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Chronic stress and asthma in adolescents.
Landeo-Gutierrez, J, Celedón, JC
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2020;(4):393-398
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Abstract
OBJECTIVE First, to review and critically discuss published evidence on psychosocial stressors, stress, and asthma in adolescents and, then, discuss potential future directions in this field. DATA SOURCES The data source is the National Library of Medicine (PubMed database). STUDY SELECTIONS A literature search was conducted for human studies on stressors or stress and asthma between 2000 and 2020. Studies that were published in English, contained a full text, and included adolescents were considered for inclusion in this review. RESULTS Compared with the available body of evidence in children and adults, relatively few studies have been published in adolescents. Current evidence suggests that exposure to stressors (at the individual, family, and community levels) or stress (acute and chronic) is associated with asthma and worse asthma outcomes, but such evidence must be cautiously interpreted owing to limitations in the design or the analytical approach of the published studies. CONCLUSION Future large studies with a prospective design should determine whether and how stressors or stress causes or worsens asthma in adolescents. At present, clinicians should assess exposure to stressors (eg, violence or abuse) and screen for anxiety and depressive disorders when caring for adolescents with asthma in addition to providing referrals to social workers or mental health professionals when appropriate. Public health policies are needed to reduce psychosocial stressors, such as gun violence and racism, in adolescents.
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Vitamin D receptor gene polymorphism and susceptibility to asthma: Meta-analysis based on 17 case-control studies.
Makoui, MH, Imani, D, Motallebnezhad, M, Azimi, M, Razi, B
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2020;(1):57-69
Abstract
BACKGROUND During the last decade, several studies have evaluated the potential association between vitamin D receptor (VDR) gene polymorphism and susceptibility to asthma. In spite of valuable findings, the results are still contradictory. Therefore, a comprehensive meta-analysis not only solves discrepancies but provides a clue for future projects. OBJECTIVE This meta-analysis was performed to identify whether VDR gene polymorphisms (FokI (rs2228570) or TaqI (rs731236) or BsmI (rs1544410) or ApaI (rs7975232)) play a role in the risk of asthma. METHODS Electronic search of Web of Science, Scopus, and PubMed databases were systematically conducted from their inception until June 2019, to identify all published studies. Eligibility of the studies was confirmed by precise inclusion and exclusion criteria, and the resultant studies were analyzed. RESULTS A total of 17 studies concerning VDR gene polymorphisms and asthma risk were included in this meta-analysis. The results of pooled analysis indicated a statistically significant association between FokI SNP (dominant model [OR = 0.78, 95% CI, 0.62-0.98, random effect model] and allelic model [OR = 0.81, 95% CI, 0.67-0.98, random effect model]) and TaqI SNP (homozygote contract model [OR = 0.70, 95% CI, 0.54-0.89]) with asthma risk. Moreover, subgroup analysis showed that ethnicity influences asthma risk in Asian, African, and American populations. The sensitivity analyses confirmed the stability of the results. CONCLUSION This meta-analysis suggests that VDR gene polymorphism is associated with the risk of asthma.
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Vitamin D Metabolism Is Dysregulated in Asthma and Chronic Obstructive Pulmonary Disease.
Jolliffe, DA, Stefanidis, C, Wang, Z, Kermani, NZ, Dimitrov, V, White, JH, McDonough, JE, Janssens, W, Pfeffer, P, Griffiths, CJ, et al
American journal of respiratory and critical care medicine. 2020;(3):371-382
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Abstract
Rationale: Vitamin D deficiency is common in patients with asthma and chronic obstructive pulmonary disease (COPD). Low 25-hydroxyvitamin D (25[OH]D) levels may represent a cause or a consequence of these conditions.Objectives: To determine whether vitamin D metabolism is altered in asthma or COPD.Methods: We conducted a longitudinal study in 186 adults to determine whether the 25(OH)D response to six oral doses of 3 mg vitamin D3, administered over 1 year, differed between those with asthma or COPD versus control subjects. Serum concentrations of vitamin D3, 25(OH)D3, and 1α,25-dihydroxyvitamin D3 (1α,25[OH]2D3) were determined presupplementation and postsupplementation in 93 adults with asthma, COPD, or neither condition, and metabolite-to-parent compound molar ratios were compared between groups to estimate hydroxylase activity. Additionally, we analyzed 14 datasets to compare expression of 1α,25(OH)2D3-inducible gene expression signatures in clinical samples taken from adults with asthma or COPD versus control subjects.Measurements and Main Results: The mean postsupplementation 25(OH)D increase in participants with asthma (20.9 nmol/L) and COPD (21.5 nmol/L) was lower than in control subjects (39.8 nmol/L; P = 0.001). Compared with control subjects, patients with asthma and COPD had lower molar ratios of 25(OH)D3-to-vitamin D3 and higher molar ratios of 1α,25(OH)2D3-to-25(OH)D3 both presupplementation and postsupplementation (P ≤ 0.005). Intergroup differences in 1α,25(OH)2D3-inducible gene expression signatures were modest and variable if statistically significant.Conclusions: Attenuation of the 25(OH)D response to vitamin D supplementation in asthma and COPD associated with reduced molar ratios of 25(OH)D3-to-vitamin D3 and increased molar ratios of 1α,25(OH)2D3-to-25(OH)D3 in serum, suggesting that vitamin D metabolism is dysregulated in these conditions.
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Vitamin D in pediatric health and disease.
Peroni, DG, Trambusti, I, Di Cicco, ME, Nuzzi, G
Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology. 2020;:54-57
Abstract
Several scientific societies established that vitamin D (VD), in its metabolized form 25(OH)D, levels higher than 20 ng/mL are sufficient to ensure optimal bone health, while 25(OH)D levels higher than 30 ng/mL are needed to favor VD extraskeletal actions. However, it has been estimated that approximately 30% of children and 60% of adults worldwide are VD deficient and insufficient, respectively. This is the reason why it is important to provide a practical approach to VD supplementation for infants, children, and adolescents. It is the pediatrician's role to evaluate the modifiable lifestyle risk factors for deficiency, particularly a reduced sun exposure, following an evidence-based approach, and to suggest VD supplementation only when there is a rational reason to support its use.
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Rational use of mucoactive medications to treat pediatric airway disease.
Linssen, RSN, Ma, J, Bem, RA, Rubin, BK
Paediatric respiratory reviews. 2020;:8-14
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Abstract
Many airway diseases in children, notably bronchiolitis, cystic fibrosis (CF), non-CF bronchiectasis including primary ciliary dyskinesia, pneumonia, and severe asthma are associated with retention of airway secretions. Medications to improve secretions clearance, the mucoactive medications, are employed to treat these diseases with varying degrees of success. This manuscript reviews evidence for the use of these medications and future directions of study.
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Short course gamma tocopherol did not mitigate effects of ozone on airway inflammation in asthmatics.
Burbank, AJ, Hernandez, ML, Robinette, C, Wang, T, Zhou, H, Alexis, N, Bennett, WD, Peden, DB
Inhalation toxicology. 2020;(7):279-281
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INTRODUCTION Exposure to elevated ambient ozone levels has been associated with exacerbation of asthma, likely mediated by oxidative stress. We have shown that supplementation with the antioxidant vitamin E isoform, gamma tocopherol, mitigates the inflammatory effects of inhaled endotoxin exposure, a key component of ambient air particulate matter. OBJECTIVE The objective of the current study was to assess the efficacy of gamma tocopherol for mitigating pulmonary effects of ozone, using an abbreviated dosing regimen that could be rapidly begun when high ozone days are anticipated. MATERIALS AND METHODS We conducted a randomized, double blind, placebo-controlled crossover study of adults with mild asthma who were pre-treated with gamma tocopherol-enriched supplement and exposed to 0.25 ppm ozone for 3 hours. Induced sputum samples were obtained before and after ozone exposure to measure airway inflammation. Mucociliary clearance was estimated using gamma scintigraphy. RESULTS With the short course of gamma tocopherol pre-treatment, we found no significant effect on ozone-induced airway inflammation. A transient slowing of clearance in the large airways was seen following ozone exposure in the placebo treatment period that was not present during gamma tocopherol treatment. DISCUSSION Short course gamma tocopherol did not protect against ozone-induced airway inflammation. Future work will focus on the efficacy of longer courses of gamma tocopherol supplementation for mitigating pollutant-induced health effects. The early transient ozone effect on airway clearance as well as the impact of gamma tocopherol on this effect will be further explored in future studies.
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Association between processed meat intake and asthma symptoms in the French NutriNet-Santé cohort.
Andrianasolo, RM, Hercberg, S, Touvier, M, Druesne-Pecollo, N, Adjibade, M, Kesse-Guyot, E, Galan, P, Varraso, R
European journal of nutrition. 2020;(4):1553-1562
Abstract
PURPOSE Processed meat intake may adversely affect lung health, but data on asthma remains sparse. The magnitude of the processed meat-asthma association may also depend on other unhealthy behaviors. We investigated the association between processed meat intake and the asthma symptom score, and the combined role of unhealthy weight, smoking, low diet quality, and high processed meat intake on the asthma score. METHODS In 2017, 35,380 participants to the NutriNet-Santé cohort answered a detailed respiratory web-questionnaire. Asthma was defined by the asthma symptom score (sum of 5 questions; continuous variable). Based on repeated 24-h dietary records collected on a dedicated website, processed meat consumption was classified as 0, < 2, 2-5, > 5 servings/week. We examined the combined role of body mass index (BMI) (< 25 vs. ≥ 25 kg/m2), smoking (never vs. ever), diet quality score (highest vs. lowest), and processed meat (≤ 5 vs. > 5 servings/week) on the asthma symptom score. RESULTS Participants were aged 54 on average (women: 75%, smokers: 49%, BMI ≥ 25: 32%, ≥ 1 asthma symptoms: 27%). After adjustment for confounders, processed meat intake was positively and significantly associated with asthma symptom score: odds ratios (ORs) (95% CI) for > 5 vs. 0 servings/week were 1.15 (1.04-1.27) in women; 1.23 (1.01-1.50) in men. Compared to participants with 0 unhealthy behaviors, ORs for the asthma symptom score among participants with the 4 combined unhealthy behaviors were 2.18 (1.91-2.48) in women; 2.70 (2.10-3.45) in men. CONCLUSION High processed meat consumption was associated with higher asthma symptoms, and combining overweight/obesity, smoking, low diet quality, with high processed meat intake was strongly associated with asthma symptoms.
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Question 5: Magnesium Sulphate for Acute Asthma in children.
Aniapravan, R, Pullattayil, A, Al Ansari, K, Powell, CVE
Paediatric respiratory reviews. 2020;:112-117
Abstract
Most children who present to the emergency department with acute asthma, respond well to inhaled β2-agonists (spacer or nebuliser), oxygen (if required) and systemic steroids. Guidelines across the world agree on this simple, straight forward evidenced based approach. In children with more severe asthma attacks and those who do not respond to initial treatment, the evidence base for the secondary level treatment is less clear. Many regimens exist for the next step. Intravenous Magnesium Sulphate (MgSO4) is now used frequently in these situations and some centres are starting to use nebulized MgSO4 as part of the initial maximal inhaled therapy options. This paper examines the role of MgSO4 in acute asthma in children. It focusses on how MgSO4 might work, what are the current recommendations for use and then what is the current evidence base to support its use. We have presented the evidence for the use of both nebulized and intravenous MgSO4. At the end of the paper we have suggested future directions for research in this area. Our aim is to present a synthesis of the current role of MgSO4 in the management of an acute asthma attack.
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Effect of Nebulized Magnesium vs Placebo Added to Albuterol on Hospitalization Among Children With Refractory Acute Asthma Treated in the Emergency Department: A Randomized Clinical Trial.
Schuh, S, Sweeney, J, Rumantir, M, Coates, AL, Willan, AR, Stephens, D, Atenafu, EG, Finkelstein, Y, Thompson, G, Zemek, R, et al
JAMA. 2020;(20):2038-2047
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Abstract
IMPORTANCE While intravenous magnesium decreases hospitalizations in refractory pediatric acute asthma, it is variably used because of invasiveness and safety concerns. The benefit of nebulized magnesium to prevent hospitalization is unknown. OBJECTIVE To evaluate the effectiveness of nebulized magnesium in children with acute asthma remaining in moderate or severe respiratory distress after initial therapy. DESIGN, SETTING, AND PARTICIPANTS A randomized double-blind parallel-group clinical trial from September 26, 2011, to November 19, 2019, in 7 tertiary-care pediatric emergency departments in Canada. The participants were otherwise healthy children aged 2 to 17 years with moderate to severe asthma defined by a Pediatric Respiratory Assessment Measure (PRAM) score of 5 or greater (on a 12-point scale) after a 1-hour treatment with an oral corticosteroid and 3 inhaled albuterol and ipratropium treatments. Of 5846 screened patients, 4332 were excluded for criteria, 273 declined participation, 423 otherwise excluded, 818 randomized, and 816 analyzed. INTERVENTIONS Participants were randomized to 3 nebulized albuterol treatments with either magnesium sulfate (n = 410) or 5.5% saline placebo (n = 408). MAIN OUTCOMES AND MEASURES The primary outcome was hospitalization for asthma within 24 hours. Secondary outcomes included PRAM score; respiratory rate; oxygen saturation at 60, 120, 180, and 240 minutes; blood pressure at 20, 40, 60, 120, 180, and 240 minutes; and albuterol treatments within 240 minutes. RESULTS Among 818 randomized patients (median age, 5 years; 63% males), 816 completed the trial (409 received magnesium; 407, placebo). A total of 178 of the 409 children who received magnesium (43.5%) were hospitalized vs 194 of the 407 who received placebo (47.7%) (difference, -4.2%; absolute risk difference 95% [exact] CI, -11% to 2.8%]; P = .26). There were no significant between-group differences in changes from baseline to 240 minutes in PRAM score (difference of changes, 0.14 points [95% CI, -0.23 to 0.50]; P = .46); respiratory rate (0.17 breaths/min [95% CI, -1.32 to 1.67]; P = .82); oxygen saturation (-0.04% [95% CI, -0.53% to 0.46%]; P = .88); systolic blood pressure (0.78 mm Hg [95% CI, -1.48 to 3.03]; P = .50); or mean number of additional albuterol treatments (magnesium: 1.49, placebo: 1.59; risk ratio, 0.94 [95% CI, 0.79 to 1.11]; P = .47). Nausea/vomiting or sore throat/nose occurred in 17 of the 409 children who received magnesium (4%) and 5 of the 407 who received placebo (1%). CONCLUSIONS AND RELEVANCE Among children with refractory acute asthma in the emergency department, nebulized magnesium with albuterol, compared with placebo with albuterol, did not significantly decrease the hospitalization rate for asthma within 24 hours. The findings do not support use of nebulized magnesium with albuterol among children with refractory acute asthma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01429415.
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Body composition in children with chronic inflammatory diseases: A systematic review.
Houttu, N, Kalliomäki, M, Grönlund, MM, Niinikoski, H, Nermes, M, Laitinen, K
Clinical nutrition (Edinburgh, Scotland). 2020;(9):2647-2662
Abstract
BACKGROUND & AIMS Aberrations in body composition are expected in children suffering from chronic inflammatory conditions. The objective is to examine whether children with inflammatory bowel disease (IBD: Crohn's disease and ulcerative colitis), coeliac disease, asthma and juvenile idiopathic arthritis (JIA) have an altered body composition as compared to healthy children. METHODS A systematic review, registered in Prospero (registration number: CRD42018107645), was conducted according to PRISMA guidelines. We conducted a search of three databases, Pubmed, Cochrane and Scopus. An assessment of the quality of the study was performed. RESULTS Data from 50 studies, 32 with IBD, 8 with coeliac disease, 2 with asthma and 8 with JIA, involving 2399 children were selected for review after applying the eligibility criteria. In all but 4 studies, children with Crohn's disease exhibited decreased amounts of fat mass and fat free mass. Reductions in fat mass were also evident in studies in children with coeliac disease. It is uncertain whether body composition is altered in children with asthma or JIA. CONCLUSIONS Children with Crohn's disease manifest with lowered adiposity and lean mass and therefore are likely to be at risk for suffering malnutrition-related clinical complications. Apart from Crohn's disease, data examining body composition in children with chronic inflammatory conditions are scarce and there is a paucity of reports examining the relationship between inflammation and body composition. Interpretation of the current study results is hampered by the low quality of the studies and due to the fact that the analyses have been habitually secondary outcomes.