Search Results (550)

Air pollution is linked to childhood mortality and morbidity in low- and middle-income countries globally. There is growing evidence linking air pollution to asthma and other respiratory diseases in children. Studies have shown that children are likely to experience asthma due to their narrow airways and their heightened sensitivity to environmental irritants. This study aims to investigate the relationship between ambient air pollution and respiratory diseases in children under the age of 5. The study will be conducted in the informal township of Alexandra, north of Johannesburg, South Africa. A quantitative approach will be used in this cross-sectional analytical study. Data will be collected using different tools that include a questionnaire to determine the prevalence of asthma and respiratory disease and potential risk factors. While environmental air pollution will be measured using Radiello passive samplers and Gillian pumps. Data will be analyzed using the latest version of the STATANow/MP 19.5 software. Furthermore, health risk assessment will be conducted for lifetime non-carcinogenic and carcinogenic risk estimation following the USEPA framework. The study will identify environmental triggers that exacerbate asthma and other respiratory conditions in other similar community settings and will contribute to the body of knowledge in public health. Ethical approval was obtained from the Research Ethics Committee, Faculty of Health Sciences at the University of Johannesburg. Full article

Background: The study evaluates the immunomodulatory potential of secukinumab (SECU) and honokiol (HONK) in a murine model of allergic asthma complicated by acute lung injury (ALI), with an emphasis on modulating key inflammatory pathways. The rationale is driven by the necessity to attenuate Th17-mediated cytokine cascades, wherein IL-17 plays a critical role, as well as to explore the adjunctive anti-inflammatory effects of HONK on Th1 cytokine production, including IL-6, TNF-α, and Th2 cytokines. Methods: Mice were sensitized and challenged with ovalbumin (OVA) and lipopolysaccharide (LPS) was administrated to exacerbate pulmonary pathology, followed by administration of SECU, HONK (98% purity, C₁₈H₁₈O₂), or their combination. Quantitative analyses incorporated OVA-specific IgE measurements, differential cell counts in bronchoalveolar lavage fluid (BALF), and extensive cytokine profiling in both BALF and lung tissue homogenates, utilizing precise immunoassays and histopathological scoring systems. Results: Both SECU and HONK, when used alone or in combination, display significant immunomodulatory effects in a murine model of allergic asthma concomitant with ALI. The combined therapy synergistically reduced pro-inflammatory mediators, notably Th1 cytokines, such as TNF-α and IL-6, as measured in both BALF and lung tissue homogenates. Conclusions: The combined therapy showed a synergistic attenuation of pro-inflammatory mediators, a reduction in goblet cell hyperplasia, and an overall improvement in lung histoarchitecture. While the data robustly support the merit of a combinatorial approach targeting multiple inflammatory mediators, the study acknowledges limitations in cytokine diffusion and the murine model’s translational fidelity, thereby underscoring the need for further research to optimize clinical protocols for severe respiratory inflammatory disorders. Full article

Asthma, the most common chronic respiratory condition in children, involves airway inflammation, hyper-responsiveness, and frequent exacerbation that worsen the airflow and inflammation. Exosomes, extracellular vesicles carrying microRNAs (miRNAs), play a key role in cell communication alongside other types of communication and are promising markers of asthma severity. This study compares exosomal miRNA and long non-coding RNA (lncRNA) profiles in boys with asthma, focusing on differences between those with normal lung functions and those with severe airflow obstruction. This study enrolled 20 boys aged 9–18 years with asthma, split into two groups based on their lung function. Ten had normal lung function (NLF; FEV1/FVC > 0.84, FEF75% > 69% predicted), while ten had severe airflow obstruction (SAO; FEV1/FVC < 0.70, FEF75 < 50% predicted). Saliva and blood samples were collected. Exosomes were isolated, quantified, and analyzed via small RNA sequencing to identify differentially expressed (DE) miRNA and lncRNA profiles. Bioinformatic tools were then used to explore potential miRNA biomarkers linked to asthma severity. SAO subjects were more likely to exhibit allergen sensitization, higher IgE levels, and more eosinophils. We identified 27 DE miRNAs in plasma and 40 DE miRNAs in saliva. Additionally, five key miRNAs were identified in both saliva and plasma which underline important pathways such as neurotrophins, T-cell receptor, and B-cell receptor signaling. We further outlined key features and functions of miRNAs and long non-coding RNAS (lncRNAs) and their interactions in children with asthma. This study identified DE miRNAs and lncRNAs in children with SAO when compared to those with NLF. Exosomal miRNAs show strong potential as non-invasive biomarkers for personalized asthma diagnosis, treatment, and monitoring. These RNA markers may also aid in tracking disease progression and response to therapy, thereby supporting the need for future studies aimed at applications in precision medicine. Full article

Background: Mepolizumab is an effective treatment for severe eosinophilic asthma, leading to a depletion of blood eosinophil levels, the clinical relevance of which remains unclear. Objective: The aim of this study was to assess the relationship between mepolizumab-induced blood eosinophil reduction and clinical outcome in patients with severe eosinophilic asthma, in particular, whether the magnitude of blood eosinophil reduction was associated with clinical remission. Methods: We conducted a real-world retrospective analysis of 58 adult patients with severe eosinophilic asthma treated with mepolizumab. Clinical and respiratory functional parameters were evaluated at the start of mepolizumab treatment (T0) and after two years of treatment (T2; mean follow-up: 22.8 ± 7.5 months). Blood eosinophil counts were recorded at T0 and during the first year of treatment (T1; mean follow-up: 7.7 ± 4.1 months). Results: After two years of mepolizumab treatment, 58 severe asthmatic patients showed significant improvements in ACT score, FVC, and FEV₁ and a reduction in acute exacerbations and the use of maintenance therapies. Clinical remission was achieved in 55.1% of patients. Lower blood eosinophil counts during the first year (T1) were associated with greater improvements in lung function and fewer exacerbations. A greater relative decrease in eosinophils from baseline to T1 (ΔEOS%) was significantly associated with remission, reductions in exacerbations, and no maintenance OCS use. ΔEOS% was the only independent predictor of remission in the multivariate analysis. A ≥90% reduction predicted remission with 80% specificity (AUC = 0.726). Conclusions: Monitoring blood eosinophils after mepolizumab initiation could be a useful tool for predicting long-term response to treatment. In particular, a reduction by over 90% of peripheral blood eosinophils during the first year of mepolizumab treatment predicts clinical remission with a specificity of 80%. Considering the accessibility and the low cost of this biomarker, it may help to optimize long-term asthma management. Full article

Background: Inhaled corticosteroids (ICSs) are a cornerstone in asthma management, particularly during exacerbations, when high doses are often prescribed. However, patient concerns about potential side effects such as increased appetite, weight gain, and metabolic disturbances may reduce adherence, compromising treatment outcomes. While oral corticosteroids (OCSs) are well known to induce such effects, the metabolic impact of short-term high-dose ICSs remains poorly studied. Objective: This prospective pilot study aimed to assess whether a 14-day course of high-dose ICSs in adults with stable asthma induces changes in appetite, dietary intake, leptin levels, or body weight. Methods: Thirty-five adults (19 males, 16 females; mean age 48.7 ± 15.1 years) with stable mild asthma received ≥400 µg/day extrafine beclomethasone dipropionate/formoterol via pressurized metered-dose inhaler for 14 days. Participants underwent assessments at baseline and after 14 days, including body weight, BMI, fasting serum leptin levels, dietary intake (evaluated using 24 h dietary recalls), and appetite (measured via a visual analogue scale). Results: No significant changes were observed in body weight (mean change: −0.38 kg; 95% CI: −0.81 to 0.05; p = 0.083) or BMI (p = 0.912) following high-dose ICS use. Similarly, serum leptin levels (mean change: 0.13 ng/mL; 95% CI: −3.47 to 3.72; p = 0.945), subjective appetite scores (mean change: −4.93 mm; 95% CI: −13.64 to 3.79; p = 0.267), and dietary energy intake (mean change: +255 kJ/day; 95% CI: −380 to 891; p = 0.431) did not differ significantly post-intervention. Conclusions: Short-term high-dose ICS therapy in adults with mild asthma may not significantly affect appetite, dietary intake, leptin levels, or body weight. These findings support the metabolic safety of short-term high-dose ICSs and may help alleviate patient concerns, improving adherence during exacerbation management. Full article

Background/Objectives: The overuse of short-acting β₂-agonists (SABAs) has been associated with increased asthma morbidity and mortality, prompting changes in treatment guidelines. However, the role of frequent short-acting muscarinic antagonists (SAMAs) use remains poorly defined and unaddressed in current recommendations. This study offers the first real-world analysis of SAMA overuse in asthma, quantifying its association with exacerbation risk and healthcare utilization and comparing its predictive value to that of SABAs. Methods: A retrospective multicenter cohort study analyzed electronic health records (EHRs) from 132 adults with asthma in the Spanish National Health System (SNS). Associations between annual SAMA use and clinical outcomes were assessed using negative binomial regression and 5000-sample bootstrap simulations. Interaction and threshold models were applied to explore how SAMA use affected outcomes and identify clinically actionable cutoffs. Results: SAMA use was independently associated with a 19.2% increase in exacerbation frequency per canister and a nearly sixfold increase in the odds of experiencing ≥1 exacerbation (OR = 5.97; 95% CI: 2.43–14.66). An inflection point at 2.5 canisters/year marked the threshold beyond which annual exacerbations exceeded one. Increased SAMA use was also associated with a higher number of respiratory consultations and with more frequent prescriptions of systemic corticosteroids and antibiotics. The risk increased more sharply with SAMAs than with SABAs, and the lack of correlation between them suggests distinct clinical patterns underlying their use. Conclusions: SAMA use emerges as a digitally traceable and clinically meaningful indicator of asthma instability. While the associations observed are robust and consistent across multiple outcomes, they should be considered provisional due to the study’s retrospective design and limited sample size. Replication in larger and more diverse cohorts is needed to confirm external validity. These findings support the integration of SAMA tracking into asthma management tools—alongside SABAs—to enable the earlier identification of uncontrolled disease and guide therapeutic adjustment. Full article

Background: Severe asthma, which is characterized by persistent symptoms despite standard therapies, presents a significant clinical challenge. Biologic therapies targeting specific inflammatory pathways offer a potential avenue for achieving disease remission. This retrospective study evaluates the effectiveness of biologic therapies in achieving remission in severe asthma within a central Romanian cohort. Methods: Forty-eight patients with severe asthma treated with omalizumab, benralizumab, or dupilumab (2020–2025) were assessed. Clinical remission was defined using ACT scores, exacerbation frequency, corticosteroid use, and FEV1. Biological remission was determined using FeNO and eosinophil levels. Statistical analysis was performed to compare treatment outcomes. Results: At 12 months, 75% of patients achieved biological remission, and 75% reached clinical remission criteria. Significant improvements were observed in FEV1 (p < 0.001), eosinophil counts (p < 0.001), and ACT scores (p < 0.001). Complete remission, encompassing clinical, biological, and functional normalization, was observed in 54.2% of patients. Conclusion: Biologic therapies demonstrate promise in inducing comprehensive remission in severe asthma, supporting their role in improving disease control and lung function. Further research with larger cohorts is warranted. Full article

Asthma represents a heterogeneous disorder characterized by a dynamic balance between pro-inflammatory and anti-inflammatory forces, with allergic sensitization contributing substantially to airway hyperresponsiveness and remodeling. Central to its pathogenesis are cytokines such as IL-4, IL-5, IL-13, IL-17, and IL-33, which drive recruitment of eosinophils, neutrophils, and other effector cells, thereby precipitating episodic exacerbations in response to viral and environmental triggers. Conventional biomarkers, including blood and sputum eosinophil counts, IgE levels, and fractional exhaled nitric oxide, facilitate phenotypic classification and guide the emerging biologic era. Monoclonal antibodies targeting IgE (omalizumab) and IL-5 (mepolizumab, benralizumab, reslizumab, depemokimab) have demonstrated the ability to reduce exacerbation frequency and improve lung function, with newer agents such as depemokimab offering extended dosing intervals. Itepekimab, an anti-IL-33 antibody, effectively engages its target and mitigates tissue eosinophilia, while CM310-stapokibart, tralokinumab, and lebrikizumab inhibit IL-4/IL-13 signaling with variable efficacy depending on patient biomarkers. Comparative analyses of these biologics, encompassing affinity, dosing regimens, and trial outcomes, underscore the imperative of personalized therapy to optimize disease control in severe asthma. Full article

Background/Objectives: Climate change is a major factor exacerbating non-communicable diseases (NCDs) such as cardiovascular diseases, neoplasms, respiratory diseases, and diabetes, especially in vulnerable Latin American regions. This study analyzes the impact of environmental exposures related to climate change on the NCD burden in eight Latin American countries by quantifying the disability-adjusted life years (DALYs) attributable to these factors. Using Global Burden of Disease (GBD) data (1990–2021), we performed multiple linear regression to assess associations between DALYs and environmental risk factors—air pollution (particulate matter, nitrogen dioxide), radon, lead, and extreme temperatures—in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, and Uruguay. The study included major NCDs, and the population was stratified by age and sex. Results: Ischemic heart disease was the leading cause of DALYs in most countries. Particulate matter pollution was the main environmental risk factor contributing to the NCD burden, mainly affecting cardiovascular and respiratory diseases. Mexico showed the highest DALYs from particulate and ozone pollution; temperature and lead exposure also contributed in some countries. Nitrogen dioxide was the primary risk factor for asthma. Statistically significant relationships between environmental factors and DALYs were confirmed. Conclusions: Climate change-related exposures significantly increase the burden of NCDs in Latin America. Targeted interventions in industry, transportation, and energy, along with sustainable urban policies, are essential to mitigate health impacts and reduce disparities. Integrating environmental health into public policies can improve health outcomes amid ongoing climate challenges. Full article

Equine asthma is a chronic respiratory disease characterised by neutrophilic inflammation, airway hyperresponsiveness, and impaired pulmonary function. Obesity, increasingly prevalent among domestic horses, has been identified as a potential risk factor for exacerbating inflammatory conditions. This study aimed to explore whether obesity modifies neutrophil metabolism and inflammatory responses in horses affected by asthma. Six asthmatic horses in clinical remission were categorised into two groups: obese and non-obese, based on body condition score. Serum levels of interleukin-1β (IL-1β) and peripheral blood neutrophil counts were significantly higher in obese horses, indicating a heightened systemic inflammatory state. Neutrophils from obese horses displayed a stronger oxidative burst following zymosan stimulation and elevated IL-1β gene expression in response to lipopolysaccharide, suggesting a hyperinflammatory phenotype. Metabolomic profiling of neutrophils identified 139 metabolites, with notable differences in fatty acids, branched-chain amino acids, and tricarboxylic acid (TCA) cycle intermediates. Pathway enrichment analysis revealed significant alterations in fatty acid biosynthesis, amino acid metabolism, and glutathione-related pathways. Elevated levels of itaconate, citraconic acid, and citrate in obese horses indicate profound metabolic reprogramming within neutrophils. These results suggest that obesity promotes a distinct neutrophil phenotype marked by increased metabolic activity and heightened responsiveness to inflammatory stimuli. This altered profile may contribute to the persistence or worsening of airway inflammation in asthmatic horses. The findings underscore the importance of addressing obesity in the clinical management of equine asthma and open avenues for further research into metabolic-targeted therapies in veterinary medicine. Full article

Asthma is a highly heterogeneous respiratory disease that, in its severe forms, is characterized by persistent symptoms, frequent exacerbations, and a significant impact on patients’ quality of life. Despite high-dose inhaled corticosteroids and long-acting bronchodilators, a subset of patients remains uncontrolled, necessitating advanced therapeutic strategies. The advent of biologic therapies has revolutionized the management of severe asthma, offering targeted interventions based on the underlying inflammatory endotypes, primarily T2-high and T2-low. However, selecting the most appropriate biologic remains challenging due to overlapping phenotypic features and the limited availability of validated biomarkers. This narrative review explores the clinical utility of key biomarkers, including blood eosinophils, fractional exhaled nitric oxide (FeNO), periostin, and total and specific IgE, in guiding biologic therapy. All the information provided is based on an extensive literature search conducted on PubMed. We also examine the clinical characteristics and comorbidities that influence therapeutic choices. Furthermore, we present a practical decision-making platform, including a clinical table matching phenotypes with biologic agents, such as omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab. By integrating biomarker analysis with clinical assessment, based on current guidelines and our extensive real-life experience, we aim to offer a logical framework to help clinicians select the most suitable biologic treatment for patients with uncontrolled severe asthma. Future research should focus on identifying novel biomarkers, refining patient stratification, and evaluating long-term outcomes to further advance precision medicine in the management of severe asthma. Full article

Background/Objectives: Toxocara spp. infection has been associated with severe asthma and allergic manifestations due to the activation of eosinophils by the release of Th2 cell cytokines. The aim of this study was to investigate the association between Toxocara spp. infection and eosinophil levels in severe asthmatic patients. Methods: The socio-demographic, peripheral blood eosinophils counting total IgE, sIgE to aeroallergens and FEV1 results were acquired from the Program of Asthma and Rhinitis Control (ProAR) at the Salvador–Brazil databank; IgG anti-Toxocara spp. levels were measured in 176 severely asthmatic patients by indirect ELISA. Results: The Toxocara spp. seroprevalence was 50.6%. Eosinophilia was present in 54% of the population. The correlation between IgG anti-Toxocara spp. levels and eosinophils levels was positive. Eosinophilic individuals with SPT, sIgE for D. pteronyssinus, D. farinae and B. tropicalis showed positive results; IgE ≥ 160 UI/dL and uncontrolled asthma presented more positive results for IgG anti-Toxocara spp. Conclusions: Our findings suggest that eosinophil levels are influenced by the presence of IgG antibodies against Toxocara spp. Additionally, helminth infection may modulate immunological responses in allergies and uncontrolled asthma, which could help explain the exacerbation of asthma symptoms. Full article

Background/Objectives: Pediatric asthma is a leading cause of emergency department visits, and air pollution is a known primary environmental trigger. Although worldwide air pollutants have been associated with asthma exacerbations, limited data have been reported in the Eastern Province of Saudi Arabia. This study aimed to investigate the relationship between air pollution and pediatric asthma admissions among children aged 2 to 14 years old at King Fahd Hospital of the University Hospital (KFHU). Methods: This is a retrospective cohort study, over 366 days, including 1750 pediatric asthma-related ER visits and daily concentrations of air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, CO, and O₃) and meteorological factors (temperature and humidity). Various statistical models, such as Poisson regression and ARIMA, were applied to determine the association between pollutants levels and hospital ER visits. The data were visit-based in nature, and it was not possible to follow up with repeat visits or for admission status for individual patients. Results: Elevated levels of PM_2.5, NO₂, and CO were significantly associated with more pediatric asthma ER visits, mainly on the same day and with short lags. PM_2.5 displayed the strongest association, consistent with its deeper pulmonary penetration and greater toxicity. Also, PM₁₀ levels were inversely associated with ER visits, possibly due to particle size and deposition location differences. Significantly correlated with increased ER visits are lower ambient temperature and higher humidity. Conclusions: This study offers strong evidence on the relationship between air pollution and pediatric asthma events, in turn highlighting the vital importance of air quality regulation, public health policies, and clinical vigilance for environmental exposures. Full article

Chronic respiratory diseases (CRDs) are common among children and adolescents. Asthma and cystic fibrosis are two main conditions that affect this population. Young patients face physical limitations due to structural and functional abnormalities of the airways and other lung structures. Moreover, the route of everyday life is influenced by responsibilities derived from treatments, and exacerbations imposed by the disease impacting silently their social life. To date, discussions in the literature have mostly focused on the physical limitations that face children and adolescents. On the contrary, social aspects are less investigated, even their important role in rehabilitation patterns. On this basis, we provide an overview of the social determinants that affect children and adolescents with CRDs in different social environments, such as family and school; discuss coping strategies that can be developed to attenuate the impact of CRDs on youngsters’ lives; and present the role of healthcare professionals and digital technology in social support. Full article

Background: Asthma is the most common chronic respiratory disease in children and adolescents, associated with high morbidity and healthcare costs. Telemedicine has emerged as a strategy to improve access to care, adherence to treatment and symptom control. However, its effectiveness in the pediatric population has not been clearly studied. Objective: To assess the clinical effectiveness of telemedicine interventions in asthma control and health-related quality of life in asthmatic children and adolescents. Methodology: A systematic review and meta-analysis were performed following PRISMA-2020 guidelines, with previous registration in PROSPERO (CRD42025251000837). Sixteen randomized clinical trials (n = 2642) with patients aged 2–18 years were included. The interventions included videoconferencing, mobile applications, web systems, interactive voice response and mobile units in schools. The outcomes were measured using validated quality-of-life (PAQLQ) and asthma control (ACT/c-ACT) questionnaires. Results: Seven studies were incorporated into the PAQLQ meta-analysis, whose overall effect was non-significant (mean difference = 0.06; 95% CI: −0.06 to 0.18; I² = 5.7%). Five studies provided ACT/c-ACT data, showing a significant effect in favor of telemedicine (mean difference = 0.61; 95% CI: 0.32 to 0.90; I² = 73%). Complementary qualitative analysis revealed improvements in adherence, reduction in exacerbations, emergency department visits and use of rescue medication. Conclusions: Telemedicine improves the clinical control of pediatric asthma, although its impact on the quality of life is limited. Multicenter trials with long-term follow-up and cost-effectiveness evaluation are required. Full article