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Leung SSY, Tsang HSL, Chan J, Kui OYH, Zeng P, Cheung YT, Cheng JW, Chan KCC, Yu M, Tang P, Brannan JD, Lam JKW, Chan HK, Li AM. Evaluation of bronchial hyperresponsiveness in asthmatic paediatric patients using mannitol challenge test - Impacts of body mass index. Ann Med 2025; 57:2468262. [PMID: 39977003 PMCID: PMC11843638 DOI: 10.1080/07853890.2025.2468262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 01/30/2025] [Accepted: 02/04/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Increasing epidemiological studies reported that overweight/obese asthma patients had more frequent and severe symptoms and exacerbations, indicating their asthma management may not be sufficient. Airway hyperresponsiveness (AHR), a significant feature of asthma, was found to link with the body mass index (BMI) with mixed findings using the "direct" methacholine challenge test. The objective was to examine the association between BMI and asthma control, as reflected by the "indirect" AHR with the mannitol challenge test in a paediatric asthmatic population. METHODS A total of 80 subjects with physician-diagnosed asthma, aged 6-18 years were enrolled in this cross-sectional study. Patients were first asked to complete the Asthma Control Test (ACT) questionnaire to self-evaluate their disease status. A mannitol challenge test was then performed to assess their AHR severity. RESULTS Seventy-six patients (96%) rated their asthma as well-controlled with an ACT score ≥ 20, but 42 patients (53%) were tested positive in the mannitol challenge test with mild and moderate AHR. While patients with mild AHR had comparable lung functions to those without AHR, patients with moderate AHR showed slightly but significantly lower FEV1 and FEV1/FVC values. Although no significant difference in the BMI values was noted for patients with different levels of AHR, the trend of increasing BMI with age was steeper for patients with moderate AHR. CONCLUSION A high prevalence of AHR (>50%) was found in asthmatic children who self-evaluated with good asthma control. No significant influence of the BMI on the AHR severity could be demonstrated in this population with the "indirect" mannitol challenge test. Since only a small number of overweight/obese subjects were recruited in the present study, further verification of the results with a larger sample size of obese subjects is required.
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Affiliation(s)
- Sharon S. Y. Leung
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Helen S. L. Tsang
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jasmine Chan
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Oliver Y. H. Kui
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ping Zeng
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yin Ting Cheung
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - James-Wesley Cheng
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kate C. C. Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michelle Yu
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patricia Tang
- Sydney Pharmacy School, University of Sydney, Sydney, Australia
| | - John D. Brannan
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Jenny K. W. Lam
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, London, UK
| | - Hak-Kim Chan
- Sydney Pharmacy School, University of Sydney, Sydney, Australia
| | - Albert M. Li
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Zhang A, Soogoor N, Crowther T, Vohra S, Jamal A, Srinivasan M, Kim G, Kim K, Palaniappan L, Huang R, Eggert LE. Disparities in adult asthma outcomes among disaggregated data among Asian Americans in the National Health Interview Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2025; 4:100458. [PMID: 40343011 PMCID: PMC12060444 DOI: 10.1016/j.jacig.2025.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 12/07/2024] [Accepted: 01/14/2025] [Indexed: 05/11/2025]
Abstract
Background Asthma is a chronic lung disease affecting 8% of US adults, with significant disparities among racial and ethnic groups. The Asian American population is diverse, yet asthma research often aggregates data, potentially obscuring group-specific differences. Disaggregated data reveal that although Asian Americans overall appear to have lower asthma prevalence than non-Hispanic Whites, certain subgroups, like Filipino adults, have higher rates. Asthma outcomes are influenced by genetics, environmental exposures, and social determinants, although the specific impact of these factors remains unclear. Objective The objective was to better describe asthma outcomes among disaggregated Asian American groups. Methods We analyzed 2006-18 National Health Interview Survey data on asthma prevalence among non-Hispanic White and disaggregated Asian American adults. Logistic regression was used to calculate adjusted odds ratios (ORs) for Asian American asthma outcomes compared to non-Hispanic Whites, accounting for demographic, health, and socioeconomic factors. Results Asthma prevalence varied among adults: non-Hispanic White (n = 33,764), Chinese (n = 310, OR = 0.54), Filipino (n = 603, OR = 1.03), Asian Indian (n = 236, OR = 0.43), and other Asians (n = 601, OR = 0.61). Over half had poor asthma control: 62% non-Hispanic White, 53.5% Chinese (OR = 0.72), 50.2% Filipino (OR = 0.64), 54.8% Asian Indian (OR = 0.75), and 59.2% other Asian (OR = 0.82). Filipino adults showed higher asthma prevalence (OR = 1.37) but better control (OR = 0.74). Chinese (OR = 0.39) and Asian Indian (OR = 0.48) adults had fewer emergency department visits. Sociodemographic and health factors significantly affected symptoms, attacks, and emergency department visits. Conclusion Asthma prevalence and control varied widely among Asian American populations. Sociodemographic and health factors influenced poor asthma control more than racial group.
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Affiliation(s)
- Alan Zhang
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- Department of Nanoengineering, University of California, San Diego, Calif
| | - Neha Soogoor
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- Anne Burnett School of Medicine, Texas Christian University, Fort Worth, Tex
| | - Talia Crowther
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- Department of Health Policy and Management, Emory Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Sanah Vohra
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Armaan Jamal
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Malathi Srinivasan
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, Calif
| | - Gloria Kim
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Karina Kim
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
| | - Latha Palaniappan
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Robert Huang
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- Division of Gastroenterology, Stanford University School of Medicine, Stanford, Calif
| | - Lauren E. Eggert
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, Calif
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, Calif
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Akashanand, Khatib MN, Balaraman AK, Roopashree R, Kaur M, Srivastava M, Barwal A, Prasad GVS, Rajput P, Vishwakarma T, Puri S, Tyagi P, Bushi G, Chilakam N, Pandey S, Jagga M, Mehta R, Sah S, Shabil M, Gaidhane AM, Jena D. Patterns and trends in burden of asthma and its attributable risk factors from 1990 to 2021 among South Asian countries: a systematic analysis for the Global Burden of Disease Study 2021. J Asthma 2025; 62:1020-1031. [PMID: 39817407 DOI: 10.1080/02770903.2025.2453810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 01/11/2025] [Indexed: 01/18/2025]
Abstract
OBJECTIVE Asthma poses a significant health burden in South Asia, with increasing incidence and mortality despite a global decline in age-standardized prevalence rates. This study aims to analyze asthma trends from 1990 to 2021, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across South Asia. The study also assesses the impact of risk factors like high body mass index (BMI), smoking, and occupational exposures on asthma outcomes. METHOD We extracted asthma data from the Global Burden of Disease database for South Asia (1990-2021). Joinpoint regression analysis was used to assess temporal trends in asthma burden. Total Percentage change (TPC) in age-standardized rates of incidence, mortality, and DALYs were calculated. Data were stratified by gender, and the contribution of risk factors was evaluated. RESULTS Asthma-related mortality in South Asia decreased by 37%, from 27.78 per 100,000 (1990) to 17.54 per 100,000 (2021). The Maldives showed the most significant reduction in mortality (78.31%), while Bangladesh recorded a 47.44% reduction in prevalence and a 62.64% decrease in DALYs. High BMI, smoking, and environmental risks contributed significantly to DALYs, with environmental factors playing a major role in countries like Afghanistan (20.73%) and Bhutan (18.58%). Females, particularly those over 20, experienced higher asthma-related DALYs than males. CONCLUSION Asthma burden in South Asia has reduced over the past three decades, yet the absolute number of cases continues to rise, driven by population growth and environmental risk factors. Targeted interventions addressing risk factors and healthcare disparities are essential for further reducing asthma burden.
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Affiliation(s)
- Akashanand
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | | | - R Roopashree
- Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, India
| | - Mandeep Kaur
- Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, India
| | | | - Amit Barwal
- Chandigarh Pharmacy College, Chandigarh Group of College, Mohali, India
| | - G V Siva Prasad
- Department of Chemistry, Raghu Engineering College, Visakhapatnam, India
| | - Pranchal Rajput
- School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University, Dehradun, India
| | | | - Sonam Puri
- New Delhi Institute of Management, New Delhi, India
| | - Puneet Tyagi
- Department of Pulmonary Medicine, Graphic Era (Deemed to be University), Dehradun, India
| | - Ganesh Bushi
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Nagavalli Chilakam
- Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
| | - Sakshi Pandey
- Centre of Research Impact and Outcome, Chitkara University, Rajpura, India
| | - Megha Jagga
- Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh, Solan, India
| | - Rachana Mehta
- Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, Faridabad, India
- Dr Lal PathLabs - Nepal, Kathmandu, Nepal
| | - Sanjit Sah
- Department of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Muhammed Shabil
- University Center for Research and Development, Chandigarh University, Mohali, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Iraq
| | - Abhay M Gaidhane
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
| | - Diptismita Jena
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
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Jayawardhana J, Fernandez J. Impact of medical and recreational cannabis laws on inpatient visits for asthma. Health Serv Res 2025; 60:e14427. [PMID: 39739251 DOI: 10.1111/1475-6773.14427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2025] Open
Abstract
OBJECTIVE To examine the impact of medical and recreational cannabis laws on inpatient visits for asthma and by payer-type. STUDY SETTING AND DESIGN Quasi-experimental difference-in-differences regression analysis was conducted while accounting for variations in cannabis laws implementation timing by states. Inpatient visits for asthma in states with a given type of cannabis law were compared with those in states that did not implement the specific law. Four different cannabis laws were examined in the study-initial passage of medical cannabis law, opening of a medical cannabis dispensary, home cultivation of medical cannabis, and recreational cannabis legalization. DATA SOURCES AND ANALYTIC SAMPLE State-level quarterly inpatient visit data for asthma patients were utilized from the Healthcare Cost and Utilization Project Fast Stats database. The primary analysis included inpatient visits for asthma by all payer adult patients aged 19 and above in 38 states from 2005 to 2017, and the secondary analysis included inpatient visits for asthma by payer-type (i.e., private, Medicare, Medicaid, uninsured). PRINCIPAL FINDINGS States with medical cannabis dispensaries and legalized recreational cannabis experienced 14.12% (2.14; 95% CI, 0.74-3.53; p < 0.01) and 20.45% (3.08; 95% CI, 1.47-4.69; p < 0.001) increases in inpatient visits for asthma compared with states without these policies, respectively. These increases in inpatient visits for asthma were primarily driven by populations covered by Medicare and private insurance, with Medicare population showing larger effects of both recreational cannabis laws and medical cannabis dispensaries. CONCLUSIONS States with medical cannabis dispensaries and legalized recreational cannabis experienced higher rate of inpatient visits for asthma compared with states without these policies. Clinicians and policymakers should consider strategies to curb adverse health outcomes of cannabis, that is likely to result in increased costs of healthcare.
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Affiliation(s)
- Jayani Jayawardhana
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Jose Fernandez
- Department of Economics, College of Business, University of Louisville, Louisville, Kentucky, USA
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Unsal H, Karaguzel D, Sarac BE, Aytekin ES, Dal ST, Gurel DI, Soyer O, Sekerel BE, Karaaslan C, Sahiner UM. Inflammatory and oxidative stress markers in serum, urine and exhaled breath condensate: Relationship between asthma and obesity in children. Respir Med 2025; 242:108096. [PMID: 40216206 DOI: 10.1016/j.rmed.2025.108096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 04/08/2025] [Accepted: 04/09/2025] [Indexed: 04/20/2025]
Abstract
BACKGROUND Systemic inflammation and oxidative stress are known to exacerbate airway inflammation in asthma. Obesity contributes to this pathophysiology. OBJECTIVE To determine the relationship between obesity, disease severity, disease control, and oxidative stress in asthma with multiple oxidative stress markers. METHODS The study included 65 obese-asthma (OA), 25 non-obese asthma (A), and 30 healthy non-obese controls (C). Skin prick tests, lung functions, and 8-isoprostane levels in urine samples were measured. Exhaled breath condensate (EBC) was tested for 8-isoprostane, glutathione peroxidase, and malondialdehyde (MDA). Serum samples were taken for adiponectin and leptin. RESULTS OA leptin levels were higher than those of the A and C groups (p < 0.001). Glutathione peroxidase levels in EBC were found to be different between groups (p = 0.016), while there was no difference in two-group comparisons. MDA levels were significant (p < 0.001) between groups, with the A group's lower levels contributing to this significance. 8-isoprostane levels were greater in the OA group than in other groups (p = 0.005). This significance came from the difference between the OA and A groups (p = 0.005). Urine 8-isoprostane levels were different between groups (p = 0.001), and the OA group had lower levels than the A group (p = 0.003). In EBC, there were positive correlations between BMI and MDA (p < 0.001, r = 0.484) and 8-isoprostane (p < 0.001, r = 0.471). Patients with uncontrolled/partially-controlled asthma had greater levels of MDA and 8-isoprostane than those with well-controlled asthma (p = 0.036 and p = 0.011). CONCLUSION Elevated levels of MDAand 8-isoprostane in EBC in obese asthma support that obesity increases oxidative stress markers. This relationship indicate that antioxidant therapies may be beneficial in OA patients. EBC is a reliable and noninvasive technique for measuring oxidative inflammation.
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Affiliation(s)
- Hilal Unsal
- Hacettepe University School of Medicine, Department of Pediatric Allergy, Ankara, Turkey
| | - Dilara Karaguzel
- Hacettepe University Faculty of Science, Department of Biology, Molecular Biology Section, Ankara, Turkey
| | - Basak Ezgi Sarac
- Hacettepe University Faculty of Science, Department of Biology, Molecular Biology Section, Ankara, Turkey
| | - Elif Soyak Aytekin
- Hacettepe University School of Medicine, Department of Pediatric Allergy, Ankara, Turkey
| | - Sevda Tuten Dal
- Hacettepe University School of Medicine, Department of Pediatric Allergy, Ankara, Turkey
| | - Deniz Ilgun Gurel
- Hacettepe University School of Medicine, Department of Pediatric Allergy, Ankara, Turkey
| | - Ozge Soyer
- Hacettepe University School of Medicine, Department of Pediatric Allergy, Ankara, Turkey
| | - Bulent Enis Sekerel
- Hacettepe University School of Medicine, Department of Pediatric Allergy, Ankara, Turkey
| | - Cagatay Karaaslan
- Hacettepe University Faculty of Science, Department of Biology, Molecular Biology Section, Ankara, Turkey
| | - Umit Murat Sahiner
- Hacettepe University School of Medicine, Department of Pediatric Allergy, Ankara, Turkey.
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Ganai I, Goswami AM, Sultana N, Sultana S, Laha A, Biswas H, Moitra S, Podder S. Functional insights into PTGS2 rs689466 polymorphism associated to asthma in West Bengal, India. Gene 2025:149592. [PMID: 40414468 DOI: 10.1016/j.gene.2025.149592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 05/19/2025] [Accepted: 05/21/2025] [Indexed: 05/27/2025]
Abstract
BACKGROUND Asthma is characterized by bronchoconstriction and airway hyperresponsiveness. Interplay of environmental and genetic factors led to significant rise in asthma prevalence in India during past decades. OBJECTIVE This study investigated functional insights of prostaglandin-endoperoxide synthase 2 (PTGS2) rs689466 polymorphism among 155 pollen-induced patients and 155 controls in West Bengal population, India. METHODS Genotyping was performed using Polymerase chain reaction-Restriction fragment length polymorphism. Transcription Factors (TFs) for promoter region corresponding to the polymorphism location were searched by SNP2TFBS. DNA structures were docked with TFs in HDOCK. Protein-DNA interface was analysed by DNAproDB. Relative abundance of PTGS2 mRNA in controls and different polymorphic genotypes was obtained using Real time PCR. Protein expression was analyzed by western blot. RESULTS Genotype and allele frequencies differed significantly between study groups (P = 0.01 and 0.03 respectively). Frequency of GG and AG genotype was significantly higher in patients (P = 0.02 and 0.04 respectively). Significant differences in FEV1/FVC were obtained in different polymorphic genotypes of patients (P < 0.0001) whereas no difference was found in controls (P = 0.08). It was predicted PTGS2 expression decreased due to altered interactions between DNA and TFs in promoter region harbouring the polymorphism. PTGS2 mRNA expression was upregulated in patients bearing AA genotype whereas downregulated in patients with AG and GG genotypes. Protein expression was reduced in AG and GG carrying patients compared to patients bearing AA genotype. CONCLUSION This study is the first one to report association of PTGS2 rs689466 polymorphism in Indian population. This will help in gene-based therapy for improved asthma management in future.
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Affiliation(s)
- Indranil Ganai
- Ecology and Allergology Lab, Department of Zoology, The University of Burdwan, Burdwan, West Bengal 713104, India
| | - Achintya Mohan Goswami
- Department of Physiology, Krishnagar Government College, Krishnagar, West Bengal 741101, India
| | - Nasima Sultana
- Ecology and Allergology Lab, Department of Zoology, The University of Burdwan, Burdwan, West Bengal 713104, India
| | - Saheen Sultana
- Ecology and Allergology Lab, Department of Zoology, The University of Burdwan, Burdwan, West Bengal 713104, India
| | - Arghya Laha
- Ecology and Allergology Lab, Department of Zoology, The University of Burdwan, Burdwan, West Bengal 713104, India
| | - Himani Biswas
- Post Graduate Department of Zoology, Lady Brabourne College, Kolkata, West Bengal 700017, India
| | - Saibal Moitra
- Apollo Multispecialty Hospitals, Kolkata, West Bengal 700054, India
| | - Sanjoy Podder
- Ecology and Allergology Lab, Department of Zoology, The University of Burdwan, Burdwan, West Bengal 713104, India.
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Phelan KJ, Khurana Hershey GK. Frequent exacerbator-a novel endotype of pediatric asthma. J Allergy Clin Immunol 2025:S0091-6749(25)00556-1. [PMID: 40409378 DOI: 10.1016/j.jaci.2025.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 04/22/2025] [Accepted: 05/16/2025] [Indexed: 05/25/2025]
Abstract
Asthma is a complex and chronic respiratory condition that affects both adult and pediatric populations. Several asthma endotypes have been described; they include endotypes characterized by TH2 cell inflammation, response to viral infection, and exposure to air pollution. Recent evidence has revealed a novel endotype of pediatric asthma, termed the frequent exacerbator (FE) endotype, which is characterized by recurrent exacerbations. In this review, we provide an overview of the FE endotype. We review its epidemiology, its definition, and its environmental and clinical associations. We also detail findings from recent molecular characterizations of a pediatric FE endotype, with a specific focus on airway gene expression studies. As asthma exacerbations drive mortality and economic burden associated with disease, understanding the factors leading to frequent exacerbations is an important step in development of novel therapeutics and treatment strategies.
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Affiliation(s)
- Kieran J Phelan
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Mubanga M, Gong T, Smew AI, Wikström A, Caffrey Osvald E, Eeg-Olofsson K, Janson C, Lundholm C, Almqvist C. Association between asthma and type 2 diabetes in a Swedish adult population: a register-based cross-sectional study. Thorax 2025; 80:385-391. [PMID: 40122610 DOI: 10.1136/thorax-2024-222819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 03/06/2025] [Indexed: 03/25/2025]
Abstract
OBJECTIVE Asthma and type 2 diabetes are two important causes of morbidity globally. We examined both the association of type 2 diabetes with asthma in Swedish adults and the familial co-aggregation of the diseases. METHODS We conducted a cross-sectional study of all adults aged 25-85 in Sweden between 2009 and 2013. Asthma and type 2 diabetes status were ascertained from the health registers. Models were adjusted for sex, age, education level, income and country of birth and in a subset, for body mass index (BMI). We further conducted a familial coaggregation analysis to determine if shared familial factors could explain any observed findings. RESULTS The study included 5 299 245 participants, 25 292 (0.5%) had both asthma and type 2 diabetes. In the total population, the OR for the association between type 2 diabetes and asthma was 1.47 (95% CI 1.45 to 1.49); in the population of men (1.30 (95% CI 1.27 to 1.32)) and women (1.63 (95% CI 1.60 to 1.66)). The ORs were slightly higher among men (1.51 (95% CI 1.45 to 1.56)) and women (2.04 (95% CI 1.96 to 2.11)) for whom BMI measurements were available but attenuated with adjustment for BMI (1.45 (95% CI 1.40 to 1.51)) and (1.76 (95% CI 1.68 to 1.84)). Diabetes was more likely if a full sibling had asthma than if the sibling did not (1.13 (95% CI 1.10 to 1.15)). CONCLUSIONS We found an association between asthma and type 2 diabetes that was sustained after adjusting for BMI, indicating that BMI alone does not explain this relationship. We also found that the two conditions coaggregate in siblings, indicating that the association is partly due to shared familial genetic and environmental risk factors.
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Affiliation(s)
- Mwenya Mubanga
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- HIV Surveillance Unit, Center for Infectious Disease Research, Lusaka, Zambia
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Awad I Smew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amanda Wikström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emma Caffrey Osvald
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Katarina Eeg-Olofsson
- Västra Götalandsregionen, Vanersborg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Stockholm, Sweden
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Zouein J, Que LG, Ingram JL. Obesity-driven airway eosinophilia and neutrophilia in asthma. J Asthma 2025:1-11. [PMID: 40372017 DOI: 10.1080/02770903.2025.2505464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 04/22/2025] [Accepted: 05/09/2025] [Indexed: 05/16/2025]
Abstract
OBJECTIVE Asthma patients with comorbid obesity tend to have more severe, difficult-to-control asthma than lean asthma patients. This increase in asthma severity may be due, in part, to obesity-related adipokines, such as leptin, which contribute to airway hyperresponsiveness, sustained subclinical chronic inflammation, and treatment resistance. This narrative literature review aims to elucidate the differences in airway eosinophilia and neutrophilia profiles between asthma patients with and without obesity. METHODS A PubMed search of full journal articles published between 1992 and 2024 was performed in April 2024 using the terms "asthma", "tissue eosinophilia" and "obesity" combined with the Boolean operator "AND". Articles detailing airway tissue eosinophilia and neutrophilia in asthma patients or mice were included. Only articles in English were included. RESULTS To date, several studies have reported increased airway tissue eosinophilia in obese mouse asthma models (four studies) and in asthma patients with obesity (three studies). Airway tissue eosinophilia in asthma patients with obesity is driven by altered and elevated levels of adipokines, pro-inflammatory cytokines, and eosinophil-stimulating chemokines such as eotaxin. Leptin and eotaxin levels are increased in asthma with obesity and contribute to enhanced eosinophil recruitment, migration, adhesion to airway smooth muscles and fibroblasts, and reduced apoptosis. CONCLUSIONS Airway tissue eosinophilia is an important feature of obesity-associated asthma. Airway tissue eosinophilia is mainly driven by obesity-related homeostatic changes. These increased airway tissue eosinophils contribute to a more severe disease.
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Affiliation(s)
- Joseph Zouein
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Loretta G Que
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer L Ingram
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
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Durham TA, Mansoor BS, Chorney SR, Mitchell RB, Najjar A, Johnson RF. Association Between Severe Obesity and Pediatric Obstructive Apnea-A Retrospective Case Series. Otolaryngol Head Neck Surg 2025. [PMID: 40365956 DOI: 10.1002/ohn.1295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 03/25/2025] [Accepted: 04/19/2025] [Indexed: 05/15/2025]
Abstract
OBJECTIVE To investigate the impact of severe obesity on the severity of pediatric obstructive sleep apnea (OSA). STUDY DESIGN Retrospective case series. SETTING Tertiary stand-alone pediatric hospital. METHODS Consecutive children with obesity (≥95th percentile body mass index [BMI]) who underwent full-night polysomnography between January 2021 and December 2021 were analyzed. Patients were categorized into obesity (≥95th percentile BMI and <120% of the 95th percentile) and severe obesity (≥120% of the 95th percentile BMI). The association between severe obesity and severe OSA was assessed using multiple logistic regression. RESULTS The study included 282 patients with a median age of 9.2 years (interquartile range 5.9-12.3), 63% male, and 65% Hispanic. In total, 53% were severely obese. Severely obese children had a higher prevalence of severe OSA (53% vs 33%, P < .001) and very severe OSA (apnea-hypopnea index ≥ 24; 24% vs 11%, P = .006). Multiple logistic regression revealed that severe obesity was associated with severe OSA (adjusted odds ratio [aOR] = 3.44; 95% confidence interval [CI], 1.82-6.53; P < .001) after adjusting for age, sex, and tonsillar hypertrophy. Among 170 patients who underwent posttonsillectomy polysomnography, 29% exhibited residual OSA, with 19% having residual severe OSA. Class 3 severe obesity was associated with residual OSA (aOR = 4.05, 95% CI = 1.09-15.00). CONCLUSION Children with severe obesity face substantial sleep disturbances and a heightened risk of residual OSA following adenotonsillectomy.
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Affiliation(s)
- Tyler A Durham
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Basir S Mansoor
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center of Dallas, Dallas, Texas, USA
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center of Dallas, Dallas, Texas, USA
| | - Alex Najjar
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center of Dallas, Dallas, Texas, USA
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11
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Zivadinovic N, Jaioun K, Klepaker G, Wagstaff A, Torén K, Henneberger PK, Kongerud J, Abrahamsen R, Fell AKM. Occupational risk factors for asthma exacerbation in adults: a five-year follow-up of the Norwegian Telemark study cohort. J Asthma 2025:1-8. [PMID: 40317170 DOI: 10.1080/02770903.2025.2500077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 02/17/2025] [Accepted: 04/27/2025] [Indexed: 05/07/2025]
Abstract
OBJECTIVES Asthma exacerbation due to occupational exposure is highly prevalent among adults with asthma. This study assessed the association between occupational risk factors and asthma exacerbation and estimated the impact of asthma exacerbations on job change, sick leave and work ability. METHODS In a prospective study of respiratory health in Telemark, Norway, 1857 adult participants with physician-diagnosed asthma were invited to participate in a follow-up survey. Among those who responded, 740 were found eligible for this study. Participants were categorized into overall, mild, and severe asthma exacerbation groups based on self-reports of hospitalization, doctor or emergency visits for breathing difficulties, or increased or new use of lung medications. Logistic regression, adjusted for age, sex, and smoking, was used to assess associations between self-reported asthma exacerbation and exposure to VGDF, job exposure matrix (N-JEM) data, job change, sick leave, and work ability. RESULTS Asthma exacerbation occurred in 140 (19%) responders; 83 had mild exacerbations and 57 severe exacerbations. Severe exacerbation was associated with daily VGDF exposure (OR 2.57, 95% CI 1.15-5.78) and accidental peak exposure to irritants (OR 4.62, 95% CI 1.13-18.85). Both overall and severe exacerbation were associated with job changes (OR 5.40, 1.26-5.65; OR 3.06, 1.16-8.07), sick leave (OR 1.94, 1.33-2.85; OR 2.78, 1.57-4.92), and reduced work ability (OR 1.61, 1.04-2.49; OR 2.17, 1.18-3.98). CONCLUSION Asthma exacerbation was associated with VGDF exposure and some N-JEM occupational exposures. Reducing workplace exposure may decrease job-change, sick leave, and improve work ability in individuals with asthma exacerbation.
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Affiliation(s)
- Nikola Zivadinovic
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Keson Jaioun
- Department of Research, Telemark Hospital, Skien, Norway
| | - Geir Klepaker
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway
| | - Anthony Wagstaff
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
- Norwegian Institute of Aviation Medicine, Oslo, Norway
| | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Johny Kongerud
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Regine Abrahamsen
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway
| | - Anne Kristin Møller Fell
- Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
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12
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Lu H, Li J, Liu X, Jiang P, Feng Y, Wang C, Xu F. Triglyceride-glucose index as an independent predictor of mortality in patients with chronic respiratory diseases. Front Pharmacol 2025; 16:1474265. [PMID: 40421215 PMCID: PMC12104191 DOI: 10.3389/fphar.2025.1474265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 04/21/2025] [Indexed: 05/28/2025] Open
Abstract
Objective The consequences of chronic pulmonary illness are known to exacerbate in individuals with metabolic syndrome and insulin resistance. However, the relationship between triglyceride-glucose (TyG) index, a reliable alternative biomarker of metabolic dysfunction, and chronic respiratory diseases (CRDs) are inconclusive. Research design and methods Our research involved a total of 7,819 adult individuals diagnosed with CRDs who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. To assess the correlation between the TyG index and survival rates, we employed multivariable weighted Cox regression analysis, smoothing curve fitting, survival curve analysis and subgroup analysis to investigate the relationship. Results Higher TyG index among CRDs shown a substantial positive correlation with all-cause mortality after controlling for relevant confounders. The restricted cubic spline analysis showed a nonlinear relationship between the TyG score and all-cause mortality in CRDs. Patients with higher TyG indexes had a greater risk of all-cause mortality according to Kaplan-Meier survival curves. Conclusion The clinical relevance of the TyG index in predicting the life expectancy of individuals with CRDs is highlighted by our research. The TyG index can serve as a substitute biomarker for monitoring the wellbeing of the individuals with CRDs.
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Affiliation(s)
- Hongyu Lu
- Department of Intensive Care Unit, Shenzhen Guangming District People’s Hospital, Shenzhen, Guangdong, China
| | - Jibo Li
- Department of Intensive Care Unit, Shenzhen Guangming District People’s Hospital, Shenzhen, Guangdong, China
| | - Xinlong Liu
- Department of Intensive Care Unit, Shenzhen Guangming District People’s Hospital, Shenzhen, Guangdong, China
| | - Pan Jiang
- Department of Stomatology, Shenzhen Guangming District People’s Hospital, Shenzhen, Guangdong, China
| | - Yongwen Feng
- Department of Intensive Care Unit, Shenzhen Guangming District People’s Hospital, Shenzhen, Guangdong, China
| | - Changshan Wang
- Institutes for Translational Medicine, Shenzhen Guangming District People’s Hospital, Shenzhen, Guangdong, China
| | - Feng Xu
- Department of Intensive Care Unit, Shenzhen Guangming District People’s Hospital, Shenzhen, Guangdong, China
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13
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Hu J, Tang S, Zhu Q, Liao H. Predictive value of six anthropometric indicators for prevalence and mortality of obstructive sleep apnoea asthma and COPD using NHANES data. Sci Rep 2025; 15:16190. [PMID: 40346342 PMCID: PMC12064750 DOI: 10.1038/s41598-025-99490-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Accepted: 04/21/2025] [Indexed: 05/11/2025] Open
Abstract
Obesity is linked to a greater risk of respiratory diseases. Due to limitations in body mass index (BMI), alternative anthropometric indicators have been developed to reflect body fat distribution. This study compares six anthropometric measures-BMI, waist circumference (WC), the waist-to-height ratio (WHtR), the body roundness index (BRI), the body shape index (ABSI), and the weight-adjusted waist index (WWI)-and their relationships with the prevalence and mortality of obstructive sleep apnoea (OSA), asthma, and chronic obstructive pulmonary disease (COPD) in the US population. Data from four NHANES cycles were analyzed. Multivariable logistic regression assessed the cross-sectional associations between the six anthropometric measures and disease prevalence. Mortality associations were analysed via Cox proportional hazards models, and time‒dependent ROC curve was utilised to evaluate the predictive performance of the significant marker for mortality. BMI, WC, WWI, BRI, ABSI, and WHtR were positively correlated with the prevalence of OSA, and COPD. For asthma, BMI, WC, BRI, and WHtR were positively associated with prevalence, while ABSI and WWI were negatively associated. Concerning mortality, higher WC and BMI were associated with better survival in the OSA and COPD groups, whereas elevated WWI and ABSI were linked to greater mortality risk in the participants with OSA symptoms. An increase of one standard deviation (SD) in the ABSI resulted in an 18% increase in mortality (95% CI 1.09-1.27) for the OSA population. The area under the curve (AUC) for ABSI was 0.752 for 3-year, 0.755 for 5-year, and 0.744 for 10-year mortality. Novel anthropometric indicators, including WWI, BRI, ABSI, and WHtR, show positive associations with the prevalence of OSA, and COPD, alongside traditional measures like BMI and WC. However, WWI and ABSI were more limited in their association with asthma prevalence. Longitudinal analyses revealed that traditional anthropometric indicators such as BMI and WC were negatively associated with mortality risks in the OSA and COPD, supporting the "obesity paradox." ABSI, however, emerged as a significant mortality predictor for OSA, providing a more nuanced view of central obesity's impact on mortality. However, in COPD patients, routine anthropometric measurements may not fully capture the effects of obesity.
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Affiliation(s)
- Jingdi Hu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Songwen Tang
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qijiang Zhu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huai Liao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
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14
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Sun C, Niu XL, Zeng LX. The association between triglyceride glucose-body mass index and mortality in critically ill patients with respiratory failure: insights from ICU data. Sci Rep 2025; 15:16153. [PMID: 40341139 PMCID: PMC12062496 DOI: 10.1038/s41598-025-00254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 04/28/2025] [Indexed: 05/10/2025] Open
Abstract
Respiratory failure (RF) lead to high mortality rates and extended hospital stays in intensive care unit (ICU). The Triglyceride-Glucose (TyG) index, a reliable surrogate marker for insulin resistance (IR), predicted adverse outcomes in various diseases. Combining weight-related indices like body mass index (BMI) with TyG to form the TyG-BMI enhanced the assessment of IR and its impact on patient outcomes. However, the association between TyG-BMI and outcomes in patients with RF remained underexplored. This study retrospectively analyzed data from the MIMIC-IV database, focusing on critically ill patients with RF. From an initial cohort of 19,429 patients, 2177 met the inclusion criteria and were divided into quartiles based on TyG-BMI values. Key clinical information was collected within the first 24 h of ICU admission, including demographics, lab results, vital signs, and scoring systems such as SAPS II and SOFA. Primary outcome was 28-day, secondary outcomes were 180-day and 1-year mortality. Data were analyzed using multivariable Cox regression models, Kaplan-Meier survival curves, and restricted cubic splines to assess the nonlinear relationship between TyG-BMI and mortality. The study found significant differences in baseline characteristics across TyG-BMI quartiles. Kaplan-Meier survival curves indicated a higher survival probability for patients in the lowest TyG-BMI quartile (Q1) compared to higher quartiles (Q2-Q4). Adjusted hazard ratios demonstrated a nonlinear association between higher TyG-BMI values and increased mortality risk at all three time points. The RCS-derived cut-off value of 269 for TyG-BMI was identified as a significant threshold, with higher TyG-BMI values correlating with lower mortality risks. Subgroup analyses reinforced these findings across different patient demographics and clinical profiles. Higher TyG-BMI was associated to lower short-term and long-term mortality, suggesting a potential protective effect. These findings highlighted the importance of the TyG-BMI as a robust prognostic marker, providing valuable insights for improving treatment strategies for patients with RF.
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Affiliation(s)
- Ce Sun
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Li Niu
- Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Li-Xiong Zeng
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China.
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15
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Yu R, Zhang L, Li X, Wang Q, Wu X. Effects of Nutritional Status on Treatment Outcomes and Prognosis of Infants With Bronchiolitis. Clin Pediatr (Phila) 2025:99228251339067. [PMID: 40346817 DOI: 10.1177/00099228251339067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2025]
Abstract
To explore how nutritional status impacts treatment efficacy and future asthma risk in infants with bronchiolitis. A retrospective analysis of 473 RSV-induced bronchiolitis cases from 2015 to 2018. No significant demographic differences. Obese infants showed increased respiratory distress, wheezing, and rapid breathing, with lower oxygen saturation. Elevated IgE and tumor necrosis factor-α (TNF-α) levels persisted in the obese group. A higher asthma incidence was observed after 5 years in this group. Nutritional status is crucial for bronchiolitis management; obesity prevention should be highlighted in asthma programs.
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Affiliation(s)
- Ruogu Yu
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Zhang
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Li
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Wang
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaobin Wu
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
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16
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Fox L, D'Cruz LG, Chauhan M, Gates J, Szarazova N, De Vos R, Hicks A, Brown T, Stores R, Chauhan AJ. Diagnosis of respiratory conditions using exhaled breath condensate using Inflammacheck® and advanced analytics: insights from the VICTORY study. J Breath Res 2025; 19:036005. [PMID: 40294609 DOI: 10.1088/1752-7163/add17c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2025] [Accepted: 04/28/2025] [Indexed: 04/30/2025]
Abstract
Lung cancer, the third leading cause of death in England, is challenging to diagnose early. Traditional methods are costly, time-consuming and uncomfortable. Exhaled breath condensate (EBC) analysis with the Inflammacheck® device offers a non-invasive alternative, employing advanced analytics like t-distributed stochastic neighbour embedding (t-SNE), Bhattacharyya distances and network maps to differentiate respiratory conditions. The VICTORY study recruited participants (age ⩾ 16) with physician-confirmed respiratory conditions (asthma, chronic obstructive pulmonary disease, bronchiectasis, interstitial lung disease, lung cancer, pneumonia or a breathing pattern disorder) from inpatient and outpatient settings at a single NHS university hospital. EBC was collected using the Inflammacheck® device, to assess seven parameters: H2O2levels, peak CO2percentage, peak breath humidity, peak breath temperature, exhalation flow rate, exhalation duration and sample collection time. After standardisation of EBC data, t-SNE was employed, Bhattacharyya distances calculated on tSNE components, network maps generated, and hierarchical clustering performed to illustrate the distinct classifications of the respiratory conditions based on the EBC parameters. The study included 282 participants. Multinomial logistic regression revealed elevated exhaled H2O2increased the odds of pneumonia (25.7-fold) and lung cancer (3.6-fold). t-SNE analysis showed distinct disease clusters, with Bhattacharyya distances for lung cancer and pneumonia demonstrating good separability from other conditions. Hierarchical clustering confirmed clear group distinctions, as visualised in heatmaps and dendrograms. The integration of advanced dimensionality reduction techniques t-SNE, combined with Bhattacharyya distance-based network mapping to interpret the EBC results facilitated discrimination between respiratory diseases. These methods were chosen over standard machine-learning classifiers due to their ability to provide intuitive, interpretable visualisations of complex data relationships, complementing their strong discriminatory power. Harnessing these analytical tools facilitated disease discrimination, particularly for lung cancer and pneumonia, suggesting promise as a diagnostic aid, paving the way for improved clinical decision-making and patient care.
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Affiliation(s)
- L Fox
- Research and Innovation Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO63LY, United Kingdom
- School of Dental, Health and Care Professions, Faculty of Science and Health, University of Portsmouth, Portsmouth PO12UP, United Kingdom
| | - L G D'Cruz
- Research and Innovation Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO63LY, United Kingdom
- School of Medicine, Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO12UP, United Kingdom
| | - M Chauhan
- Research and Innovation Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO63LY, United Kingdom
- School of Medicine, Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO12UP, United Kingdom
| | - J Gates
- Research and Innovation Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO63LY, United Kingdom
| | - N Szarazova
- Research and Innovation Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO63LY, United Kingdom
| | - R De Vos
- Research and Innovation Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO63LY, United Kingdom
- School of Psychology, Sport and Health Sciences, University of Portsmouth, Portsmouth PO12UP, United Kingdom
| | - A Hicks
- Research and Innovation Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO63LY, United Kingdom
- School of Medicine, Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO12UP, United Kingdom
| | - T Brown
- Research and Innovation Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO63LY, United Kingdom
- School of Medicine, Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO12UP, United Kingdom
| | - R Stores
- School of Dental, Health and Care Professions, Faculty of Science and Health, University of Portsmouth, Portsmouth PO12UP, United Kingdom
| | - A J Chauhan
- Research and Innovation Department, Portsmouth Hospitals University NHS Trust, Portsmouth PO63LY, United Kingdom
- School of Medicine, Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO12UP, United Kingdom
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17
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Mazzotta C, Barkai L. Obesity and Asthma in Children-Coexistence or Pathophysiological Connections? Biomedicines 2025; 13:1114. [PMID: 40426941 DOI: 10.3390/biomedicines13051114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2025] [Revised: 04/30/2025] [Accepted: 05/02/2025] [Indexed: 05/29/2025] Open
Abstract
The aim of this narrative review is to explore possible connections that might lead to both obesity and asthma; it will explain factors and mechanisms involved in disease pathogenesis, focusing particularly on diet and nutrients, the microbiome, inflammatory and metabolic dysregulation, lung function, the genetics/genomics of obese asthma, risk of exacerbation, atopy, and response to treatment. It highlights the role that obesity plays as a risk factor for and disease modifier of asthma, understanding the evidence supporting lifestyle changes in influencing disease progression. Pathophysiological mechanisms in obesity-related asthma have influences on the course of disease pathology. Due to these factors, the child with obese asthma needs a specific therapeutic approach taking into account the common unresponsiveness to bronchodilators, increased requirements for controller medications, poorer steroid effectiveness, and better response to leukotriene receptor (LTR) inhibitors. Therapeutic strategies centered on prevention are suggested and the development of resources to assist families with weight loss strategies and lifestyle changes is shown to be useful for effective weight control and optimal asthma management. Obese children with asthma generally should receive interventions that encourage daily physical activity, weight loss, and normalization of nutrient levels, and monitoring of common obesity-related sequelae should be considered by healthcare providers managing obese children with difficult to control asthma. Recognizing and identifying an asthmatic patient is not always easy and a detailed medical history of the patient, with particular attention paid to their presenting and past symptoms, and a complete physical examination play pivotal and fundamental roles in determining the final diagnosis.
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Affiliation(s)
- Clarissa Mazzotta
- Azienda Sanitaria Locale della Provincia di Lecce, 73100 Lecce, Italy
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Kosice, Slovakia
| | - László Barkai
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Kosice, Slovakia
- Physiological Controls Research Center, University Research and Innovation Center, Obuda University, 1034 Budapest, Hungary
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18
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Sarioglu N, Solmaz Avcikurt A, Hismiogullari AA, Erel F. The role of periostin, eosinophil cationic protein (ECP), nesfatin-1, and NUCB2 in asthma and obesity. J Asthma 2025; 62:787-793. [PMID: 39665477 DOI: 10.1080/02770903.2024.2441885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 11/22/2024] [Accepted: 12/10/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND Obesity has a significant impact on asthma incidence and control. Nesfatin-1, encoded by the nucleobindin-2 (NUCB2) gene, regulates energy balance. This study aimed to evaluate NUCB2 gene polymorphism (rs757081 C > G) and its association with serum levels of nesfatin-1 and inflammatory cytokines in obese and non-obese patients with asthma. METHODS Obese (n = 43) and non-obese (n = 44) patients diagnosed with asthma and 45 control subjects were included. Nesfatin-1, eosinophil cationic protein (ECP), and periostin were studied in serum samples using the ELISA method. NUCB2 polymorphism was studied by PCR method. RESULTS No difference was found between groups regarding NUCB2 polymorphism (CC, CG, GG) (p = 0.497). Nesfatin-1 levels were higher in the obese asthmatics than in the control (median 1.69 ng/ml vs 1.36 ng/ml, p = 0.004). ECP levels were higher in the obese asthmatics (median 7.67 ng/ml) compared to non-obese asthmatic (median 1.98 ng/ml) and control (median 1.45 ng/ml) (p < 0.001, p < 0.001 respectively). Periostin was found to be lower in both obese (median 0.34 ng/ml) and non-obese asthmatics (median 0.35 ng/ml) compared to control (median 1.2 ng/ml) (p = 0.001, p < 0.001, respectively). There was a positive correlation between BMI and nesfatin-1 (r = 0.33, p < 0.001) and ECP (r = 0.58, p < 0.001). In regression analysis, ECP (95% CI: 0.19 to 0.75, p = 0.005) and periostin (95% CI: 4.5 to 375.1, p = 0.003) were independent predictors for asthma. CONCLUSION Nesfatin-1 and ECP have been shown to be increased in obese asthmatics. ECP and periostin have been identified as a predictor of asthma independent of obesity.
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Affiliation(s)
- Nurhan Sarioglu
- Pulmonary Diseases, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | | | | | - Fuat Erel
- Pulmonary Diseases, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
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Maselli DJ, Sherratt J, Adams SG. Comorbidities and multimorbidity in asthma. Curr Opin Pulm Med 2025; 31:270-278. [PMID: 40047208 DOI: 10.1097/mcp.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2025]
Abstract
PURPOSE OF REVIEW To describe the associations between asthma and relevant comorbidities, and appraise the latest evidence on the management strategies of asthmatics with comorbid conditions. RECENT FINDINGS Conditions such as allergic rhinitis, chronic rhinosinusitis with and without nasal polyps, gastroesophageal reflux disease, obesity, chronic obstructive pulmonary disease, bronchiectasis, anxiety and depression have been linked to worse outcomes in asthma. Recognition and treatment of these conditions is important in asthma, particularly in those with uncontrolled or severe asthma. Biologics for asthma have been effective in those with chronic rhinosinusitis with nasal polyps and chronic obstructive pulmonary disease (COPD), with emerging evidence in bronchiectasis. Weight loss programs with diet and exercise improve asthma control. Anxiety and depression are often unrecognized in patients with asthma. SUMMARY Comorbid conditions have been recognized as important factors in the diagnosis and treatment of asthma, particularly in patients who have severe disease and remain uncontrolled. Comorbidities in asthma are correlated with poor quality of life and asthma control, increased healthcare utilization and their treatment is associated with improved outcomes.
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Affiliation(s)
- Diego J Maselli
- Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Texas Health San Antonio
| | - Jesse Sherratt
- Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Texas Health San Antonio
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Healthcare System, San Antonio, Texas, USA
| | - Sandra G Adams
- Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Texas Health San Antonio
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Healthcare System, San Antonio, Texas, USA
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20
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Mesarwi OA. Carotid complexity: is there a mechanistic link between asthma and OSA? J Neurophysiol 2025; 133:1404-1405. [PMID: 40139259 DOI: 10.1152/jn.00033.2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 01/29/2025] [Accepted: 03/22/2025] [Indexed: 03/29/2025] Open
Affiliation(s)
- Omar A Mesarwi
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, University of California San Diego, La Jolla, California, United States
- Section of Sleep Medicine, Jennifer Moreno Department of Veterans Affairs Medical Center, La Jolla, California, United States
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21
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Skeen EH, Hamlington KL, De Keyser HH, Liu AH, Szefler SJ. Managing childhood asthma with an eye toward environmental, social, and behavioral features. Ann Allergy Asthma Immunol 2025; 134:516-524. [PMID: 40010666 DOI: 10.1016/j.anai.2025.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Revised: 02/16/2025] [Accepted: 02/17/2025] [Indexed: 02/28/2025]
Abstract
Discussions on asthma management tend to focus on the therapeutic aspects when updates on asthma strategies are released. However, many other components of asthma management are now receiving increased attention, as we seek to make right on health disparities and strive toward health equity. In addition, with the therapeutic aspects of asthma, we now realize that our anti-inflammatory approaches largely address the high T2 component of airway inflammation. However, we know very little about what we can do to control the other inflammatory features that contribute to asthma. Factors, such as environmental exposures, social determinants of health, and risk-taking behaviors may be at the root of asthma persistence, progression, and comorbidities. We will continue to learn methods to identify these issues and draw them into a shared decision-making approach for dialogue with patients and their caregivers. This review provides information and tools to address the nonpharmacologic aspects of asthma management.
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Affiliation(s)
- Emily H Skeen
- Pediatric Pulmonary and Sleep Medicine Section, Department of Pediatrics, Breathing Institute, Anschutz Medical Campus, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Katharine L Hamlington
- Pediatric Pulmonary and Sleep Medicine Section, Department of Pediatrics, Breathing Institute, Anschutz Medical Campus, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Heather H De Keyser
- Pediatric Pulmonary and Sleep Medicine Section, Department of Pediatrics, Breathing Institute, Anschutz Medical Campus, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Andrew H Liu
- Pediatric Pulmonary and Sleep Medicine Section, Department of Pediatrics, Breathing Institute, Anschutz Medical Campus, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Stanley J Szefler
- Pediatric Pulmonary and Sleep Medicine Section, Department of Pediatrics, Breathing Institute, Anschutz Medical Campus, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
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22
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Hildebrand S, Pfeifer A. The obesity pandemic and its impact on non-communicable disease burden. Pflugers Arch 2025; 477:657-668. [PMID: 39924587 PMCID: PMC12003543 DOI: 10.1007/s00424-025-03066-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Revised: 01/13/2025] [Accepted: 01/15/2025] [Indexed: 02/11/2025]
Abstract
The rising prevalence of overweight and obesity across the globe is a major threat both to public health and economic development. This is mainly due to the link of obesity with the development and outcomes of non-communicable diseases (NCDs). NCDs are a leading cause of global death and disability, and reducing the burden of NCDs on patients and healthcare systems is of critical importance to improve public health. Obesity is projected to be the number one preventable risk factor for NCDs by 2035, and there is an urgent need to tackle the growing obesity rates in order to reduce NCD incidence and severity. Here, we review the current understanding of the impact of obesity on NCD burden in general, as well as the epidemiological and mechanistic relationship between obesity and some of the most common classes of NCDs. By literature review, we found that over 70% of NCDs have a documented association with obesity, highlighting the importance of a better understanding of the pathophysiologies underlying obesity/overweight as well as the interaction between obesity and NCDs in order to reduce global disease burden.
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Affiliation(s)
- Staffan Hildebrand
- Institute of Pharmacology and Toxicology, University Hospital, University of Bonn, 53127, Bonn, Germany.
| | - Alexander Pfeifer
- Institute of Pharmacology and Toxicology, University Hospital, University of Bonn, 53127, Bonn, Germany.
- PharmaCenter Bonn, University of Bonn, Bonn, Germany.
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23
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Yamamoto Y, Shirai Y, Sonehara K, Namba S, Ojima T, Yamamoto K, Edahiro R, Suzuki K, Kanai A, Oda Y, Suzuki Y, Morisaki T, Narita A, Takeda Y, Tamiya G, Yamamoto M, Matsuda K, Kumanogoh A, Yamauchi T, Kadowaki T, Okada Y. Dissecting cross-population polygenic heterogeneity across respiratory and cardiometabolic diseases. Nat Commun 2025; 16:3765. [PMID: 40295474 PMCID: PMC12037804 DOI: 10.1038/s41467-025-58149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/11/2025] [Indexed: 04/30/2025] Open
Abstract
Biological mechanisms underlying multimorbidity remain elusive. To dissect the polygenic heterogeneity of multimorbidity in twelve complex traits across populations, we leveraged biobank resources of genome-wide association studies (GWAS) for 232,987 East Asian individuals (the 1st and 2nd cohorts of BioBank Japan) and 751,051 European individuals (UK Biobank and FinnGen). Cross-trait analyses of respiratory and cardiometabolic diseases, rheumatoid arthritis, and smoking identified negative genetic correlations between respiratory and cardiometabolic diseases in East Asian individuals, opposite from the positive associations in European individuals. Associating genome-wide polygenic risk scores (PRS) with 325 blood metabolome and 2917 proteome biomarkers supported the negative cross-trait genetic correlations in East Asian individuals. Bayesian pathway PRS analysis revealed a negative association between asthma and dyslipidemia in a gene set of peroxisome proliferator-activated receptors. The pathway suggested heterogeneity of cell type specificity in the enrichment analysis of the lung single-cell RNA-sequencing dataset. Our study highlights the heterogeneous pleiotropy of immunometabolic dysfunction in multimorbidity.
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Affiliation(s)
- Yuji Yamamoto
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuya Shirai
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Kyuto Sonehara
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Genome Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinichi Namba
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Genome Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takafumi Ojima
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Genome Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of Medicine, Tohoku University, Sendai, Japan
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kenichi Yamamoto
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryuya Edahiro
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Ken Suzuki
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akinori Kanai
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Yoshiya Oda
- Department of Lipidomics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Suzuki
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Takayuki Morisaki
- Division of Molecular Pathology, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Laboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Akira Narita
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yoshito Takeda
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Gen Tamiya
- Graduate School of Medicine, Tohoku University, Sendai, Japan
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masayuki Yamamoto
- Graduate School of Medicine, Tohoku University, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Koichi Matsuda
- Laboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Immunopathology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan
- Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Suita, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutional Science and Technology (AMED-CREST), Tokyo, Japan
- Center for Advanced Modalities and DDS (CAMaD), Osaka University, Suita, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Japan Agency for Medical Research and Development-Core Research for Evolutional Science and Technology (AMED-CREST), Tokyo, Japan.
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Toranomon Hospital, Tokyo, Japan.
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan.
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan.
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.
- Department of Genome Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Suita, Japan.
- Center for Advanced Modalities and DDS (CAMaD), Osaka University, Suita, Japan.
- Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe), Osaka University, Suita, Japan.
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Pham H, Koehl R, Woo H, Wu TD, Qiu AY, Brigham EP, Hansel NN, McCormack MC. Association Between Hemoglobin A1c and Pediatric Asthma Control. J Asthma Allergy 2025; 18:649-654. [PMID: 40322736 PMCID: PMC12047264 DOI: 10.2147/jaa.s498269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 03/20/2025] [Indexed: 05/08/2025] Open
Abstract
Purpose To examine the relationship between Hemoglobin A1c (HbA1c) and asthma outcomes in an urban cohort of children with asthma. Methods The AIRWEIGHS Study was a randomized controlled clinical trial of an air cleaner intervention testing the hypothesis that overweight/obese children would experience greater improvement in asthma control compared to normal weight children. The study enrolled 164 children with asthma from Baltimore, MD and assessed HbA1c levels and asthma outcomes during clinic visits at baseline and three months. HbA1c levels were analyzed as a continuous measure and categorized as either normal (<5.7%) or consistent with pre-diabetes (≥5.7%). Asthma outcomes included standardized questionnaires, spirometry, and fractional exhaled nitric oxide (FeNO). Generalized Estimating Equation (GEE) regression models were used to analyze the association between the HbA1c and asthma outcomes. Results Participants included 164 children with an average age of 11 (± 2) years, predominately African American (85%), male (59%), moderate or severe asthma by NAEPP criteria (59%), households with an income below $34,999 (60%), publicly insured (83%), and overweight/obese (61%). 52 participants were excluded from the analysis due to unsuccessful blood draws or participant refusal. Twenty of 112 distinct participants (18%) had HbA1c measurements ≥5.7%, consistent with prediabetes. Increased HbA1c levels were associated with worse asthma control as indicated by an increase in the Asthma Therapy Assessment Questionnaire (β-0.74 p<0.05). In the interaction analysis, BMI percentile had a significant interaction with HbA1c such that HbA1c had a stronger association with maximum symptoms days and exacerbation risk among children with lower versus higher BMI percentile values. Conclusion Higher HbA1c levels were associated with worse asthma control among children with asthma, adding to evidence that metabolic dysfunction may influence asthma morbidity. Additionally, HbA1c could have a stronger influence among non-obese children with underlying metabolic dysfunction, suggesting the need for future studies to investigate metabolic pathways in asthma.
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Affiliation(s)
- Hewlett Pham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Rachelle Koehl
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tianshi David Wu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anna Yue Qiu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emily P Brigham
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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25
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Liu X, Ling J, Wu Y, Zhao H, Hu Y, Yan Z, Zhu W, Yu P, Wang J, Zhang Y, Bucci T, Lip GYH. Association between metabolically healthy obesity and atrial fibrillation: A systematic review and meta-analysis of longitudinal studies. Diabetes Metab Syndr 2025; 19:103228. [PMID: 40306065 DOI: 10.1016/j.dsx.2025.103228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/12/2025] [Accepted: 04/20/2025] [Indexed: 05/02/2025]
Abstract
INTRODUCTION Obesity is not a single diagnosis, and the association of 'metabolically unhealthy' obesity with cardiovascular disease is well-described. However, the relationship between metabolically healthy obesity (MHO) and atrial fibrillation (AF) is still debated. OBJECTIVE Our objective is to investigate the association between MHO and the risk of AF. METHODS A comprehensive search of databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library regarding longitudinal studies of MHO and risk of AF was performed. Random effects were used to pool the effect estimates. RESULTS Nine cohort studies comprising 4,250,557 participants were included. The pooled results revealed that individuals with MHO were associated with a greater incidence of AF than those with a metabolically healthy normal weight (HR: 1.34, 95 % CI: 1.26 to 1.42) with moderate certainty according to the Grading of Recommendations Assessment, Development, and Evaluation assessment. Individuals with MHO were associated with a lower risk of AF compared with participants with metabolically unhealthy obesity (RR: 0.48, 95 % CI: 0.36 to 0.64). Individuals with MHO were not significantly associated with the risk of AF as compared to metabolically unhealthy normal weight (HR: 1.04, 95 % CI: 0.89 to 1.22). CONCLUSION MHO is associated with a greater incidence of AF, highlighting the importance of weight reduction in individuals without metabolic disorders in reducing the risk of AF. REGISTRATION PROSPERO - registration number CRD42023432195.
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Affiliation(s)
- Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
| | - Jitao Ling
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yifan Wu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Huilei Zhao
- Anesthesiology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuzhe Hu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Zhiwei Yan
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Shenyang, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peng Yu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
| | - Jinfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Yuling Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Tommaso Bucci
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool JohnMoores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy
| | - Gregory Y H Lip
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool JohnMoores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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26
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Sun J, Chen L, Zhao P, Bai X, Nie S, Li Y. New insights into causal relationship between serum lipids, obesity, and asthma: a Mendelian randomization study. J Asthma 2025:1-12. [PMID: 40227003 DOI: 10.1080/02770903.2025.2493177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2025] [Revised: 04/07/2025] [Accepted: 04/10/2025] [Indexed: 04/15/2025]
Abstract
OBJECTIVE To identify causal risk factors for asthma using a Mendelian randomization (MR) approach. METHODS Genetic variants associated with the exposures at the genome-wide significance level (p < 5 × 10 - 8) were obtained from corresponding genome-wide association studies. Summary-level statistical data for asthma were obtained from the UK Biobank (UKB) and the FinnGen Consortia. Univariate and multivariate MR analyses were performed to clarify causal relationships among obesity, serum lipids, and asthma. Meta-analyses were performed to combine UKB and FinnGen results using a fixed-effects model. RESULTS In FinnGen, the odds for asthma increased for every 1-SD increase in body mass index (BMI; odds ratio [OR] 1.292, p = 1.34 × 10-7), together with body fat percentage (BF%; OR 1.449, p = 4.90×10-3), and total cholesterol level (OR = 0.949, p = 0.027). However, higher BMI and BF% were found to increase the risk for asthma in the multivariate MR analysis. In the UKB, the BMI results were replicated. Meta-analysis revealed that high-density lipoprotein cholesterol could also increase the risk for asthma, although there were no associations with other risk factors included in this study. CONCLUSION This MR study found that genetically predicted higher BF% and BMI could increase the risk for asthma and corroborated some risk factors for asthma from previous MR studies. Moreover, the results suggest that higher BMI and BF% could serve as independent risk factors for asthma.
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Affiliation(s)
- Jialiang Sun
- Department of Pediatric Pulmonary Medicine, Children's Medical Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lanlan Chen
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Peiliang Zhao
- Department of Pediatric Pulmonary Medicine, Children's Medical Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xinquan Bai
- Department of Pediatric Pulmonary Medicine, Children's Medical Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Shu Nie
- Department of Pediatric Cardiology, Children's Medical Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yanan Li
- Department of Pediatric Pulmonary Medicine, Children's Medical Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Cojocaru E, Arcana RI, Radu S, Trofor AC, Cojocaru C. Challenges and Opportunities in Achieving Asthma Remission. J Clin Med 2025; 14:2835. [PMID: 40283665 PMCID: PMC12027850 DOI: 10.3390/jcm14082835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Revised: 04/08/2025] [Accepted: 04/18/2025] [Indexed: 04/29/2025] Open
Abstract
Background: Asthma is a chronic inflammatory disorder in millions of individuals across the globe with high morbidity, mortality, and health care costs. Despite advances in asthma treatment, long-term remission is a challenging target to achieve. Objectives: This review will address the path to remission in asthma with focus on the role of biologic agents in severe asthma management and on the question as to whether long-term disease control and remission are a reality. Methods: A systematic literature review from 1971 to 2025 was conducted through databases such as PubMed, MEDLINE, Scopus, and Web of Science. Clinical trials, meta-analyses, and real-world evidence concerning biologic therapies, such as monoclonal antibodies targeting interleukin -5 (IL-5), IL-4/IL-13, immunoglobulin E, and thymic stromal lymphopoietin, were considered. Symptom control, exacerbation frequency, lung function, and oral corticosteroid (OCS) use were some of the outcomes considered. Results: Biologic treatments have yielded significant gains in asthma control and reduction of exacerbation. Complete remission-long-term resolution of symptoms, inflammation, and drug dependence-is still difficult to achieve. Early intervention with biologics may prevent irreversible airway remodeling, but long-term remission is not in sight. These drugs reduce OCS dependency, but sustainability of remission remains to be investigated. Conclusions: Biologic therapies have advanced asthma treatment, particularly in severe cases, by improving symptoms and reducing exacerbations. However, complete remission remains a distant goal. The development of standardized remission criteria, better patient stratification, and long-term clinical studies are necessary to help achieve sustained asthma control and remission.
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Affiliation(s)
- Elena Cojocaru
- Morpho-Functional Sciences II Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Raluca Ioana Arcana
- Medical III Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.T.); (C.C.)
| | - Steluta Radu
- Faculty of Agriculture, Food Technologies Department, Life of Sciences University “Ion Ionescu de la Brad”, 700490 Iasi, Romania;
| | - Antigona Carmen Trofor
- Medical III Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.T.); (C.C.)
| | - Cristian Cojocaru
- Medical III Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.T.); (C.C.)
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28
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Marinelli A, Dragonieri S, Portacci A, Quaranta VN, Carpagnano GE. Reconsidering Gender in Asthma: Is It All About Sex? A Perspective Review. J Clin Med 2025; 14:2506. [PMID: 40217954 PMCID: PMC11989258 DOI: 10.3390/jcm14072506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 03/28/2025] [Accepted: 04/02/2025] [Indexed: 04/14/2025] Open
Abstract
Asthma is a prevalent chronic condition, affecting an estimated 260 million people worldwide, according to the 2021 Global Burden of Disease Study. This condition significantly impacts individuals of all ages. One notable finding is that asthma prevalence among adults was higher in females than males. Recent evidence suggests that these disparities in asthma prevalence and outcomes are likely due to complex interactions among hormonal, anatomical, and environmental factors, coupled with societal and behavioral influences. The interchangeable use of the terms "sex" and "gender" in the scientific literature is frequently inconsistent. Biological sex is defined by anatomical and physiological characteristics determined by genetics; "gender", on the other hand, is a more complex construct and a universally accepted definition is still lacking. This lack of clarity, coupled with potential knowledge gaps, misunderstandings, or the inherent difficulty in differentiating sex- and gender-related effects, often leads to the terms being poorly defined or used interchangeably. Such imprecise usage hinders accurate data interpretation and research progress. This paper provides a perspective review synthesizing current knowledge regarding the influence of sex and gender on asthma, specifically focusing on their impact on disease pathogenesis, clinical presentation, severity, and management strategies.
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Affiliation(s)
| | - Silvano Dragonieri
- Department of Respiratory Diseases, University of Bari, 70121 Bari, Italy; (A.M.); (A.P.); (V.N.Q.); (G.E.C.)
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29
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Lang L, Ma M, Zhao H, Zhang J, Liu S, Liu H. Global research trends in obesity-related asthma (2004-2023): a bibliometric analysis. Front Nutr 2025; 12:1528366. [PMID: 40248034 PMCID: PMC12003137 DOI: 10.3389/fnut.2025.1528366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 03/18/2025] [Indexed: 04/19/2025] Open
Abstract
Background In recent years, an increasing body of evidence has revealed a complex interplay between obesity and asthma, prompting academic and medical communities to intensify their focus on this area of research. The objective of this study is to undertake a comprehensive bibliometric analysis of the research literature pertaining to obesity-related asthma from 2004 to 2023. This analysis aims to provide precise and valuable insights, as well as to systematically reflect upon the current status and emerging trends within the field. Methods Literature data on obesity and asthma research was sourced from the Web of Science Core Collection database. CiteSpace and VOSviewer were utilized to visually analyze bibliometric indicators such as co-authorship, citation networks, and publication frequency of the data to facilitate the identification of patterns and trends. Results A total of 3,118 papers were included in the analysis, encompassing 2,539 articles and 579 reviews. Throughout the last 20 years, the volume of publications has shown a consistent upward trend. The United States and Harvard University are at the forefront of this research field. Professor Dixon Anne E. is recognized as a pioneer and leading figure in the cultivation of obesity-related asthma research. Keyword analysis identified topics such as "childhood asthma," "bariatric surgery," "physical activity," "gut microbiota," "COVID-19," "food allergy," "asthma control," "nutrition examination," and "severe asthma." Conclusion The research domain of obesity-related asthma has experienced a substantial growth, with the United States, the United Kingdom, and China leading the global landscape. The focus on asthma in obese adolescents and children, the role of bariatric surgery, and lifestyle interventions remains a consistent area of interest, with considerable potential for further study. These findings provide a scientific basis for the development of personalized treatment programs for obese asthma patients. In addition, this study highlights the importance of further research in the fields of gut microbiota, COVID-19, and food allergy, providing directions for future policymaking.
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Affiliation(s)
| | | | | | | | | | - Hua Liu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
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Ibrahim RT, Moustafa YM, Alwaili MA, Alrebdi AN, Alharthi A, Noufal NR, Khodeer DM. Chromium and formoterol therapy for obesity-induced asthma in rats. Front Pharmacol 2025; 16:1537022. [PMID: 40242447 PMCID: PMC12000533 DOI: 10.3389/fphar.2025.1537022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 02/06/2025] [Indexed: 04/18/2025] Open
Abstract
The development of asthma is impacted by fat. Asthma is more common in obese persons. The purpose of the experimental study is to determine how chromium, formoterol, and their combination can improve the quality of life for obese people with lung anomalies. Thirty-six male Wistar rats were divided into six groups: control (C), obesity (CO), obese-asthma (COA), and obese-asthma groups treated with formoterol (OAF), chromium (OACR), or both (OACRF). Except for group C, all groups received a high-fat diet for 4 weeks. Subsequently, ovalbumin (OVA) was administered subcutaneously (s.c.) to all groups except C and CO to induce sensitization. Asthma was triggered via 1% OVA aerosol challenges on days 26-28. Over 5 days, OAF and OACRF received daily formoterol inhalations (50 μg/kg), while OACR and OACRF were given chromium (400 μg/kg). Treatments were timed to align with asthma induction protocols. Lipid profile and inflammatory indicators were examined at the end of the trial-Immunohistochemical analysis of lung tissue, Histopathological and lung tissue stained with Hematoxylin and Eosin. The combination therapy (OACRF) significantly reduced body weight (p < 0.05), lowered LDL and triglycerides, increased HDL, and normalized lung tissue architecture compared to controls. Immunohistochemistry revealed reduced IL-1β and IL-17α expression. The (OACRF) group demonstrated superior asthma control by reducing body weight, improving inflammatory indicators, and restoring lung tissue to its normal state by administering chromium and formoterol therapy. The most effective strategy for treating both obesity and asthma is to address their two connected conditions. These findings demonstrate that combined chromium and formoterol therapy effectively addresses metabolic and inflammatory components of obesity-induced asthma, offering a promising dual-target therapeutic strategy.
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Affiliation(s)
- Rania T. Ibrahim
- Department of Scientific Research, Egypt Healthcare Authority, Ismailia, Egypt
| | - Yasser M. Moustafa
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo, Egypt, Egypt
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Maha Abdullah Alwaili
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Amjad N. Alrebdi
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Afaf Alharthi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Noha R. Noufal
- Basic Medical Science Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
- Pathology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Dina M. Khodeer
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
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31
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Sun C, Li N, Xiao X, Zhang Q. Association between lipid accumulation products and asthma among adults: Data from National Health and Nutrition Examination Survey (NHANES) 2003-2018. Respir Med 2025; 240:108017. [PMID: 40024334 DOI: 10.1016/j.rmed.2025.108017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 02/23/2025] [Accepted: 02/27/2025] [Indexed: 03/04/2025]
Abstract
OBJECTIVE The goal of our study was to investigate the potential relationship between Lipid Accumulation Product (LAP) and prevalence of asthma. DESIGN Cross-sectional study. SETTING The National Health and Nutrition Examination Survey (2003-2018). PARTICIPANTS The study included a total of 13,993 participants, all of whom had complete data on both asthma and LAP. BACKGROUND The Lipid accumulation product (LAP) index is a potential estimator of visceral fat accumulation. Overweight and obesity are the risk factors for asthma. However, no research investigated the possible correlation between LAP and the incidence of asthma. METHODS We undertook a cross-sectional analysis to investigate the link between LAP and asthma, utilizing data from the National Health and Nutrition Examination Surveys (NHANES 2003-2018). To address the complex, multistage, and clustered survey design, sample weights were incorporated into all the statistical analyses. The association between LAP and the prevalence of asthma was examined through multivariable logistic regression. Additionally, the linear correlation between these variables was assessed via smoothed curve fitting and threshold effect analyses. Subgroup analysis was conducted to identify any vulnerable populations. RESULTS The study included 13,993 participants, of whom 1965 (14.0 %) were diagnosed with asthma. Following adjustment for all covariates, a notable positive correlation emerged between the LAP index and asthma according to a multivariate logistic regression analysis. A heightened prevalence of asthma was observed with each unit increase in LnLAP (OR = 1.17, 95 % CI = 1.09-1.27, P < 0.001). Compared to individuals in the lowest LAP quartile, those in the highest quartile had a 34 % increased probability of developing asthma. (OR 1.34, 95 % CI 1.13-1.60, P = 0.001). Additionally, smoothed curve-fitting analysis revealed a nonlinear correlation between the LAP index and asthma. Through threshold effect analysis, the inflection point was established at 114.495. CONCLUSION The study found a positive association between the LAP index and asthma in adults, suggesting that LAP may serve as a potential biomarker for early detection of asthma and assessment of treatment efficacy.
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Affiliation(s)
- Chuang Sun
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Changzhou, The Third Affiliated Hospital of Nanjing Medical University, Changzhou, 213164, China
| | - Na Li
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Changzhou, The Third Affiliated Hospital of Nanjing Medical University, Changzhou, 213164, China
| | - Xinru Xiao
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Changzhou, The Third Affiliated Hospital of Nanjing Medical University, Changzhou, 213164, China
| | - Qian Zhang
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Changzhou, The Third Affiliated Hospital of Nanjing Medical University, Changzhou, 213164, China; Changzhou Medical Center, Nanjing Medical University, Changzhou, 213164, China.
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32
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Heng CKM, Darlyuk-Saadon I, Liao W, Mohanam MP, Gan PXL, Gilad N, Chan CCMY, Plaschkes I, Wong WSF, Engelberg D. A combination of alveolar type 2-specific p38α activation with a high-fat diet increases inflammatory markers in mouse lungs. J Biol Chem 2025; 301:108425. [PMID: 40118456 PMCID: PMC12018981 DOI: 10.1016/j.jbc.2025.108425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 01/25/2025] [Accepted: 01/28/2025] [Indexed: 03/23/2025] Open
Abstract
Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease afflict millions of individuals globally and are significant sources of disease mortality. While the molecular mechanisms underlying such diseases are unclear, environmental and social factors, such as cigarette smoke and obesity, increase the risk of disease development. Yet, not all smokers or obese individuals will develop chronic respiratory diseases. The mitogen-activated protein kinase p38α is abnormally active in such maladies, but its contribution, if any, to disease etiology is unknown. To assess whether p38α activation per se in the lung could impose disease symptoms, we generated a transgenic mouse model allowing controllable expression of an intrinsically active variant, p38αD176A+F327S, specifically in lung alveolar type 2 pneumocytes. Sustained expression of p38αD176A+F327S did not appear to induce obvious pathological outcomes or to exacerbate inflammatory outcomes in mice challenged with common respiratory disease triggers. However, mice expressing p38αD176A+F327S in alveolar type 2 cells and fed with a high-fat diet exhibited increased numbers of airway eosinophils and lymphocytes, upregulated levels of proinflammatory cytokines and chemokines including interleukin-1β and eotaxin, as well as a reduction in levels of leptin and adiponectin within the lung. Neither high-fat diet nor p38αD176A+F327S alone induced such outcomes. Perhaps in obese individuals with associated respiratory diseases, elevated p38α activity which happens to occur is the factor that promotes their development.
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Affiliation(s)
- C K Matthew Heng
- Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore-HUJ Alliance for Research and Enterprise, Mechanisms of Liver Inflammatory Diseases Program, National University of Singapore, Singapore
| | - Ilona Darlyuk-Saadon
- Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore-HUJ Alliance for Research and Enterprise, Mechanisms of Liver Inflammatory Diseases Program, National University of Singapore, Singapore
| | - Wupeng Liao
- Singapore-HUJ Alliance for Research and Enterprise, Mechanisms of Liver Inflammatory Diseases Program, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Manju P Mohanam
- Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore-HUJ Alliance for Research and Enterprise, Mechanisms of Liver Inflammatory Diseases Program, National University of Singapore, Singapore
| | - Phyllis X L Gan
- Singapore-HUJ Alliance for Research and Enterprise, Mechanisms of Liver Inflammatory Diseases Program, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nechama Gilad
- Singapore-HUJ Alliance for Research and Enterprise, Mechanisms of Liver Inflammatory Diseases Program, National University of Singapore, Singapore; Department of Biological Chemistry, The Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Christabel C M Y Chan
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Drug Discovery and Optimization Platform, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Inbar Plaschkes
- Info-CORE, Bioinformatics unit of the I-CORE, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - W S Fred Wong
- Singapore-HUJ Alliance for Research and Enterprise, Mechanisms of Liver Inflammatory Diseases Program, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Drug Discovery and Optimization Platform, Yong Loo Lin School of Medicine, National University Health System, Singapore.
| | - David Engelberg
- Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore-HUJ Alliance for Research and Enterprise, Mechanisms of Liver Inflammatory Diseases Program, National University of Singapore, Singapore; Department of Biological Chemistry, The Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Jesenak M, Bobcakova A, Djukanovic R, Gaga M, Hanania NA, Heaney LG, Pavord I, Quirce S, Ryan D, Fokkens W, Conti D, Hellings PW, Scadding G, Van Staeyen E, Bjermer LH, Diamant Z. Promoting Prevention and Targeting Remission of Asthma: A EUFOREA Consensus Statement on Raising the Bar in Asthma Care. Chest 2025; 167:956-974. [PMID: 39672229 DOI: 10.1016/j.chest.2024.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 11/26/2024] [Accepted: 11/27/2024] [Indexed: 12/15/2024] Open
Abstract
Asthma is a common, multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes and endotypes and the availability of targeted biologic treatment options, the disease remains uncontrolled in a substantial proportion of patients with risk of exacerbations, requiring systemic corticosteroids, and with progressive disease. Current international guidelines advocate for a personalized management approach to patients with uncontrolled severe asthma. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) asthma expert panel was convened to discuss strategies to optimize asthma care and to prevent systemic corticosteroid overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current one-size-fits-most concept, which focuses on a symptom-driven treatment strategy, and shift toward a phenotype- and endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life. Herein, we provide a consensus view on asthma care that advocates a holistic approach and highlight some unmet needs to be addressed in future clinical trials and population studies.
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Affiliation(s)
- Milos Jesenak
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Institute of Clinical Immunology and Medical Genetics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
| | - Anna Bobcakova
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Institute of Clinical Immunology and Medical Genetics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
| | - Ratko Djukanovic
- NIHR Southampton Biomedical Centre, Faculty of Medicine, University of Southampton, United Kingdom
| | - Mina Gaga
- 1st Respiratory Medicine Dept., Hygeia Hospital, Athens, Greece
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Ian Pavord
- NIHR Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Dermot Ryan
- AUKCAR, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Wytske Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Diego Conti
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium; Escuela de Doctorado UAM, Centro de Estudios de Posgrado, Universidad Autónoma de Madrid. Calle Francisco Tomás y Valiente, nº 2. Ciudad Universitaria de Cantoblanco, Madrid, Spain
| | - Peter W Hellings
- Department of Otorhinolaryngology, University of Leuven, Leuven, Belgium; Laboratory of Allergy and Clinical Immunology, University of Leuven, Leuven, Belgium; Upper Airways Disease Laboratory, University of Ghent, Ghent, Belgium
| | - Glenis Scadding
- The Royal National ENT Hospital, London, United Kingdom; Division of Infection and Immunity, University College, London, United Kingdom
| | - Elizabeth Van Staeyen
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium
| | - Leif H Bjermer
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
| | - Zuzana Diamant
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands; Department of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.
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Abushahin A, Abu‐Hasan M, Shailesh H, Antonisamy B, Hani Y, Muhayimana A, Al Theyab M, Janahi I. Inhomogeneity of lung ventilation in children with obesity and its potential role in worsening asthma. Physiol Rep 2025; 13:e70257. [PMID: 40243130 PMCID: PMC12004273 DOI: 10.14814/phy2.70257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 01/24/2025] [Accepted: 02/12/2025] [Indexed: 04/18/2025] Open
Abstract
Asthma is more frequent and severe in individuals with obesity compared to those with normal weight. While inhomogeneity of lung ventilation due to distal airway obstruction is a key feature in asthma, the effect of obesity on ventilation homogeneity is unclear. We conducted a cross-sectional study comparing lung clearance index (LCI) using multiple breath nitrogen washout technique between children with normal weight and asthma (n = 97), overweight/obesity and asthma (n = 100), overweight/obesity and no asthma (n = 100), and children with normal weight and no asthma (n = 67). Spirometry, lung volumes, and fractional exhaled nitric oxide (FeNO) were obtained for comparison. Results showed no significant difference in LCI between overweight/obesity groups and normal weight groups and no significant correlation between LCI and body mass index (BMI). However, LCI was higher in the asthma groups compared to non-asthma groups (p = 0.017, p = 0.003). There was a significant negative correlation between LCI and FEV1% predicted, FEV1/FVC, and FEF25-75% predicted (r = -0.24, p < 0.001; r = -0.26, p < 0.001; r = -0.23, p < 0.001), and a positive correlation with RV/TLC (r = 0.17, p = 0.003) and FeNO (r = 0.29, p < 0.001). These findings indicate that obesity does not affect the homogeneity of lung ventilation. Therefore, alternative mechanisms should be considered to explain the association between asthma and obesity.
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Affiliation(s)
- Ahmed Abushahin
- Department of Pediatric Medicine, Division of PulmonologySidra MedicineDohaQatar
- Clinical PediatricsWeill Cornel Medicine‐Qatar (WCM‐Q)DohaQatar
| | - Mutasim Abu‐Hasan
- Department of Pediatric Medicine, Division of PulmonologySidra MedicineDohaQatar
| | - Harshita Shailesh
- Department of Pediatric Medicine, Division of PulmonologySidra MedicineDohaQatar
| | | | - Yahya Hani
- Department of Pediatric Medicine, Division of PulmonologySidra MedicineDohaQatar
| | - Abidan Muhayimana
- Department of Pediatric Medicine, Division of PulmonologySidra MedicineDohaQatar
| | | | - Ibrahim Janahi
- Department of Pediatric Medicine, Division of PulmonologySidra MedicineDohaQatar
- Clinical PediatricsWeill Cornel Medicine‐Qatar (WCM‐Q)DohaQatar
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Iqbal MZ, Alqahtani SS, Shahid S, Mubarak N. Socio-demographic environmental and clinical factors influencing asthma control in community pharmacies of Lahore Pakistan. Sci Rep 2025; 15:10587. [PMID: 40148570 PMCID: PMC11950406 DOI: 10.1038/s41598-025-95373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Accepted: 03/20/2025] [Indexed: 03/29/2025] Open
Abstract
Asthma is a significant non-communicable disease affecting over 300 million people worldwide. This study aimed to evaluate the influence of socio-demographic, environmental, and clinical factors on asthma control among patients visiting community pharmacies in Lahore, Pakistan. A multicenter prospective observational study was conducted with 284 participants using a validated data collection tool. Data included demographics and potential confounders such as smoking, obesity, co-morbidities (e.g., allergic rhinitis, gastroesophageal reflux disease [GERD]), and adherence to treatment. Asthma control was classified into full, partial, and uncontrolled levels based on established guidelines. Statistical analyses, including chi-square tests and logistic regression, were performed to identify significant predictors. The results indicated that 53.5% of participants were female, 74.6% were aged above 40 years, and 42.3% were obese. A family history of asthma was reported in 55.6% of participants, while smoking was prevalent in 77.1%. Clinical co-morbidities, such as allergic rhinitis (49.3%) and GERD (50.7%), were notable. Participants who adhered to treatment (62.3%) and engaged in daily exercise (59.5%) exhibited significantly better asthma control. Multivariate analysis revealed that higher education, rural residence, and the absence of obesity were positively associated with asthma control, whereas passive smoking and prolonged asthma history had a negative impact. This study underscores the multifaceted nature of asthma management and the importance of addressing socio-demographic, environmental, and clinical factors. Improved asthma outcomes require targeted interventions, including promoting adherence to treatment plans, encouraging physical activity, and minimizing exposure to smoking and environmental allergens. The findings highlight the need for community-centered strategies to enhance asthma control and reduce its public health burden, particularly in middle-income countries like Pakistan.
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Affiliation(s)
- Muhammad Zahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia.
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological & Applied Sciences, Lahore, Pakistan.
| | - Saad S Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Sara Shahid
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological & Applied Sciences, Lahore, Pakistan
| | - Naeem Mubarak
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological & Applied Sciences, Lahore, Pakistan
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Banić I, Jankić M, Miletić Gospić A, Pentek K, Anić P, Burkuš T, Hrg K, Zadro K, Miličević J, Šuljić I, Lipej M, Plavec D, Penava L, Turkalj M. A multidisciplinary protocol for reducing excessive and maintaining a healthy body weight in the personalized management of chronic diseases in children and adults. PLoS One 2025; 20:e0306400. [PMID: 40080478 PMCID: PMC11906058 DOI: 10.1371/journal.pone.0306400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/11/2024] [Indexed: 03/15/2025] Open
Abstract
Despite regularly used treatment asthma in both children and adults is not fully controlled. This is more prominent in certain disease subtypes, such as obese asthma. The vast complexity of asthma phenotypes and often overlapping endotypes emphasizes the need for implementing the concept of precision medicine in disease management. In order to address these concerns, an innovative and personalized programme for reducing excessive and maintaining a healthy body weight will be developed by experts from pharmaceutical and food industry (Belupo Inc. and Podravka Inc., Croatia) as well as clinical experts (Srebrnjak Children`s Hospital, Croatia). The programme will involve meals replacement (standard and innovative formulas), dietary program and nutritional counseling, physical activity and other individually tailored measures according specific disease phenotypes and underlying pathophysiological mechanisms in each participant. The outcomes of this study should contribute to better control of the underlying condition, reduction of the frequency and severity of symptoms and, consequently, in the improvement of the participant's overall quality of life.
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Affiliation(s)
- Ivana Banić
- Department of Translational medicine, Srebrnjak Children`s Hospital, Zagreb, Croatia
| | - Marija Jankić
- Department of Nutraceuticals, Belupo Pharmaceuticals and Cosmetics Inc., Koprivnica, Croatia
| | | | - Katarina Pentek
- Culinary Department, Podravka Food Industry Inc., Koprivnica, Croatia
| | - Petra Anić
- Research Department, Srebrnjak Children’s Hospital, Zagreb, Croatia
| | - Tajana Burkuš
- Research Department, Srebrnjak Children’s Hospital, Zagreb, Croatia
| | - Krešimir Hrg
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Karmen Zadro
- Department of Nutraceuticals, Belupo Pharmaceuticals and Cosmetics Inc., Koprivnica, Croatia
| | - Jelena Miličević
- Department of Nutraceuticals, Belupo Pharmaceuticals and Cosmetics Inc., Koprivnica, Croatia
| | - Ivana Šuljić
- Research Department, Srebrnjak Children’s Hospital, Zagreb, Croatia
| | - Marcel Lipej
- IT Department, Srebrnjak Children’s Hospital, Zagreb, Croatia
| | - Davor Plavec
- Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia
| | - Lenkica Penava
- Department of Nutraceuticals, Belupo Pharmaceuticals and Cosmetics Inc., Koprivnica, Croatia
| | - Mirjana Turkalj
- Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia
- Catholic University of Croatia, Zagreb, Croatia
- Department of Pediatric Allergy and Pulmonology, Srebrnjak Children’s Hospital, Zagreb, Croatia
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37
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Du LJ, Che C, Liu Q, Zhang X, Feng N, Chen L, Wang L. The relationship between energy intake and asthma in Americans aged 1-18 years: a cross-sectional study. BMC Pediatr 2025; 25:180. [PMID: 40065274 PMCID: PMC11895307 DOI: 10.1186/s12887-025-05552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Accepted: 02/26/2025] [Indexed: 03/14/2025] Open
Abstract
OBJECTIVE The objective of this study was to investigate the effects of total dietary energy intake on asthma. STUDY SELECTION The study was a retrospective cross-sectional study of Americans aged 1-18 year. Comprehensive demographic, dietary, examination, laboratory, and asthma questionnaire data were collected for each participant. Multivariate logistic regression, restricted triple spline curves, threshold effects, and stratified analyses were used for analysis. RESULTS Of 12,090 participants, 1,893 (15.66%) had a diagnosis of asthma. After accounting for potential confounders, compared with the group with the lowest energy intake (Q1), groups 2 (Q2), groups 3 (Q3), and groups 4 (Q4) had adjusted odds ratios (ORs) of 0.72 (0.62-0.85), 0.63 (0.51-0.77) and 0.55 (0.43-0.7) for asthma. The relationship between total energy intake and asthma showed an L-shaped curve (p = 0.001). The results were further verified by stratification and sensitivity analyses. In the threshold analysis, we found that the saturation effect was reached at a total energy intake of 56.442 kcal/kg/day with an OR of 0.981 (0.973-0.989). CONCLUSION The prevalence of asthma in Americans aged 1-18 years was associated with total dietary energy intake in an L-shaped curve, with a significant turning point found at approximately 56.442 kcal/kg/day.
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Affiliation(s)
- Lin Jun Du
- The Third People's Hospital of Liaocheng City, Liaocheng, Shandong Province, China
| | - Chao Che
- Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Qian Liu
- Jinan Fifth People's Hospital, Jinan, Shandong Province, China
| | - Xiaolan Zhang
- The Third People's Hospital of Liaocheng City, Liaocheng, Shandong Province, China
| | - Ning Feng
- The Third People's Hospital of Liaocheng City, Liaocheng, Shandong Province, China
| | - Lifang Chen
- The Third People's Hospital of Liaocheng City, Liaocheng, Shandong Province, China
| | - Lili Wang
- Maternal and Child Health Center, Chiping District, Liaocheng City, Shandong Province, China.
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Holden KA, Hawcutt DB, Sinha IP. Socioeconomic determinants of outcomes in childhood asthma. Paediatr Respir Rev 2025:S1526-0542(25)00028-4. [PMID: 40133122 DOI: 10.1016/j.prrv.2025.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Accepted: 03/07/2025] [Indexed: 03/27/2025]
Abstract
Asthma is the commonest chronic condition of childhood. Children with asthma in the UK have the worst outcomes across Europe and other high-income countries. There are significant socioeconomic inequalities that impact the prevalence and outcomes of asthma (emergency healthcare utilisation, hospitalisation, critical care admission, mortality and quality of life). In this review we discuss these inequalities and the underlying mechanistic links, using the UK as an example of how poverty in a high-income country results in inequality in asthma outcomes. These inequalities and underlying mechanisms need to be understood by clinicians, policymakers and wider stakeholders to be redressed such that avoidable harm and asthma deaths in children can be prevented.
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Affiliation(s)
- Karl A Holden
- Lab to Life Child Health Data Centre, Alder Hey Children's Hospital, Liverpool, UK; Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK; NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK; Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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Hu J, Fan Y, Luo R, Li Q, Ai T, Wang L. Application of Impulse Oscillometry Combined with Fractional Exhaled Nitric Oxide in Monitoring Asthma Control Levels in Children. J Asthma Allergy 2025; 18:391-402. [PMID: 40070491 PMCID: PMC11895688 DOI: 10.2147/jaa.s507446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 02/28/2025] [Indexed: 03/14/2025] Open
Abstract
Purpose To investigate whether Impulse Oscillometry (IOS) could more effectively monitor children with uncontrolled asthma and evaluate small airway function changes, while establishing a prediction model in combination with fractional exhaled nitric oxide (FeNO) to assist in clinical management and treatment of asthmatic children. Patients and Methods A retrospective study was conducted on 203 asthmatic children who were followed up in our hospital from August 2023 to August 2024. Patients were divided into controlled asthma group (n=80) and uncontrolled asthma group (n=123). Conventional ventilatory parameters, IOS parameters, FeNO levels, and clinical data were analyzed and compared between the two groups. The optimal prediction model was established through multivariate logistic regression. Results In the uncontrolled asthma group, the respiratory system impedance at 5 hz (Z5), resistance at 5 hz (R5), the difference between resistance at 5 hz and resistance at 20 hz (R5-R20), resonant frequency (Fres), and FeNO levels were significantly higher compared to the controlled asthma group. The ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), forced expiratory flow at 50% (FEF50), forced expiratory flow at 75% (FEF75), and maximal mid-expiratory flow (MMEF) were lower in the uncontrolled group (P<0.05). Receiver operating characteristic curve (ROC) analysis demonstrated that Z5, R5, R5-R20, Fres, and FeNO were valuable in asthma diagnosis (P<0.05), with higher sensitivity in monitoring small airway function compared to MMEF. Multivariate logistic regression analysis established the optimal prediction model combining R5+(R5-R20) +FeNO, with an area under curve (AUC) of 0.915 (P<0.05), sensitivity of 0.831, and specificity of 0. 892. Conclusion Compared to conventional pulmonary function tests, IOS effectively identifies uncontrolled status in asthmatic children, particularly in younger patients, with higher sensitivity to small airway function changes. The model comprising R5+(R5-R20) +FeNO demonstrates clinical value in identifying uncontrolled status in asthmatic children.
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Affiliation(s)
- Jie Hu
- Department of Pediatric Respiratory Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Yinghong Fan
- Department of Pediatric Respiratory Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Ronghua Luo
- Department of Pediatric Respiratory Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Qianqian Li
- Department of Pediatric Respiratory Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Tao Ai
- Department of Pediatric Respiratory Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Li Wang
- Department of Pediatric Respiratory Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
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Mao Z, Zhu X, Zheng P, Wang L, Zhang F, Chen L, Zhou L, Liu W, Liu H. Global, regional, and national burden of asthma from 1990 to 2021: A systematic analysis of the global burden of disease study 2021. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2025; 3:50-59. [PMID: 40226600 PMCID: PMC11993038 DOI: 10.1016/j.pccm.2025.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Indexed: 04/15/2025]
Abstract
Background Asthma is a prevalent non-communicable disease that affects individuals of all ages and has emerged as a significant global public health concern. This study aims to conduct a comprehensive assessment of the burden of asthma worldwide, as well as at regional and national levels, utilizing the Global Burden of Diseases (GBD) 2021 database for the years 1990 to 2021. Methods This study utilized the GBD 2021 database to report the prevalent cases and incident cases of asthma, alongside age-standardized prevalence rates (ASPR), age-standardized incidence rate (ASIR), the number of disability-adjusted life years (DALYs), age-standardized DALY rates (ASDR), the number of deaths, and age-standardized mortality rates (ASMR) at global, regional, and national levels for the year 2021. Additionally, it computed the estimated annual percentage change (EAPC) for these asthma burden indicators from 1990 to 2021. This study further analyzed the levels of the above indicators in different gender and age groups, and investigated the association between asthma ASDR/ASMR levels and socio-demographic index (SDI). It also provided an analysis of the contribution of four risk factors to the overall asthma burden. Results From 1990 to 2021, the global EAPC for asthma ASIR was -1.04 (95 % confidence interval [CI]:-1.18 to -0.89), the EAPC for ASPR was -1.59 (95 % CI:-1.74 to -1.43), the EAPC for ASDR was -1.91 (95 % CI:-1.98 to -1.84), and the EAPC for ASMR was -2.03 (95 % CI:-2.09 to -1.98). In 2021, the prevalent cases of asthma remained alarmingly high at 260.48 million (95 % UI: 227.21 million to 297.97 million). Developed countries, exemplified by the United States, exhibited elevated asthma ASPR. However, the burden of asthma-related mortality and DALYs predominantly afflicted low- and middle-income nations. In China, there has been a significant decline in ASIR, ASPR, ASDR and ASMR for asthma. In most age groups, the burden of asthma among women was markedly higher than that among men, particularly evident in prevalence and DALYs. Children and the elderly bore a heavier burden of asthma. In 2021, ASDR and ASMR levels varied across countries, generally exhibiting a negative correlation with SDI levels. A high body-mass index continued to be a primary risk factor for asthma on a global scale. Decomposition analysis reveals that population growth plays a significant role in exacerbating the burden of asthma-related deaths and DALYs. Conclusions From 1990 to 2021, the burden of asthma as measured by age-standardized rate (ASR) has shown a declining trend. However, the overall burden of asthma remains significantly high. Moreover, there is a notable inequality in the burden of asthma across different regions and populations worldwide. This highlights the urgent need for countries to prioritize asthma management and control strategies to address these disparities and improve health outcomes for affected individuals.
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Affiliation(s)
- Zhenyu Mao
- Department of Respiratory and Critical Care Medicine, National Health Committee Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiaoyan Zhu
- Department of Respiratory and Critical Care Medicine, National Health Committee Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Pengdou Zheng
- Department of Respiratory and Critical Care Medicine, National Health Committee Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Lingling Wang
- Department of Respiratory and Critical Care Medicine, National Health Committee Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Fengqin Zhang
- Department of Respiratory and Critical Care Medicine, National Health Committee Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Lixiang Chen
- Department of Respiratory and Critical Care Medicine, National Health Committee Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Ling Zhou
- Department of Respiratory and Critical Care Medicine, National Health Committee Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Wei Liu
- Department of Geriatrics, Key Laboratory of Vascular Aging, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, National Health Committee Key Laboratory of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Olsthoorn SEM, van Krimpen A, Hendriks RW, Stadhouders R. Chronic Inflammation in Asthma: Looking Beyond the Th2 Cell. Immunol Rev 2025; 330:e70010. [PMID: 40016948 PMCID: PMC11868696 DOI: 10.1111/imr.70010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Accepted: 02/11/2025] [Indexed: 03/01/2025]
Abstract
Asthma is a common chronic inflammatory disease of the airways. A substantial number of patients present with severe and therapy-resistant asthma, for which the underlying biological mechanisms remain poorly understood. In most asthma patients, airway inflammation is characterized by chronic activation of type 2 immunity. CD4+ T helper 2 (Th2) cells are the canonical producers of the cytokines that fuel type 2 inflammation: interleukin (IL)-4, IL-5, IL-9, and IL-13. However, more recent findings have shown that other lymphocyte subsets, in particular group 2 innate lymphoid cells (ILC2s) and type 2 CD8+ cytotoxic T (Tc2) cells, can also produce large amounts of type 2 cytokines. Importantly, a substantial number of severe therapy-resistant asthma patients present with chronic type 2 inflammation, despite the high sensitivity of Th2 cells for suppression by corticosteroids-the mainstay drugs for asthma. Emerging evidence indicates that ILC2s and Tc2 cells are more abundant in severe asthma patients and can adopt corticosteroid-resistance states. Moreover, many severe asthma patients do not present with overt type 2 airway inflammation, implicating non-type 2 immunity as a driver of disease. In this review, we will discuss asthma pathophysiology and focus on the roles played by ILC2s, Tc2 cells, and non-type 2 lymphocytes, placing special emphasis on severe disease forms.
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Affiliation(s)
- Simone E. M. Olsthoorn
- Department of Pulmonary MedicineErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Anneloes van Krimpen
- Department of Pulmonary MedicineErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Rudi W. Hendriks
- Department of Pulmonary MedicineErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Ralph Stadhouders
- Department of Pulmonary MedicineErasmus MC University Medical CenterRotterdamthe Netherlands
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Kim SH, Lee H, Jung JH, Kim BG, Park DW, Park TS, Moon JY, Kim TH, Sohn JW, Yoon HJ, Han K, Kim SH. Asthma Increases Long-Term Risk of Death by Suicide: A Nationwide Population-Based Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2025; 13:559-567.e3. [PMID: 39608752 DOI: 10.1016/j.jaip.2024.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 11/13/2024] [Accepted: 11/15/2024] [Indexed: 11/30/2024]
Abstract
BACKGROUND Previous studies have identified an increased risk of suicidal behaviors among individuals with asthma. OBJECTIVE To evaluate the long-term risk and factors related to suicide in the adult population with asthma. METHODS This study used the Korean National Health Insurance Service data. We investigated the risk of suicide concerning the presence or absence of asthma and potential risk factors for suicide among 3,914,041 adults aged 20 years or more. RESULTS During a median follow-up of 12.3 years (interquartile range, 12.1-12.6 years), 1383 (0.48%) individuals with asthma died by suicide. Individuals with asthma had an increased risk of suicide compared with controls (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.19-1.33). Suicide risk was especially high in individuals with asthma phenotypes: hospitalization-prone (aHR, 1.61; 95% CI, 1.40-1.84), nonobese (aHR, 1.37; 95% CI, 1.27-1.64), and asthma-chronic obstructive pulmonary disease overlap (aHR, 1.47; 95% CI, 1.22-1.76). Coexisting underweight status (aHR, 2.54; 95% CI, 2.05-3.16), mental health disorders (schizophrenia [aHR, 3.38; 95% CI, 2.28-5.02], depression [aHR, 3.24; 95% CI, 2.85-3.68], and anxiety disorder [aHR, 2.47; 95% CI, 2.00-3.05]), and cancers (aHR, 2.22; 95% CI, 1.73-2.84) further increased the suicide risk. CONCLUSIONS Asthma was associated with an increased risk of suicide, particularly in hospitalization-prone, nonobese, and asthma-chronic obstructive pulmonary disease overlap phenotypes. The risk was further increased when asthma coexisted with underweight status, mental health disorders, or cancers.
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Affiliation(s)
- Sang Hyuk Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Jin-Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Bo-Guen Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Won Park
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Tai Sun Park
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Tae-Hyung Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Jang Won Sohn
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
| | - Sang-Heon Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Korea.
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Pescari D, Mihuta MS, Bena A, Stoian D. Independent Predictors of Circulating Trimethylamine N-Oxide (TMAO) and Resistin Levels in Subjects with Obesity: Associations with Carotid Intima-Media Thickness and Metabolic Parameters. Nutrients 2025; 17:798. [PMID: 40077669 PMCID: PMC11902032 DOI: 10.3390/nu17050798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 02/18/2025] [Accepted: 02/18/2025] [Indexed: 03/14/2025] Open
Abstract
Background: Obesity contributes to cardiometabolic risk, including subclinical atherosclerosis and insulin resistance. This study examines the predictive roles of trimethylamine N-oxide (TMAO) and resistin in relation to carotid intima-media thickness and metabolic parameters; Methods: Sixty adults (18-71 years) with varying body weights were assessed for body composition, subclinical atherosclerosis, and blood biomarkers, including TMAO and resistin; Results: TMAO correlated strongly with CIMT (r = 0.674, p < 0.001), indicating its role in subclinical atherosclerosis. Logistic regression identified TMAO (threshold 380; AUC = 0.880, accuracy = 91.7%) as a predictor of cardiometabolic risk. Resistin was associated with CIMT, WHR, and total cholesterol, inversely linked to LDL cholesterol (p = 0.003). Less active participants exhibited higher TMAO (p = 0.001) and resistin (p = 0.02). Family histories of obesity and diabetes correlated with elevated TMAO, while resistin linked to shorter sleep duration and diabetes history, highlighting their importance in obesity-related cardiometabolic risks; Conclusions: TMAO is strongly linked to abdominal fat, insulin resistance, and subclinical atherosclerosis, while resistin is associated with lipid metabolism and aging. Their combined assessment enhances the prediction of obesity-related cardiometabolic risk, supporting their role in risk stratification and targeted interventions.
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Affiliation(s)
- Denisa Pescari
- Department of Doctoral Studies, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Monica Simina Mihuta
- Center for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Andreea Bena
- Discipline of Endocrinology, Second Department of Internal Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Dana Stoian
- Center for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
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Yang S, Chen H, Xie C, Zhang N. Protective effect of dietary phosphorus intake on cardiovascular mortality in asthma: evidence from NHANES 1999-2018. Front Nutr 2025; 12:1533514. [PMID: 40070480 PMCID: PMC11893399 DOI: 10.3389/fnut.2025.1533514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Accepted: 02/11/2025] [Indexed: 03/14/2025] Open
Abstract
Background Asthma is associated with an increased risk of cardiovascular mortality, potentially influenced by dietary phosphorus intake through its effects on inflammation and oxidative stress. Methods Data from 7,539 asthma patients in the National Health and Nutrition Examination Survey (NHANES) 1999-2018 cohort were analyzed using weighted Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI). Kaplan-Meier survival curves and a nomogram were used to assess survival probabilities and individualized risk, while restricted cubic spline (RCS) analysis evaluated non-linear dose-response relationships. Sensitivity analyses were conducted to test the robustness of the findings. Results Higher dietary phosphorus intake was associated with reduced cardiovascular mortality (HR: 0.43; 95% CI: 0.22-0.85 for the highest vs. lowest quartile; p for trend = 0.018). Kaplan-Meier curves showed improved survival with increasing phosphorus intake, a result consistently supported by subgroup analyses. RCS analysis confirmed a non-linear dose-response relationship, identifying a threshold at 1,861.52 mg/day, below which higher phosphorus intake was significantly associated with lower cardiovascular mortality. However, above this threshold, the protective effect diminished. Sensitivity analyses further validated these results. Conclusion Elevated dietary phosphorus intake is associated with reduced cardiovascular mortality in asthma patients, suggesting its potential as a dietary intervention.
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Affiliation(s)
- Shuwen Yang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, China
| | - Haiyan Chen
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, China
| | - Congyi Xie
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, China
| | - Ning Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, China
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Zhangjiang Institute, Shanghai, China
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Celebi Sozener Z, Oguzulgen IK, Ozalp Ates FS, Baccioglu A, Argun Barıs S, Ediger D, Gunaydın FE, Sevinc C, Seker U, Yılmaz Kara B, Beyaz S, Mungan D, Aydin O, Gokmen D, Buhari GK, Gemicioglu B, Bulut I, Orcen C, Kepil Ozdemir S, Keren M, Damadoglu E, Yakut T, Kalpaklioglu AF, Alan Yalim S, Yilmaz I, Koca Kalkan I, Uysal MA, Ozgun Niksarlioglu EY, Kalyoncu AF, Karakaya G, Erbay M, Nayci S, Tepetam FM, Akkor Gelincik A, Dirol H, Goksel O, Karaoglanoglu S, Oner Erkekol F, Isik SR, Yildiz F, Yavuz Y, Karadogan D, Bozkurt N, Basyigit I, Yilmazel Ucar E, Erdogan T, Polatli M, Turk M, Pur L, Yegin Katran Z, Sekibag Y, Aykac EF, Gul O, Cengiz A, Akkurt B, Ozden S, Demir S, Unal D, Aslan AF, Can A, Gumusburun R, Bogatekin G, Akten HS, Inan S, Erdinc M, Ogus AC, Kavas M, Polat Yulug D, Cakmak ME, Kaya SB, Alpagat G, Ozgur ES, Uzun O, Gulen ST, Pekbak G, Kizilirmak D, Havlucu Y, Donmez H, Arslan B, Cetin GP, Soyyigit S, Pasaoglu Karakis G, Dursun AB, Kendirlinan R, Ozturk AB, Omeroglu Simsek G, Abadoglu O, Cerci P, Yucel T, Yorulmaz I, Tezcaner ZC, Cadalli Tatar E, Suslu AE, Ozer S, Dursun E, Yorgancioglu A, Celik GE. Asthma patients with obesity have a unique phenotype: a subanalysis of the Turkish adult asthma registry. J Asthma 2025:1-11. [PMID: 39932533 DOI: 10.1080/02770903.2025.2466182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 02/04/2025] [Accepted: 02/09/2025] [Indexed: 02/17/2025]
Abstract
OBJECTIVE The obese-asthma phenotype has gradually increased in the last few years. We aimed to assess the differences between obese and non-obese patients with asthma. METHODS This research is a subanalysis of the Turkish Adult Asthma Registry (TAAR). Clinical presentation, disease control, severity, and demographics of obese and non-obese (normal-weight, overweight) patients were compared. RESULTS The obesity rate in TAAR was 32.2% (n = 619/1919; 18-83 years; 527 F/92 M). Patients with asthma and obesity had higher rates of childhood obesity, longer symptom duration, later onset of asthma, and more severe asthma. These patients were more likely to be female, older, less educated, and live in rural areas. Patients with obesity had more scheduled visits and emergency visits compared with non-obese patients, but similar asthma control, oral corticosteroid use, hospitalizations, intensive care unit admissions, and unscheduled visits. They also had a higher frequency of T2-high but lower frequency of possible T2-low phenotypes compared with normal-weight asthmatics. The risk of severe asthma in patients with obesity was 6.04 times higher for allergic than non-allergic patients and 3.58 times higher for the T2-high phenotype than for possible T2-low phenotypes. A one-unit increase in the asthma control test reduced the risk of severe asthma by 22%. CONCLUSIONS A good definition of this phenotype is important to ensure that appropriate treatment strategies are implemented to achieve the control goal. We also believe that prevention of childhood obesity is an effective and pivotal strategy to achieve the goal of asthma control.
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Affiliation(s)
- Zeynep Celebi Sozener
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara University, Ankara, Turkey
- Ankara Bilkent City Hospital, Immunology and Allergic Diseases, Ankara, Turkey
| | | | - Funda Seher Ozalp Ates
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Manisa Celal Bayar University, Manisa, Turkey
| | - Ayse Baccioglu
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Kirikkale University, Kırıkkale, Turkey
| | - Serap Argun Barıs
- Faculty of Medicine, Department of Chest Diseases, Kocaeli University, Kocaeli, Turkey
| | - Dane Ediger
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Uludağ University, Bursa, Turkey
| | - Fatma Esra Gunaydın
- Faculty of Medicine, Department of Chest Diseases, Dokuz Eylül University, İzmir, Turkey
| | - Can Sevinc
- Bursa City Hospital, Immunology and Allergic Diseases, Bursa, Turkey
| | - Ummuhan Seker
- Faculty of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Bilge Yılmaz Kara
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Sengul Beyaz
- Ankara Bilkent City Hospital, Immunology and Allergic Diseases, Ankara, Turkey
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Dilsad Mungan
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara University, Ankara, Turkey
| | - Omur Aydin
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara University, Ankara, Turkey
| | - Derya Gokmen
- Faculty of Medicine, Department of Biostatistics, Ankara University, Ankara, Turkey
| | - Gozde Koycu Buhari
- Department of Immunology and Allergy, University of Health Sciences Türkiye, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Bilun Gemicioglu
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ismet Bulut
- Department of Immunology and Allergy, Sureyyapasa Chest Diseases, Thoracic Surgery Training and Research Hospital, University of Health Sciences Türkiye, Istanbul, Turkey
| | - Cihan Orcen
- Clinic of Allergy and Immunology, University of Health Sciences Türkiye, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Secil Kepil Ozdemir
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences Türkiye, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Metin Keren
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Ebru Damadoglu
- Clinic of Immunology and Allergic Diseases, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Tugce Yakut
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Ayse Fusun Kalpaklioglu
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Kirikkale University, Kırıkkale, Turkey
| | - Sumeyra Alan Yalim
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Kirikkale University, Kırıkkale, Turkey
| | - Insu Yilmaz
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Ilkay Koca Kalkan
- Department of Immunology and Allergy, University of Health Sciences Türkiye, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Mehmet Atilla Uysal
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, University of Health Sciences Türkiye, Istanbul, Turkey
| | - Elif Yelda Ozgun Niksarlioglu
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, University of Health Sciences Türkiye, Istanbul, Turkey
| | - Ali Fuat Kalyoncu
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gul Karakaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Muge Erbay
- Clinic of Immunology and Allergy Diseases, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Sibel Nayci
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Fatma Merve Tepetam
- Department of Immunology and Allergy, Sureyyapasa Chest Diseases, Thoracic Surgery Training and Research Hospital, University of Health Sciences Türkiye, Istanbul, Turkey
| | - Asli Akkor Gelincik
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Hulya Dirol
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ozlem Goksel
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Selen Karaoglanoglu
- Department of Pulmonology, Ordu University, Training and Research Hospital, Ordu, Turkey
| | - Ferda Oner Erkekol
- Faculty of Medicine, Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
- Division of Allergy and Immunology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Sacide Rana Isik
- American Hospital, Adult Allergy and Immunology Department, Istanbul, Turkey
| | - Fusun Yildiz
- Faculty of Medicine, Department of Chest Diseases, Kocaeli University, Kocaeli, Turkey
- School of Medicine, Department of Pulmonary Diseases, Cyprus Internatıonal Unıversıty, Nicosia, Cyprus
| | - Yasemin Yavuz
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara University, Ankara, Turkey
| | - Dilek Karadogan
- Faculty of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Nurgul Bozkurt
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ilknur Basyigit
- Faculty of Medicine, Department of Chest Diseases, Kocaeli University, Kocaeli, Turkey
| | - Elif Yilmazel Ucar
- Faculty of Medicine, Department of Pulmonary Disease, Ataturk University, Erzurum, Turkey
| | - Tuba Erdogan
- Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergy, Baskent University, Ankara, Turkey
| | - Mehmet Polatli
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Murat Turk
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
- Kayseri City Hospital, Clinic of Immunologic and Allergic Diseases, Kayseri, Turkey
| | - Leyla Pur
- Adult Allergy Service, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Zeynep Yegin Katran
- Department of Immunology and Allergy, Sureyyapasa Chest Diseases, Thoracic Surgery Training and Research Hospital, University of Health Sciences Türkiye, Istanbul, Turkey
| | - Yonca Sekibag
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Enes Furkan Aykac
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ozcan Gul
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara University, Ankara, Turkey
| | - Ali Cengiz
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara University, Ankara, Turkey
| | - Bulent Akkurt
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences Türkiye, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Seyma Ozden
- Department of Immunology and Allergy, Sureyyapasa Chest Diseases, Thoracic Surgery Training and Research Hospital, University of Health Sciences Türkiye, Istanbul, Turkey
| | - Semra Demir
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Derya Unal
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ayse Feyza Aslan
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ali Can
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Reyhan Gumusburun
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Gulhan Bogatekin
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Hatice Serpil Akten
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Sinem Inan
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Munevver Erdinc
- Faculty of Medicine, Department of Pulmonology, Ege University, Izmir, Turkey
| | - Aliye Candan Ogus
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Murat Kavas
- Department of Immunology and Allergy, Sureyyapasa Chest Diseases, Thoracic Surgery Training and Research Hospital, University of Health Sciences Türkiye, Istanbul, Turkey
| | - Demet Polat Yulug
- Clinic of Chest Diseases, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Mehmet Erdem Cakmak
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Saltuk Bugra Kaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gulistan Alpagat
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Kirikkale University, Kırıkkale, Turkey
| | - Eylem Sercan Ozgur
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Oguz Uzun
- Department of Pulmonary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sule Tas Gulen
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Gulseren Pekbak
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Uludağ University, Bursa, Turkey
| | - Deniz Kizilirmak
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Yavuz Havlucu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Halil Donmez
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Bahar Arslan
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Gulden Pacaci Cetin
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Sadan Soyyigit
- Faculty of Medicine, Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Gulden Pasaoglu Karakis
- School of Medicine, Department of Chest Diseases, Adult Allergy-Immunology Unit, Biruni University, Istanbul, Turkey
| | - Adile Berna Dursun
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
- Medical School, Department of Respiratory Medicine, Lokman Hekim University, Ankara, Turkey
| | - Resat Kendirlinan
- Clinic of Immunology and Allergic Diseases, Izmir Kâtip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ayse Bilge Ozturk
- Faculty of Medicine, Department of Allergy and Immunology, Medeniyet University, Istanbul, Turkey
| | - Gokcen Omeroglu Simsek
- Faculty of Medicine, Department of Chest Diseases, Dokuz Eylül University, İzmir, Turkey
| | | | - Pamir Cerci
- Clinic of Immunology and Allergic Diseases, Van Regional Training and Research Hospital, Van, Turkey
| | - Taskin Yucel
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Irfan Yorulmaz
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Zahide Ciler Tezcaner
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Emel Cadalli Tatar
- Department of Otolaryngology, University of Health Sciences Türkiye, Etlik City Hospital, Ankara, Turkey
| | - Ahmet Emre Suslu
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
- Ahmet Emre Suslu Private Ear Nose and Throat Clinic, Ankara, Turkey
| | - Serdar Ozer
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Engin Dursun
- Faculty of Medicine, Department of Otorhinolaryngology, Lokman Hekim University, Ankara, Turkey
| | - Arzu Yorgancioglu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Gulfem Elif Celik
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara University, Ankara, Turkey
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Li T, Wang Q, Li Y, Zhang W, Chen M, Deng B, Liang L, Lin W, Lin Y, Meng Y. Predictive effects of advanced lung cancer inflammation index and serum vitamin D on mortality in patients with asthma. Nutr J 2025; 24:26. [PMID: 39955522 PMCID: PMC11829343 DOI: 10.1186/s12937-024-01065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 12/22/2024] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND Changes in systemic inflammation, nutritional status and serum vitamin D level are important characteristics of asthma. However, role and importance of nutritional inflammatory indicators or serum vitamin D concentrations in predicting the prognosis of asthma remain unclear. The advanced lung cancer inflammation index (ALI), based on body mass index (BMI), serum albumin and neutrophil-lymphocyte ratio (NLR), is a comprehensive index to assess systemic inflammation and nutrition. This study aimed to evaluate their independent and combined predictive value of mortality in asthma patients. METHODS This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. Cox regression analysis was used to assess the independent or joint effect of ALI and serum vitamin D on mortality risks of asthma. Receiver operator characteristic curve analysis was used to compare the prognostic ability of ALI with its component factors, including NLR, albumin, neutrophil, lymphocyte and BMI. RESULTS A total of 2870 eligible asthma patients were included. After adjustment, higher ALI correlated significantly with reduced all-cause and respiratory disease mortality (adjusted hazard ratio [aHR] = 0.64 and 0.34; P < 0.05). Meanwhile, vitamin D deficiency correlated significantly with increased all-cause and respiratory disease mortality (aHR = 2.06 and 2.73; P < 0.05). The area under the curve of ALI in predicting 1-year, 5-year or 10-year all-cause mortality surpassed that of its five component indices. Joint analyses showed that individuals with higher levels of ALI and vitamin D had the lowest risks of all-cause and respiratory disease mortality (aHR = 0.31 and 0.17; P < 0.05). CONCLUSIONS ALI and serum vitamin D are robust independent and combined predictors of mortality in asthma patients. ALI offers superior predictive capability over its components, and sufficient vitamin D levels are beneficial for survival outcomes. The synergistic effect of high ALI and adequate vitamin D highlights the benefit of integrating both metrics into clinical practice for enhanced prognostic accuracy.
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Affiliation(s)
- Ting Li
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, Guangzhou, 510515, China
- Department of Respiratory and Critical Care Medicine, Ganzhou Hospital-Nanfang Hospital, Ganzhou, 341000, China
| | - Qi Wang
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Yuhan Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Wenyong Zhang
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Manyu Chen
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Bihua Deng
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Lin Liang
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Weixian Lin
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Yuying Lin
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Ying Meng
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou North Road, Guangzhou, 510515, China.
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47
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Grunwell JR, Fitzpatrick AM. Asthma Phenotypes and Biomarkers. Respir Care 2025. [PMID: 40013975 DOI: 10.1089/respcare.12352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2025]
Abstract
Asthma experienced by both adults and children is a phenotypically heterogeneous condition. Severe asthma, characterized by ongoing symptoms and airway inflammation despite high doses of inhaled and/or systemic corticosteroids, is the focus of research efforts to understand this underlying heterogeneity. Clinical phenotypes in both adult and pediatric asthma have been determined using supervised definition-driven classification and unsupervised data-driven clustering methods. Efforts to understand the underlying inflammatory patterns of severe asthma have led to the seminal discovery of type 2-high versus type 2-low phenotypes and to the development of biologics targeted at type 2-high inflammation to reduce the rates of severe asthma exacerbations. Type 2-high asthma is characterized by upregulation of T helper 2 immune pathways including interleukin (IL)-4, IL-5, and IL-13 along with eosinophilic airway inflammation, sometimes allergic sensitization, and responsiveness to treatment with corticosteroids. Type 2-low asthma is poorly responsive to corticosteroids and is not as well characterized as type 2-high asthma. Type 2-low asthma is limited by being defined as the absence of type 2-high inflammatory markers. Choosing a biologic for the treatment of severe asthma involves the evaluation of a panel of biomarkers such as blood eosinophils, total and specific immunoglobulin E/allergic sensitization, and fractional exhaled nitric oxide. In this review, we focus on the underlying pathobiology of adult and pediatric asthma, discuss the different phenotype-based treatment options for adult and pediatric type 2-high with or without allergic asthma and type 2-low asthma, and describe a clinical phenotyping approach to patients to guide out-patient therapy. Finally, we end with a discussion of whether pediatric asthma exacerbations necessitating admission to an ICU constitute their own high-risk phenotype and/or whether it is a part of other previously defined high-risk subgroups such as difficult-to-control asthma, exacerbation-prone asthma, and severe treatment-resistant asthma.
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Affiliation(s)
- Jocelyn R Grunwell
- Dr. Grunwell is affiliated with Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Anne M Fitzpatrick
- Dr. Fitzpatrick is affiliated with Division of Pulmonary, Allergy/Immunology, Cystic Fibrosis, and Sleep Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
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Zhang P, Xu J, Xu B, Zhang Y, Xie Y. Health loss and economic burden of asthma in China: a qualitative review based on existing literature. Arch Public Health 2025; 83:28. [PMID: 39905572 DOI: 10.1186/s13690-025-01515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 01/18/2025] [Indexed: 02/06/2025] Open
Abstract
BACKGROUND Asthma is a significant public health issue that cannot be ignored in China and around the world, bringing a huge social burden. OBJECTIVES To evaluate the disease burden of asthma in China, including health loss and cost of illness, and identify its influencing factors. METHODS A systematic literature review and qualitative descriptive analysis were conducted, Literature was accessed through PubMed, EMBASE, Web of Science, CNKI, Wangfang Data, and VIP databases, with a cutoff date of April 3, 2024. The analysis focused on two main aspects: health loss burden, measured by disability-adjusted life years (DALYs), including years of life lost (YLLs) and years lived with disability (YLDs); and economic burden, assessed through direct and indirect costs. The risk of bias in economic studies was assessed using an 11-item methodological checklist for cost of illness, while cross-sectional studies were evaluated using the Agency for Healthcare Research and Quality's recommendation rating tool. RESULTS The analysis included 50 studies, with eight focused on health loss and 42 on economic burden. The health loss studies showed a 51% decrease in asthma's age-standardized DALYs rate over 30 years, from 209.24 to 102.81 per 100,000 person-years. The health loss burden is influenced by factors such as high BMI, smoking, and occupational exposure. Economic burden studies reported annual direct costs from $348 to $1187 per capita, indirect costs from $7 to $1195, and hospitalization costs from $177 to $1547, influenced by frequency and severity of acute exacerbation, comorbidities, and treatment adherence. Quality assessment revealed moderate overall quality, with gaps in sensitivity analyses and cost data transparency. CONCLUSION The health loss burden of asthma in China has significantly decreased from 1990 to 2019, with males experiencing a higher burden. However, regional disparities in the economic burden persist, highlighting the need for improved management and adherence to standardized treatment protocols to address these disparities.
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Affiliation(s)
- Peng Zhang
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, No.19 Renmin Road, Zhengzhou, Henan, 450046, People's Republic of China
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Jiaxin Xu
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, No.19 Renmin Road, Zhengzhou, Henan, 450046, People's Republic of China
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Baichuan Xu
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, No.19 Renmin Road, Zhengzhou, Henan, 450046, People's Republic of China
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yiyin Zhang
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, No.19 Renmin Road, Zhengzhou, Henan, 450046, People's Republic of China
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yang Xie
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, No.19 Renmin Road, Zhengzhou, Henan, 450046, People's Republic of China.
- Collaborative Innovation Center for Chinese Medicineand, Respiratory Diseases Co-Construction By Henan Province & Education Ministry of P.R. China , Henan University of Chinese Medicine, Zhengzhou, People's Republic of China.
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China.
- Henan International Joint Laboratory of Evidence-based Evaluation for Respiratory Diseases, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.
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Bonomo F, Ferrante G, Piazza M, Tenero L, Zaffanello M, Piacentini G. Severe asthma in adolescents: Clinical implications and beyond. Paediatr Respir Rev 2025:S1526-0542(25)00023-5. [PMID: 39965991 DOI: 10.1016/j.prrv.2025.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/30/2025] [Accepted: 01/31/2025] [Indexed: 02/20/2025]
Abstract
Severe asthma affects about 6.7% of adolescents worldwide, posing a substantial burden on their physical and psychosocial well-being. The impact of severe asthma on adolescents is multifaceted, with several factors that contribute to this burden, such as comorbidities including obesity, dysfunctional breathing, sleep-disordered breathing and mental health issues. Moreover, daily therapy management is often complex and may require lifestyle modification that could lead to a failure in treatment adherence and to peer-related stressors such as feelings of exclusion. Furthermore, adolescents with severe asthma are prone to risk-taking behaviours, including vaping and substance misuse. While current management strategies often fail to account for their developmental stage, digital technologies offer novel solutions to improve disease management. This narrative review aims to provide a comprehensive overview of the multifaceted impact of severe asthma on adolescents, addressing the main clinical management issues and exploring the role of innovative digital tools to enhance asthma management in this critical population.
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Affiliation(s)
- Francesca Bonomo
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, Verona, Italy
| | - Giuliana Ferrante
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, Verona, Italy; Institute of Translational Pharmacology (IFT), National Research Council (CNR), Palermo, Italy.
| | - Michele Piazza
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, Verona, Italy
| | - Laura Tenero
- Pediatric Division, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, Verona, Italy
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50
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Mousavi S, Bieber K, Zirpel H, Vorobyev A, Olbrich H, Papara C, De Luca DA, Thaci D, Schmidt E, Riemekasten G, Lamprecht P, Laudes M, Kridin K, Ludwig RJ. Large-scale analysis highlights obesity as a risk factor for chronic, non-communicable inflammatory diseases. Front Endocrinol (Lausanne) 2025; 16:1516433. [PMID: 39963282 PMCID: PMC11830592 DOI: 10.3389/fendo.2025.1516433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 01/09/2025] [Indexed: 02/20/2025] Open
Abstract
Background Overweight and obesity are a global pandemic, contributing to death and disability-adjusted life-years. Obesity is a major factor in the onset of chronic inflammatory diseases (CIDs). Yet, several knowledge gaps remain: For several CIDs, inconsistent results have been reported, relating to their obesity-imposed risk, data on most rare CIDs remain unavailable, sex differences and racial disparities remain mostly unaddressed. Methods A large-scale cohort study compared the risk of developing 46 CIDs in individuals with overweight/obesity (n=3,101,824) to an equal number of non-overweight/obese individuals. Propensity score matching optimized between-group comparability, and sensitivity analyses assessed study robustness. Results The risk of developing any CID was 28.48% in overweight/obese individuals versus 17.55% in non-overweight/obese controls, with a hazard ratio (95%-confidence interval) of 1.52 (1.509-1.521, p<0.0001). This risk was consistent across all sensitivity, sex-, and race-stratified analyses. Overweight and obesity were associated with an increased risk for 24 of 46 CIDs in the primary analysis and all sensitivity analyses. For 12 diseases, increased risks were confirmed to one of the two sensitivity analyses, while for 10 diseases, results were discordant. No increased risk was observed for one disease. In sex-stratified analysis, overweight and obesity posed a more pronounced risk for four CIDs in female individuals. In race-stratified analysis, overweight and obesity were linked to a higher risk for seven CIDs in White individuals and to one CID in "Black or African American" individuals. Conclusion Overweight and obesity increase the risk for the majority of CIDs in a sex- and race-specific manner.
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Affiliation(s)
- Sadegh Mousavi
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Henner Zirpel
- Institute and Comprehensive Centre for Inflammatory Medicine, University of Lübeck, Lübeck, Germany
| | - Artem Vorobyev
- Department of Dermatology, University Hospital Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Henning Olbrich
- Department of Dermatology, University Hospital Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Cristian Papara
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Institute and Comprehensive Centre for Inflammatory Medicine, University of Lübeck, Lübeck, Germany
| | - David A. De Luca
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Institute and Comprehensive Centre for Inflammatory Medicine, University of Lübeck, Lübeck, Germany
| | - Diamant Thaci
- Institute and Comprehensive Centre for Inflammatory Medicine, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Gabriele Riemekasten
- Department of Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Matthias Laudes
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Ralf J. Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University Hospital Schleswig-Holstein Lübeck, Lübeck, Germany
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