Pauci-granulocytic stable asthma (Article from Allergy 2017)

Read new article on hot topic paucigranulocytic asthma in comparison with another inflammatory asthma phenotypes! The emergence and increasing availability of validated, feasible non-invasive methods of assessment of inflammation has led to a greater understanding of inflammatory phenotypes in asthma. Two distinct and apparently stable sputum inflammatory phenotypes have been described, eosinophilic and non-eosinophilic, which have a differential treatment response, particularly to glucocorticosteroids. The classification has been further revised:  eosinophilic, neutrophilic, mixed granulocytic (raised eosinophils and neutrophils) and paucigranulocytic (normal levels of eosinophils and neutrophils).

http://onlinelibrary.wiley.com/doi/10.1111/all.13184/abstract

Background

According to induced sputum cell count, four different asthma phenotypes have been recognised(eosinophilic, neutrophilic, mixed and pauci-granulocytic). The aim of the present study was to detect functional and inflammatory characteristics of patients with pauci-granulocytic asthma.

Methods

240 asthmatic patients were categorised in the four phenotypes according to cell counts in induced sputum. All patients underwent pulmonary function tests, and measurement of FeNO. The levels of IL-8, IL-13, and ECP were also measured in sputum supernatant. Treatment, asthma control and the presence of Severe Refractory Asthma(SRA) were also recorded.

Results

Patients were categorized in the four phenotypes as follows: eosinophilic (40%), mixed (6.7%), neutrophilic (5.4%) and pauci-granulocytic (47.9%). Although ACT did not differ between groups (p=0.288) patients with pauci-granulocytic asthma had better lung function (FEV₁%pred) (median (IQR):71.5(59.0-88.75) vs 69.0(59.0-77.6) vs 68.0(60.0-85.5) vs 80.5(69.7-95.0), p=0.009] for eosinophilic, mixed, neutrophilic and pauci-granulocytic asthma respectively, p=0.009). SRA occurred more frequently in the eosinophilic and mixed phenotype (41.6% and 43.7% respectively) and less frequently in the neutrophilic and pauci-granulocytic phenotype (25% and 21.7% respectively, p=0.01). FeNO, ECP and IL-8 were all low in the pauci-granulocytic, whereas as expected FeNO and ECP were higher in eosinophilic and mixed asthma, while IL-8 was higher in patients with neutrophilic and mixed asthma(p<0.001 for all comparisons). Interestingly, 14.8% of patients with pauci-granulocytic asthma had poor asthma control.

Conclusion

Pauci-granulocytic asthma most likely represents a “benign” asthma phenotype, related to a good response to treatment, rather than a “true” phenotype of asthma. However, pauci-granulocytic patients that remain not-well-controlled despite optimal treatment represent an asthmatic population that requires further study for potential novel targeted interventions.

Direct link to article:

http://onlinelibrary.wiley.com/doi/10.1111/all.13184/abstract

Effects of body mass index, tobacco smoking, alcohol drinking and solid fuel use on the risk of asthma: meta-analysis from BMJ Open Resp Res 2016 (free full text)

Background We assessed the relationship of body mass index (BMI), smoking, drinking and solid fuel use (r; SFU), and the individual and combined effects of these factors on wheezing symptoms (WS) and on diagnosed asthma (DA).

Methods We analysed 175 000 individuals from 51 nationally representative surveys, using self-reports of WS and DA as the measures of asthma. The fixed-effects and random-effects estimates of the pooled ORs between asthma and underweight (BMI <18.5 kg/m²), obesity (BMI ≥30 kg/m²), smoking, drinking and SFU were reported.

Results The pooled risks of all individual risk factors were significantly associated with WS and DA (with the exception of current smoking with DA in women and SFU with DA in both genders). Stronger dose–response relationships were seen in women for smoking amounts and duration; BMI showed stronger quadratic relationships. The combined risks were generally larger in women than in men, with significant risks for underweight (OR=2.73) as well as obese (OR=2.00) smokers for WS (OR=2.13 and OR=1.58 for DA, respectively). The magnitude of the combined effects from low/high BMI, smoking and drinking were also consistently higher among women than among men in WS and DA. SFU among underweight smokers also had positive association with WS (men and women) and DA (women).

Conclusions BMI, smoking, drinking and SFU—in combination—are associated with double or triple the risk of development of asthma. These risk factors might help explain the wide variation in asthma burden across countries. 

Free full text:

http://bmjopenrespres.bmj.com/content/3/1/e000121.full

Evolving Concepts of Asthma in 2015

Dear Friends, in American Journal of Respiratory and Critical Care Medicine appeared new article on concepts of asthma!
Our understanding of asthma has evolved over time from a singular disease to a complex of various phenotypes, with varied natural histories, physiologies, and responses to treatment. Early therapies treated most patients with asthma similarly, with bronchodilators and corticosteroids, but these therapies had varying degrees of success. Similarly, despite initial studies that identified an underlying type 2 inflammation in the airways of patients with asthma, biologic therapies targeted toward these type 2 pathways were unsuccessful in all patients. These observations led to increased interest in phenotyping asthma. Clinical approaches, both biased and later unbiased/statistical approaches to large asthma patient cohorts, identified a variety of patient characteristics, but they also consistently identified the importance of age of onset of disease and the presence of eosinophils in determining clinically relevant phenotypes. These paralleled molecular approaches to phenotyping that developed an understanding that not all patients share a type 2 inflammatory pattern. Using biomarkers to select patients with type 2 inflammation, repeated trials of biologics directed toward type 2 cytokine pathways saw newfound success, confirming the importance of phenotyping in asthma. Further research is needed to clarify additional clinical and molecular phenotypes, validate predictive biomarkers, and identify new areas for possible interventions.

Read more: 
http://www.atsjournals.org/doi/abs/10.1164/rccm.201504-0763PP#.VhKqFitqqUl

Call for Repiratory patient organisation representatives to join the European Medicines Agency's management board

Dear Respiratory friends, this is speacial call for Respiratory Patient Organisations!
The Health and Food Safety Directorate-General of the European Commission has launched a call for expressions of interest to represent civil society in the Management Board of the European Medicines Agency (EMA).

http://ec.europa.eu/health/documents/public_call/call_index_en.htm

Two members representing patients’ organisations, one member representing healthcare professionals’ organisations and one member representing veterinarians’ organisations will be appointed for a renewable three-year period. The term of office of the current members expires on 20 March 2016.
Further details, including information on the assessment criteria and the application procedure, can be found on the Commission’s website.

New Global Initiative for Asthma 2015 strategy: a roadmap to asthma control

Today was published in ERJ: A summary of the new GINA strategy: a roadmap to asthma control!

Over the past 20 years, the Global Initiative for Asthma (GINA) has regularly published and annually updated a global strategy for asthma management and prevention that has formed the basis for many national guidelines. However, uptake of existing guidelines is poor. A major revision of the GINA report was published in 2014, and updated in 2015, reflecting an evolving understanding of heterogeneous airways disease, a broader evidence base, increasing interest in targeted treatment, and evidence about effective implementation approaches. During development of the report, the clinical utility of recommendations and strategies for their practical implementation were considered in parallel with the scientific evidence. 

This article provides a summary of key changes in the GINA report, and their rationale. The changes include a revised asthma definition; tools for assessing symptom control and risk factors for adverse outcomes; expanded indications for inhaled corticosteroid therapy; a framework for targeted treatment based on phenotype, modifiable risk factors, patient preference, and practical issues; optimisation of medication effectiveness by addressing inhaler technique and adherence; revised recommendations about written asthma action plans; diagnosis and initial treatment of the asthma−chronic obstructive pulmonary disease overlap syndrome; diagnosis in wheezing pre-school children; and updated strategies for adaptation and implementation of GINA recommendations. 

Full text of the article:

http://erj.ersjournals.com/content/early/2015/07/23/13993003.00853-2015.full

Asthma 2015 Guidelines: The 2015 update of the Global Strategy for Asthma Management and Prevention

The 2015 update of the Global Strategy for Asthma Management and Prevention incorporates new scientific information about asthma based on a review of recent scientific literature by an international panel of experts on the GINA Science Committee. It is the first annual update of the document since a major revision was launched on World Asthma Day, May 6, 2014. This comprehensive and practical resource about one of the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.

You Can Control Your Asthma on World Asthma Day 2014

World Asthma Day is organized by the Global Initiative for Asthma (GINA) in collaboration with health care groups and asthma educators to raise awareness about asthma and improve asthma care throughout the world

Each year GINA chooses a theme and organizes preparation and distribution of World Asthma Day materials and resources. World Asthma Day activities are organized in each country by health care professionals, educators, and members of the public who want to help reduce the burden of asthma.

 

The first World Asthma Day, in 1998, was celebrated in more than 35 countries in conjunction with the first World Asthma Meeting held in Barcelona, Spain. Participation has increased with each World Asthma Day held since then, and the day has become one of the world's most important asthma awareness and education events.

World Asthma Day 2014 will take place on Tuesday, May 6, 2014. The theme will be "You Can Control Your Asthma," continuing the emphasis on asthma control highlighted in past WAD events. The sub-theme, "It's Time to Control Asthma" will also be continued this year, with activity organizers encouraged to adapt the "It's Time to..." statement in ways relevant to their individual events. On World Asthma Day 2014 GINA will release a new, extensively revised version of the Global Strategy for Asthma Management and Prevention. 

AMERICAN COLLEGE OF PHYSICIANS RECOMMENDS THE DOCTORS DO NOT ACCEPT REQUESTS FOR FRIENDSHIP OF PATIENTS BY NETWORKS

Physicians should avoid accepting as "friend" requests from former or current patients through social networks, according to a new statement issued by the American College of Physicians (ACP), together with Federation of State Medical Boards (FSMB) at its annual meeting in the U.S., last Friday. Pages business or group medical practices are acceptable, but doctors should keep this separate from their personal pages.

While social networks may provide benefits in the doctor-patient relationship, they can also present ethical problems. In a survey of state boards of health in the U.S., 92% received complaints about the behavior of the doctors on the Internet, which led to actions including revocation of license.

According to the document, the physician should respect five principles:
- Protect the confidence, confidentiality, privacy and respect in online communications with patients;
- Maintain professional and social spheres independent online but act professionally in both
- Use e-mail and other electronic communications only in doctor-patient relationships established;
- Make a "self-audit" to determine the periodic accuracy of the information available online;
- Be aware that online postings may have other implications for their professional lives.

Do you agree with these principles?

Disabled Lady with Brittle Asthma

Dear Respiratory Friends today we are publishing real story of one patient with asthma from UK: Disabled Lady with Brittle Asthma to be forced out of her own private home, because a housing association wants to do works on an estate.

I live in Cheshire and have brittle asthma. This means I am hypersensitive to dust especially building dust. The local housing association are to carry out works on 7 blocks of flats, all within 300 yards of my home. I will therefore have to leave our home for 4 months whilst the works are carried out. I am also disabled, and cannot carry more than the weight of 2 pints of milk.

http://epetitions.direct.gov.uk/petitions/33111

If you the reader were to be effectively evicted from your own property for 4 months through no fault of your own, how would you feel.

The housing association do not believe that the disturbance that they are going to cause is enough that I will have to move out, and that they think that I am the one being unreasonable in my request. This is despite them having all the medical evidence from my doctors and other specialists, and me previously having to move out during previous works.

At birth I had eczema and later at puberty, I developed type 1 brittle asthma with atopy. This means that I am hypersensitive to chemicals, food types straw and irritants, such as building dust, paint and wet or dry cement. They will either affect my eczema or asthma.

I am affected by this type of pollution, up to half a mile away.

I am not unique, there are about 250,000 people with brittle asthma in the UK, and 10% of the population have asthma at some level. There are two types of asthma. My type I have several asthma attacks per day, and I need to get away from the cause. Otherwise my breathing will get worse until I will have to go to hospital. The other type of asthma is people who are generally fine, but very occasionally come into contact with something that will cause a severe asthma attack, which can often be fatal.

We have set up an e petition regarding respiratory disease and asthma sufferers. This is non-political in the sense that it is not party political, and would benefit practically everyone. We have been going since May 2012, and we are well inside the top 6.5% of current e petitions. This is for a cause that is not aimed at giving the beneficiaries of the e petition financial gain, so you can see it has much merit.

What we are proposing is that people who have been certified by their doctor to be hypersensitive to anything related to external pollution, which affects them within their own home (either purchased or with a 6 month tenancy or more) can ask to be moved to a suitable accommodation out of harm’s way.

The housing association have a guest flat which is far enough away with a bed a suttee and a hob, where I could go, but they won’t let me have it because they say that my requests are unreasonable. They also have all sorts of other properties all over the north west.

As you can see I am not looking for luxury or anything that will cost them much at all, just a clean  dwelling that does not affect my asthma, that I can stay in permanently. They have tried to say that they have day centres I can go to, but as a disabled person, I can’t move every day to a day centre.

I think it is disgraceful that a housing association can make someone leave their own home, and not think that they have any responsibility for their actions. It is against human rights law, but I cannot afford to take them to court. It is my opinion, that in these conditions the boot should be on the other foot.

Asthma UK say that the UK Government is looking at prevention rather than than cure. If this is the case, then this is what they have been looking for, as there are on average 219 emergency cases of asthma each day sent to hospital, and 3 of these die.

Most building companies and councils and the like have spare accommodation that can be used for this type of issue. Other companies may need to make a very small provision in their building contracts for people like me.

The massive savings to the country will be the following:

1.      Fewer deaths (currently 3 per day from asthma)

2.      Fewer admissions to hospital (219 per day from asthma alone currently)

3.      Fewer doctor’s appointments

4.      Fewer days off sick

5.      Increase in wages or financial security for RD & A sufferers

6.      Increased productivity for the employee

7.      Increased productivity for the employer

8.      Savings for the NHS

9.      Fewer respiratory drugs needed by patients of the NHS

All of this available just for making provision for the estimated 250,000 people who suffer even low level pollution from works. Over time this can be even more accurately predicted, with the knowledge of where these respiratory disease and asthma sufferers live.

I hope this makes perfect sense to you, and that we can work together to get these changes implemented.

REF: Respiratory disease and asthma e petition.

http://epetitions.direct.gov.uk/petitions/33111

Press Conference at ERS Annual Congress 2012: Connection between Parental Problems and Children's Non-Adherence to Asthma Medication

Professor Paul Brand, Princess Amalia children's Clinic, The Netherlands presented a study on parental problems which prevent children taking much-needed asthma medication.

The motive of realising this investigation is the indeterminacy of major barriers which many little patients face while asthma treatment. The research was based not only on clinical cases, but mostly on discussion of hows and whys of (non)adherence. A part of qualitative study consisted in recording and analysing of factors associated with family lifestyles which could be causing low adherence to asthma medication.  

It was established that there are several types of users:

1) Followers manifest stable adherence to doctor's prescriptions.  These are highly disciplined parents who are always aware of giving the medicine to their children. 

2) Self-managers usually look closely at how child is doing. They have a high observation spirit and link the treatment to their schedule. 

3) A highly variable adherence is typical for Strugglers who follow the medication in a disordered way.

4) Chaotic users belong to the families with lower education. They never force the child and are even shocked when the kids do not take the medication. They think of a child as of an adult who is responsible and can do everything by himself.

In-depth interviews have shown that the lifestyle factors often hide behind children's non-adherence to the prescribed medication. It was concluded that parenting problems can be the reasons of ineffective following of the treatment.

Therefore it would be reasonable if doctors would give a genuine interest in what happens with the patient and would encourage the parents to keep a close eye on their child's adherence. Otherwise it will be impossible to reveal and to remove the barriers preventing the appropriate asthma treatment in children.

Liudmila CORLATEANU,
Respiratory Decade Official Media-Representative at ERS 2012 Vienna Congress

LUNGUAGE and ReSpublic: new Respiratory resources

Dear Respiratory friends, we are happy to launch LUNGUAGE and ReSpublic: two new Respiratory Resources. Here we will share all new information about all respiratory!

We are encouraging everybody to share with us all relevant respiratory resources, because LUNGUAGE and ReSpublic will be the First Free open sources of Respiratory information for Health care professionals, patients and all public interested in lung health! 


Our LUNGUAGE is Respiratory! 

Today is World Asthma Day 2012!

Asthma is a serious global health problem. People of all ages in countries throughout the world are affected by this chronic airway disorder that, when uncontrolled, can place severe limits on daily life and is sometimes fatal. The prevalence of asthma is increasing in most countries, especially among children. Asthma is a significant burden, not only in terms of health care costs but also of lost productivity and reduced participation in family life.

GINA

GINA's (Global Strategy for Asthma Management and Prevention) presents a comprehensive plan to manage asthma with the goal of reducing chronic disability and premature deaths while allowing patients with asthma to lead productive and fulfilling lives. 

GINA is a global guidelines which unites all our actual knowledge about treatment of this chronic disorder. It is updated every year, we are presenting you the last update which was published in December 2011. 

 

WE ARE CONGRATULATING EVERYBODY WITH THIS IMPORTANT DAY! HAPPY WORLD ASTHMA DAY 2012!

World Asthma Day 2012

World Asthma Day 2012, organized and sponsored by the Global Initiative for Asthma (GINA), will be held on May 1, 2012 as a partnership between health care groups and asthma educators to raise awareness about asthma and improve asthma care throughout the world.

The theme of World Asthma Day 2012 will be “You Can Control Your Asthma.” This year’s event continues the focus on this positive theme established over the past several years, and is consistent with the emphasis on asthma control set out in the latest versions of the GINA documents.

The event will also bring continued efforts around the Asthma Control Challenge, a global campaign GINA launched on World Asthma Day 2010 to encourage governments, health departments, and health care professionals to improve asthma control and reduce asthma hospitalization 50% in 5 years. Researchers and public health workers around the world are encouraged to enter their information in the online data collection system to help track their
progress towards this goal: http://www.core.ubc.ca/Asthma/GINA.


Asthma control is the goal of treatment and can be achieved in the vast majority of asthma patients with proper management. A person’s asthma is under control when he or she has:
• No (or minimal) asthma symptoms.
• No waking at night due to asthma.
• No (or minimal) need to use “reliever” medication.
• The ability to do normal physical activity and exercise.
• Normal (or near-normal) lung function test results (PEF and FEV1).
• No (or very infrequent) asthma attacks.


A strategy for achieving and maintaining asthma control is set out in the GINA Global Strategy for Asthma Management and Prevention. The strategy requires four interrelated components of
therapy:

• Develop patient/doctor partnership.
• Identify and reduce exposure to risk factors.
• Assess, treat, and monitor asthma.
• Manage asthma exacerbations.


Under this strategy, asthma is treated in a stepwise manner to achieve and maintain control of the disease. Medication is increased—“stepped up”—when asthma is not controlled, and gradually stepped down once good control is achieved and maintained for a period of time. 

Respiratory Decade joins World Allergy Week 2012!

Dear Respiratory friends we have great news: next week is World Allergy Week 2012! This is Global event which is organized by World Allergy Organization! Join this important event! Be a part of this Respiratory event in your country at the local level and you will become visible globally!

The prevalence of allergic diseases worldwide is rising  dramatically in both developed and developing countries.

These diseases include:  

  asthma; 

  rhinitis; 

  anaphylaxis; 
  drug, food, and insect allergy; 
  eczema; 
  urticaria (hives) 
  angioedema.
This increase is especially problematic in children, who are bearing the greatest burden of the rising trend which has occurred over the last two decades. In spite of this increase, even in the developed world, services for patients with allergic diseases are fragmented and far from ideal. Very few countries have comprehensive services in this field of medicine.

2012 International Guidelines on Rhinitis, Asthma and COPD: Italian Update of Global Initiatives ARIA, GINA and GOLD

These days in Modena, Italy (28 February-2 March 2012) is taking place Congress 2012 International Guidelines on Rhinitis, Asthma and COPD Global Initiatives ARIA, GINA and GOLD.

I invite you to see free online and directly all presentations from this important Respiratory event. Speakers are world known leaders of opinion in Respiratory Medicine from Italy and from all over the world.

Today is day dedicated to Asthma and will be many interesting presentations: 

IgE, anti-IgE and remodelling in allergic asthma by Professor Klaus F. Rabe, President of European Respiratory Society;

Novel therapies for asthma and COPD by Professor Leonardo M. Fabbri

Viral infections and asthma by Professor Alberto Papi.

Please watch live translation HERE

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Moderate Alcohol Consumption: A Protective Effect Against Asthma Development

by Liudmila Corlateanu

During the European Respiratory Society Annual Congress Sophie Lieberoth from Copenhagen University presented a curious study about the connection between asthma treatment and alcohol intake.

There is a vast range of studies concerning the hazards and benefits of alcohol. Some studies proved that frequent alcohol consumption (1-2 times/day) increases the chances of good health in old age by 30%. The authors of another work have found that consumption of one glass of wine a day helps you lose weight. 

Danish researches established that drinking alcohol in moderate quantities can reduce the risk of developing asthma. In this way, drinking 1-6 units of alcohol a week could reduce the risk of developing the condition. But what is considered to be a unit of alcohol? A half pint (284 ml) of beer that has a strength of 3.5% abv contains almost exactly one unit or a medium glass (175 ml) of 12% abv wine contains around two units of alcohol.

The research examined 19,349 twins between the ages of 12 and 41 years of age. All participants have completed a questionnaire at the start and end of the study to compare alcohol intake with the risk of developing asthma over 8 years. The results showed that the lowest risk of asthma was seen in the group which had a moderate intake of alcohol, as less than 4% of those who drank 1-6 units per week developed asthma.

Another important point of the study was that a preference for beer drinking was associated with an increased risk of asthma when compared with no preference.

It was concluded that higher incidence of asthma development occurs in the never drinking and rarely drinking group.

The relationship between alcohol intake and the risk of developing adult-onset asthma could be U-shaped, but still there is a need of further investigation. What needs no basis or explanation is the old French Proverb which states: “Eat with pleasure; drink with measure.”

WINNER OF U-BIOPRED ASTHMA ART CONTEST 2011

Dear Respiratory Friends, we wrote earlier about U-BIOPRED project and U-BIOPRED Asthma Art Contest 2011.

The art contest is part of a European-wide project called U-BIOPRED - Unbiased BIOmarkers in PREDiction of respiratory disease outcomes.

Marije Kootstra from The Netherlands won the competition and will be presented with her award at the European Respiratory Society  Amsterdam Congress Opening Ceremony on September 24, 2011. 

ASTHMA ART CONTEST 2011

On World Asthma Day 2011 (3 May), people with asthma and severe asthma are being encouraged to get creative for a unique art contest which will explore what it is like to live with the condition. 

The contest is open to people of all ages and will help bridge the gap between doctors’ understanding of the condition and a person’s experience of it.

Asthma is a major health problem around the world and is a one of the world’s major non-communicable diseases. Not all types of asthma are the same and current treatments adopt a uniform approach, meaning they don’t work well for everybody. The art contest is part of a European-wide project called U-BIOPRED - Unbiased BIOmarkers in PREDiction of respiratory disease outcomes. U-BIOPRED is a research project funded by the Innovative Medicines Initiative (IMI), to understand more about severe asthma that involves scientists from universities, research institutes, the pharmaceutical industry and small companies.

U-BIOPRED will help scientists understand more about severe asthma. The researchers will look at how severe asthma differs from one person to another in the hope of uncovering more effective treatments in the future. 

                                            U-BIOPRED video

The competition is open to any person with asthma and all types of art work from dance, music and poetry, to paintings and photography are encouraged. The top three winning entries will be displayed on the U-BIOPRED website. 

The winner will be invited to the European Respiratory Society Congress in Amsterdam (24-25 September) to receive their award and see their winning entry presented at the opening ceremony. Professor Peter Sterk, project lead, said:  “The U-BIOPRED project aims to understand more about asthma and severe asthma. One important way we can do this is to hear from patients directly. This contest enables patients to express, through art, what the condition is like and how it impacts upon their life.”

Professor Peter STERK

University of Amsterdam

“The winning entry will be the piece which best conveys what it is like to have asthma and we want to hear from anyone with the condition, whether you are a budding or artist, or a complete beginner.”

The closing date for all entries is 1 June 2011. You can enter the art contest by uploading a digital copy of your artwork to the website. For full terms and conditions, visit: www.ubiopred.european-lung-foundation.org/artcontest.