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Vitamin D deficiency is associated with impaired disease control in asthma-COPD overlap syndrome patients.

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Vitamin D deficiency is associated with impaired disease control in asthma-COPD overlap syndrome patients.

Int J Chron Obstruct Pulmon Dis. 2015;10:2017-25

Authors: Odler B, Ivancsó I, Somogyi V, Benke K, Tamási L, Gálffy G, Szalay B, Müller V

Abstract
INTRODUCTION: The association between vitamin D and clinical parameters in obstructive lung diseases (OLDs), including COPD and bronchial asthma, was previously investigated. As asthma-COPD overlap syndrome (ACOS) is a new clinical entity, the prevalence of vitamin D levels in ACOS is unknown.
AIM: Our aim was to assess the levels of circulating vitamin D (25-hydroxyvitamin D [25(OH)D]) in different OLDs, including ACOS patients, and its correlation with clinical parameters.
METHODS: A total of 106 men and women (control, n=21; asthma, n=44; COPD, n=21; and ACOS, n=20) were involved in the study. All patients underwent detailed clinical examinations; disease control and severity was assessed by disease-specific questionnaires (COPD assessment test, asthma control test, and modified Medical Research Council); furthermore, 25(OH)D levels were measured in all patients.
RESULTS: The 25(OH)D level was significantly lower in ACOS and COPD groups compared to asthma group (16.86±1.79 ng/mL and 14.27±1.88 ng/mL vs 25.66±1.91 ng/mL). A positive correlation was found between 25(OH)D level and forced expiratory volume in 1 second (r=0.4433; P<0.0001), forced vital capacity (FVC) (r=0.3741; P=0.0004), forced expiratory flow between 25% and 75% of FVC (r=0.4179; P<0.0001), and peak expiratory flow (r=0.4846; P<0.0001) in OLD patient groups. Asthma control test total scores and the 25(OH)D level showed a positive correlation in the ACOS (r=0.4761; P=0.0339) but not in the asthma group. Higher COPD assessment test total scores correlated with decreased 25(OH)D in ACOS (r=-0.4446; P=0.0495); however, this was not observed in the COPD group.
CONCLUSION: Vitamin D deficiency is present in ACOS patients and circulating 25(OH)D level may affect disease control and severity.

PMID: 26451099 [PubMed - in process]

The Influence of Insulin Therapy on the Course of Acute Exacerbation of Bronchial Asthma.

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The Influence of Insulin Therapy on the Course of Acute Exacerbation of Bronchial Asthma.

Adv Exp Med Biol. 2015 Oct 10;

Authors: Wytrychowski K, Obojski A, Hans-Wytrychowska A

Abstract
Large doses of systemic corticosteroids are the basis of treatment of acute exacerbation of bronchial asthma. The hyperglycemic activity of systemic corticosteroids often leads to the loss of control of diabetes diagnosed earlier or to its first diagnosis during treatment of the exacerbation of asthma. We conducted a prospective, randomized study in a group of 24 adult patients treated for asthma exacerbation, with the blood glucose level at admission above 8.4 mmol/l. The patients were randomly divided into a group treated with intravenous insulin infusion by an electric syringe pump in doses controlling glycemia at 4.5-7.2 mmol/l (Group A) and a group of patients treated with insulin administered subcutaneously in three doses controlling glycemia at 7.2-10.0 mmol/l (Group B). A control group (Group C) consisted of patients without any disturbances in carbohydrate metabolism, treated for exacerbation of asthma. Asthma exacerbation was treated in all groups in a uniform way. We found that the average hospitalization time was 8.2 ± 2.4 days in Group A, 10.2 ± 5.2 days in Group B, and 5.8 ± 1.9 days in Group C; the last being significantly shorter than those in Groups A and B. We conclude that hyperglycemia is a significant factor increasing the risk of extending hospitalization time due to asthma exacerbation, regardless of the way of insulin therapy.

PMID: 26453066 [PubMed - as supplied by publisher]

Update on Pediatric Cough.

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Update on Pediatric Cough.

Lung. 2015 Oct 11;

Authors: Kantar A

Abstract
Despite the high prevalence of cough in children, the topic has been poorly researched. Although pediatricians recognize that chronic cough in children is different from that in adults, this difference seems less recognizable to other health professionals. During childhood, the respiratory tract and nervous system undergo a series of anatomical and physiological maturation processes that influence the cough reflex. Additionally, immunological responses undergo developmental and memorial processes that make infection and congenital abnormalities the overwhelming cause of cough in children. The lack of comprehensive clinical data regarding chronic cough in children has initially required pediatricians to adopt an adult approach to the problem. In the last 10 years, however, research has led to the reconsideration of the etiology of chronic cough in children. Currently, attention has focused on protracted bacterial bronchitis as a major cause of chronic cough in preschool-aged children and as a possible precursor of bronchiectasis. New research horizons are emerging for both the treatment and prevention of particular causes of chronic cough in children.

PMID: 26455825 [PubMed - as supplied by publisher]

Roflumilast for asthma: Efficacy findings in non-placebo-controlled comparator and dosing studies.

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Roflumilast, a phosphodiesterase-4 inhibitor, has an established place in the treatment of chronic obstructive pulmonary disease. Its potential role as a treatment for asthma is unclear.

AIM: We report the results from seven double-blind, parallel group, phase II or III studies designed to compare roflumilast with two anti-inflammatory treatments, beclomethasone dipropionate (BDP) and montelukast, in patients with asthma.

METHODS: The studies of 6 to 12 week duration were conducted at 309 sites in Europe, North America, South Africa and Australia from 1998 to 2005. Data from 3,802 patients, aged 12-70 years who received either roflumilast 100μg, 250μg or 500μg once daily, BDP 400μg or 500μg twice daily, or 10mg montelukast once daily was analyzed. Primary endpoints were mean change and time averaged excess area under the curve in forced expiratory volume in one second (FEV1) over the duration of the study. Secondary endpoints included change in forced vital capacity and peak expiratory flow, asthma symptoms and the concomitant use of rescue medication.

RESULTS: Roflumilast was non-inferior to BDP and montelukast and consistently increased FEV1. Use of rescue medication and all asthma symptom scores decreased significantly with all treatments, but no statistically significant between-group differences were observed. Secondary lung function endpoints generally supported the conclusions of the primary outcome measure.

CONCLUSIONS: Roflumilast improves FEV1 and asthma symptoms in patients with mild to moderate asthma, and is non-inferior compared with both BDP and montelukast. It deserves further study as a potentially effective anti-inflammatory treatment for asthma.

Gut Microbiome and the Development of Food Allergy and Allergic Disease.

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The impact of gut microbiome on human development, nutritional needs, and disease has become evident with advances in the ability to study these complex communities of microorganisms, and there is growing appreciation for the role of the microbiome in immune regulation. Several studies have examined associations between changes in the commensal microbiota and the development of asthma, allergic rhinitis, and asthma, but far less have evaluated the impact of the microbiome on the development of food allergy.

This article reviews the human gastrointestinal microbiome, focusing on the theory and evidence for its role in the development of IgE-mediated food allergy and other allergic diseases.

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