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Asthma and allergies: is the farming environment (still) protective in Poland? The GABRIEL Advanced Studies.

Evidence exists that a farming environment in childhood may provide protection against atopic respiratory disease. In the GABRIEL project based in Poland and Alpine regions of Germany, Austria and Switzerland, we aimed to assess whether a farming environment in childhood is protective against allergic diseases in Poland and whether specific exposures explain any protective effect.

METHODS: In rural Poland, 23 331 families of schoolchildren completed a questionnaire enquiring into farming practices and allergic diseases (Phase I). A subsample (n = 2586) participated in Phase II involving a more detailed questionnaire on specific farm exposures with objective measures of atopy.

RESULTS: Farming differed between Poland and the Alpine centres; in the latter, cattle farming was prevalent, whereas in Poland 18% of village farms kept ≥1 cow and 34% kept ≥1 pig. Polish children in villages had lower prevalences of asthma and hay fever than children from towns, and in the Phase II population, farm children had a reduced risk of atopy measured by IgE (aOR = 0.72, 95% CI 0.57, 0.91) and skin prick test (aOR = 0.65, 95% CI 0.50, 0.86). Early-life contact with grain was inversely related to the risk of atopy measured by IgE (aOR = 0.66, 95% CI 0.47, 0.92) and appeared to explain part of the farming effect.

CONCLUSION: While farming in Poland differed from that in the Alpine areas as did the exposure-response associations, we found in communities engaged in small-scale, mixed farming, there was a protective farming effect against objective measures of atopy potentially related to contact with grain or associated farm activities.

Lung transplantation in patients with cystic fibrosis.

Cystic fibrosis (CF) an autosomal recessive genetic disorder, affects many organs. The great majority of deaths occur due to respiratory failure after many years of chronic pulmonary infection. Despite recent progress in early detection by studies of genetic mutations and better understanding to treat nutritional and infectious states, lung transplantation is the CF treatment for most advanced cases.

According to the International Society for Heart and Lung Transplantation (ISHLT) data, CF is the third most common reason for lung transplantation (16.8%) showing the best survival rate (60% at 5 years). We have described our experience in lung transplantation of CF patients between January 2000 and December 2011, reviewing medical charts of these patients were for gender, age, body mass index (BMI), comorbidities, disease duration, previous sputum gram stain, ischemic time, incidence of severe primary graft dysfunction (PGD Grade 3), intensive care unit (ICU) length of stay, and Kaplan-Meier survival. Among 150 lung transplantation, the 30 CF patients (20%) represented the second most common cause. The average age was 27.4 ± 9.2 years, with a slight predominance of males (n = 16; 53.3%). The average BMI was 18.9 ± 2.6. Most patients (60%) had pancreatic exocrine dysfunction. Also, 83.3% of patients showed a positive sputum culture for Pseudomonas, while Burkholderia cepacia was identified in only 4 patients (13.3%). The average time of the disease was 20.8 ± 9.7 years. All transplantation were bilateral with an average ischemic time of 472 ± 98.3 minutes and ICU length of stay of 9.9 ± 6.3 days.

The survival rates at 1 and 5 years were 92% and 77%, respectively, corresponding to the best outcomes among underlying diseases, comparable with other worldwide series and better than the ISHLT reports. CF, the second most common cause for lung transplantation among our cases, showed the best survival rate among all causes. Our survival rate was comparable with other reports.

Viral and bacterial infection in acute asthma & chronic obstructive pulmonary disease increases the risk of readmission.

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Viral and bacterial infection in acute asthma & chronic obstructive pulmonary disease increases the risk of readmission.

Respirology. 2013 Apr 22;

Authors: Wark P, Tooze M, Powell H, Parsons K

Abstract
BACKGROUND AND OBJECTIVE: Infection is as an important trigger for acute asthma and chronic obstructive pulmonary disease (COPD). We aimed to determine the prevalence and impact of virus and bacterial infections in acute asthma and COPD. METHODS: Subjects were recruited, within 24 hours of hospital admission for acute exacerbations of asthma and COPD. Nose/throat swabs and sputum samples were collected and examined by multiplex PCR for respiratory viruses and cultured for bacteria. The primary outcomes were length of stay (LOS) and readmission to hospital within 60 days. RESULTS: A total of 199 subjects were recruited (96 had asthma and 103 COPD) for 235 events (36 re-presented). A virus was detected in 79 subjects (40%), bacteria in 41 (21%) and of these, 18 had both. Rhinovirus-A was the most frequently isolated virus. A multivariate analysis was performed to control for confounders. It found that detection of a virus, a virus and bacteria, FEV1 and a diagnosis of COPD were all independent predictors of prolonged LOS. While risk of readmission within 60 days was increased with virus infection alone, virus and bacterial infection, lower FEV1 and current smoking. CONCLUSIONS: Virus infection, especially in the presence of chronic bacterial infection is an important determinant of more severe acute exacerbations in both asthma and COPD and co-infection are more likely to be readmitted to hospital following their exacerbation.

PMID: 23600594 [PubMed - as supplied by publisher]

New treatments for COPD.

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New treatments for COPD.

Curr Opin Pharmacol. 2013 Apr 18;

Authors: Ngkelo A, Adcock IM

Abstract
Chronic obstructive pulmonary disease (COPD) is a major health problem worldwide. It is characterised by chronic inflammation in the lungs that leads to progressive chronic airflow obstruction. The main strategy for treating COPD is control of the chronic inflammation. However, current anti-inflammatory treatments fail to prevent disease progression. New long-acting bronchodilators and their combinations are currently under development. Research has been focused on identifying the key inflammatory regulators. CXCR2 antagonists inhibit neutrophilic inflammation; inhibitors of phosphodiesterase-4 (PDE4), p38 mitogen-activated protein kinase (p38), Janus kinases and IL-6 have also shown some promising effects. There is an emerging need for identification of key modulators of the oxidative stress-regulated corticosteroid function aiming the development of monotherapies which will resolve any side effects issues currently faced.

PMID: 23602653 [PubMed - as supplied by publisher]

Indacaterol on dyspnea in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized placebo-controlled trials.

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Indacaterol on dyspnea in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized placebo-controlled trials.

BMC Pulm Med. 2013 Apr 25;13(1):26

Authors: Han J, Dai L, Zhong N

Abstract
BACKGROUND: Indacaterol is a novel, once-daily (od), inhaled, long-acting Ss2-agonist bronchodilator for maintenance treatment of airflow limitation in patients with COPD. The aim of this study was to evaluate the efficacy of indacaterol on dyspnea, using available randomized placebo-controlled trials. METHODS: A systematic search was made of MEDLINE, EMBASE, the Cochrane trials databases, and a manual search of journals. Randomized placebo-controlled trials of 12 weeks or more comparing indacaterol with placebo were reviewed, and eligible studies were included in a meta-analysis. The odds ratio (OR) for likelihood of achieving TDI score >= 1 after 12 weeks of treatment was used as an outcome measure to compare indacaterol to placebo. RESULTS: Six trials were included in the analysis. Relative to placebo, the overall ORs for response were: indacaterol 75mug od 1.784 (95% CI 1.282 to 2.482); indacaterol 150mug od 2.149 (95% CI 1.746 to 2.645); and indacaterol 300mug od 2.458 (95% CI 2.010 to 3.006). Overall OR for response in TDI tended to increase with higher indacaterol doses. CONCLUSIONS: Patients receiving indacaterol had clinically significant improvements in symptoms of dyspnea compared to placebo. Incremental benefits in TDI were observed with increasing doses. Indacaterol may provide patients and physicians with a useful treatment option in symptomatic patients with dyspnea.

PMID: 23617268 [PubMed - as supplied by publisher]

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