSTRACT FROM AUTHOR]

Introduction: Asthma and bronchiolitis in children are considered common clinical problems associated with gut microbiota. However, the exact relationship between gut microbiota and the above‐mentioned diseases remains unclear. Here, we discussed recent advances in understanding the potential mechanism underlying immune regulation of gut microbiota on asthma and bronchiolitis in children as well as the role of the gut–lung axis. Methods: We retrieved and assessed all relevant original articles related to gut microbiota, airway inflammation‐induced wheezing in children, and gut–lung axis studies from databases that have been published so far, including PubMed/MEDLINE, Scopus, Google Scholar, China National Knowledge Infrastructure (CNKI) and the Wanfang Database. Results: The infant period is critical for the development of gut microbiota, which can be influenced by gestational age, delivery mode, antibiotic exposure and feeding mode. The gut microbiota in children with asthma and bronchiolitis is significantly distinct from those in healthy subjects. Gut microbiota dysbiosis is implicated in asthma and bronchiolitis in children. The presence of intestinal disturbances in lung diseases highlights the importance of the gut–lung axis. Conclusion: Gut microbiota dysbiosis potentially increases the risk of asthma and bronchiolitis in children. Moreover, a deeper understanding of the gut–lung axis with regard to the gut microbiota of children with respiratory diseases could contribute to clinical practice for pulmonary diseases. [ABSTRACT FROM AUTHOR]

This paper proposes family based Hotelling's T(2) tests for high resolution linkage disequilibrium (LD) mapping or association studies of complex diseases. Assume that genotype data of multiple markers or haplotype blocks are available for a sample of nuclear families, in which some offspring are affected. Paired Hotelling's T(2) test statistics are proposed for a high resolution association study using parents as controls for affected offspring, based on two coding methods: haplotype/allele coding and genotype coding. The paired Hotelling's T(2) tests take not only the correlation between the haplotype blocks or markers into account, but also take the correlation within each parent-offspring pair into account. The method extends two sample Hotelling's T(2) test statistics for population case control association studies, which are not valid for family data due to correlation of genetic data among family members. The validity of the proposed method is justified by rigorous mathematical and statistical proof under the large sample theory. The non-centrality parameter approximations of the test statistics are calculated for power and sample size calculations. From power comparison and type I error calculations, it is shown that the test statistic based on haplotype/allele coding is advantageous over the test statistic of genotype coding. Analysis using multiple markers may provide higher power than single marker analysis. If only one marker is utilized the power of the test statistic based on haplotype/allele coding is nearly identical to that of 1-TDT. Moreover, a permutation procedure is provided for data analysis. The method is applied to data from a German asthma family study. The results based on the paired Hotelling's T(2) statistic tests confirm the previous findings. However, the paired Hotelling's T(2) tests produce much smaller P-values than those of the previous study. The permutation tests produce similar results to those of the previous study; moreover, additional marker combinations are shown to be significant by permutation tests. The proposed paired Hotelling's T(2) statistic tests are potentially powerful in mapping complex diseases. A SAS Macro, Hotel&#95;fam.sas, has been written to implement the method for data analysis.

Background: Recommendations on contraindications to allergen immunotherapy (AIT) have been independently developed by National and International Societies/Academies. AIT contraindications are mainly based on case reports, case‐series, or experts' opinion, while evidence‐based information is limited. The aim of the present review was to describe existing guidelines on contraindications to AIT and to highlight differences between them. Main body: An extended review of the literature regarding contraindications to AIT for respiratory allergy and venom hypersensitivity was performed. Furthermore, Societies and Academies registered in the World Allergy Organization and EAACI databases, were asked for additional information. Only AIT guidelines published under official auspicies were included. A large heterogeneity among the various recommendations on contraindications was registered. Common contraindications to most of the guidelines were: lack of adherence, pregnancy before the start of AIT, the use of beta‐blockers, certain age groups, uncontrolled asthma, autoimmune diseases and malignancies. Conclusion: As new data arise, revisions might soon be needed allowing AIT in the cases of patients treated with ACE inhibitors and beta‐blockers, in elderly patients and in patients with concomitant autoimmune diseases and neoplasias in remission. The decision to prescribe AIT is always tailor‐made, balancing risk vs benefit. Creating globally accepted guidelines would help Allergologists in their decision making. [ABSTRACT FROM AUTHOR]

Introduction: A Task Force was commissioned jointly by the European Academy of Allergy and Clinical Immunology (EAACI) and the Respiratory Effectiveness Group (REG) to develop a quality assessment tool for real‐life observational research to identify high‐quality real‐life asthma studies that could be considered within future guideline development. Methods: The resulting REal Life EVidence AssessmeNt Tool (RELEVANT) was achieved through an extensive analysis of existing initiatives in this area. The first version was piloted among 9 raters across 6 articles; the revised, interim, version underwent extensive testing by 22 reviewers from the EAACI membership and REG collaborator group, leading to further revisions and tool finalisation. RELEVANT was validated through an analysis of real‐life effectiveness studies identified via systematic review of Medline and Embase databases and relating to topics for which real‐life studies may offer valuable evidence complementary to that from randomised controlled trials. The topics were selected through a vote among Task Force members and related to the influence of adherence, smoking, inhaler device and particle size on asthma treatment effectiveness. Results: Although highlighting a general lack of high‐quality real‐life effectiveness observational research on these clinically important topics, the analysis provided insights into how identified observational studies might inform asthma guidelines developers and clinicians. Overall, RELEVANT appeared reliable and easy to use by expert reviewers. Conclusions: Using such quality appraisal tools is mandatory to assess whether specific observational real‐life effectiveness studies can be used to inform guideline development and/or decision‐making in clinical practice. [ABSTRACT FROM AUTHOR]

Pollen is an important environmental cause of allergic asthma episodes. Prior work has established a proof of concept for assessing projected climate change impacts on future oak pollen exposure and associated health impacts. This paper uses additional monitor data and epidemiologic functions to extend prior analyses, reporting new estimates of the current and projected future health burden of oak, birch, and grass pollen across the contiguous United States. Our results suggest that tree pollen in the spring currently accounts for between 25,000 and 50,000 pollen‐related asthma emergency department (ED) visits annually (95% confidence interval: 14,000 to 100,000), roughly two thirds of which occur among people under age 18. Grass pollen in the summer season currently accounts for less than 10,000 cases annually (95% confidence interval: 4,000 to 16,000). Compared to a baseline with 21st century population growth but constant pollen, future temperature and precipitation show an increase in ED visits of 14% in 2090 for a higher greenhouse gas emissions scenario, but only 8% for a moderate emissions scenario, reflecting projected increases in pollen season length. Grass pollen, which is more sensitive to changes in climatic conditions, is a primary contributor to future ED visits, with the largest effects in the Northeast, Midwest, and Southern Great Plains regions. More complete assessment of the current and future health burden of pollen is limited by the availability of data on pollen types (e.g., ragweed), other health effects (e.g., other respiratory disease), and economic consequences (e.g., medication costs). Key Points: We link pollen, climate, and epidemiological data to estimate the health burden of oak, birch, and grass pollen across the contiguous United StatesWe found that 35,000 to 60,000 asthma emergency department visits (two thirds of these among children) may be linked with pollen each yearWe project that future climate changes could increase pollen‐related asthma emergency department visits by 14% in 2090 [ABSTRACT FROM AUTHOR]

Skeletal muscles play key roles in the development of various pathologies, including bronchial asthma and several types of auto-immune disorders, e.g. polymyositis. Since most of these maladies have an immunological/allergic element, this paper is devoted to assessing the impact of immunobiological reorganization on the functional properties of isolated skeletal muscles in mice. A combination of two methods (myography and electrophysiology) was used to evaluate extensor digitorum longus (EDL) and diaphragmatic muscle (DM) in this regard. Conventional myographic technique showed that ovalbumin-induced sensitization (OS) produced different changes in the contractile properties of EDL and DM. The amplitudes of carbachol (CCh)-induced contractions increased in DM but decreased in EDL. Those changes were inversely related to OS-mediated changes of non-quantal acetylcholine (ACh) release intensity within the muscle endplate, as shown by the electrophysiologically measured H-effect. These results clearly show that OS-mediated changes of non-quantal ACh release alter the functional properties of postjunctional ACh receptors and therefore contribute to the disturbance of CCh-induced contractility of skeletal muscles. Other mechanisms of OS-mediated changes of skeletal muscle contractility are also proposed and discussed. [ABSTRACT FROM AUTHOR]

ABSTRACT: Limited information exists regarding asthma management practices and education needs of Head Start directors and staff. This paper describes asthma management practices and education needs of Head Start directors and staff in 15 Baltimore, Md., Head Start programs. From February to December 2000, all Head Start staff and directors were asked to complete a survey. Data from 268 Head Start staff and 12 Head Start directors were analyzed. Results revealed discrepancies between Head Start staff and directors regarding location of asthma medications and presence of asthma action plans in programs. Both Head Start staff and directors stated they had no curriculum to teach Head Start children how to manage asthma. This finding provides evidence that asthma education is needed in Head Start programs. Findings also indicate a need for improved communication between Head Start directors and staff. (J Sch Health. 2002;72(8):329-333) [ABSTRACT FROM AUTHOR]

Previous studies have suggested that vitamin D has a protective effect on allergic diseases, while an individual's sex may have a moderating effect on the relationship between vitamin D and allergic‐related immunity. This study aimed to determine the role of vitamin D in children with coexisting allergic diseases in the context of sex differences and to explore the behavioral profiles of these patients. We recruited a total of 103 children with atopic diseases and divided them into four groups: males with one allergic disease (MA1, n = 20), males with two or more allergic diseases (MA2, n = 26), females with one allergic disease (FA1, n = 30), and females with two or more allergic diseases (FA2, n = 27). We measured serum calcium levels using the colorimetric method and serum 25‐OH vitamin D total levels using electrochemiluminescence immunoassay. We found that MA2 had significantly lower vitamin D levels than MA1 and FA2. The levels of IgE were negatively correlated with vitamin D in females, whereas the levels of IgE were not significantly correlated with vitamin D in males. Furthermore, serum IgE was significantly correlated with children's adaptive skills, and different sexes were associated with different aspects of adaptive skills. Our findings suggest a protective role of vitamin D in the development of one allergic disease against the coexistence of allergic diseases in males, as well as extend the evidence for sex differences in immunity by demonstrating a sex‐different correlation between IgE and vitamin D and the relationship between IgE and children's adaptive skills. [ABSTRACT FROM AUTHOR]

Background and Aims: Winter endurance athletes have a high prevalence of exercise‐induced bronchoconstriction (EIB) and asthma, probably due to repeated and prolonged inhalation of cold and dry air. Heat‐ and moisture‐exchanging devices (HME) warm and humidify inhaled air and prevent EIB. The aim of this study was to share cross‐country skiers and biathletes' experiences of training and competition in low temperatures, views on temperature limits, usage of HME, and consequences of cold exposure on their health. Methods: Eleven Swedish World Championship or Olympic medalists in cross‐country skiing and biathlon were interviewed and transcripts were analyzed using qualitative content analysis. Results: Participants described how cold temperatures predominantly affected the airways, face, and extremities. During training, extreme cold was managed by choosing warmer clothing, modification of planned sessions, use of HME, delaying training, or changing location. In competition, participants described limited possibility for such choices and would prefer adjustment of existing rules (i.e., more conservative temperature limits), especially since they understood elite skiing in low temperatures to present an occupational hazard to their health. Participants had at times used HMEs during training in cold environments but described mixed motives for their use—that HMEs warm and humidify cold inhaled air but introduce additional resistance to breathing and can cause problems due to mucus and ice build‐up. Skiers also perceived that they had become more sensitive to cold during the latter part of their careers. Conclusions: The present study gives a unique insight into the "cold" reality of being an elite athlete in skiing and biathlon. Cold exposure results in negative health consequences that are preventable, which means that rules must be followed, and organizers should acknowledge responsibility in protecting athletes from occupational hazards. Development of evidence‐based guidelines for protection of athletes' respiratory health should be a focus for future translational research. Key points: Most former elite skiers had experience of using heat‐ and moisture‐exchanging devices and felt they were able to protect the airways from damage, but that there was potential for improved ergonomics.Skiers expressed that current competition temperature limits may be too low to protect athletes' health.Skiers cited diminished responsibility for their own health when partaking in competitions than their own training; in competitions, they were likely to participate so long as the race was going ahead.The "athletes voice" on training and competing in the cold should be considered by other stakeholders in winter sports. [ABSTRACT FROM AUTHOR]

Background: Asthma with NSAID‐exacerbated respiratory disease (NERD) is associated with uncontrolled or severe asthma. NERD patients are more prone to severe allergic reactions and their asthma exacerbations lead to hospitalisations twice as often compared to patients with non‐NERD‐asthma. NERD patients are prone to recurrent nasal polyposis requiring frequent endoscopic sinus surgeries. However, the early risk factors of NERD are not fully understood. The aim was to identify risk factors of NERD among patients with adult‐onset asthma. Methods: We used data from 1350 population‐based adult asthmatics with adult‐onset asthma from Finnish national registers. NERD was defined as self‐reported wheeze or other typical respiratory symptoms after ingestion of NSAIDs. Thirty‐six covariates covering several domains (personal characteristics, life‐style, early life factors, asthma characteristics and multimorbidities) were selected based on literature and were studied in association with NERD using logistic regressions. Results: The study population included 153 (11.3%) asthmatics with NERD. Thirty‐six covariates were entered in univariate logistic regression analysis, in which 23 were associated with NERD (p < 0.05). These variables were entered in a multivariable logistic regression model in which allergic respiratory symptoms, female sex, osteoarthritis, difficult asthma, nasal polyps, second‐hand smoke exposure at home, having 3 or more older siblings and being overweight were significantly associated with asthma with NERD (p < 0.05). Overweight decreased the risk of NERD, other factors increased it. Conclusion: According to our study, risk factors of NERD in part are associated with female sex, BMI, exposure to tobacco smoke, allergy, orthopaedic disorders and infection history, and their early recognition might thus be important to manage the burden of NERD. [ABSTRACT FROM AUTHOR]

Contributions of candidate-gene associations studies and genome-wide association studies (GWAS) to identification of genetic variations associated with asthma. By focusing on unexpected and potentially confounding genetic variations, we can expand our understanding of the genetic factors associated with asthma susceptibility and identify new therapeutic targets for the treatment of this condition (Friedrich et al., [1]). Thank you for your comment on the publication 'Associations between interleukin 17A and 17F polymorphisms and asthma susceptibility: A meta-analysis' (Lee & Song, [2]). [Extracted from the article]

Background: Smoking, biomass, and occupational exposure are the main environmental risk factors for asthma. The purpose of this study was to analyze the clinical characteristics of exposure to these risk factors in patients with asthma. Methods: This cross‐sectional study enrolled patients with asthma from an outpatient department according to the Global Initiative for Asthma. Demographics, forced expiratory volume in 1 s (FEV1), FEV1%pred, FEV1/forced vital capacity (FVC), laboratory tests, asthma control test (ACT), asthma control questionnaire (ACQ) scores, and the inhaled corticosteroid (ICS) dose were recorded. A generalized linear mixed model was used to adjust for potential confounders. Results: A total of 492 patients with asthma were included in this study. Of these patients, 13.0% were current smokers, 9.6% were former smokers, and 77.4% were never smokers. Compared with never smokers, the current and former smokers had a longer duration of asthma; lower ACT scores, FEV1, FEV1%pred, and FEV1/FVC; and higher ACQ scores, IgE, FeNO, blood eosinophils, and ICS dose (p <.05). In addition, the patients exposed to biomass alone were older; had higher exacerbation in the past year; a longer duration of asthma; and lower FEV1, FEV1%pred, FEV1/FVC, IgE, and FeNO compared with smoking or occupational exposure alone. Compared with smoking exposure alone, patients with occupational exposure alone had a longer duration of asthma and lower FEV1, FEV1%pred, FVC, IgE, FeNO, and ICS dose (p <.05). Conclusions: There are significant differences in the clinical characteristics of patients with asthma depending on the smoking status. In addition, significant differences also observed among smoking, biomass, and occupational exposure. [ABSTRACT FROM AUTHOR]

Mepolizumab, a humanized anti‐IL‐5 monoclonal antibody used for severe asthma, results in a reduced rate of asthma exacerbation, improved lung function, reduced oral corticosteroid use, and improved quality of life. A 62‐year‐old man using high‐dose inhaled corticosteroid visited our hospital because of poorly‐controlled asthma. He had eosinophilia in peripheral blood and sputum, and high levels of fraction of exhaled nitric oxide. Therefore, he was treated with mepolizumab for severe asthma. Mepolizumab treatment resulted in significantly improved pulmonary function and reduced frequencies of asthma exacerbations. Because of his good asthma control, mepolizumab treatment was discontinued after 3 years. Since discontinuing mepolizumab, his asthma control has remained without exacerbation. Previous studies suggest that mepolizumab should be continued to sustain clinical benefits. However, cases of long‐term controlled asthma have not been reported after mepolizumab withdrawal, and our case may be instructive. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the relationship between the glucocorticoid‐induced transcript 1 (GLCCI1) gene variant and the degree of improvement in lung function with inhaled corticosteroids (ICS). Methods: We searched the PubMed, Embase, Cochrane Library, CBM, CNKI and Wanfang databases to obtain studies on the GLCCI1 rs37973 variant and the efficacy of ICS in asthma. Results: The overall meta‐analysis showed that patients with the GG phenotype (mutant homozygotes) exhibited significantly smaller forced expiratory volume in 1 sec (FEV1) change than patients with the AG phenotype (mutant heterozygous) (MD = −0.08, 95% CI [−0.12, −0.03], P = 0.001). Compared with the AA phenotype (wild homozygotes), the GG phenotype (MD = −4.23, 95% CI [−6.09, −2.38], P < 0.00001) and AG phenotype (MD = −1.92, 95% CI [−2.35, −1.49], P < 0.00001) had significantly smaller FEV1%pred changes. The FEV1 change subgroup analysis showed that the GG phenotype group was smaller than the AA phenotype group at 8 (MD = −0.53, 95% CI [−0.91, −0.14], P = 0.007), 12 (MD = −0.16, 95% CI [−0.30, −0.02], P = 0.02) and 24 (MD = −0.09, 95% CI [−0.17, −0.01], P = 0.02) weeks of treatment; the GG phenotype group was smaller than the AG phenotype group at 12 weeks (MD = −0.08, 95% CI [−0.15, −0.01], P = 0.02). Conclusion: This meta‐analysis suggests that the GLCCI1 rs37973 variant affects the efficacy of ICS and that the presence of the G allele attenuates the improvement in lung function with ICS. [ABSTRACT FROM AUTHOR]