May 2nd is Now "Bronchial Thermoplasty Awareness Day" in Pennsylvania

Asthma is a disease that causes the airways of the lungs to swell and narrow, leading to wheeze, shortness of breath, chest tightness, and cough. Asthma is the most common chronic lung disease, affecting up to 10% of adults and 30% of children. Bronchial Thermoplasty (BT) is one of the treatment options for severe asthma - see below:



Asthma Treatment Options in 6 Steps (click to enlarge the image).

May 2nd is Now "Bronchial Thermoplasty Awareness Day" in Pennsylvania. From the manufacturer's YouTube channel: Bronchial Thermoplasty Day in Pennsylvania:



Here is how the procedure looks like, again from the manufacturer's channel:

Proton pump inhibitors are first-line treatment for EoE, achieving improvement of symptoms in 60% of patients

There are various therapeutic options available for treating patients with eosinophilic esophagitis (EoE):

- dietary modifications
- proton pump inhibitors (PPI)
- topical corticosteroids
- endoscopic esophageal dilation

Proton pump inhibitors are currently considered the first-line treatment for eosinophilic esophagitis, achieving histological remission and improvement of symptoms in 50.5% and 60.8% of patients, respectively.

Regarding topical corticosteroids in eosinophilic esophagitis, budesonide and fluticasone propionate both decrease eosinophil densities in the esophageal mucosa and relieve symptoms. However, owing to differences in drug delivery, viscous budesonide seems to be the best pharmacological therapy for eosinophilic esophagitis.

Results for dietary modifications have been mixed depending on the type of diet prescribed:

- amino acid-based elemental diets are the most effective in inducing histological remission of eosinophilic esophagitis (90.8% but they have drawbacks limiting implementation in clinical practice

- allergy testing-based food elimination provides a suboptimal remission rate of 45.5%, although this is lower in adults than in children (32.2% vs 47.9%, respectively)

- empirical 6-food elimination diets were shown to be the best diet-based therapy, with a remission rate of 72%



Eosinophilic Esophagitis (click here to enlarge the image).



References:

Eosinophilic Esophagitis: An Evidence-Based Approach to Therapy. González-Cervera J, Lucendo AJ. J Investig Allergol Clin Immunol. 2016;26(1):8-18; quiz 2p following 18.
http://www.ncbi.nlm.nih.gov/pubmed/27012011?dopt=Abstract

Image source: Eosinophilic esophagitis, Wikipedia, GNU Free Documentation License.

Improvements in impulse oscillometry after chronic dosing with formoterol compared with salmeterol might reflect better deposition to small airways

Effects of small-particle long-acting beta-agonists on the small airways have been poorly documented. This study used impulse oscillometry (IOS) to compare single and repeated dosing effects of small- (formoterol MDI) and large-particle (salmeterol DPI) long-acting beta-agonists.

16 patients received either formoterol or salmeterol twice daily plus inhaled corticosteroid for 1 to 2 weeks with a 1- to 2-week washout period in between (mean age, 43 years; FEV1, 80%, FEF25-75, 48%).

There were greater improvements with formoterol versus salmeterol in all IOS outcomes but not FEV1.

Significant improvements in IOS outcomes but not spirometry results occurred after chronic dosing with formoterol compared with salmeterol. This might reflect better deposition to the entire lung, including the small airways.

References:

Effects of formoterol or salmeterol on impulse oscillometry in patients with persistent asthma. Arvind Manoharan et al. JACI, March 2016, Volume 137, Issue 3, Pages 727–733.e1.
http://www.jacionline.org/article/S0091-6749(15)00861-1/abstract

Image source: Lungs, Wikipedia, public domain.

60% of elderly patients with asthma have rhinitis, mainly allergic and often untreated, whose onset preceded asthma symptoms by 10 years

Allergic rhinitis is a group of symptoms affecting the nose such as runny nose, congestion, sneezing and itchy eyes. These symptoms occur when you breathe in something you are allergic to, such as dust, animal dander, or pollen. Allergic rhinitis affects between 20% and 40% of people.

This study from Italy investigated the role of rhinitis and sensitization to airborne allergens in 368 elderly patients with asthma (65 years and older). Approximately 30% of patients had some features of overlapping COPD. Skin prick tests for common allergens were performed.

Rhinitis was present in 59% of patients, with an age of onset significantly different from that of asthma (49 for rhinitis vs 57 years for asthma). At least 1 sensitization was observed in 52% of subjects, more frequently for house dust mite (HDM; 31.8%).

The prevalence of poorly and partially controlled asthma was higher in patients sensitized to airborne allergens (odds ratio 1.64), in particular to HDM (odds ratio 1.73).

Approximately 60% of elderly subjects with asthma had rhinitis, mainly allergic and often untreated, whose onset preceded asthma symptoms by a mean of approximately 10 years. HDM sensitization was greater in patients with asthma with features resembling COPD (39% vs 28%).

Nonallergic asthma was better controlled than allergic asthma.



Treatment Options for 
Allergic Rhinitis (AR) and 
Non-Allergic Rhinitis (NAR) in 6 Steps (click to enlarge the image). En Español.



Treatment Options for 
Non-Allergic Rhinitis (NAR) (click to enlarge the image).

References:

Phenotyping asthma in the elderly: allergic sensitization profile and upper airways comorbidity in patients older than 65 years. Carlo Lombardi et al. Annals of Allergy, Asthma and Immunology, March 2016, Volume 116, Issue 3, Pages 206–211.
http://www.annallergy.org/article/S1081-1206(15)00826-1/abstract

Image source: Wikipedia, Creative Commons license.

Microbes and asthma: “old friends” may offer opportunities for intervention

Asthma is an umbrella term for different phenotypes or endotypes, which arise through different pathophysiologic pathways.

Microbes have developed mechanisms to manipulate the human immune system during their coevolution with people. This the background of the so called “old friends” hypothesis which is an extension of the hygiene hypothesis.

The “old friends” are a group of microbes with which the human race has coevolved and that in the past 50 years were rapidly lost because of changes in lifestyle, living conditions, or occupations.

This article investigates how modulation of the immune system by bacterial, parasitic, and viral infections might affect the development of asthma.

References:

Microbes and asthma: Opportunities for intervention. Hermelijn H. Smits et al. JACI, March 2016, Volume 137, Issue 3, Pages 690–697 (free full text).
http://www.jacionline.org/article/S0091-6749(16)00123-8/fulltext

Image source: OpenClipArt.org, public domain.
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