Search Results (38)

Background: Glucocorticoid insensitivity is a problem for the therapy of chronic inflammatory lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD). Both are non-communicable chronic inflammatory lung diseases with worldwide increasing incidences. Only symptoms can be controlled by inhaled or systemic glucocorticoids, often combined with β2 agonists and/or muscarinic receptor antagonists. The therapeutic effect of glucocorticoids varies between individuals, and a significant number of patients do not respond well. It is believed that only protein-free circulating unbound glucocorticoids can enter cells by diffusion and achieve their therapeutic effect by binding to the intracellular glucocorticoid receptor (GR), encoded by the NR3C1 gene, for which over 3000 single-nucleotide polymorphisms have been described. In addition, various GR protein isoforms result from 11 transcription start sites, and differential mRNA splicing leads to further GR protein variants; each can be modified post-translational and alter steroid response. To add more variety, some GR isoforms are expressed cell-type specific or in a sub-cellular location. The GR only functions when it forms a complex with other intracellular proteins that regulate ligand binding, cytosol-to-nuclear transport, and nuclear and cytosolic action. Importantly, the timing of the GR activity can be cell type, time, and condition specific. These factors are rarely considered when assessing disease-specific loss or reduced GR response. Conclusions: Future studies should analyze the timing of the availability, activity, and interaction of all components of the glucocorticoid signaling cascade(s) and compare these factors between non-diseased and diseased probands, applying the combination of all omics methods (250). Full article

Asthmatic children who tested positive for COVID-19 experienced changes in lung function and persistent symptoms following SARS-CoV-2 infection, even for several months after diagnosis, and with the same features as in an acute phase. This study aimed to analyze a pediatric age group (between 0 and 17 years old) diagnosed with asthma, and SARS-CoV-2 infection attending regular monitoring visits in a Pediatric Department of a Regional Tertiary Hospital (Filantropia Clinical Municipal Hospital Craiova, Romania) during the COVID-19 pandemic and post-pandemic time interval (i.e., March 2020–July 2024), and identify how the infection influenced their long-term symptoms and treatment. Materials and Methods. The following variables were recorded: demographic data (gender, age group, residence), data related to allergies (allergic rhinitis, atopic dermatitis, and food allergies), the presence of exacerbations, the fraction of exhaled nitric oxide, the ventilatory function, the asthma phenotype (allergic or non-allergic), as well as the GINA assessment of asthma control at clinical visits were analyzed. SARS-CoV-2 infections were evaluated in terms of year of infection, symptoms, cough presence and persistence, and modifications of the asthma treatment during and after COVID-19 disease. The data were statistically analyzed with SPSS, using the Mann–Whitney U, Kruskal–Wallis H, and Chi-Square tests. Results. A lower incidence of COVID-19 cases was recorded in the first pandemic of asthmatic patients (2020 and 2021), but an increase in the rate of cases was observed at the beginning of the second pandemic, in 2022. The nitric oxide values in asthmatic children who were infected with SARS-CoV-2 were statistically significantly increased (p < 0.0005), especially for children with persistent cough for more than 4 weeks. A significant increase in the number of exacerbations was also observed in patients who tested positive for SARS-CoV-2 infection (p < 0.0005). Ventilatory function values were statistically significantly different in asthmatic children with and without SARS-CoV-2 infection (p < 0.05). Conclusions. The persistence of cough after the acute phase of SARS-CoV-2 infection as well as the changes in ventilatory tests emphasize the need of periodic medical check-ups, as well as the implementation of a therapeutic regimen appropriate for each pediatric patient. Full article

Respiratory disorders significantly impact adolescents’ health, often resulting in hospital admissions. Meteorological elements such as wind patterns have emerged as potential contributors to respiratory symptoms. However, it remains uncertain whether fluctuations in wind characteristics over extended periods have a tangible impact on respiratory health, particularly in regions characterized by distinct annual wind patterns. Crete is situated in the central-eastern Mediterranean Sea and frequently faces southerly winds carrying Sahara Desert sand from Africa and northerly winds from the Aegean Sea. This retrospective study analyzes long-term wind direction data and their relationship to respiratory symptoms observed in children up to 14 years old admitted at the University Hospital of Heraklion between 2002 and 2010. Symptoms such as headache, dyspnea, dry cough, dizziness, tachypnea, throat ache, and earache were predominantly reported during the presence of southern winds. Fever, productive cough, and chest pain were more frequently reported during northern winds. Cough was the most common symptom regardless of the wind pattern. Southern winds were significantly associated with higher probabilities of productive or non-productive cough, headache, dyspnea, tachypnea, dizziness, earache, and throat ache. Northern winds were related to a higher incidence of productive cough. Rhinitis, asthma, allergies, pharyngitis, and sinusitis were related to southern winds, while bronchiolitis and pneumonia were associated with northern winds. These findings underscore the critical role of local climatic factors, emphasizing their potential impact on exacerbating respiratory conditions in children. Moreover, they point out the need for further research to elucidate the underlying mechanisms and develop targeted interventions for at-risk populations. Full article

Background: In recent decades, the incidence of depression has gradually increased in the general population globally. Depression is also common during gestation and could result in detrimental gestational complications for both the mother and the fetus. The survey presented aimed to evaluate whether pregnant women’s perinatal depression could be associated with socio-demographic, anthropometry and lifestyle factors, and perinatal and postnatal outcomes. Methods: This is a cross-sectional survey conducted on 5314 pregnant women. Socio-demographic and lifestyle factors were recorded by relevant questionnaires via face-to-face interviews. Anthropometric parameters were measured by qualified personnel. Perinatal depressive symptomatology status was evaluated by Beck’s Depression Inventory (BDI-II) questionnaire. Results: Depressive symptoms throughout gestation were found in 35.1% of the enrolled women. Perinatal depression was significantly associated with lower educational and economic level, pre-pregnancy regular smoking and reduced levels of Mediterranean diet adherence levels, a higher prevalence of gestational diabetes and preterm birth, as well as a higher incidence of delivering by caesarean section and abnormal childbirth weight. Perinatal depression was also significantly associated with a higher prevalence of maternal postpartum depression and lower prevalence of exclusive breastfeeding practices, as well as with a higher incidence of childhood asthma. Conclusions: Pregnant women’s perinatal depression appears to be associated with various socio-demographic, anthropometry, and lifestyle characteristics and with a higher frequency of several adverse pregnancy complications. The present findings emphasize the importance of pregnant women’s perinatal mental health, highlighting the need to develop and apply public strategies and policies for psychological counseling and support of future mothers to minimize probable risk factors that may trigger perinatal depression. Novel well-organized, follow-up surveys of enhanced validity are highly recommended to establish more definitive conclusions. Full article

The incidence of allergic problems has notably increased in recent decades, affecting approximately 20% of the population and becoming a public health issue. Some studies have suggested that asthma and atopy could result from an increased dietary intake of n-6 polyunsaturated fatty acids (PUFA) and a decreased intake of n-3 PUFA. During pregnancy, the fetus depends on the transplacental transfer of n-3 PUFA from maternal circulation, which implies that maternal lipid profile alterations might predispose to allergy onset during infancy and childhood. The aim of this study was to evaluate the circulating fatty acid profile in pregnant women with allergic problems as well as in fetal plasma at birth. Plasma samples from 73 allergic and 179 healthy pregnant women as well as cord venous plasma were collected at delivery in the NELA cohort (Murcia, Spain). Maternal allergy was diagnosed according to the symptoms and via a positive skin prick test. The fatty acid profile was determined by gas cromatography. The allergic mothers had a lower percentage of n-3 PUFA in the plasma compared to the healthy ones (Allergic: 4.06 ± 0.15 vs. Control: 4.66 ± 0.11, p = 0.002), especially in those with asthma or food allergies. This contributed to a significantly higher n-6/n-3 PUFA ratio in women with allergies (Allergic: 9.45 ± 0.31 vs. Control: 8.28 ± 0.20, p = 0.002), mainly asthma and food allergies, which was indicative of a proinflammatory status. The same tendency was observed in women affected by atopic dermatitis (p = 0.094). In cord blood, despite the fact that there were no differences in the n-6/n-3 PUFA ratio between the groups, the fetuses born from allergic mothers showed a tendency towards lower n-3 PUFA content compared to those born from healthy mothers (Allergic: 5.63 ± 0.19 vs. Control: 6.17 ± 0.21, p = 0.093). In conclusion, allergy led to a decreased n-3 PUFA and an increased n6-/n-3 ratio fatty acid profile in pregnant women at delivery, especially in those affected by asthma and food allergies. The same tendency was observed in cord plasma. A higher n-3 PUFA consumption could be desirable in women with allergic diseases in order to improve their lipid profile and proinflammatory status and their offspring’s health. Full article

Background: Most epidemiological studies indicate that bronchial asthma is not a risk factor for COVID-19, but previous analyses have not additionally focused on the socioeconomic determinants of SARS-CoV-2 infection in children with asthma, bronchitis, and respiratory symptoms. Aims: This research aimed to investigate the correlation between the socioeconomic status of families and the prevalence of respiratory conditions such as asthma, bronchitis, and respiratory symptoms in children, in addition to exploring their association with the prevalence of COVID-19. The study involved a cross-sectional epidemiological investigation conducted in 2022, encompassing 2454 students from elementary schools in Poland. The parents of the students completed a questionnaire modeled after the International Study on Asthma and Allergies in Childhood (ISAAC). Socioeconomic status (SES) indicators were determined based on parental education, self-reported economic status, and housing conditions. To assess the impact of social factors and health on the occurrence of COVID-19, odds ratios (ORs) were calculated. The findings revealed several COVID-19 risk factors, including higher maternal (OR 2.2; 95%CI: 1.3–3.0) and paternal education (OR 1.9; 95%CI: 1.3–2.4), urban residence (OR 1.7; 95%CI: 1.3–2.1), the presence of mold in residences (OR 1.7; 95%CI: 1.0–2.3), bronchitis (OR 1.5; 95%CI: 1.2–2.0), and chronic cough (OR 1.8; 95%CI: 1.3–2.4). Further analysis, stratifying children based on their baseline health status (i.e., presence or absence of asthma, bronchitis, and chronic cough), indicated that higher parental education increased the risk of COVID-19 solely for children without pre-existing conditions. The occurrence of SARS-CoV-2 infections was found to be notably associated with mold exposure in children who did not have bronchial asthma. Rigorous multivariate analyses substantiated the collective impact of factors such as residential environment, the existence of mold and moisture, and a history of bronchitis. This study’s conclusions highlight a higher frequency of SARS-CoV-2 infections in cases where bronchitis had been diagnosed previously and chronic cough was prevalent. Interestingly, the initially hypothesized higher prevalence of COVID-19 among children with bronchial asthma did not receive confirmation in our findings. This study highlights the importance of urban residence, exposure to mold or dampness, and higher parental education in the incidence of COVID-19. Higher parental education was a significant factor in increasing the risk of COVID-19 among children without bronchitis, chronic cough, and asthma. Full article

Obesity and asthma are two common health issues that have shown increased prevalence in recent years and have become a significant socioeconomic burden worldwide. Obesity increases asthma incidence and severity. Obese asthmatic individuals often experience increased exacerbation rates, enhanced airway remodeling, and reduced response to standard corticosteroid therapy. Recent studies indicate that obesity-associated non-T2 factors such as mechanical stress, hyperinsulinemia, systemic inflammation, adipose tissue mediators, metabolic dysregulation, microbiome dysbiosis, and high-fat-diet are responsible for increased asthma symptoms and reduced therapeutic response in obese asthmatic individuals. This manuscript reviews the recent findings highlighting the role of obesity-associated factors that contribute to airway hyper-reactivity, airway inflammation and remodeling, and immune cell dysfunction, consequently contributing to worsening asthma symptoms. Furthermore, the review also discusses the possible future therapies that might play a role in reducing asthma symptoms by diminishing the impact of obesity-associated non-T2 factors. Full article

The increasing incidence and common specific inflammatory type 2 intracellular pathways have recently allowed for the rise of new biologic therapies in two inflammatory chronic diseases in children: atopic dermatitis (AD) and severe asthma. Such therapies aim at relieving symptoms and reducing inflammation by treating the underlying molecular causes. Dupilumab is a monoclonal antibody indicated in children with moderate–severe AD and severe asthma ineffectively responsive to standard treatments. Here, we report a case series of seven consecutive children with moderate–severe AD, with three of them also affected by asthma and treated with dupilumab. The children experienced a reduction in the extent and severity of lesions and decreased intensity of symptoms, leading to better asthma control, a general improvement in sleep and quality of life (QoL), with a good safety profile. Notwithstanding the observed clinical improvement, further larger prospective studies are needed to better tailor the treatment duration and the potential preventive and long-lasting effects. Full article

Asthma is a common respiratory disease with symptoms such as repeated wheezing, shortness of breath, and coughing. However, currently, asthma cannot be cured but only controlled or relieved using medication. The metered-dose inhaler (MDI) is known to lead to high deposition fractions of drug particles in the mouth and throat, resulting in inadequate drug efficacy. Therefore, herein, the factors influencing the deposition fraction of asthma drugs in the mouth and throat regions were explored by computational fluid dynamics and a smart MDI for asthma was designed. The smart MDI was designed based on the obtained simulation results, which demonstrated that the deposition fraction gradually increased from 55.78% to 65.75% with an increase in the peak inspiratory flow rate at an angle of incidence of 0°. The deposition fraction first decreased and then increased as the angle of incidence increased at a constant peak inspiratory flow rate. The deposition fraction increased as the inspiration–press interval time increased at a constant angle of incidence and peak inspiratory flow rate. Meanwhile, performance analysis of the designed smart MDI indicated that the inhaler could effectively reduce the deposition fraction of drugs in the mouth and throat regions by 17% on average. Full article

Competing risks survival analysis is used to answer questions about the time to occurrence of events with the extension of multiple causes of failure. Studies that investigate how clinical features and risk factors of COVID-19 are associated with the survival of patients in the presence of competing risks (CRs) are limited. The main objective of this paper is, under a CRs setting, to estimate the Cumulative Incidence Function (CIF) of COVID-19 death, the CIF of other-causes death, and the probability of being cured in subjects with COVID-19, who have been under observation from the date of symptoms to the date of death or exit from the study because they are cured. In particular, we compared the non-parametric estimator of the CIF based on the naive technique of Kaplan–Meier (K–M) with the Aalen–Johansen estimator based on the cause-specific approach. Moreover, we compared two of the most popular regression approaches for CRs data: the cause-specific hazard (CSH) and the sub-distribution hazard (SDH) approaches. A clear overestimation of the CIF function over time was observed under the K–M estimation technique. Moreover, exposure to asthma, diabetes, obesity, older age, male sex, black and indigenous races, absence of flu vaccine, admission to the ICU, and the presence of other risk factors, such as immunosuppression and chronic kidney, neurological, liver, and lung diseases, significantly increased the probability of COVID-19 death. The highest hazard ratio of $2.03$ was observed for subjects with an age greater than 70 years compared with subjects aged 50–60 years. The SDH approach showed slightly higher survival probabilities compared with the CSH approach. An important foundation for producing precise individualized predictions was provided by the competing risks regression models discussed in this paper. This foundation allowed us, in general, to more realistically model complex data, such as the COVID-19 data, and can be used, for instance, by many modern statistical learning and personalized medicine techniques to obtain more accurate conclusions. Full article

Foreign body aspiration (FBA) is a frequent diagnosis in children. In the absence of other lung conditions, such as asthma or chronic pulmonary infections, this manifests as a sudden onset of cough, dyspnea, and wheezing. The differential diagnosis is based on a scoring system which takes into account the clinical picture as well as the radiologic aspects. The treatment that is considered the gold-standard for FBA in children remains to be rigid fibronchoscopy, however it comes with several potentially crucial local complications such as airway edema, bleeding, and bronchospasm, along inherent issues due to general anesthesia. Material and methods: Our study is a retrospective study analyzing the medical files of the cases from our hospital over the span of 9 years. The study group consisted of 242 patients aged 0–16 years diagnosed with foreign body aspiration in the Emergency Clinical Hospital for Children “Sfânta Maria” Iași, between January 2010–January 2018. Clinical and imaging data were extracted from the patients’ observation sheets. Results: In our cohort, the distribution of children with foreign body aspiration was uneven, with the highest incidence being reported in children from rural areas (70% of cases), whereas the most affected age group was 1–3 years, amounting to 79% of all cases. The main symptoms which led to emergency admittance were coughing (33%) and dyspnea (22%). The most important factors that determined the unequal distribution were socio-economic status, which relates to a lack of adequate supervision by parents, as well as the consumption of food inappropriate for their age. Conclusions: Foreign body aspiration is a major medical emergency that may be associated with dramatic clinical manifestations. Several scoring algorithms designed to establish the need for bronchoscopy have been proposed, taking into account both the clinical and radiological results. The issue with asymptomatic or mild symptomatic cases, as well as difficulties managing cases with radiolucent foreign bodies, remains a challenge. Full article

Exercise-induced bronchoconstriction (EIB) is a dysfunction of the respiratory tract consisting of transient airflow obstruction. This study is a retrospective analysis of two prospective studies concerning EIB symptoms in two adolescent populations. Our study group included 400 non-athletes and 101 athletes. Due to the similarity of indoor exercise conditions, an analysis was performed on the basis of where training took place. The study aims to assess the EIB prevalence in the following groups of adolescent children: non-athletes and athletes. In “indoor” athletes, the EIB prevalence was 22.4%. Among non-athletes, EIB was diagnosed in 10.2% (p = 0.007). A history of asthma was found in 6.5% of non-athletes and 29.3% of indoor athletes (p < 0.001). The incidence of EIB without asthma was higher in indoor athletes (14.6%) than in non-athletes (9.9%). Athletes achieved higher mean values in forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum expiratory flow rate at 25% (MEF₂₅) parameters. In the group of non-athletes, higher results were observed in forced expiratory volume in one second % of vital capacity (FEV₁%VC), MEF₅₀, and MEF₇₅. The findings of the study present the complexity of the EIB diagnosis among children training in an indoor environment. Full article

Inhaled selective short-acting β-2 agonists (SABA), such as salbutamol, are the rescue treatment of choice for the relief of symptoms of acute asthma exacerbations: one of the leading causes of pediatric emergency department admission and hospitalization. Cardiovascular events, including supraventricular arrhythmias, are the most frequent side effects reported with inhaled SABA in children with asthma and are the main reason for a continuing debate about their safety, despite their widespread use. Although supraventricular tachycardia (SVT) is the most common potentially serious dysrhythmia in children, the incidence and risk factor of SVT after SABA administration is currently unknown. We here reported three cases and conducted a review of the literature in an attempt to gain insight into this issue. Full article

Background: Dietary and environmental factors may influence tolerance acquisition in food protein-induced allergic proctocolitis (FPIAP). This retrospective observational study explored the role of maternal diet during pregnancy and breastfeeding in tolerance acquisition in infantile FPIAP. Methods: Breastfed infants with FPIAP from six diverse regions in Greece were divided into two groups, based on development of tolerance to the trigger food: Group A (n = 43), before, and Group B (n = 53), after, the 6th month of age. Maternal diet during pregnancy and breastfeeding was elicited using the Mediterranean Diet Score Questionnaire and the Mediterranean Oriented Culture Specific Semi-Quantitative Food Frequency Questionnaire. Results: Mean age at diagnosis of FPIAP (1.5 months) and weaning (5.5 months) were the same in both groups. The main trigger was cow’s milk. Group A received infant milk formula earlier than Group B. Group B had a higher incidence of asthma/wheeze, siblings with milk allergy, maternal smoking and rural residence. On multivariate analysis, earlier resolution of FPIAP was associated with higher maternal education and with salt intake and consumption of goat/sheep cheese during pregnancy and olive oil during breastfeeding. Consumption of multivitamins during pregnancy and meat, winter fruits, green vegetables, butter, salt, “ready-to-eat” meals and pastries during breastfeeding were correlated with longer duration of symptoms. Conclusions: Mothers of children with FPIAP to cow’s milk protein can be advised to eat more yogurt, cheese and olive oil during subsequent pregnancies, and avoid multivitamins, grilled food, “ready-to-eat” meals, pastries, meat and alcohol during breastfeeding, to reduce the duration of FPIAP presenting in future infants. Full article

We aimed to test the hypothesis that adherence to a healthful plant-based diet (hPDI) is associated with a subsequent decrease in the incidence of asthma symptoms, with an opposite association with adherence to an unhealthful plant-based diet (uPDI). In addition, we evaluated a potential mediating role of body mass index (BMI) and the modifying effect of smoking. Among 5700 elderly women from the French Asthma-E3N study with dietary data in 1993 and 2005, we assessed the incidence of asthma symptoms in 2018 among women with no asthma symptoms in 2011. BMI was evaluated in 2008. Mediation analyses in the counterfactual framework were used to disentangle total, direct, and indirect effects mediated by BMI. We found that both healthful and unhealthful plant-based diets were associated with a lower incidence of asthma symptoms over time, mediated by BMI (OR (95%CI) for the indirect effect: 0.94 (0.89–1.00) for hPDI and 0.92 (0.70–1.00) for uPDI)). Associations with both healthful and unhealthful PDIs were mediated by changes in BMI by 33% and 89%, respectively. Plant-based diets (healthful and unhealthful) were associated with subsequently reduced incidences of asthma symptoms over time, partly or almost totally mediated by BMI according to their nutritional quality. Full article