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Asma , Oscilometría , Humanos , Asma/diagnóstico , Asma/fisiopatología , Asma/epidemiología , Preescolar , Femenino , Masculino , Pulmón/fisiopatología , Pruebas de Función Respiratoria , NiñoRESUMEN
PURPOSE: Montelukast is used extensively in children and adolescents for allergic rhinitis and asthma. However, concerns have been raised regarding the increased risk of neuropsychiatric adverse events (NPAEs) associated with montelukast use. Therefore, our case-crossover study was conducted to observe whether there is an increased risk of NPAEs associated with montelukast use in children and adolescents. MATERIALS AND METHODS: A population-based case-crossover study using the customised Health Insurance Review and Assessment (HIRA) dataset was conducted. Paediatric patients aged between 0 and 19 years diagnosed with allergic rhinitis and/or asthma with a history of at least one montelukast prescription between 1 January 2018 and 31 December 2021 were included. Exposure to montelukast was assessed during 3-, 7-, 14-, 28- and 56-day hazard periods prior to each patient's NPAE. Stratified analyses according to age group, gender and season for the risk of NPAEs associated with montelukast use in the previous 7 days and 14 days were performed, respectively. Conditional logistic regression analysis was used to calculate adjusted ORs (aORs) with their corresponding 95% CIs, adjusting for concomitant medications. RESULTS: A total of 161 386 paediatric patients was identified. An increased risk of NPAEs associated with montelukast was found in all time window periods, including 3-day (aOR 1.28, 95% CI 1.24 to 1.32), 7-day (aOR 1.29, 95% CI 1.26 to 1.33), 14-day (aOR 1.34, 95% CI 1.31 to 1.37), 28-day (aOR 1.38, 95% CI 1.36 to 1.41) and 56-day (aOR 1.21, 95% CI 1.19 to 1.22) preceding hazard periods compared with use in the four control periods. CONCLUSION: Children and adolescents with allergic rhinitis and/or asthma should be prescribed montelukast with caution considering clinical benefits.
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Acetatos , Antiasmáticos , Asma , Estudios Cruzados , Ciclopropanos , Quinolinas , Sulfuros , Humanos , Niño , Adolescente , Masculino , Femenino , Preescolar , Acetatos/efectos adversos , Acetatos/uso terapéutico , Quinolinas/efectos adversos , Quinolinas/uso terapéutico , Sulfuros/efectos adversos , Asma/tratamiento farmacológico , Asma/epidemiología , Lactante , Antiasmáticos/efectos adversos , Antiasmáticos/administración & dosificación , Antiasmáticos/uso terapéutico , Rinitis Alérgica/epidemiología , Recién Nacido , Adulto JovenRESUMEN
BACKGROUND: Consumption of ultra-processed foods [UPFs] may be associated with negative health outcomes. Limited data exist regarding the potential role of UPFs in the occurrence of allergic diseases. The underlying mechanisms underpinning any such associations are also poorly elucidated. METHODS: We performed a systematic review and narrative evidence synthesis of the available literature to assess associations between UPF consumption and pediatric allergy outcomes (n = 26 papers), including data on the association seen with the gut microbiome (n = 16 papers) or immune system (n = 3 papers) structure and function following PRISMA guidelines. RESULTS: Dietary exposure to fructose, carbonated soft drinks, and sugar intake was associated with an increased risk of asthma, allergic rhinitis, and food allergies in children. Commercial baby food intake was associated with childhood food allergy. Childhood intake of fructose, fruit juices, sugar-sweetened beverages, high carbohydrate UPFs, monosodium glutamate, UPFs, and advanced glycated end-products (AGEs) was associated with the occurrence of allergic diseases. Exposure to UPFs and common ingredients in UPFs seem to be associated with increased occurrence of allergic diseases such as asthma, wheezing, food allergies, atopic dermatitis, and allergic rhinitis, in many, but not all studies. CONCLUSION: More preclinical and clinical studies are required to better define the link between UPF consumption and the risk of allergies and asthma. These observational studies ideally require supporting data with clearly defined UPF consumption, validated dietary measures, and mechanistic assessments to definitively link UPFs with the risk of allergies and asthma.
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Hipersensibilidad a los Alimentos , Humanos , Hipersensibilidad a los Alimentos/epidemiología , Hipersensibilidad a los Alimentos/etiología , Niño , Comida Rápida/efectos adversos , Microbioma Gastrointestinal/inmunología , Asma/epidemiología , Asma/etiología , Asma/inmunología , Manipulación de Alimentos , Rinitis Alérgica/epidemiología , Rinitis Alérgica/etiología , Preescolar , Comités Consultivos , Alimentos ProcesadosAsunto(s)
Asma , Sobrepeso , Humanos , Asma/epidemiología , Asma/complicaciones , Niño , Masculino , Femenino , Sobrepeso/complicaciones , Sobrepeso/epidemiología , Adolescente , Índice de Masa CorporalRESUMEN
Viral lower respiratory tract infections (LRTIs), including rhinovirus and respiratory syncytial virus during early childhood, have been linked to subsequent asthma. However, the impact of other respiratory viruses remains unclear. We analyzed nationwide Korean data from January 1, 2008, to December 31, 2018, utilizing the national health insurance database. Our study focused on 19 169 meticulously selected children exposed to severe respiratory infections requiring hospitalization with documented viral pathogens, matched with 191 690 unexposed children at a ratio of 1:10 using incidence density sampling. Our findings demonstrate that asthma exacerbation rates were higher among the exposed cohort than the unexposed cohort over a mean follow-up of 7.8 years. We observed elevated risks of asthma exacerbation and newly developed asthma compared to the unexposed cohort. Hospitalization due to rhinovirus, respiratory syncytial virus, influenza, metapneumovirus, and adenovirus was related to increased asthma exacerbations. Notably, we found a stronger association in cases of multiple LRTI hospitalizations. In conclusion, our study shows that early childhood respiratory viral infections are related to subsequent asthma exacerbations and new asthma diagnoses.
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Asma , Hospitalización , Infecciones del Sistema Respiratorio , Humanos , Asma/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Hospitalización/estadística & datos numéricos , Masculino , Preescolar , Femenino , Lactante , República de Corea/epidemiología , Niño , Virosis/epidemiología , Incidencia , Factores de Riesgo , Infecciones por Virus Sincitial Respiratorio/epidemiología , Rhinovirus/aislamiento & purificaciónRESUMEN
The presence of fungi in tracheal wash (TW) of horses was recently linked to mild-moderate equine asthma, indicating a possible causal role; however, increased numbers of fungi may also stem from asthma-related alteration of tracheal mucus clearance or from environmental exposure. Our objective was to elucidate the association between the presence of fungi in TW and asthma status while controlling for relevant confounders. We conducted a retrospective case-control study involving 73 horses, including 34 controls and 39 asthmatic cases. Each asthmatic horse was matched with a control from the same barn to account for the influence of environmental exposure. All horses underwent respiratory clinical scoring, endoscopy, TW, and bronchoalveolar lavage (BAL). The association between asthma status and presence of TW fungi was tested with multivariable logistic regression modelling, accounting for selected management factors, tracheal mucus accumulation, and selected TW and BAL cytological characteristics, including multinucleated giant cells (MGCs) in the TW. Given the variability in MGC definitions in the literature, particularly concerning their morphology and number of nuclei, we constructed two distinct models for each outcome (asthma status or presence of fungi in TW): one considering MGCs as cells with ≥ 3 nuclei, and another using a criterion of ≥ 10 nuclei. Horses with a tracheal mucus score ≥ 2 exhibited 3.6 to 4.3 higher odds of being asthmatic, depending on the MGC definition. None of the other variables examined were associated with either asthma status or TW fungi detection. Notably, the presence of fungal elements in the TW was not associated with equine asthma.
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Asma , Hongos , Enfermedades de los Caballos , Tráquea , Animales , Caballos/microbiología , Asma/microbiología , Tráquea/microbiología , Estudios de Casos y Controles , Enfermedades de los Caballos/microbiología , Hongos/aislamiento & purificación , Estudios Retrospectivos , Masculino , Femenino , Líquido del Lavado Bronquioalveolar/microbiologíaRESUMEN
BACKGROUND: Oscillometry devices (also termed forced oscillation technique) devices such as MasterScreen-IOS® (Jaeger, Hochberg, Germany) and MostGraph-01® (Chest, Tokyo, Japan) are useful for obtaining physiological assessments in patients with obstructive lung diseases, including asthma. However, as oscillometry measurements have not been fully compared between MasterScreen-IOS® and MostGraph-01® in patients with asthma, it is unknown whether there are differences in the measurements between the devices. This study aimed to determine whether there is any difference in oscillometry measurements obtained using the two devices in patients with asthma. METHODS: Oscillometry measurements obtained using MasterScreen-IOS® and MostGraph-01® were retrospectively evaluated in 95 patients with asthma at Juntendo University Hospital between October 2009 and November 2009. RESULTS: There was a strong positive correlation in the measurements between the two devices. However, the values of R5, R20, ALX and Fres were lower when measured with MostGraph-01® than with MasterScreen-IOS®, and vice versa for the values of X5. The results were used in correction equations to convert oscillometry parameters measured using MasterScreen-IOS® to those measured using MostGraph-01®. CONCLUSIONS: To our knowledge, this is the first report to compare MostGraph-01® and MasterScreen-IOS® devices using practical clinical data obtained in patients with asthma. The values obtained by both devices can be interpreted in a similar way, although there is slight variation. The conversion equations produced in this study may assist to compare the oscillometry measurements obtained by each of the two devices.
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Asma , Oscilometría , Humanos , Asma/fisiopatología , Asma/diagnóstico , Oscilometría/métodos , Oscilometría/instrumentación , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Estudios Retrospectivos , Pruebas de Función Respiratoria/métodos , Pruebas de Función Respiratoria/instrumentaciónRESUMEN
INTRODUCTION: Children in boarding schools spend most of their time without their parents or caregivers, causing concerns about the suitability of such schools for children with asthma. This study assessed individuals' opinions regarding the suitability of boarding secondary schools for children with asthma. METHODS: A qualitative design was adopted for this study using a focus group discussion held on a social media platform (WhatsApp®) of the Asthma Awareness and Care Group (AACG), The group comprised 150 registered members. The study was guided by a structured protocol and based on a vignette comprising three questions. Data were analysed via thematic analysis using framework principles. RESULTS: Out of the 150 eligible members, there were responses from only 19 participants. Majority of the respondents were aged ≤ 30 years (n = 17, 89.5%). The three main themes generated from the thematic analysis include the appropriateness of boarding schools for children with asthma; facilities necessary for boarding schools to cater to children with asthma; and outright rejection of children with asthma by boarding schools. Respondents conceptualised the appropriateness of boarding schools for students with asthma in six distinct sub-themes: asthma severity and extent of control, child's self-efficacy and assertiveness, child equipped with tools (knowledge, inhalers, and asthma control diary), school awareness, facilities, and active support, availability of a guardian, and the knowledge and perception of teachers and schoolmates about asthma. The sub-themes associated with the themes were presented, alongside exemplar quotes from respondents. The majority of the respondents (61.5%) were in support of allowing children with asthma attend boarding schools but with some caveats such as without liability to the school, if facilities are unavailable. CONCLUSION: Children's age, autonomy, asthma management status, and the school's readiness were identified as important considerations for the safe attendance of children with asthma at boarding schools.
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Asma , Grupos Focales , Instituciones Académicas , Estudiantes , Humanos , Asma/terapia , Masculino , Femenino , Estudiantes/psicología , Adulto , Niño , Adolescente , Conocimientos, Actitudes y Práctica en Salud , Adulto Joven , Persona de Mediana EdadRESUMEN
The heterogeneous nature of asthma results in a wide range of presentations during exacerbation. Despite UK pre-hospital management guidelines focusing on ß2 agonists, variables such as cause, severity, underlying health, comorbidities, and drug side effects can often make emergency treatment optimisation difficult. This article examines paramedics' methods of observing, perceiving, interpreting, and treating asthma with ß2 agonists, often acting on limited information in rapidly evolving situations. We recruited paramedics from a single UK National Health Service ambulance Trust for qualitative semi-structured interviews. Responses underwent framework analysis to identify data similarities and differences. Fifteen qualitative interviews with paramedics revealed three main themes affecting patient management: clinician experience of presentation, adaptation of patient management approaches, and severity of side effects. Paramedics felt their ability to manage various asthma presentations was enhanced through guideline adaptation based on their own clinical experience and understanding of ß2 agonist side effects, allowing tailored responses based on a set of reinforcing factors. Inductive analysis revealed additional complexities within these themes, such as anxiety and diabetes, which may influence ß2 agonist administration and result in multiple care pathways being initiated during exacerbation. Paramedic care mirrors asthma's complexity, accounting for a range of characteristics. A dynamic, critically thought approach enables patient management to be based on the presenting conditions rather than strict adherence to a single algorithm. Comprehending the complexities and variables in treatment can be crucial to how paramedics rationalise their treatment and optimise the care provided.
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Agonistas de Receptores Adrenérgicos beta 2 , Técnicos Medios en Salud , Asma , Nebulizadores y Vaporizadores , Investigación Cualitativa , Humanos , Asma/tratamiento farmacológico , Agonistas de Receptores Adrenérgicos beta 2/uso terapéutico , Agonistas de Receptores Adrenérgicos beta 2/administración & dosificación , Masculino , Femenino , Servicios Médicos de Urgencia/métodos , Entrevistas como Asunto , Adulto , Reino Unido , Auxiliares de Urgencia , ParamédicoRESUMEN
BACKGROUND: Asthma is a leading cause of emergency hospital visits and a significant factor in lost productive hours. The lack of a synthesized body of knowledge on bronchial asthma has notable public health implications. OBJECTIVE: This systematic review and meta-analysis aim to investigate the prevalence of asthma and its predictors among patients presenting in Ethiopian public hospitals. DESIGN: Duplicate studies were removed using EndNote version X9. The Newcastle-Ottawa Scale guided the quality assessment, and data extraction followed the Joanna Briggs Institute format. DATA SOURCE AND METHODS: The authors used advanced search methods, including databases such as PubMed, Scopus, Embase, Africa Index Medicus, Science Direct, HINARI, Google Scholar, and manual searches. Data presentation adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Publication bias was assessed using Egger's regression test and a funnel plot. Sensitivity analysis was also conducted. RESULTS: The search yielded 352 original articles, with 22 meeting the criteria for inclusion. Using the random-effects DerSimonian-Laird model, the prevalence of bronchial asthma was found to be 9.02% (95% CI: 7.50, 10.53). Several factors were associated with the prevalence of bronchial asthma, including the spring season (AOR 3.7; 95% CI: 2.11, 6.49), childhood age (AOR 4.2; 95% CI: 1.84, 9.55), and urban residence (AOR 1.7; 95% CI: 1.29, 2.31). Other significant factors include family history of asthma (AOR 2.89; 95% CI: 2.22, 3.75), insecticide exposure (AOR 3.3; 95% CI: 2.23, 4.91), and the presence of household insects like cockroaches (AOR 3.33; 95% CI: 2.15, 5.15). Smoking (AOR 3.64; 95% CI: 2.66, 4.98), obstructive sleep apnea (AOR 4.29; 95% CI: 2.37, 7.76), and recurrent upper respiratory tract infections (AOR 4.31; 95% CI: 2.24, 8.32) were also significant. CONCLUSION: The pooled prevalence of bronchial asthma is notably high in Ethiopia. Key predictors include childhood age, spring season, urban living, family history of asthma, exposure to insecticides, presence of cockroaches, smoking, obstructive sleep apnea, and recurrent upper respiratory infections. Targeted interventions are crucial and should focus on lifestyle improvements, allergen identification, cockroach control, smoking cessation, reducing insecticide exposure, and promoting a safe environment. TRIAL REGISTRATION: This review's protocol was pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42023491222).
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Asma , Hospitales Públicos , Asma/epidemiología , Asma/diagnóstico , Asma/fisiopatología , Prevalencia , Humanos , Etiopía/epidemiología , Factores de Riesgo , Adulto , Masculino , Femenino , Niño , Adolescente , Persona de Mediana Edad , Adulto Joven , Estaciones del Año , Medición de Riesgo , Preescolar , AncianoRESUMEN
Exposure to storage mite (SM) and house dust mite (HDM) allergens is a risk factor for sensitization and asthma development; however, the related immune responses and their pathology have not been fully investigated. The HDMs Dermatophagoides farinae and Dermatophagoides pteronyssinus and SM Tyrophagus putrescentiae are potent allergens that induce asthma. Most SM-related studies have focused on the allergic reactions of individuals by measuring their immunoglobulin (Ig)E expression. Considering the limited research on this topic, the present study aims to investigate the differences in the immune responses induced by HDMs and SMs and histologically analyze lung tissues in a mouse asthma model to understand the differential effects of HDM and SM. The results revealed that all mite species induced airway inflammation. Mice challenged with T. putrescentiae had the highest airway resistance and total cell, eosinophil, and neutrophil counts in the bronchoalveolar lavage fluid (BALF). The SM-sensitized groups showed more severe lesions and mucus hypersecretions than the HDM-sensitized groups. Although the degree of HDM and SM exposure was the same, the damage to the respiratory lung tissue was more severe in SM-exposed mice, which resulted in excessive mucin secretion and increased fibrosis. Furthermore, these findings suggest that SM sensitization induces a more significant hypersensitivity response in mucosal immunity than HDM sensitization in asthma models.
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Asma , Pulmón , Pyroglyphidae , Animales , Ratones , Pyroglyphidae/inmunología , Pulmón/inmunología , Pulmón/patología , Asma/inmunología , Asma/patología , Femenino , Neumonía/inmunología , Neumonía/patología , Líquido del Lavado Bronquioalveolar/inmunología , Líquido del Lavado Bronquioalveolar/citología , Modelos Animales de Enfermedad , Ratones Endogámicos BALB C , Acaridae/inmunología , Alérgenos/inmunología , Eosinófilos/inmunología , Eosinófilos/patologíaRESUMEN
INTRODUCTION: Both physicians and patients are increasingly aware of the environmental impacts of medication. The shift of treatment paradigm towards MART-treatment (Maintenance and Reliever Therapy) in asthma affects the treatment-related emissions. The carbon footprint of inhaled medication is also tied to the type of the device used. Today the most commonly used propellant-containing pressurised metered-dose inhalers (pMDIs) have a carbon footprint typically 20-40-fold higher than propellant-free dry powder inhalers (DPIs) and soft mist inhalers. METHODS: We analysed the carbon footprint of inhaled medications in Europe using published life cycle analyses of marketed inhalers and comprehensive 2020 European sales data. In addition, we give an estimate on treatment-related emissions of different treatment regimens on Global Initiative for Asthma (GINA) step 2. RESULTS: There is potential to reduce the carbon footprint of inhaled medications by 85% if DPIs are preferred over pMDIs. Emissions from pMDIs in the EU were estimated to be 4.0 megatons of carbon dioxide equivalent (MT CO2e) and this could be reduced to 0.6 MT CO2e if DPIs were used instead. In the treatment of moderate asthma with DPI, an as-needed combination of inhaled corticosteroid and long-acting beta-agonist in a single inhaler had a substantially lower annual carbon footprint (0.8 kg CO2e) than the more traditional maintenance therapy with an inhaled corticosteroid alone with as-needed short-acting beta-agonist (2.9 kg CO2e). DISCUSSION: There has been an urgent call for healthcare to reduce its carbon footprint for appropriate patients with asthma and chronic obstructive pulmonary disease (COPD), changing to non-propellant inhalers can reduce the carbon footprint of their treatment by almost 20-fold.
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Asma , Huella de Carbono , Inhaladores de Polvo Seco , Gases de Efecto Invernadero , Inhaladores de Dosis Medida , Humanos , Asma/tratamiento farmacológico , Administración por Inhalación , Gases de Efecto Invernadero/análisis , Europa (Continente) , Antiasmáticos/administración & dosificaciónRESUMEN
BACKGROUND: Association of early pregnancy body mass index (BMI) and maternal gestational weight gain (GWG), and asthma and allergic disease in children is unclear. METHODS: We analyzed data from 3176 mother-child pairs in a prospective birth cohort study. Maternal anthropometric measurements in the first and last antenatal clinic visits were obtained through post-delivery questionnaires to calculate early pregnancy BMI and maternal GWG. Asthma and allergic diseases in children by the age of 5 years was assessed using a validated questionnaire. Furthermore, serum samples were analyzed for IgE antibodies to eight allergens. We applied Cox proportional hazards and logistic regression analyses to estimate the association of early pregnancy BMI and maternal GWG (as continuous variables and categorized into quarters), and asthma, atopic eczema, atopic sensitization, and allergic rhinitis in children. RESULTS: Neither early pregnancy BMI nor maternal GWG was associated with asthma and allergic disease in children when analyzed as continuous variables. However, compared to the first quarter of GWG (a rate <0.32 kg/week), mothers in the third quarter (rate 0.42-0.52 kg/week) had children with significantly higher odds of developing atopic eczema (adjusted OR 1.49, 95% CI [1.13-1.96]) by 5 years of age. CONCLUSION: Association of early pregnancy BMI and maternal GWG, and asthma and allergic disease in children, is inconsistent. High maternal GWG may be associated with increased odds of atopic eczema.
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Asma , Índice de Masa Corporal , Ganancia de Peso Gestacional , Hipersensibilidad , Humanos , Embarazo , Femenino , Asma/epidemiología , Asma/inmunología , Preescolar , Masculino , Estudios Prospectivos , Hipersensibilidad/epidemiología , Hipersensibilidad/inmunología , Adulto , Inmunoglobulina E/sangre , Lactante , Dermatitis Atópica/epidemiología , Dermatitis Atópica/inmunología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Efectos Tardíos de la Exposición Prenatal/inmunología , Encuestas y Cuestionarios , Estudios de Cohortes , Cohorte de Nacimiento , Recién NacidoRESUMEN
Immunoglobulin G (IgG) is the main isotype of antibody in human blood. IgG consists of four subclasses (IgG1 to IgG4), encoded by separate constant region genes within the Ig heavy chain locus (IGH). Here, we report a genome-wide association study on blood IgG subclass levels. Across 4334 adults and 4571 individuals under 18 years, we discover ten new and identify four known variants at five loci influencing IgG subclass levels. These variants also affect the risk of asthma, autoimmune diseases, and blood traits. Seven variants map to the IGH locus, three to the Fcγ receptor (FCGR) locus, and two to the human leukocyte antigen (HLA) region, affecting the levels of all IgG subclasses. The most significant associations are observed between the G1m (f), G2m(n) and G3m(b*) allotypes, and IgG1, IgG2 and IgG3, respectively. Additionally, we describe selective associations with IgG4 at 16p11.2 (ITGAX) and 17q21.1 (IKZF3, ZPBP2, GSDMB, ORMDL3). Interestingly, the latter coincides with a highly pleiotropic signal where the allele associated with lower IgG4 levels protects against childhood asthma but predisposes to inflammatory bowel disease. Our results provide insight into the regulation of antibody-mediated immunity that can potentially be useful in the development of antibody based therapeutics.
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Asma , Estudio de Asociación del Genoma Completo , Inmunoglobulina G , Polimorfismo de Nucleótido Simple , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Inmunoglobulina G/genética , Adulto , Femenino , Masculino , Asma/genética , Asma/inmunología , Asma/sangre , Niño , Adolescente , Receptores de IgG/genética , Persona de Mediana Edad , Cadenas Pesadas de Inmunoglobulina/genética , Cadenas Pesadas de Inmunoglobulina/sangre , Alelos , Adulto Joven , Enfermedades Autoinmunes/genética , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/sangre , Cromosomas Humanos Par 17/genética , Predisposición Genética a la Enfermedad , Antígenos HLA/genética , Antígenos HLA/inmunología , Proteínas de la MembranaRESUMEN
Asthma is a chronic inflammatory airway disorder and is among the top ten causes of morbidity and mortality in Indonesia, highlighting the need for effective management strategies. This study aimed to evaluate changes in asthma knowledge levels before and after using the "Paru Sehat" smartphone application for digital education. A quasi-experimental study using a pre- and post-test design was conducted over three months at the outpatient clinic of Universitas Sumatera Utara Hospital, Medan, Indonesia, among asthma patients aged over 18 years. The patients completed the Patient Asthma Knowledge Questionnaire (PAKQ) before installing the "Paru Sehat" application to establish baseline knowledge. Once a week, patients received reminders to access materials covering an asthma overview, peak flow meter use, medication differences, and management techniques. After four weeks of intervention, the participants' knowledge was reassessed using the PAKQ. Data were analyzed using either paired Student's t-test or Wilcoxon test to assess the improvement in knowledge. The results showed increases in knowledge about asthma in general, asthma triggers, and asthma diagnosis domains, with the median score in each domain rising by one point (p=0.003, p=0.001, and p=0.002, respectively). The asthma management domain exhibited the largest change, with a median increase of two points (p<0.001). The total scores increased by an average of five points (p<0.001), indicating an overall improvement in patient knowledge about asthma. The "Paru Sehat" application demonstrated significant potential in enhancing asthma knowledge across multiple domains. Further research is warranted to explore the long-term effectiveness of the application in diverse populations and settings, ultimately contributing to improved asthma management and patient outcomes.
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Asma , Conocimientos, Actitudes y Práctica en Salud , Educación del Paciente como Asunto , Teléfono Inteligente , Humanos , Asma/terapia , Femenino , Masculino , Adulto , Educación del Paciente como Asunto/métodos , Indonesia , Encuestas y Cuestionarios , Persona de Mediana Edad , Aplicaciones MóvilesRESUMEN
OBJECTIVE: To investigate the correlation between serum Rac1 enzyme (Rac1) level with asthma control, airway inflammatory response and lung function in asthmatic children. METHODS: A retrospective analysis was performed on 79 children with asthma who were diagnosed and treated in our hospital from June 2020 to January 2023. According to the severity of the disease, the children were divided into mild group (25 cases), moderate group (30 cases) and severe group (24 cases). 36 healthy children who underwent physical examination at the same period in our hospital were selected as the control group. The state of an illness, control level, serum mRNA Rac1, inflammatory factors, and lung function of the children in two groups were compared between the control group and the observation group. RESULTS: The Rac1 mRNA levels, forced vital capacity (FVC), forced expiratory volume in one second/FVC (FEV1/FVC), peak expiratory flow (PEF), and maximum mid-expiratory flow (MMEF) in the observation group were significantly lower than these in the control group (P < 0.05). The tumor necrosis factor-alpha (TNF-α), interleukin-5 (IL-5), IL-6, and IL-33 in the observation group were markedly higher than these in the control group (P < 0.05). As the state of an illness worsened, the Rac1 mRNA levels, FVC, FEV1/FVC, PEF, and MMEF gradually reduced (P < 0.05), while the levels of TNF-α, IL-5, IL-6, and IL-33 increased (P < 0.05). As the degree of disease control improved, the Rac1 mRNA levels, FVC, FEV1/FVC, PEF, and MMEF gradually elevated (P < 0.05), and the levels of TNF- α, IL-5, IL-6, and IL-33 showed the opposite trend (P < 0.05). Rac1 was negatively related to the levels of TNF-α, IL-5, IL-6 and IL-33 (P < 0.05), and positively to the levels of FVC, FEV1/FVC, PEF and MMEF (P < 0.001). Rac1 mRNA levels, FVC, FEV1/FVC, PEF and MMEF were protective factors, while TNF-α, IL-5, IL-6 and IL-33 were risk factors for the prognosis of children with asthma (P < 0.05). CONCLUSION: Children with asthma have obviously lower serum Rac1 mRNA levels, higher inflammatory factor levels and lower lung function. Serum Rac1 mRNA level may be associated with better asthma control, lower airway inflammatory response, better lung function and lower disease severity. It has important reference value for the evaluation of the state of an illness, efficacy and prognosis of children with bronchial asthma.
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Asma , Proteína de Unión al GTP rac1 , Humanos , Asma/fisiopatología , Asma/genética , Asma/sangre , Proteína de Unión al GTP rac1/metabolismo , Proteína de Unión al GTP rac1/genética , Femenino , Masculino , Niño , Estudios Retrospectivos , Capacidad Vital , Volumen Espiratorio Forzado , Pulmón/fisiopatología , Pruebas de Función Respiratoria , Factor de Necrosis Tumoral alfa/sangre , Estudios de Casos y Controles , Interleucina-33/sangre , Interleucina-33/genética , Preescolar , Interleucina-6/sangre , Adolescente , Índice de Severidad de la Enfermedad , Interleucina-5/sangre , ARN Mensajero/metabolismoRESUMEN
Objective: To ascertain the prevalence of asthma attacks among archivists and identify the associated occupational factors in this understudied professional population. Methods: We conducted a cross-sectional, questionnaire-based study among 1,002 archival workers. A multiple logistic regression was conducted to identify the association between asthma attacks and occupational exposures. The Strobe Protocol was applied. Results: 999 workers were included in the final analysis with the asthma prevalence of 33.3%. Main factors associated with asthma attacks (OR [95% CI]) were the presence of chemically irritating odors (2.152 [1.532-3.024]), mold odors (1.747 [1.148-2.658]), and insects (1.409[1.041-1.907]). A significant synergistic effect was observed between chemical irritants and mold, the odds ratio was 7.098 (95% CI, 4.752-10.603). Conclusion: There was a high prevalence of asthma attacks among archival workers, an under-studied population. Chemical irritants, molds and insects were associated with their asthma attacks. Notably, this study's data analysis has revealed a strong synergy (OR = 7.098) between chemical odors and molds in the workplace. While the existing international literature on this specific interaction remains somewhat limited, previous studies have already demonstrated the potential for chemical irritants, such as sulfur dioxide and ozone, to synergistically interact with inhalable allergens, including fungi, molds and dust mites. Consequently, this interaction seems to exacerbate asthma symptoms and perpetuate untreated exposure. Furthermore, in damp and damaged buildings, the presence of microbial components, such as cellular debris or spores released during fungal growth can trigger an inflammatory response, potentially served as a shared pathway for the development of asthma among individuals exposed to these hazardous factors.
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Asma , Hongos , Exposición Profesional , Humanos , Estudios Transversales , Masculino , Adulto , Femenino , Asma/epidemiología , Asma/etiología , Exposición Profesional/efectos adversos , Exposición Profesional/estadística & datos numéricos , Prevalencia , Encuestas y Cuestionarios , Persona de Mediana Edad , Hongos/aislamiento & purificación , Factores de Riesgo , Salud Pública , Odorantes , Irritantes/efectos adversosRESUMEN
COPD is the second leading cause of death in India. The guidelines for early detection of COPD were released by the Government of India in 2019. However, due to the COVID-19 pandemic, its implementation could not be optimal. Diagnosis of COPD is based on the presence of respiratory symptoms, the presence of exposure to risk factors, and the presence of poorly reversible airflow obstruction as assessed using a spirometer. Spirometers are currently available only at a few district hospitals. The existing guidelines expect the patient to visit the Rural hospital/ Community Health Centre, which does not have a spirometer or a pulmonary medicine specialist. Also, it is not feasible or accessible for patients to visit the district hospital to get diagnosed. The current study will be implemented to determine the prevalence, annual incidence of COPD and asthma, quality of life, and nutritional status of COPD and asthma patients. The novelty of this implementation research, which will be conducted in collaboration with Zilla Parishad (i.e., Government), Pune district, is the empowerment of an Accredited Social Health Activist (ASHA), a peripheral health worker to screen all individuals using a peak flow meter and confirmation of the diagnosis at health and wellness center (HWC). An accredited Social Health Activist (ASHA) will take relevant history to suspect COPD and asthma in 30+-year-old adults, and she will refer the suspected cases to the Community Health Officer (CHO) at the Health and Wellness Center. The CHO/ Medical officer of PHC will initiate the appropriate treatment after confirming the diagnosis using a portable spirometer. The difficult-to-diagnose patients with comorbidity and acute exacerbations will be referred to the nearest higher center, i.e., Primary Health Centre (PHC) or Community Health Centre (CHC), where a primary care physician is available. The ASHA workers will provide two follow-ups to these patients in a year, depending on the severity, to ensure compliance with the treatment. Thus, early diagnosis and appropriate treatment of COPD and asthma at the community level may help to reduce the episodes of acute exacerbations.
Asunto(s)
Asma , Tamizaje Masivo , Enfermedad Pulmonar Obstructiva Crónica , Espirometría , Humanos , India/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Asma/diagnóstico , Asma/epidemiología , Tamizaje Masivo/métodos , COVID-19/epidemiología , COVID-19/diagnóstico , Personal de Salud , Femenino , Empoderamiento , Calidad de Vida , Masculino , Guías de Práctica Clínica como AsuntoRESUMEN
OBJECTIVE: Aim: To develop the criteria of small airways response to bronchodilators (by spirometry indices maximal expiratory flow (MEF50 and MEF25) as the markers of uncontrolled asthma course. PATIENTS AND METHODS: Materials and Methods: The study involved 92 participants (64 boys and 28 girls) aged 6 to 17 years (60 were less than 12 years old) with diagnosed asthma. Asthma control was assessed with the use of Asthma Control Test and Asthma Control Questionnaire. Spirometry and bronchodilator responsiveness testing were performed for all participants. RESULTS: Results: Mostly, the studied children had a normal level of forced expiratory volume in the first second (FEV1), even at unsatisfactory symptoms control. The indicators of the medium and small airways patency were significantly worse in uncontrolled asthma children even in normal FEV1. Among children, the lack of asthma control can be caused by small airways obstruction in up to 80% cases. Among children who need the high dose inhaled corticosteroids treatment 93.3% have uncontrolled asthma with small airways obstruction. We found out that MEF50 and MEF25 could be the signs of the reversibility of bronchial obstruction and uncontrolled asthma with high sensitivity and specificity. CONCLUSION: Conclusions: Indices MEF50 and MEF25 allow detecting the small airways obstruction and their reversibility as a mark of uncontrolled asthma (MEF25 has a higher diagnostic value). In case of MEF50 and/or MEF25 increasing for 22% or 25% accordingly in bronchodilator test in children, the asthma should be considered uncontrolled.