RESUMEN
Severe asthma is an entity with a complex diagnosis, requiring an adequate differential diagnosis and identification of endotypes for a correct approach and therapeutic process. In the present review, we show a synthesis of the current literature on the diagnosis, pathophysiology, and management of severe asthma, having critically analyzed the evidence in search engines such as Medline, Scopus, and Embase.
El asma grave es una enfermedad compleja, que requiere un enfoque y diagnóstico diferencial ordenado e identificación de endotipos para el correcto abordaje y tratamiento. El tratamiento farmacológico cuenta cada vez con más moléculas a disposición del personal médico para el control efectivo de los síntomas. Esta revisión muestra una síntesis de la bibliografía actual acerca del diagnóstico, fisiopatología y tratamiento del asma grave, mediante la lectura crítica previa de la evidencia científica en buscadores como Medline, Scopus y Embase.
Asunto(s)
Asma , Índice de Severidad de la Enfermedad , Humanos , Asma/diagnóstico , Asma/terapia , Asma/fisiopatología , Antiasmáticos/uso terapéuticoRESUMEN
The respiratory tract, from the nose to the lung, behaves as an anatomical and pathophysiological unit under a holistic model. Lower airway abnormalities, such as bronchial hyperresponsiveness, reduced lung function and inflammation of the bronchial mucosa without clinical expression, have been observed in patients with rhinitis without asthma. These would be the consequence of a common systemic inflammatory phenomenon with simultaneous impact on the nose and lung. For unknown reasons, these patients do not exhibit a full clinical expression, which could mean an increased risk of developing asthma. In this review we address the frequency and characteristics of existing pulmonary abnormalities in children and adolescents with chronic rhinitis that derive from our previous research and, more recently, within the project "Allergic Respiratory Disease: The United Airway Concept" supported by the Universidad Católica de Córdoba, and a comparative analysis with the evidence provided by other authors in the medical literature.
El aparato respiratorio, desde la nariz al pulmón, se comporta como una unidad anatómica y fisiopatológica bajo un modelo holístico. Se han observado alteraciones pulmonares sin traducción clínica en pacientes con rinitis sin asma, que se manifiestan como hiperreactividad bronquial, reducción de la función pulmonar e inflamación bronquial. Estas serían consecuencia de un fenómeno inflamatorio sistémico con impacto simultáneo en nariz y pulmón, que por razones desconocidas no tiene una expresión clínica completa, pero que podrían significar un mayor riesgo de desarrollo de asma. En esta revisión abordamos la frecuencia y características de las anormalidades pulmonares existentes en niños y adolescentes con rinitis crónica derivadas de nuestras investigaciones previas y, más recientemente, del proyecto "Enfermedad Alérgica Respiratoria: El Concepto de Unidad de la Vía Aérea", línea de investigación acreditada por la Universidad Católica de Córdoba y un análisis comparativo con las evidencias aportadas por otros autores en la literatura médica.
Asunto(s)
Rinitis , Humanos , Niño , Adolescente , Rinitis/fisiopatología , Hiperreactividad Bronquial/fisiopatología , Hiperreactividad Bronquial/etiología , Asma/fisiopatología , Enfermedad CrónicaRESUMEN
INTRODUCTION: The evaluation of the asthmatic patient is usually based on clinical and functional parameters that do not necessarily evidence the degree of airway inflammation. The aim of this study was to analyze whether clinical scores (CS) correlate with spirometry (S), impulse oscillometry (IO) and FeNO, in severe asthmatic children. MATERIAL AND METHODS: A multicentric, prospective, cross-sectional study was conducted over a 12-month period. All SA patients (6-18 years old) followed-up in the Pulmonology Department were recruited. CS, FeNO measurements, IO and S were consecutively performed on the same day. Asthma control was ascertained using ACT and GINAq. A cut-off value of ≥ 25 parts per billion (ppb) was used to define airway inflammation. RESULTS: Eighty-one patients were included. ACT: 75% (n 61) were controlled; GINAq: 44.5% (n 36) were controlled; 39.5% (n 32) were partly controlled, and 16% (n 13) were uncontrolled. FeNO had a median value of 24 ppb (IQR 14-41); FeNO ≥ 25 ppb was observed in 49% of patients (n 39). ROC AUC for FeNO vs. ACT was 0.71 (95%CI 0.57-0.86), PPV 0.47, NPV 0.87, SE 0.61, SP 0.80; FeNO vs. GINAq was ROC AUC 0.69 (95%CI 0.54-0.85), PPV 0.34, NPV 0.91, SE 0.62, SP 0.77; Youden cut-off FeNO > 39 ppb for both CS. CONCLUSION: In severe asthmatic children, current symptoms control as evidenced by ACT and GINA correlates with low FeNO values. Clinical scores showed good correlation with airway inflammation.
Asunto(s)
Asma , Óxido Nítrico , Oscilometría , Índice de Severidad de la Enfermedad , Espirometría , Humanos , Asma/diagnóstico , Asma/fisiopatología , Niño , Femenino , Masculino , Oscilometría/métodos , Estudios Transversales , Estudios Prospectivos , Adolescente , Óxido Nítrico/análisis , Óxido Nítrico/metabolismo , Curva ROCRESUMEN
BACKGROUND: Continuous monitoring of pulse oximetry (SpO2 ) is recommended during the 6-min walk test (6MWT) to ensure that the lowest SpO2 is recorded. In this case, severe exercise-induced desaturation (EID; SpO2 < 80%) triggers walking interruption by the examiner. Our main objective was to assess the impact of this approach on 6MWT distance in patients with chronic respiratory diseases and, second, to evaluate the safety of the test without interruption due to severe EID. METHODS: 6MWTs with continuous monitoring of SpO2 were prospectively performed in subjects with chronic respiratory disease. The participants were randomly allocated to walk with or without SpO2 real-time assessment. SpO2 visualization during the test execution was available only in the first group, and walking interruption was requested by the examiner if SpO2 < 80%. RESULTS: One hundred forty-five participants were included in each group (68.6% females, 62 [52-69] y old) without differences in demographic and resting lung function parameters between them. The main respiratory conditions were COPD (n = 101), asthma (n = 73), pulmonary hypertension (n = 47), and interstitial lung disease (n = 39). The walked distance was similar comparing groups (349.5 ± 117.5 m vs 351.2 ± 105.4 m). Twenty-five subjects presented with severe EID in the group with real-time SpO2 assessment, and 20 subjects had severe EID in the group without real-time assessment respectively (overall prevalence of 15.5%). The 23 participants who had their test interrupted by the examiner due to severe EID in the first group (2 subjects stopped by themselves due to excessive symptoms) walked a shorter distance compared to the 11 subjects with severe EID without test interruption in the second group (9 subjects stopped by themselves due to excessive symptoms): 240.6 ± 100.2 m versus 345.9 ± 73.4 m. No exercise-related serious adverse events were observed. CONCLUSIONS: Interruption driven by severe EID reduced the walked distance during the 6MWT. No serious adverse event, in turn, was observed in subjects with severe desaturation without real-time SpO2 assessment.
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Oximetría , Enfermedad Pulmonar Obstructiva Crónica , Prueba de Paso , Humanos , Oximetría/métodos , Femenino , Masculino , Prueba de Paso/métodos , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Caminata/fisiología , Asma/fisiopatología , Enfermedad Crónica , Hipertensión Pulmonar/fisiopatología , Enfermedades Pulmonares Intersticiales/fisiopatología , Saturación de Oxígeno/fisiologíaRESUMEN
BACKGROUND: Although allergic rhinitis (AR) can negatively impact the ability to smell, the degree to which this occurs is not clear and prevalence estimates vary among studies. This study had 4 main objectives: (1) To estimate the prevalence and the degree of olfactory dysfunction in AR patients; (2) To compare olfactory perception between AR patients with different persistence and severity of symptoms and determine if olfactory testing may aid in differentiating among Allergic Rhinitis and its Impact on Asthma (ARIA) groups; (3) To determine whether allergic reactions to different allergens differentially impact olfactory function, and (4) Verify possible changes in the olfactory epithelium (OE) caused by AR. METHODS: One hundred thirty-three patients with AR and one hundred controls were tested. The main outcome was the score in University of Pennsylvania Smell Identification Test (UPSIT®). The OE was examined using immunofluorescence markers for neuronal activity, apoptosis, oxidative stress, signal transduction, eosinophils, and epithelial thickness. RESULTS: Prevalence of olfactory dysfunction in the AR patients was higher (AR: 42.9% vs controls: 9%, P < .001). No difference was found either between intermittent and persistent disease cases (P = .58) or between cases with mild and those with moderate/severe symptomatology (P = .33). Lower olfactory capacity was not associated with the reaction to more (P = .48) or diverse types of allergens (Ps > .05). Although not significant, patients with AR had a greater amount of eosinophilia and a lower amount of cAMP (cyclic adenosine monophosphate) in the OE. CONCLUSION: The study highlights a higher prevalence of olfactory dysfunction in AR patients compared to controls, but olfactory testing may not effectively differentiate AR severity or allergen sensitivities. Although trends suggest potential pathophysiological changes in the OE of AR patients, further research is needed to validate these findings.
Asunto(s)
Trastornos del Olfato , Rinitis Alérgica , Humanos , Masculino , Femenino , Prevalencia , Adulto , Rinitis Alérgica/epidemiología , Persona de Mediana Edad , Trastornos del Olfato/epidemiología , Trastornos del Olfato/etiología , Mucosa Olfatoria/patología , Adulto Joven , Índice de Severidad de la Enfermedad , Alérgenos/inmunología , Adolescente , Olfato/fisiología , Asma/epidemiología , Asma/diagnóstico , Asma/fisiopatologíaRESUMEN
BACKGROUND: The Pediatric Asthma Severity Score (PASS) is one of the most-used clinical scoring systems for assessing the severity of asthma exacerbations in children. The aim of the present study was to validate a Spanish version of the PASS in a population of Hispanic children with asthma exacerbations living in urban Bogota, Colombia. METHODS: In a prospective cohort and a validation study, parents/caregivers of children between 2 and 18 years old attended in the emergency department (ED) with asthma exacerbations who were admitted to the inpatient unit were invited to participate in the study. During the hospitalization period, we gathered the necessary data for assessing the criterion validity (comparing its score with the Pediatric Respiratory Assessment Measure [PRAM]), construct validity, interrater reliability, responsiveness, and internal consistency of the Col-PASS, the Colombian version of the PASS. RESULTS: At baseline, the scores of the Col-PASS correlated positively with the scores of the PRAM score (ρ = 0.588, p < .001). The baseline Col-PASS scores in patients who required admission to a more complex service were significantly higher than those in patients who presented clinical improvement (1.0 (0.0-2.0) vs. 0.0 (0.0-0.0), p < .001). The interrater reliability was found to be κ = 0.897, 95% CI 0.699-1.000, p < .001. Cronbach's α was .701 for the questionnaire as a whole. CONCLUSION: The Col-PASS has excellent construct validity, adequate criterion validity, interrater reliability, responsiveness; and acceptable internal consistency when used in children between 2 and 18 years old with asthma exacerbations.
Asunto(s)
Asma , Hispánicos o Latinos , Índice de Severidad de la Enfermedad , Humanos , Niño , Asma/diagnóstico , Asma/fisiopatología , Asma/etnología , Femenino , Masculino , Adolescente , Hispánicos o Latinos/estadística & datos numéricos , Estudios Prospectivos , Preescolar , Reproducibilidad de los Resultados , Colombia , Encuestas y Cuestionarios , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricosRESUMEN
BACKGROUND: Asthmatic children present variable degrees of airway inflammation, remodeling, and resistance, which correlate with disease control and severity. The chronic inflammatory process of the airway triggers airway remodeling, which reflects the degree of airway resistance. Pro-inflammatory and pro-fibrotic mediators are centrally involved in this process. OBJECTIVE: To investigate whether the levels of pulmonary and systemic pro-inflammatory and pro-fibrotic mediators present a correlation with the resistance of the respiratory system and of the proximal and distal airways. METHODS: 39 Asthmatic children (persistent mild and moderate) and 39 non-asthmatic children (both between 6 and 13 years old) were evaluated for anthropometric characteristics, lung function and mechanics, and pulmonary and systemic immune responses. RESULTS: Asthmatic children showed an increased number of blood eosinophils (p < 0.04), basophils (p < 0.04), monocytes (p < 0.002) and lymphocytes (p < 0.03). In addition, asthmatic children showed impaired lung function, as demonstrated by FEV1 (p < 0.0005) and FEV1/FVC (p < 0.004), decreased total resistance of the respiratory system (R5Hz; p < 0.009), increased resistance of the proximal airways (R20Hz; p < 0.02), increased elastance (Z5Hz; p < 0.02) and increased reactance (X5Hz; p < 0.002) compared to non-asthmatic children. Moreover, the following inflammatory factors were significantly higher in asthmatic than non-asthmatic children: GM-CSF in the breath condensate (BC) (p < 0.0001) and in the serum (p < 0.0001); TGF-beta in the BC (p < 0.0001) and in the serum (p < 0.004); IL-5 in the BC (p < 0.02) and in the serum (p < 0.01); IL-4 in the serum (p < 0.0002). CONCLUSIONS: Impulse oscillometry is a sensitive method to detect airway resistance in persistent mild and moderate asthmatic children, an event followed by increased levels of pro-inflammatory and pro-fibrotic mediators.
Asunto(s)
Remodelación de las Vías Aéreas (Respiratorias) , Resistencia de las Vías Respiratorias , Asma , Humanos , Asma/fisiopatología , Asma/inmunología , Niño , Remodelación de las Vías Aéreas (Respiratorias)/fisiología , Femenino , Masculino , Adolescente , Resistencia de las Vías Respiratorias/fisiología , Pruebas de Función Respiratoria , Citocinas/sangreRESUMEN
BACKGROUND: The pathophysiological mechanisms by which asthma and bronchiectasis are associated are still unclear. The association of these two diseases can result in more severe symptoms and a greater number of exacerbations. OBJECTIVE: The aim of this systematic review is to collect evidence of the pathophysiology of non-cystic fibrosis bronchiectasis with associated asthma in children and adolescents, aged 6-18 years old. METHODS: A systematic and comprehensive search will be performed using eight main databases, PubMed, PubMed PMC, BVS/BIREME, Scopus, EMBASE, Cochrane Library, Scielo and Web of Science. Articles will be searched from the earliest available time to July 2023. The studied population will be composed of children and adolescents with asthma and non-cystic fibrosis bronchiectasis. From the data obtained, all articles found will be transferred to the Rayyan platform. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Checklist (PRISMA P-2015). In addition, if sufficient data are available, a meta-analysis will be conducted. Two independent reviewers will conduct the studies selection, data extraction, and risk of bias assessment. The outcome measures will be to analyze if non-cystic fibrosis bronchiectasis is related to a specific inflammatory profile. DISCUSSION: A systematic review will provide better knowledge about the etiopathogenesis and causes of the association between asthma and bronchiectasis and its role in the severity and control of asthma. Identifying, selecting and critically evaluating studies on asthma and bronchiectasis, would be possible to illuminate the characteristics of children and adolescents with associated diagnoses and provide information to help individualized treatments in order to control and prevent complications. The findings of this study will be published in a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION: The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in July 2023 (registration number CRD42023440355).
Asunto(s)
Asma , Bronquiectasia , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto , Humanos , Asma/fisiopatología , Asma/complicaciones , Adolescente , Bronquiectasia/fisiopatología , Bronquiectasia/complicaciones , NiñoRESUMEN
OBJECTIVE: To compare the thermographic pattern of regions of interest (ROI) of respiratory muscles in young asthmatics with and without bronchospasm induced by eucapnic voluntary hyperpnea (EVH). MATERIALS AND METHODS: Cross-sectional study carried out with 55 young (55% male and 45% females) aged 12.5 ± 3.3 years, divided in nine nonasthmatics, 22 asthmatics without exercise-induced bronchospasm compatible response (EIB-cr) and 24 asthmatics with EIB-cr. The diagnosis of EIB was given to subjects with a fall in forced expiratory volume in the first second (FEV1) ≥ 10% compared to baseline. Thermographic recordings of respiratory muscles were delimited in ROI of the sternocleidomastoid (SCM), pectoral, and rectus abdominis intention area. Thermal captures and FEV1 were taken before and 5, 10, 15 and 30 min after EVH. RESULTS: Twenty-four (52.1%) of asthmatics had EIB-cr. There was a decrease in temperature at 10 min after EVH test in the SCM, pectoral and rectus abdominis ROIs in all groups (both with p < 0.05). There was a decrease in temperature (% basal) in asthmatic with EIB-cr compared to nonasthmatics in the rectus abdominis area (p < 0.05). CONCLUSION: There was a decrease in temperature in the ROIs of different muscle groups, especially in asthmatics. The greater drop in FEV1 observed in individuals with EIB-cr was initially associated with a decrease in skin temperature, with a difference between the nonasthmatics in the abdominal muscle area. It is likely that this decrease in temperature occurred due to a temporary displacement of blood flow to the most used muscle groups, with a decrease in the region of the skin evaluated in the thermography.
Asunto(s)
Valor Predictivo de las Pruebas , Músculos Respiratorios , Termografía , Humanos , Masculino , Femenino , Estudios Transversales , Niño , Adolescente , Músculos Respiratorios/fisiopatología , Volumen Espiratorio Forzado , Termografía/métodos , Estudios de Casos y Controles , Factores de Tiempo , Asma Inducida por Ejercicio/fisiopatología , Asma Inducida por Ejercicio/diagnóstico , Pulmón/fisiopatología , Factores de Edad , Asma/fisiopatología , Asma/complicaciones , Asma/diagnóstico , Hiperventilación/fisiopatología , Espasmo Bronquial/fisiopatología , Espasmo Bronquial/etiologíaRESUMEN
INTRODUCTION: Reactance inversion (RI) has been associated with impaired peripheral airway function in persistent asthma. However, there is little to no data about the difference between asthmatic children with and without RI. This study aimed to detect clinical and lung function differences in moderate-severe asthmatic children with and without RI. METHODS: This study was conducted between 2021 and 2022 in asthmatic school-age children. Impulse oscillometry (IOS) and spirometry were performed according to ATS/ERS standards. RESULTS: A total of 62 patients, with a mean age of 8.4 years, 54.8% were males and were divided into three groups: group 1 (32.3%) with no RI, group 2 (27.4%) with RI but disappearing after bronchodilator test and group 3 (40.3%) with persistent RI after bronchodilator test. Children in groups 2 and 3 had significantly lower birth weights than in group 1. Group 2 had lower gestational age compared to group 1. FEV1 and FEF25-75 of forced vital capacity were significantly lower in groups 2 and 3. In group 3, R5, AX, R5-20, and R5-R20/R5 ratios were significantly higher. Bronchodilator responses (BDR) in X5c, AX, and R5-R20 were significantly different between groups and lower in group 3. CONCLUSION: RI is frequently found in children with moderate-severe persistent asthma, particularly in those with a history of prematurity or low birth weight. In some patients, RI disappears after the bronchodilator test; however, it, persists in those with the worst pulmonary function. RI could be a small airway dysfunction marker.
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Asma , Broncodilatadores , Recién Nacido de Bajo Peso , Humanos , Asma/fisiopatología , Asma/tratamiento farmacológico , Masculino , Femenino , Niño , Broncodilatadores/uso terapéutico , Broncodilatadores/administración & dosificación , Espirometría , Índice de Severidad de la Enfermedad , Pruebas de Función Respiratoria , Oscilometría , Recién NacidoRESUMEN
INTRODUCTION: Aquatic exercises are among the types of exercise most tolerated by people with asthma. Therefore, the objective of this study was to synthesize the evidence on the effects of aquatic exercise on lung function and quality of life in asthmatic patients. DATA SOURCES: A systematic search encompassing the Medline, CINAHL, Cochrane Library, Embase, AMED, SPORTDiscus, and Physiotherapy Evidence Database databases was conducted to identify randomized controlled trials assessing the impact of aquatic exercise in comparison to control conditions or land-based exercise on lung function and quality of life in individuals diagnosed with asthma. STUDY SELECTIONS: The stages of selection, data extraction and methodological evaluation, and level of evidence of the manuscripts were carried out independently by two authors. RESULTS: Ten studies, comprising a total of 393 participants, were incorporated into this systematic review. Very low-quality evidence was found in favor of aquatic exercise in asthmatic patients for forced expiratory volume in 1 s (MD: 0.20 L, 95% CI: 0.02 L-0.38L N: 91) and for forced vital capacity (MD: 0.32 L, 95% CI: 0.08 L-0.56L N: 80). No effect of aquatic exercise was observed on the FEV1/FVC ratio (MD:1.11L, 95% CI: -1.28 L-3.49L N:80) compared with control. Only one study evaluated the effect of aquatic exercise on patients' quality of life. CONCLUSIONS: Improvements in lung function and quality of life in asthmatic patients undergoing aquatic exercise are not supported by high-quality evidence. The present findings will need to be confirmed by new, methodologically more rigorous clinical trials.
The effect of aquatic exercise on pulmonary function and quality of life in asthma patients is still uncertain.The current quality of evidence for aquatic exercise in asthma patients is low.There is an urgent need for higher-quality studies investigating the effects of aquatic exercise among asthma patients.
Asunto(s)
Asma , Terapia por Ejercicio , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Asma/terapia , Asma/fisiopatología , Terapia por Ejercicio/métodos , Pruebas de Función Respiratoria , Volumen Espiratorio Forzado , Capacidad VitalRESUMEN
Asthma is a disease characterized by chronic inflammation and hyper responsiveness of airways. We aimed to assess the relaxant potential of phosphodiesterase-4 (PDE4) inhibitors N-sulfonilhidrazonic derivatives on non-asthmatic and asthmatic guinea pig trachea. Firstly, guinea pigs were sensitized and challenged with ovalbumin, and then morphological, and contractile changes were evaluated resulting from asthma, followed by evaluation of relaxant effect of derivatives on guinea pig trachea and the cAMP levels measurement by ELISA. It has been evidenced hypertrophy of airway smooth muscle, inflammatory infiltrate, and vascular abnormalities. Moreover, only sensitized tracheal rings were responsive to OVA. Contractile response to histamine, but not to carbachol, was greater in sensitized animals, however the relaxant response to aminophylline and isoprenaline were the same in non-asthmatics and asthmatics. N-sulfonilhidrazonic derivatives presented equipotent relaxant action independent of epithelium, with exception of LASSBio-1850 that presented a low efficacy (< 50%) and LASSBio-1847 with a 4-fold higher potency on asthmatics. LASSBio-1847 relaxant curve was impaired in the presence of propranolol and potentiated by isoprenaline in both groups. Furthermore, relaxation was potentiated 54- and 4-fold by forskolin in non-asthmatics and asthmatics, respectively. Likewise, LASSBio-1847 potentiated relaxant curve of aminophylline 147- and 4-fold in both groups. The PKA inhibitor H-89 impaired the relaxant potency of the derivative. Finally, LASSBio-1847 increased tracheal intracellular cAMP levels similarly to rolipram, selective PDE4 inhibitor, in both animals. LASSBio-1847 showed to be promising to relax guinea pig trachea from non-sensitized and sensitized guinea pigs by activation of ß2-adrenergic receptors/AC/cAMP pathway.
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Asma , Broncodilatadores , AMP Cíclico , Modelos Animales de Enfermedad , Inhibidores de Fosfodiesterasa 4 , Tráquea , Animales , Cobayas , Inhibidores de Fosfodiesterasa 4/farmacología , Asma/tratamiento farmacológico , Asma/fisiopatología , Tráquea/efectos de los fármacos , Masculino , Broncodilatadores/farmacología , AMP Cíclico/metabolismo , Músculo Liso/efectos de los fármacos , Ovalbúmina , Relajación Muscular/efectos de los fármacos , Aminofilina/farmacologíaRESUMEN
Introducción: Se han informado patrones de deterioro temprano de la función pulmonar en el asma pediátrica. Nuestro objetivo fue identificar las trayectorias de la función pulmonar en la espirometría, desde la edad preescolar hasta la edad escolar. Materiales: Estudio prospectivo realizado entre el 2016 y el 2021. Se reclutaron pacientes con asma persistente a quienes se les realizó oscilometría de impulso (IOS)-espirometría al inicio y después de 3 años. La espirometría anormal se definió de acuerdo con las guías ATS/ERS. Métodos: se utilizó χ2 y ANOVA para comparar las características clínicas y promedios de parámetros de la espirometría e IOS entre trayectorias. Resultados: 86 pacientes, promedio de edad 5,3 y 8,3 años en su primera y segunda evaluación. El 70,9% de los pacientes mantuvo la espirometría normal en ambas evaluaciones (trayectoria 1), el 9,3% presentó espirometría preescolar anormal que normalizó en la edad escolar (trayectoria 2) y el 19,8% espirometría en anormal en ambas evaluaciones (trayectoria 3). La trayectoria 3 registró menor peso promedio al nacer (2,4 kg vs 3,02 kg p = 0,04), mayor promedio de exacerbaciones (5,3 vs 2,01 p = 0,00002), mayor promedio de hospitalizaciones (0,61 vs 0,16 p = 0,04), parámetros promedio más bajos en espirometría (relación VEF1/CVF %, relación VEF0,75/CVF %, VEF0,75 L, VEF0,5 L), promedios más bajos en X5 kPa/Ls y más altos en AX kPa/Ls, que la trayectoria 1. Conclusiones: La trayectoria 1 fue la más frecuente, con persistencia de función pulmonar normal. La trayectoria 3, la segunda más frecuente, inició seguimiento con función pulmonar disminuida en la espirometría y disfunción de vía aérea pequeña en el IOS que se mantuvo en la edad escolar. Los niños que siguieron la trayectoria 3 tuvieron menor peso al nacer, más exacerbaciones y hospitalizaciones que los niños de la trayectoria 1.
Introduction: Patterns of early decline in lung function have been reported in pediatric asthma. Our objective was to identify pulmonary function trajectories in spirometry, from preschool age to school age. Materials: Prospective study conducted between 2016 and 2021. Patients with persistent asthma who underwent impulse oscillometry (IOS)-spirometry at baseline and after 3 years were recruited. Abnormal spirometry was defined according to ATS/ERS guidelines. Methods: χ2 and ANOVA was used to compare clinics characteristics and means of IOS-spirometry parameters between trajectories. Results: 86 patients, mean age of 5,3 and 8,3 years in their first and second evaluation. 70.9% of the patients maintained normal spirometry in both evaluations (Track 1), 9.3% presented abnormal preschool spirometry that normalized at school age (Track 2) and 19.8% abnormal spirometry in both evaluations (Track 3). Trajectory 3 had a lower average birth weight (2,4 kg vs 3,02 kg p = 0,04), higher average of exacerbations (5,3 vs 2,01 p = 0,00002), higher average of hospitalizations (0,61 vs 0,16 p = 0,04), lowest averages parameters in spirometry (FEV1/FVC % ratio, FEV0,75/FVC % ratio, FEV0,75 L, FEV0,5 L), lower average in X5 kPa/Ls and higher in AX kPa/Ls, than trajectory 1. Conclusions: Trajectory 1 was the most common, with persistent normal lung function. Trajectory 3, the second most frequent, started follow-up with decreased lung function in spirometry and small airway disfunction in the IOS that were maintained at school age. Children who followed trajectory 3 had lower birth weight, more exacerbations, and hospitalizations than children in trajectory 1.
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Humanos , Masculino , Femenino , Preescolar , Niño , Asma/fisiopatología , Oscilometría , Espirometría , Capacidad Vital , Volumen Espiratorio Forzado , Estudios Prospectivos , Análisis de VarianzaRESUMEN
Bajo la teoría de vía aérea unificada, se ha observado que el asma y la rinosinusitis crónica (RSC) tienen una estrecha relación, con efectos importantes de una enfermedad sobre el control de la otra. El objetivo de esta revisión bibliográfica es clarificar cómo ambas enfermedades se relacionan desde su origen, epidemiología, fisiopatología y tratamiento. Sabemos que la presencia de RSC se asocia con peores resultados del asma, mayor frecuencia de exacerbaciones, hospitalizaciones y mayor uso de corticoides sistémicos. Varios mecanismos parecen tener un rol en la disfunción de la vía aérea inferior en pacientes con RSC, dentro de los cuales se plantea que la respuesta inflamatoria en común de tipo Th2 juega un papel principal. Existe amplia literatura respecto al efecto que tiene el tratamiento de la RSC en el control del asma, en esta revisión se expondrá la evidencia disponible del tratamiento médico con corticoides nasales, montelukast y macrólidos, así como también del tratamiento quirúrgico de la RSC y el uso de biológicos.
Under the unified airway theory, asthma and chronic rhinosinusitis (CRS) have a close relationship, with significant effects of one disease on the control of the other. This bibliographic review aims to clarify how both diseases relate to each other from their origin, epidemiology, pathophysiology, and treatment. CRS is associated with worse asthma outcomes, higher frequency of exacerbations, hospitalizations, and increased use of systemic corticosteroids. Several mechanisms play a role in lower airway dysfunction in patients with CRS, among which the common Th2-type inflammatory response plays a substantial role. There is extensive literature regarding the effect of the treatment of CRS in the control of asthma. We present the available evidence regarding the effect of medical treatment with nasal corticosteroids, montelukast, and macrolides, as well as the surgical treatment and use of biologics.
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Humanos , Asma/fisiopatología , Asma/epidemiología , Sinusitis/fisiopatología , Sinusitis/epidemiología , Rinitis/fisiopatología , Rinitis/epidemiología , Enfermedad CrónicaRESUMEN
Las enfermedades obstructivas de la vía aérea pediátrica son muy frecuentes debido a los fenómenos mecánicos que están involucrados. En los niños más pequeños, la marcada resistencia de las vías aéreas pequeñas, determinada por la falta de tejido elástico y una caja torácica aún no bien desarrollada; tanto su estructura como la musculatura, facilitarán que cuadros infecciosos, mecánicos (cuerpo extraño) y compresivos, determinen que los flujos de aire se vean limitados y con ello la ventilación alveolar. La respuesta fisiológica con aumento del trabajo respiratorio es limitada y por lo tanto la fatiga muscular determinará hipoventilación con las consecuencias de hipoxemia e hipercapnia.
Obstructive diseases of the pediatric airway are very frequent due to the mechanical phenomena that are involved. The marked resistance of the small airways, such as the lack of elastic tissue and a thoracic cage that is not yet well developed, both in its structure and in the musculature, will make it easier for infectious, mechanical (foreign body), compressive and other conditions to determine that the flows of air are limited and with it the alveolar ventilation. The physiological response with increased work of breathing is limited and therefore muscle fatigue will determine hypoventilation, with the consequences of hypoxemia and hypercapnia.
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Humanos , Niño , Enfermedades Pulmonares Obstructivas/fisiopatología , Asma/fisiopatología , Bronquiolitis/fisiopatología , Mecánica Respiratoria , Cuerpos Extraños/fisiopatología , HipoventilaciónRESUMEN
PURPOSE: We quantified the magnitude of exercise-induced bronchodilation in adult asthmatics under conditions of narrowed and dilated airways. We then assessed the effect of the bronchodilation on ventilatory capacity and the extent of ventilatory limitation during exercise. METHODS: Eleven asthmatics completed three exercise bouts on a cycle ergometer. Exercise was preceded by no treatment (trialCON), inhaled ß2 agonist (trialBD), or a eucapnic voluntary hyperpnea challenge (trialBC). Maximal expiratory flow-volume maneuvers (MEFV) were performed before and within 40 s of exercise cessation. Exercise tidal flow-volume loops were placed within the preexercise and postexercise MEFV curve and used to determine expiratory flow limitation and maximum ventilatory capacity (VËECap). RESULTS: Preexercise airway function was different among the trials (forced expiratory volume 1 s during trialCON, trialBD, and trialBC = 3.3 ± 0.8 L, 3.8 ± 0.8 L, and 2.9 ± 0.8 L, respectively; P < 0.05). Maximal expired airflow increased with exercise during all three trials, but the increase was greatest during trialBC (delta forced expiratory volume 1 s during trialCON, trialBD, and trialBC = +12.2% ± 13.1%, +5.2% ± 5.7%, +28.1% ± 15.7%). Thus, the extent of expiratory flow limitation decreased, and VËECap increased, when the postexercise MEFV curve was used. During trialCON and trialBC, actual exercise ventilation exceeded VËECap calculated with the preexercise MEFV curve in seven and nine subjects, respectively. CONCLUSIONS: These findings demonstrate the critical importance of exercise bronchodilation in the asthmatic with narrowed airways. Of clinical relevance, the results also highlight the importance of assessing airway function during or immediately after exercise in asthmatic persons; otherwise, mechanical limitations to exercise ventilation will be overestimated.
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Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Asma/fisiopatología , Bronquios/fisiología , Ejercicio Físico/fisiología , Ventilación Pulmonar/fisiología , Adolescente , Adulto , Bronquios/fisiopatología , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Función Respiratoria , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the exercise capacity of children and adolescents with severe therapy resistant asthma (STRA) aiming to identify its main determinants. METHODS: Cross-sectional study including individuals aged 6-18 years with a diagnosis of STRA. Clinical (age and gender), anthropometric (weight, height and body mass index) and disease control data were collected. Lung function (spirometry), cardiopulmonary exercise testing (CPET) and exercise-induced bronchoconstriction (EIB) test were performed. RESULTS: Twenty-four patients aged 11.5 ± 2.6 years were included. The mean forced expiratory volume in one second (FEV1) was 91.3 ± 9.2%. EIB occurred in 54.2% of patients. In CPET, the peak oxygen uptake (VO2peak) was 34.1 ± 7.8 mL kg-1 min-1. A significant correlation between ventilatory reserve and FEV1 (r = 0.57; p = 0.003) was found. Similarly, there was a significant correlation between CPET and percent of FEV1 fall in the EIB test for both VE/VO2 (r = 0.47; p = 0.02) and VE/VCO2 (r = 0.46; p = 0.02). Patients with FEV1<80% had lower ventilatory reserve (p = 0.009). In addition, resting heart rate correlated with VO2peak (r=-0.40; p = 0.04), VE/VO2 (r = 0.46; p = 0.02) and VE/VCO2 (r = 0.48; p = 0.01). CONCLUSIONS: Exercise capacity is impaired in approximately 30% of children and adolescents with STRA. The results indicate that different aspects of aerobic fitness are influenced by distinct determinants, including lung function and EIB.
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Asma/fisiopatología , Tolerancia al Ejercicio , Adolescente , Asma/diagnóstico , Asma/tratamiento farmacológico , Niño , Estudios Transversales , Prueba de Esfuerzo/métodos , Tolerancia al Ejercicio/fisiología , Volumen Espiratorio Forzado , HumanosRESUMEN
Abstract Aim: To show the possible immunologic pathways of protection for asthmatics against infection of Covid-19 through the capacity of recognition and cytotoxicity to eliminate pathogens improved by regular exercise aerobic. Methods: The bibliographic search was conducted on the following databases: Pubmed/Medline, Scielo, and Scholar Google from 2020 to 2021. The following keywords and Boolean operators were used: asthma, aerobic training (AT), immune system, and Covid-19. Results: After the screening, 349 were initially found, after evaluation only 20 studies had all criteria. Twelve studies showed that AT induces changes in the immune system with a reduction of inflammation. In complement, the literature showed an innate pathway that improves immune function against COVID-19 by reducing angiotensin-converting enzyme 2 (ACE2) in the lung, which seems to hinder the multiplication of the COVID-19 virus in the lung. Apparently, asthmatics patients are less susceptible to respiratory infection caused by COVID-19 because they have low levels of ACE2. Furthermore, trained asthmatics showed a lower risk of infection for SARS-CoV-2. Conclusion: The findings reported that asthmatics people can benefit from AT, and these individuals seem not to be a risk group for covid-19 because they have low levels of ACE2 protein. Taken together, this review reinforces the importance of asthmatic patients be physically active throughout their lifetime, but specially during the pandemic to prevent contamination by SARS-CoV-2.
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Humanos , Asma/fisiopatología , Ejercicio Físico , SARS-CoV-2/inmunología , COVID-19/epidemiología , Sistema InmunológicoRESUMEN
BACKGROUND: The prostaglandin D2 (PGD2) receptor 2 (DP2 receptor) pathway is an important regulator of the inflammatory cascade in asthma, which can be stimulated by allergic or non-allergic triggers. Fevipiprant is an oral, non-steroidal, highly selective, reversible antagonist of the DP2 receptor that inhibits the binding of PGD2 and its metabolites. METHODS: SPIRIT, a 2-treatment period (52-week, double-blind and optional 104-week single-blind), randomised, placebo-controlled, multicentre, parallel-group study, assessed the long-term safety of fevipiprant (150 mg and 450 mg o.d.) added to standard of care in patients ≥ 12 years with uncontrolled asthma. Stratified block randomisation was used. Patients were randomised in an approximate ratio of 3:3:1 (fevipiprant 150 mg, fevipiprant 450 mg or placebo). Patients were either newly enrolled or had participated in a previous fevipiprant Phase 3 trial. Primary endpoints were: time-to-first treatment emergent adverse event (AE); serious AE; and AE leading to discontinuation from study treatment. Data from both treatment periods were combined for analyses. Data were collected during study site visits. RESULTS: In total, 1093 patients were randomised to receive fevipiprant 150 mg, 1085 to fevipiprant 450 mg, and 360 to placebo. Overall, 1184 patients had ≥ 52 weeks' treatment, while 163 received ≥ 104 weeks' treatment. Both doses were well tolerated, with a safety profile similar to placebo both in new patients and in those enrolled from previous studies. In exploratory analyses, reduced rates of moderate-to-severe asthma exacerbations, increased time-to-first moderate-to-severe asthma exacerbation and improved FEV1 were observed for both doses of fevipiprant versus placebo; these were without multiplicity adjustment and should be interpreted with caution. SPIRIT was terminated early, on 16 December 2019, by the Sponsor. CONCLUSIONS: In patients with uncontrolled asthma, the addition of fevipiprant had a favourable long-term safety profile. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03052517, prospectively registered 23 January 2017, https://clinicaltrials.gov/ct2/show/NCT03052517 .