Asthma & COVID-19 / Asthma News

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Asthma & COVID-19 / Asthma News

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People with asthma could be negatively affected by increased disinfectant use in the COVID-19 era

2/12/21


https://www.news-medical.net/news/20210 ... 9-era.aspx


Those with asthma are experiencing less asthma control related to an increase in using household disinfectants -- known asthma triggers -- because of COVID-19, according to a survey co-conducted by University of Illinois Chicago researchers.

" We became concerned with increased cleaning and disinfecting related to the COVID-19 pandemic, combined with people spending more time indoors may expose people with asthma to more environmental triggers for asthma symptoms. This prompted our interest in studying the impact of disinfectants and asthma control among those living with asthma."

- Kamal Eldeirawi, Researcher, University of Illinois at Chicago

Cleaning products are considered respiratory irritants that cause inflammation and bronchial hyperresponsiveness, Eldeirawi explained.

In the online survey, conducted between May and September 2020, adults with asthma answered questions about handwashing and hand sanitizer use, household disinfectant use and frequency. They also were asked five questions about asthma symptoms, use of rescue medications, effect of asthma on daily functioning, and personal control over the past four weeks with responses on a 1-5 scale to determine participants' asthma control score, which ranges from 5 to 25. A score of 19 or less was considered an indication of uncontrolled asthma.

Of the 795 respondents, the percent who reported household disinfectant use five or more times per week increased 138% for disinfectant wipes, 121% for disinfectant sprays, 155% for bleach and water solution, and 89% for other liquids since the COVID-19 pandemic began.

Researchers also observed significant associations of frequent disinfectant use since the pandemic with uncontrolled asthma. And, while the researchers did not collect data on increases in health care providers' or ER visits for asthma, a large percentage of the respondents indicated having had an asthma attack, Eldeirawi said.

The study indicates people with asthma could be negatively affected by increases in disinfectant use and should discuss with their health care providers safer alternatives for cleaning, as well as managing symptoms. Cleaning product alternatives include vinegar, water and a drop of dish detergent, 70% alcohol, or hydrogen peroxide.

Eldeirawi said it is yet unknown what COVID-19's impact is on those with asthma, but research is being conducted around the world. Eldeirawi and his research team will continue their research, this time asking survey respondents about their symptoms and mask use.

Source:

University of Illinois at Chicago

Journal reference:


Eldeirawi, K., et al. (2020) Increased disinfectant use among adults with asthma in the era of COVID-19. Journal of Allergy and Clinical Immunology: In Practice. doi.org/10.1016/j.jaip.2020.12.038.
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Cleaning product use affecting asthma more during COVID-19 measures, survey finds

2/11/21


https://www.sciencedaily.com/releases/2 ... 090131.htm


Those with asthma are experiencing less asthma control related to an increase in using household disinfectants -- known asthma triggers -- because of COVID-19, according to a survey co-conducted by University of Illinois Chicago researchers.

"We became concerned with increased cleaning and disinfecting related to the COVID-19 pandemic, combined with people spending more time indoors may expose people with asthma to more environmental triggers for asthma symptoms," Eldeirawi said. "This prompted our interest in studying the impact of disinfectants and asthma control among those living with asthma."

Cleaning products are considered respiratory irritants that cause inflammation and bronchial hyperresponsiveness, Eldeirawi explained.

In the online survey, conducted between May and September 2020, adults with asthma answered questions about handwashing and hand sanitizer use, household disinfectant use and frequency. They also were asked five questions about asthma symptoms, use of rescue medications, effect of asthma on daily functioning, and personal control over the past four weeks with responses on a 1-5 scale to determine participants' asthma control score, which ranges from 5 to 25. A score of 19 or less was considered an indication of uncontrolled asthma.

Of the 795 respondents, the percent who reported household disinfectant use five or more times per week increased 138% for disinfectant wipes, 121% for disinfectant sprays, 155% for bleach and water solution, and 89% for other liquids since the COVID-19 pandemic began.

Researchers also observed significant associations of frequent disinfectant use since the pandemic with uncontrolled asthma. And, while the researchers did not collect data on increases in health care providers' or ER visits for asthma, a large percentage of the respondents indicated having had an asthma attack, Eldeirawi said.

The study indicates people with asthma could be negatively affected by increases in disinfectant use and should discuss with their health care providers safer alternatives for cleaning, as well as managing symptoms. Cleaning product alternatives include vinegar, water and a drop of dish detergent, 70% alcohol, or hydrogen peroxide.

Eldeirawi said it is yet unknown what COVID-19's impact is on those with asthma, but research is being conducted around the world. Eldeirawi and his research team will continue their research, this time asking survey respondents about their symptoms and mask use.

The research paper's additional authors are Luz Huntington-Moskos of the University of Louisville, Dr. Sharmilee Nyenhuis of UIC, and Barbara Polivka of the University of Kansas.

Story Source:

Materials provided by University of Illinois at Chicago.

Journal Reference:

Kamal Eldeirawi, Luz Huntington-Moskos, Sharmilee M. Nyenhuis, Barbara Polivka. Increased disinfectant use among adults with asthma in the era of COVID-19. The Journal of Allergy and Clinical Immunology: In Practice, 2020; DOI: 10.1016/j.jaip.2020.12.038
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Re: Asthma & COVID-19 / Asthma News

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Study: Asthma does not increase risk of severe illness or death from COVID-19

2/20/21


https://www.news-medical.net/news/20210 ... ID-19.aspx


A new study looking at how COVID-19 affects people with asthma provides reassurance that having the condition doesn't increase the risk of severe illness or death from the virus.

George Institute for Global Health researchers in Australia analyzed data from 57 studies with an overall sample size of 587,280. Almost 350,000 people in the pool had been infected with COVID-19 from Asia, Europe, and North and South America and found they had similar proportions of asthma to the general population.

The results, published in the peer-reviewed Journal of Asthma, show that just over seven in every 100 people who tested positive for COVID-19 also had asthma, compared to just over eight in 100 in the general population having the condition. They also showed that people with asthma had a 14 percent lower risk of acquiring COVID-19 and were significantly less likely to be hospitalized with the virus.

There was no apparent difference in the risk of death from COVID-19 in people with asthma compared to those without.

Head of The Institute's Respiratory Program, co-author Professor Christine Jenkins said that while the reasons for these findings weren't clear, there were some possible explanations - such as some inhalers perhaps limiting the virus' ability to attach to the lungs.

"Chemical receptors in the lungs that the virus binds to are less active in people with a particular type of asthma and some studies suggest that inhaled corticosteroids - commonly used to treat asthma - can reduce their activity even further," she said.

"Also, initial uncertainty about the impact of asthma on COVID-19 may have caused anxiety among patients and caregivers leading them to be more vigilant about preventing infection."

Lead author Dr Anthony Sunjaya added that while this study provides some reassurance about the risks of exposure to COVID-19 in people with asthma, doctors and researchers were still learning about the effects of the virus.

" While we showed that people with asthma do not seem to have a higher risk of infection with COVID-19 compared to those without asthma and have similar outcomes, we need further research to better understand how the virus affects those with asthma."

- Dr Anthony Sunjaya, Lead Author

When the COVID-19 pandemic first spread across the world concerns were raised that people with asthma might be at a higher risk of becoming infected, or of becoming sicker or even dying.

Previous findings have shown that people with chronic respiratory conditions like asthma were reported to be at greater risk during the Middle East Respiratory Syndrome (MERS) outbreak, caused by a virus with a similar structure.

"Respiratory infections like those caused by coronaviruses can exacerbate asthma symptoms and corticosteroid treatment may increase susceptibility to COVID-19 infection and its severity," Dr Sunjaya said.

However this study using the best evidence available on the risk of infection, severe illness - requiring admission to ICU and/or ventilator use - and death from COVID-19 in people with asthma finds "no significant difference" of people with asthma being at higher risk.

Funded by Asthma Australia, the review included analysis of 45 hospital-based studies, six studies in the community and six with mixed setting. 22 of the studies were carried out in North America, 19 Asia, 14 Europe, and two in South America. Four of the studies only included children, making up 211 of the participants.

The average age of the participants was roughly 52; while 52.5% were males, 11.75% were current smokers and 16.2% were former. 54% had some form of comorbidities, 21% had diabetes and approximately 8% had chronic obstructive pulmonary disease.

Thirty-six studies were peer-reviewed publications; another 17 were preprints, 3 were government reports and 1 an open dataset.

The paper's findings also show increasing age is strongly associated with an increased risk of acquiring COVID-19 among asthmatics and explained 70% of the in-between study variance in the analysis. "This is an expected finding and in line with other COVID-19 studies showing age as one of the most important predictors for vulnerability to COVID-19 and prognosis," the authors add.

This review has "rigorously adhered to the guidelines of performing systematic reviews", limitations, however are that this is the synthesis of primarily observational studies, with a short duration of follow-up, mainly self-reported asthma and variable reporting of outcomes which may introduce bias in the pooled effect.

Source:

Taylor & Francis Group

Journal reference:

Sunjaya, A.P., et al. (2021) Asthma and risk of infection, hospitalisation, ICU admission and mortality from COVID-19: Systematic review and meta-analysis. Journal of Asthma. doi.org/10.1080/02770903.2021.1888116.Covid-19 lockdown restrictions may have led to reduction in asthma exacerbations
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Re: Asthma & COVID-19 / Asthma News

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Covid-19 lockdown restrictions may have led to reduction in asthma exacerbations

3/27/21

https://www.news-medical.net/news/20210 ... tions.aspx


Fewer patients with severe attacks were seen by their GP or admitted to hospital during the covid-19 pandemic, and fewer were admitted to hospital for pneumonia, influenza and chronic lung diseases, show findings from three papers published online in the journal Thorax.

Early in the pandemic, asthma was identified as a potential risk factor for hospital admission and death from covid-19, and since the majority of asthma exacerbations are associated with respiratory viral illnesses, it was expected that asthma exacerbations might increase.

Stay at home messages from governments, and fear of the virus could have dissuaded patients experiencing asthma exacerbations from seeking help from health services. On the other hand, restrictions on travel and social contact, resulted in reduced air pollution and transmission of other respiratory viruses, which could have led to a true reduction in asthma exacerbations during lockdown.

In the UK the first nationwide lockdown began on 23 March 2020.

In the first paper Shah and colleagues use the Optimum Patient Care Database of 9,949,387 patients in England to assess weekly asthma exacerbation rates over the period January to August 2020, using January to August 2016–2019 as a baseline, to see how they changed after lockdown.

After 23 March there were almost 20 fewer episodes for every 100 patients with asthma. When looked at by health setting, the reduction was only significant for patients who did not attend hospital or require hospital admission.

" We believe that a combination of factors led to a reduction in asthma exacerbations. These factors include changing behavior due to lockdown measures leading to reduction in air pollution, reduced circulation of respiratory viruses, improved self-management driven by patient concerns during the pandemic and shielding by a subset of patients.”

- Shah and colleagues

In the second paper, Davies and colleagues follow a similar approach. They use official data on emergency admissions and deaths due to asthma from Scotland’s Public Health Scotland and Wales’ SAIL Databank to compare weekly rates in the first 18 weeks of 2020 with the national averages over 2015-2019. They look at how trends changed between the first 13 weeks of 2020 compared with the five weeks post-lockdown.

Across both countries, the number of asthma exacerbations resulting in emergency hospital admission fell by more than a third (36%) post-lockdown, and there was no significant change in asthma deaths.

" We do not yet know to what degree the reduced numbers of emergency presentations of asthma in our study are due to improvements in asthma control or reductions in exposures to triggers during the pandemic versus avoidance of healthcare settings.”

- Davies and colleagues

And they note that in Wales there was a large spike in GP prescriptions for asthma medication the week before lockdown - 121% more inhaled corticosteroids and 133% more oral corticosteroid prescriptions compared with the five-year average.

In the third and final paper, Jung and colleagues report that the covid-19 pandemic has been associated with a fall in hospital admissions for pneumonia, influenza, COPD (chronic obstructive pulmonary disease) and asthma in South Korea. They looked at weekly hospitalization for the four conditions over February-July 2020, using figures from the National Health Insurance Service for January 2016-January 2020 as a baseline.


" Since the early days of the covid-19 epidemic, South Korea has thoroughly carried out social distancing, personal hygiene and universal use of face masks. In this study, the significant decrease in hospital admissions for influenza, pneumonia, COPD and asthma suggests the unintended benefits of these measures.”

- Jung and colleagues

Personal hygiene and droplet precautions are well-known effective measures for preventing the spread of influenza and a substantial portion of pneumonia, they add, “Our findings suggest that the decrease in admissions due to COPD and asthma might be associated with the decrease in respiratory infections, which are the most common triggers for acute exacerbation of COPD and asthma.”

These are observational studies, and as such, can’t establish cause. The authors of all three studies also point out several limitations including that diagnoses were not validated and that reliance on specific databases may have meant that some care episodes may have been missed as they were recorded in other databases.

Source:

BMJ

Journal reference:


Shah, S.A., et al. (2021) Decrease in hospital admissions for respiratory diseases during the COVID-19 pandemic: a nationwide claims study. Thorax. doi.org/10.1136/thoraxjnl-2020-216526.
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Cross-border asthma study investigates hygiene hypothesis amid COVID-19 pandemic

4/8/21


https://www.news-medical.net/news/20210 ... demic.aspx


A cross-border investigation of children's susceptibility to asthma and other childhood illnesses in the United States and Mexico is the focus of a new study led by researchers in the Asthma and Airway Disease Research Center at the University of Arizona Health Sciences.

The study is funded by a $15.3 million grant from the National Institute of Allergy and Infectious Diseases.

The Binational Early Asthma and Microbiome Study, or BEAMS, will recruit 500 Mexican-American and Mexican children - 250 in Tucson, Arizona, and 250 in Nogales, Sonora, Mexico - before the mothers have given birth.

The mothers will be evaluated while pregnant and the children will be followed from birth to age 5 to examine how the "hygiene hypothesis" affects them and their risk of asthma.

According to the U.S. Food and Drug Administration, the hygiene hypothesis suggests reduced exposure to germs keeps a child's immune system from developing the ability to naturally fight infectious organisms.

"Paradoxically, in the middle of all the poverty and underdevelopment in many 'barrios' and 'colonias' in Nogales, Sonora, there is less asthma," said Fernando Martinez, MD, study principal investigator, director of the UArizona Health Sciences Asthma and Airway Disease Research Center, the Swift-McNear Professor of Pediatrics at the UArizona College of Medicine - Tucson and a BIO5 Institute member.

"There is four times less asthma there than here, and our studies show the main reason is because, although children in Nogales, Sonora, are exposed to harmful bacteria that cause many infections, they are also exposed to a lot of protective bacteria that train their immune system to distinguish between dangerous and innocuous microbes."

BEAMS is the latest in a series of UArizona-led respiratory studies - anchored by the Tucson Children's Respiratory Study, ongoing since 1980 - that have yielded revelations and remedies on asthma, the hygiene hypothesis and respiratory disease progression from infancy to adulthood.

This current study seeks to provide a better understanding of the early origins of asthma and to offer new asthma prevention strategies to improve respiratory health for the Mexican-American community in Southern Arizona, and potentially for all Americans.

" One of the reasons why it is so important for us to be a Hispanic Serving Institution is because our unique location in the Sonoran Desert creates incredible opportunities for transborder research and collaboration that could have worldwide benefits. Asthma is the most common noncommunicable disease among children, and Dr. Martinez's research could have far-reaching impact for our most vulnerable populations."

- Robert C. Robbins, MD, President, University of Arizona

"I am very excited to follow the results of this study to better understand what causes asthma and to develop therapies that will provide respiratory relief for our borderlands region and nearly 340 million people worldwide."

BEAMS takes three approaches to analyzing asthma susceptibility: a population study on subjects' immunological and epidemiological risks, including family health history; a microbiological study to look at environmental exposures and the microbiome; and a mechanistic study to try to re-create that microbiome in animal models.

Environmental samples to be collected include water and dust from the home, while blood, stool and airway swabs will be gathered from participants. These will be evaluated to learn how microbes dictate - or don't - the development of allergies and asthma, as well as what genetic influences may result in better preventive therapies.

"It is this three-pronged approach - the population, microbiological and mechanistic studies - that gives BEAMS its edge," said Donata Vercelli, MD, professor of cellular and molecular medicine, associate director of the Asthma and Airway Disease Research Center and one of several principal investigators.

"We are going to do something absolutely novel and, to some extent, revolutionary. We will have a microbiological picture of whatever is happening in the lives of these children and their mothers at very high resolution."

Both Drs. Martinez and Vercelli are interested to see if the social isolation and enhanced hygiene of the COVID-19 pandemic will affect children participating in the study.

"These changes in lifestyle related to COVID-19 might also prompt differences in how the developmental trajectory in these children occurs," Dr. Vercelli added. "This could be an enormous confounding factor. Whereas, because we are proposing this in-depth analysis, we have an opportunity to actually see if, whether and how these differences in behavior and lifestyle impact these children and their mothers."

Source:

University of Arizona Health Sciences
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Scientists identify severe asthma species, show air pollutant as likely contributor

4/13/21


https://www.sciencedaily.com/releases/2 ... 081424.htm


Asthma afflicts more than 300 million people worldwide. The most severe manifestation, known as non-Th2, or non-atopic childhood asthma, represents the majority of the cases, greater than 85%, particularly in low-income countries, according to Hyunok Choi, an associate professor at the Lehigh University College of Health. Yet, whether non-Th2 is a distinct disease (or endotype) or simply a unique set of symptoms (or phenotype) remains unknown.

"Non-Th2 asthma is associated with very poor prognosis in children and great, life-long suffering due to the absence of effective therapies," says Choi. "There is an urgent need to better understand its mechanistic origin to enable early diagnosis and to stop the progression of the disease before it becomes severe."

Studies show that nearly 50% of the children whose asthma is poorly controlled are expected to emerge as severe adult cases. Yet, a one-size-fits-all treatment approach, currently the norm for asthma, is ineffective and, says Choi, and partially responsible for asthma's growing economic burden.

"The primary reason for lack of therapeutic and preventive measures is that no etiologic, or causal, driver has ever been identified for the non-Th2 asthma," says Choi.

Now, for the first time, an epidemiological study, led by Choi, has shown that not only is non-Th2 a distinct disease, its likely inducer is early childhood exposure to airborne Benzo[a]pyrene, a byproduct of fossil fuel combustion. Choi and her colleagues are the first to demonstrate air pollution as a driver of the most challenging type of asthma, the severe subtype which is non-responsive to current therapies.

The team describes their results in an article recently published online in Environmental Health Journal called "Airborne Benzo[a]Pyrene May Contribute to Divergent Pheno-Endotypes in Children."

What is termed asthma is an umbrella word for multiple diseases with common symptoms. Asthma has been broadly classified as two major sets of symptoms: T helper cell high (Th2-high) and T helper cell low (non-Th2). Th2-high is associated with early-childhood allergies to common pollutants such as pet dander, tree pollens, or mold. In contrast, non-TH2 is not related to an allergic response. The non-Th2 type, marked explicitly by being non-allergy-related, is far less understood than the TH-2 type and could transform into severe or difficult to treat type.

"The identification of non-Th2 asthma as a distinct disease, with early exposure to Benzo[a]pyrene as a driver, has the potential to impact tens of millions of sufferers, since this would make it possible to intervene before the onset of irreversible respiratory injuries," says Choi.

The team tested two comparable groups of children from an industrial city, Ostrava, and the surrounding semi-rural area of Southern Bohemia, in the Czech Republic: 194 children with asthma and a control group consisting of 191 children. According to the study, Ostrava is an industrial city with a high level of coal mining activities, coal processing, and metallurgical refinement. The district-level ambient mean for Benzo[a]pyrene at the time of their investigation November 2008) was 11-times higher than the recommended outdoor and indoor air quality standard.

Not only was elevated exposure to Benzo[a]pyrene associated with correspondingly elevated odds of non-Th2 asthma, it was also associated with depressed systemic oxidant levels.

"Contrary to the current body of evidence supporting adult onset of non-atopic asthma, our data suggest for the first time that the lung function deficit and suppressed oxidative stress levels during early childhood are critical sentinel events preceding non-atopic asthma," says Choi.

Journal Reference:

Hyunok Choi, Miroslav Dostal, Anna Pastorkova, Pavel Rossner, Radim J. Sram. Airborne Benzo[a]Pyrene may contribute to divergent Pheno-Endotypes in children. Environmental Health, 2021; 20 (1) DOI: 10.1186/s12940-021-00711-4
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Overgrowth of gut yeast in newborns may increase asthma risk

4/20/21


https://medicalxpress.com/news/2021-04- ... sthma.html


An overgrowth of yeast in the gut within the first few months of life may cause changes to the immune system that increase the risk of asthma later on, shows a study published today in eLife.

Asthma is a common and sometimes difficult-to-manage, life-long lung condition that affects one in 10 children in developed countries. The findings explain a possible cause of asthma and may help scientists develop new strategies to prevent or treat the condition.

The period just after birth is a critical window for the development of a healthy immune system and gut microbiome. Disruptions to gut bacteria that produce anti-inflammatory compounds called short-chain fatty acids (SCFAs) early in life have previously been linked to asthma.

"We recently showed that overgrowth of a type of gut yeast called Pichia kudriavzevii in newborns in Ecuador is associated with an increased risk of asthma," says first author Rozlyn Boutin, an MD/Ph.D. student in the Department of Microbiology and Immunology at the University of British Columbia, Vancouver, Canada. "In this study, we wanted to see if we could replicate these findings in children from an industrialized setting and identify how fungi of the gut microbiota affect the development of the immune system."

Boutin and colleagues began with a study of 123 newborns in Canada, who are part of the CHILD Cohort Study. They again found that an overgrowth of Pichia kudriavzevii in the stools of the newborns during the first three months of life was associated with a higher risk of asthma.

To understand how this yeast overgrowth might contribute to asthma later in life, the team applied Pichia kudriavzevii to newborn mice with immature gut microbiota communities. In this mouse model of asthma, the team found that the newborns exposed to the yeast experienced more lung inflammation than those who were unexposed. Applying Pichia kudriavzevii to an adolescent mouse model, however, did not cause this excess inflammation.

"Our findings show that there is a critical window in early life where disruptions in the gut microbiota caused by Pichia kudriavzevii affect the development of the immune system and increase the risk and severity of asthma later in life," Boutin says.

Previous studies have shown that bacterial SCFAs have beneficial effects on immune development that protect against asthma. In this study, the team also showed that anti-inflammatory SCFAs produced by gut bacteria inhibit the growth of Pichia kudriavzevii.

"Immune responses to gut microbe disruptions early in life have long-term consequences for diseases of the immune system later in life," concludes senior author Brett Finlay, Professor at the Michael Smith Laboratories and the Departments of Biochemistry and Molecular Biology, and Microbiology and Immunology, University of British Columbia. "Our study adds to our understanding of microbiota-associated asthma and suggests that inhibiting yeast overgrowth with SCFAs in early life could be an effective approach to preventing this condition."

More information: Rozlyn CT Boutin et al, Bacterial-fungal interactions in the neonatal gut influence asthma outcomes later in life, eLife (2021). DOI: 10.7554/eLife.67740
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World Asthma Day 2021: How could smart inhalers improve asthma care?

5/5/21


https://www.news-medical.net/news/20210 ... -care.aspx


Please could you introduce yourself and tell us about your expertise in asthma?


I’m Krisnah Poinasamy, the Head of Research and Innovation Advocacy at Asthma UK and the British Lung Foundation.

My expertise in asthma comes from over 6 years of working to improve the lives of people with asthma advocating for policy changes and increase investment in asthma research and innovation.

What inspired your career and subsequent research into asthma?


Though I’m not a scientist, I’m inspired by the opportunity to create significant changes for people with asthma via research that focuses on their needs. In my career, I have always sought to create a major impact by altering the narrative surrounding that particular field.

For asthma, this means bringing in an era in which people are treated for their specific type of asthma and supported to manage their asthma more effectively all throughout the year. Around 1 in 11 people are currently receiving treatment for asthma.

What is asthma and what are some of the common misconceptions surrounding asthma?

Asthma is a long-term condition that affects your airways – the tubes that carry air in and out of your lungs. When your airways react to certain triggers, it can make it difficult to breathe and lead to symptoms, such as chest tightness, wheezing, or coughing.

Perhaps the most common misconception is that all asthma is the same. People with asthma intuitively know that there are many different triggers of asthma, and there are many different types. Despite this, treatment options have remained broadly the same for decades, primarily inhaled steroids. We now understand that up to 50% of people respond poorly to steroids.

The second misconception is the view that asthma is not a life-threatening condition. In fact, asthma continues to kill thousands of people every year, globally. Therefore, we urgently need research into these types of asthma that are driven by mechanisms that are not responsive to steroid treatments.

What treatment options are currently available for people suffering from asthma?


Steroids are the main treatment for people with asthma and they have been for many years. However, we need treatments for the millions who are not responding well to steroid treatments.

In recent years, biologics have also been developed to help people with severe asthma. These drugs can be truly transformative for people but currently, there is no simple way to determine which biologic will work for which person.

If we had a way to identify candidates for these treatments early on in their lives, we could save years of morbidity.

A lot of your research has been dedicated to smart inhalers and implementing these within the NHS. Can you describe what a smart inhaler is and how it works?

A smart inhaler attempts to use technology to improve a patient’s asthma. There are many different variations, but most focus on improving adherence by using tracking features. By utilizing Bluetooth technology, they can send information, such as the frequency of usage, from the inhaler to the users’ phone and potentially to the healthcare provider as well.

Newer innovations seek to determine how well the inhaler was used or provide information on the external environment that is relevant to the user.

What benefits do smart inhalers have for asthma sufferers?


Smart inhalers have the potential to improve adherence, which can dramatically improve outcomes for people with asthma. By providing more information on their patterns of usage, it is also possible that smart inhalers could help to stratify those at greater risk due to worsening asthma. There are some individuals that suffer from asthma so severe that current treatment options do not work.

What investment and research is still needed within asthma research and how will this research help to improve the lives of people suffering from asthma?

Asthma UK coordinated the European Asthma Research and Innovation Partnership (EARIP), which brought together scientists, industry, and people with asthma from around the world. EARIP produced a set of fifteen priorities for research and innovation to make a breakthrough for people with asthma. It also produced a series of landmark publications diving into unmet needs for asthma mechanisms.

In 2019, we produced a report, Asthma Still Kills, that built on the outputs of EARIP and followed a high-level discussion with leading scientists from around the world. The contributors focused on the need for more research into non-T2 asthma, which responds poorly to steroids.

The report noted the following areas as critical for scientific progress: sex hormones, airway nerves, the microbiome, and air pollution. Additionally, it was felt that more needed to be done in the fields of primary prevention in children at elevated risk of asthma, and incomplete response to steroid therapy in severe asthma.

Over the last year, the ongoing COVID-19 pandemic has been at the forefront of a lot of people's minds. What impact has the COVID-19 pandemic had on asthma sufferers?

Basic asthma care has been severely affected by the COVID-19 pandemic. Due to the backlog of care created by the pandemic, an estimated 3.5 million people living with asthma are not receiving all elements of basic asthma care.

There are signs that asthma has been a signal for long COVID. However, the reasons behind this are unclear.

Your career in asthma research has been remarkable. What achievement are you most proud of during your career?


In recent years, we have begun to turn a corner in securing major commitments from UK funders for further research and innovation. For asthma diagnostics, we secured a co-funding commitment of £500,000 from Innovate UK.

In the past year, we have also secured funding of £2m+ from NIHR and EPSRC for research and innovation into asthma health technology.

We are also immensely proud of our strong links with research groups across Europe and the US as this has enabled us to drive major funders, such as Horizon Europe and NIH, to drastically increase their commitment to asthma research.

What does the future of asthma research and treatment look like?



The future of asthma is better tools to diagnose:

If someone has asthma
Which type of asthma they have?
And to predict if they or their child will develop asthma.

For treatments and self-management, building on precise diagnosis, we want people with asthma to receive personalized treatments for their type of asthma, and equipped with tools to manage their type of asthma daily.
Where can readers find more information?

https://www.asthma.org.uk/60a27fe6/glob ... proved.pdf
https://www.asthma.org.uk/support-us/ca ... cs-report/
https://www.asthma.org.uk/support-us/ca ... artasthma/
https://www.asthma.org.uk/support-us/ca ... al-asthma/ About Krisnah Poinasamy
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Re: Asthma & COVID-19 / Asthma News

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Asthma exacerbation prevalence during the COVID-19 lockdown in a moderate-severe asthma cohort

5/5/21


https://bmjopenrespres.bmj.com/content/8/1/e000758

(For full article, click the link above)


Abstract


Introduction

Following the recent COVID-19 lockdown, a reduction in emergency healthcare visits was reported. Infectious diseases were less often diagnosed, while it was not clear if this was due to a decrease in prevalence or a decrease in emergency healthcare visits due to fear of COVID-19.

Methods


This study comprises a follow-up from a recently finished randomised controlled trial, to gain insight into the prevalence of asthma exacerbation and fear of COVID-19 in patients with moderate-severe asthma and controls in the Netherlands. Participants, patients with asthma and controls, were invited to fill out a short survey by email or post. Exacerbation frequencies until 1 July 2020 were verified with the hospitals’ and general practitioners’ medical records, pharmacies and patient interviews.

Results


In quarter 2 of 2020, mean exacerbation frequency per patient was significantly lower (χ2(3)=9.91, p=0.019) compared with quarter 2 in previous years. Patients with asthma were more likely to avoid (38.8%; controls, 0.0%, p<0.01) or delay (24.5%; controls, 0.0%, p=0.02) essential medical visits due to fear of SARS-CoV-2 infection at medical facilities.

Conclusion

In conclusion, we found a significantly reduced asthma exacerbation frequency during COVID-19 social distancing measures compared with previous years. Patients with asthma also showed more anxiety towards (acquiring) COVID-19 infection.


Discussion

In this study, we identified a decrease in AE during the COVID-19 lockdown measures in patients with moderate-severe asthma. We expect social distancing and fear towards acquiring COVID-19 to be responsible for this decrease.

Our original study cohort was designed to investigate the effect of bacterial lysates on AE frequency. Patients used either a bacterial lysate or placebo during the winter seasons of 2017/2018 or 2018/2019. Since the COVID-19 lockdown started almost a year later, and both patients with bacterial lysate and placebo use participated in the current study, we do not expect to find an effect of bacterial lysates on AE frequency.

Although the sample size in our study was small, it is of note that frequencies of AEs during the COVID-19 pandemic could be compared with baseline data acquired by quarterly monitoring of AEs over the past 3 years. Exacerbation frequencies in 2018 and 2017 were indeed higher compared with 2019 and 2020. Nevertheless, IQRs were large and it is possible that there was regression towards the mean. Exacerbation frequency in Q2 for 2020 is significantly lower compared with Q1 in 2020 and all other quarters in previous years. However, it might be possible that AEs were missed. Although we counterchecked AE frequency using different resources, there is still a possibility that patients did not report their AE anywhere. Also, we do not have information of patients who did not respond to the surveys.

Nevertheless, social distancing is known to reduce RTIs in children and influenza in adults.2 8 Therefore, we suggest abiding the COVID-19 lockdown is responsible for AE reduction. Q2 is a known period for aeroallergens and RTIs to increase AE prevalence in the Netherlands. RTIs might be reduced by social distancing. The COVID-19 lockdown also could have reduced aeroallergen exposure, as people mainly worked from their homes and outdoor exposition was decreased. Therefore, AE prevalence could have benefited from both, social distancing and reduced environmental exposures.

Patients with asthma experienced more fear of SARS-CoV-2 infection compared with controls. In a different study in which patients with asthma (GINA 3–4) were compared with controls without respiratory disease, we found no differences in HADS scores at baseline.11 Follow-up data showed comparable results with the current study, with HADS scores during COVID-19 lockdown increasing only in patients with asthma and not in controls.12 Nevertheless, fear of acquiring a SARS-CoV-2 infection at medical facilities did not lead to missed AEs or seriously delayed care for an AE because of e-consulting possibilities. Also, no patient with an AE was seen at the emergency department. It is possible that fear of acquiring COVID-19 in patients with asthma reduces the COVID-19 infection rate in patients with asthma in the Netherlands.

Conflicting reports on COVID-19 risks and asthma might confuse patients with asthma and increase their fear of acquiring COVID-19. Recent studies indicate that allergic asthma is not a risk factor for severe disease in the current COVID-19 pandemic and that type 2 inflammation might be protective.2–5 Thus, an increased fear of COVID-19 experienced by patients with allergic asthma seems irrational. However, asthma was described as a top three comorbidity in younger patients who were hospitalised for COVID-19, next to obesity and diabetes, in the USA.13 Possibly, asthma heterogeneity is responsible for the different outcomes with some evidence for type 2 high asthma not conferring a higher risk. We suggest information on COVID-19 disease should be adequate and more patient specific.

While patients with asthma would rather delay or avoid visits to medical care facilities, they did reach out via e-consults if needed. Our study suggests usage of an e-consult underlines the importance of a good communication platform between patients and their healthcare provider.

In conclusion, we found a significantly reduced AE frequency during COVID-19 social distancing measures compared with previous years. Patients with asthma also showed more anxiety towards (acquiring) COVID-19 infection. Because the risk of acquiring COVID-19 infection will be present for a yet unknown period, it is important to encourage them to contact their practitioner by e-consults.
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Re: Asthma & COVID-19 / Asthma News

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Study uncovers toxic air pollutant mixtures linked to poor childhood asthma outcomes

10/8/21

https://www.news-medical.net/news/20211 ... comes.aspx


Researchers at the Icahn School of Medicine at Mount Sinai have developed a novel machine learning algorithm and used it to identify previously unknown mixtures of toxic air pollutants that appear to be linked to poor asthma outcomes later in a child's life.

The study examined early exposure to dozens of pollutants potentially experienced by 151 children with mild to severe forms of the disease. While some cases could be linked to an individual, established air pollutant, others appeared to be linked to mixtures of pollutants that had never been associated with asthma. The results and a description of the new algorithm were described in an article in the Journal of Clinical Investigation.

"Asthma is one the most prevalent diseases affecting children in the United States. In this study, we developed a list of air pollutants a young child may be exposed to that can lead to longer-term problems with asthma," said Supinda Bunyavanich, MD, MPH, MPhil, Professor of Pediatrics, and Genetics and Genomic Sciences, at Icahn Mount Sinai and a senior author of the study. "Our results show how breathing individual and combinations of pollutants may lead to poor asthma outcomes. We hope that having a more comprehensive, holistic view of air pollution may one day be able to reduce the chances that children will be burdened by asthma."

Affecting about seven percent of children in the United States, asthma is a lung disease that can cause people to wheeze, suffer chest tightness, and bouts of coughing. Although several studies have shown that breathing individual toxic air pollutants, or "air toxics", raises the chances a child may suffer from asthma, little is known about what happens when the pollutants mix.

In this study, the researchers used a novel machine learning algorithm to find that 18 individual chemicals may be linked to poor asthma outcomes later in life. Specifically, they looked at whether a child needed daily asthma-controlling medication or had to visit an emergency room or spend time in the hospital as a result of their condition. However, they also found new associations between the outcomes and 20 different pollutant mixtures. Several of the chemicals in the mixtures had never been linked to long-term asthma risk.

" Like many scientists, we wanted to provide a more comprehensive picture of how air toxics contribute to childhood asthma. Traditionally, for technical reasons, it has been difficult to study the health effects of more than one toxic at a time. We overcame this by tapping into the power of machine learning algorithms."

- Gaurav Pandey, PhD, Assistant Professor of Genetics and Genomic Sciences and Study Senior Author

The study and development of the algorithm was led by Yan-Chak Li, PhD, a bioinformatician in the Pandey lab, and Hsiao-Hsien Leon Hsu, ScD, Assistant Professor of Environmental Medicine and Public Health at Icahn Mount Sinai.

The researchers first mapped emissions estimates for 125 known pollutants to the residential areas and birth years of 151 children from the New York metropolitan region who were part of Mount Sinai's Airway in Asthma study. The emissions data were obtained from the Environmental Protection Agency's National Air Toxics Assessment resource.

Then, the researchers applied a novel algorithm, which they named "Data-driven ExposurE Profile (DEEP) extraction", to test out whether increased levels of the pollutants observed early in the child's life were correlated with asthma problems reported around 12 years of age. DEEP relies on a powerful machine learning algorithm called "eXtreme Gradient Boosting (EXBoost), which builds hundreds of "decision trees," or possible ways that each pollutant, alone or in combination with others, could be associated with the asthma problems seen later in the patient's lives.

The results showed that some pollutants may have worked alone. For instance, exposure to the ammonia-scented waterproofing agent trimethylamine raised the chances that a child with asthma would have to spend a night in the hospital.

Other pollutants could act alone or in mixtures. Most notably, exposure to acrylic acid raised the chances a child needed daily medication. Mixing acrylic acid with other chemicals not only increased this possibility, but also raised the chances of emergency room visits and overnight hospitalizations.

Interestingly, the researchers also found that some pollutants, such as toluene and cobalt compounds, were only associated with poor outcomes when mixed with other compounds. In fact, 16 of the chemicals they evaluated fell into this category.

"As a physician who treats children with asthma, I was struck by how many potential air toxics are not on our radar," said Dr. Bunyavanich. "These results changed my view of the heightened risk some children face."

Finally, the researchers found that demographic factors may play additional roles. For example, exposure to a combination of hydroquinone and ethylidene dichloride was the strongest predictor of overnight hospitalizations. The study found that children who fell into this category were also younger and from lower family incomes than ones who were not exposed to the pollutants.

"Our study is an example of how machine learning has the potential to alter medical research," said Dr. Pandey. "It is allowing us to understand how a wide variety of environmental factors-;or the exposome-;influences our health. In the future, we plan to use DEEP and other computer science techniques to tackle environmental factors associated with other complex disorders."

Source:

Mount Sinai Health System

Journal reference:

Li, Y.C., et al. (2021) Machine learning-driven identification of early-life air toxic combinations associated with childhood asthma outcomes. Journal of Clinical Investigation. doi.org/10.1172/JCI152088.
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