Cough in Asthma Is due to Eosinophilic Airway Inflammation: A Pro/Con Debate.

Lung. 2013 Dec 14;

Authors: Niimi A, Brightling CE, Dicpinigaitis PV

Abstract
Multiple prospective studies have demonstrated that asthma is among the most common etiologies of chronic cough, along with upper-airway cough syndrome (formerly known as postnasal drip syndrome) and gastroesophageal reflux disease. More recently, the entity of nonasthmatic eosinophilic bronchitis has been appreciated as a significant cause of chronic cough worldwide. Chronic cough associated with both of these conditions typically responds well to therapy with systemic or inhaled corticosteroids, thus leading to a general assumption that the suppression of eosinophilic airway inflammation explains the improvement in cough. However, some recent studies challenge a causal relationship between eosinophilic airway inflammation and cough in asthmatics. The 4th American Cough Conference, held in New York in June 2013, provided an ideal forum for discussion and debate of this issue between two internationally recognized experts in the field of asthma and chronic cough.

PMID: 24337175 [PubMed - as supplied by publisher]

Clinical significance of small airway obstruction markers in patients with asthma.

Clin Exp Allergy. 2013 Dec 16;

Authors: Gonem S, Natarajan S, Desai D, Corkill S, Singapuri A, Bradding P, Gustafsson P, Costanza R, Kajekar R, Parmar H, Brightling CE, Siddiqui S

Abstract
BACKGROUND: The role of small airway obstruction in the clinical expression of asthma is incompletely understood.
OBJECTIVE: We tested the hypotheses that markers of small airway obstruction are associated with (i) increased asthma severity, (ii) impaired asthma control and quality of life, and (iii) frequent exacerbations.
METHODS: Seventy-four adults with asthma and 18 healthy control subjects underwent impulse oscillometry (IOS), multiple breath inert gas washout (MBW), body plethysmography, single-breath determination of carbon monoxide uptake and spirometry. Patients completed the six-point Asthma Control Questionnaire (ACQ-6) and standardised Asthma Quality of Life Questionnaire (AQLQ(S)). Asthma severity was classified according to the Global Initiative for Asthma (GINA) treatment steps.
RESULTS: The putative small airway obstruction markers Sacin , resistance at 5Hz minus resistance at 20 Hz (R5-R20) and reactance area (AX) were not independently associated with asthma severity, control, quality of life or exacerbations. In contrast, markers of total (R5) and mean airway resistance of large and small airways (R20) were significantly higher in the severe asthma group compared to the mild-moderate group (0.47 vs 0.37, p < 0.05 for R5; 0.39 vs 0.31, p < 0.01 for R20). The strongest independent contributors to ACQ-6 score were R20 and forced expiratory volume in one second (% pred.), and the strongest independent contributors to AQLQ(S) score were R20 and forced vital capacity (% pred.). A history of one or more exacerbations within the previous year was independently associated with R20.
CONCLUSIONS AND CLINICAL RELEVANCE: Previously reported markers of small airway obstruction do not appear to be independently associated with asthma disease expression. In contrast, the IOS parameter R20, a marker of mean airway resistance of both large and small airways, appears to have independent clinical significance. These observations require confirmation in prospective longitudinal studies. This article is protected by copyright. All rights reserved.

PMID: 24341600 [PubMed - as supplied by publisher]

Procalcitonin guided antibiotic therapy of acute exacerbations of asthma: a randomized controlled trial.

BMC Infect Dis. 2013 Dec 17;13(1):596

Authors: Tang J, Long W, Yan L, Zhang Y, Xie J, Lu G, Yang C

Abstract
BACKGROUND: This randomized controlled trial aimed to evaluate whether the serum procalcitonin (PCT) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma.
METHODS: A total of 293 consecutive patients with suspected asthma attacks from February 2005 to July 2010 participated in this study. 225 patients completed the study. Serum PCT levels, and other inflammatory biomarkers of all patients were measured. In addition to the standard treatment, the control group received antibiotics according to the attending physicians' discretions, while the patients in the PCT group were treated with antibiotics according to serum PCT concentrations. Antibiotics usage was strongly discouraged when the PCT concentration was below 0.1 mug/L; discouraged when the PCT concentration was between 0.1 mug/L and 0.25 mug/L; or encouraged when the PCT concentration was above 0.25 mug/L. The primary endpoint was the determination of antibiotics usage. The second endpoints included the diagnostic accuracy of PCT and other laboratory biomarkers the effectiveness of asthma control, secondary ED visits, hospital re-admissions, repeated needs for steroids or dosage increase, needs for antibiotics, WBC count, PCT levels and FEV1%.
RESULTS: At baseline, two groups were identical regarding clinical, laboratory and symptom score. Probability of the antibiotics usage in the PCT group (46.1%) was lower than that in the control group (74.8%) (chi2 = 21.97, p < 0.001. RR = 0.561, 95% CI 0.441-0.713). PCT and IL-6 showed good diagnostic significance for bacterial asthma (r = 0.705, p = 0.003). The degrees of asthma control in patients were categorized to three levels and were comparable between the two groups at the six weeks follow-up period (chi2 = 1.62, p = 0.45). There were no significant difference regarding other secondary outcomes (p > 0.05).
CONCLUSIONS: The serum PCT concentration can be used to effectively determine whether the acute asthma patients have bacterial infections in the respiratory tract, and to guide the use of antibiotics in the treatment of acute asthma exacerbations, which may substantially reduce unnecessary antibiotic use without compromising the therapeutic outcomes.Trial registration: ICTRP ChiCTR-TRC-12002534.

PMID: 24341820 [PubMed - as supplied by publisher]

Skin sensitization to aeroallergens in the child: cross-sectional study of 200 cases.

Tunis Med. 2013 Nov;91(11):627-32

Authors: Malouche S, Boussetta K, Ben Hassine L, Malouche K, Siala M, Nessib F, Mongalgi MA, Ben Hassen A, Rejeb S, Boussnina S

Abstract
Background: The prevalence of the allergic diseases increased considerably during the last decades. The clinical expression of allergy depends on the interaction of genetic and environmental factors. aim: The aim of our study was to evaluate the prevalence of sensitizing to aeroallergens in the child and to determine the risk factors of sensitizing. methods: We carried out a cross-sectional study relating to 200 pediatric patients of the Mahmoud El Matri hospital, aged from 3 to14 years. We performed skin prick test to 12 current aeroallergens. results: The prevalence of sensitizing to aeroallergens was 14%. Acarina (DP and/or DF) represented the allergens accused in the majority of the cases (96,4% of the cases). The statistical analysis of the various risk factors of sensitizing showed that these factors were: the presence of a family atopy (p= 0,0034) particularly a maternal asthma (p< 0,001), the personal atopy specially an asthma, an allergic rhinitis or eczema atopic (p< 10-5), the short breast-feeding (p= 0,033) and the home humidity (p=0,0072). Several risk factors reported in the literature did not seem to intervene in our study (the passive smoking, the urban dweling, the age of food diversification, infections at the low age). Conclusion: The prevalence of sensitizing to aeroallergens is relatively high in our series. Many factors could explain the increase of the allergic diseases. Our study stresses the importance of the genetic, nutritional and environmental factors in the appearance of aeroallergens sensitization.

PMID: 24343484 [PubMed - in process]