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The Journal of Allergy and Clinical... Dec 2021The last 2 years yielded a proliferation of high-quality asthma research. These include new understandings of the incidence and natural history of asthma, findings on... (Review)
Review
The last 2 years yielded a proliferation of high-quality asthma research. These include new understandings of the incidence and natural history of asthma, findings on the effects of exposure to air pollution, allergens, and intake of acetaminophen, soy isoflavones, and polyunsaturated fatty acids, and exposure to microbial products. The past 2 years have benefited from great strides in determining potential mechanisms of asthma development and asthma exacerbations. These novel understandings led to identification and development of exciting new avenues for potential therapeutic intervention. Finally, there has been significant progress made in the development of tools to facilitate the diagnosis of asthma and measurement of airway physiology and in precision diagnostic approaches. Asthma guidelines were updated and new insights into the pharmacologic management of patients, including biologics, were reported. We review the most notable advances in the natural history of asthma, risk factors for the development of asthma, underlying mechanisms, diagnostic approaches, and treatments. Although greater knowledge of the mechanisms underlying responses and nonresponses to novel therapeutics and across asthma phenotypes would be beneficial, the progress over just the past 2 years has been immense and impactful.
Topics: Animals; Anti-Asthmatic Agents; Asthma; Biological Products; Biomarkers; Desensitization, Immunologic; Humans; Immunity, Innate; Microbiota; Phenotype; Risk Factors; T-Lymphocytes; Virus Diseases
PubMed: 34655640
DOI: 10.1016/j.jaci.2021.10.001 -
Paediatric Respiratory Reviews Nov 2020Asthma is a common disease in paediatrics and adults with a significant morbidity, mortality, and financial burden worldwide. Asthma is now recognized as a heterogeneous... (Review)
Review
Asthma is a common disease in paediatrics and adults with a significant morbidity, mortality, and financial burden worldwide. Asthma is now recognized as a heterogeneous disease and emerging clinical and laboratory research has elucidated understanding of asthma's underlying immunology. The future of asthma is classifying asthma by endotype through connecting discernible characteristics with immunological mechanisms. This comprehensive review of the immunology of asthma details the currently known pathophysiology and clinical practice biomarkers in addition to forefront biologic and targeted therapies for all of the asthma endotypes. By understanding the immunology of asthma, practitioners will be able to diagnose patients by asthma endotype and provide personalized, biomarker-driven treatments to effectively control patients' asthma.
Topics: Asthma; Asthma, Aspirin-Induced; Asthma, Exercise-Induced; Biological Products; Biomarkers; Cytokines; Eosinophilia; Humans; Invasive Pulmonary Aspergillosis; Leukotrienes; Molecular Targeted Therapy; Obesity; Oxidative Stress; Phenotype; Respiratory Hypersensitivity; Respiratory Sounds; Th1 Cells; Th2 Cells
PubMed: 31678040
DOI: 10.1016/j.prrv.2019.08.002 -
International Journal of Molecular... Feb 2021Asthma is one of the most common respiratory disease that affects both children and adults worldwide, with diverse phenotypes and underlying pathogenetic mechanisms... (Review)
Review
Asthma is one of the most common respiratory disease that affects both children and adults worldwide, with diverse phenotypes and underlying pathogenetic mechanisms poorly understood. As technology in genome sequencing progressed, scientific efforts were made to explain and predict asthma's complexity and heterogeneity, and genome-wide association studies (GWAS) quickly became the preferred study method. Several gene markers and loci associated with asthma susceptibility, atopic and childhood-onset asthma were identified during the last few decades. Markers near the genes were associated with childhood-onset asthma, interleukin (IL)33 and SNPs were associated with atopic asthma, and the gene was identified as protective against the risk to TH2-asthma. The latest efforts and advances in identifying and decoding asthma susceptibility are focused on epigenetics, heritable characteristics that affect gene expression without altering DNA sequence, with DNA methylation being the most described mechanism. Other less studied epigenetic mechanisms include histone modifications and alterations of miR expression. Recent findings suggest that the DNA methylation pattern is tissue and cell-specific. Several studies attempt to describe DNA methylation of different types of cells and tissues of asthmatic patients that regulate airway remodeling, phagocytosis, and other lung functions in asthma. In this review, we attempt to briefly present the latest advancements in the field of genetics and mainly epigenetics concerning asthma susceptibility.
Topics: Animals; Asthma; Epigenomics; Gene Expression Regulation; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Immunity, Innate
PubMed: 33673725
DOI: 10.3390/ijms22052412 -
The Veterinary Clinics of North... Mar 2020Asthma is an important allergic lower-airway disease in cats affecting approximately 1% to 5% of the pet cat population. New diagnostics are being developed to help... (Review)
Review
Asthma is an important allergic lower-airway disease in cats affecting approximately 1% to 5% of the pet cat population. New diagnostics are being developed to help better differentiate asthma from other lower-airway diseases and improve monitoring. In addition, new treatments are being developed to help in refractory cases or in those cases in which traditional therapeutics are contraindicated. This article discusses potential pitfalls in the diagnosis of asthma. In addition, current literature investigating new diagnostic tests and therapies for feline asthma is reviewed.
Topics: Animals; Asthma; Cat Diseases; Cats; Diagnosis, Differential; Immunotherapy; Steroids
PubMed: 31812220
DOI: 10.1016/j.cvsm.2019.10.002 -
Allergy Nov 2021Last year brought a significant advance in asthma management, unyielding to the pressure of the pandemics. Novel key findings in asthma pathogenesis focus on the... (Review)
Review
Last year brought a significant advance in asthma management, unyielding to the pressure of the pandemics. Novel key findings in asthma pathogenesis focus on the resident cell compartment, epigenetics and the innate immune system. The precision immunology unbiased approach was supplemented with novel tools and greatly facilitated by the use of artificial intelligence. Several randomised clinical trials and good quality real-world evidence shed new light on asthma treatment and supported the revision of several asthma guidelines (GINA, Expert Panel Report 3, ERS/ATS guidelines on severe asthma) and the conception of new ones (EAACI Guidelines for the use of biologicals in severe asthma). Integrating asthma management within the broader context of Planetary Health has been put forward. In this review, recently published articles and clinical trials are summarised and discussed with the goal to provide clinicians and researchers with a concise update on asthma research from a translational perspective.
Topics: Artificial Intelligence; Asthma; Biological Products; Humans
PubMed: 34392546
DOI: 10.1111/all.15054 -
Nutrition Reviews Nov 2020Asthma is a chronic respiratory condition characterized by airway inflammation and hyperreactivity. Prevalence has continued to rise in recent decades as Western dietary... (Review)
Review
Asthma is a chronic respiratory condition characterized by airway inflammation and hyperreactivity. Prevalence has continued to rise in recent decades as Western dietary patterns have become more pervasive. Evidence suggests that diets emphasizing the consumption of plant-based foods might protect against asthma development and improve asthma symptoms through their effects on systemic inflammation, oxidation, and microbial composition. Additionally, increased fruit and vegetable intake, reduced animal product consumption, and weight management might mediate cytokine release, free radical damage, and immune responses involved in the development and course of asthma. The specific aim of this review paper is to examine the current literature on the associations between dietary factors and asthma risk and control in children and adults. Clinical trials examining the mechanism(s) by which dietary factors influence asthma outcomes are necessary to identify the potential use of nutritional therapy in the prevention and management of asthma.
Topics: Adult; Asthma; Child; Diet; Humans; Nutritional Status
PubMed: 32167552
DOI: 10.1093/nutrit/nuaa005 -
Chest Mar 2020This review focuses on recent clinical and translational discoveries in severe and uncontrolled asthma that now enable phenotyping and personalized therapies in these... (Review)
Review
This review focuses on recent clinical and translational discoveries in severe and uncontrolled asthma that now enable phenotyping and personalized therapies in these patients. Although asthma is common in both children and adults and typically responds to standard therapies, a subset of individuals with asthma experience severe and/or persistent symptoms despite appropriate therapies. Airflow obstruction leading to frequent symptoms requiring higher levels of controller therapy is the cardinal feature of severe asthma, but the underlying molecular mechanisms, or endotypes, are diverse and variable between individuals. Two major risk factors that contribute to severe asthma are genetics and environmental exposures that modulate immune responses, and although these often interact in complex manners that are not fully understood, certain endotypes converge in severe asthma. A number of studies have evaluated various features of patients with severe asthma and classified patients into phenotypes with clinical relevance. This phenotyping is now incorporated into clinical practice and can be used to guide advanced biological therapies that target specific molecules and inflammatory pathways that contribute to asthma pathogenesis.
Topics: Anti-Asthmatic Agents; Asthma; Biological Products; Bronchial Thermoplasty; Environmental Exposure; Genetic Predisposition to Disease; Humans; Phenotype; Precision Medicine; Risk Factors; Severity of Illness Index
PubMed: 31678077
DOI: 10.1016/j.chest.2019.10.009 -
European Respiratory Review : An... Dec 2021Asthma is a heterogenous disease, and its prevalence and severity are different in males females through various ages. As children, boys have an increased prevalence of... (Review)
Review
Asthma is a heterogenous disease, and its prevalence and severity are different in males females through various ages. As children, boys have an increased prevalence of asthma. As adults, women have an increased prevalence and severity of asthma. Sex hormones, genetic and epigenetic variations, social and environmental factors, and responses to asthma therapeutics are important factors in the sex differences observed in asthma incidence, prevalence and severity. For women, fluctuations in sex hormone levels during puberty, the menstrual cycle and pregnancy are associated with asthma pathogenesis. Further, sex differences in gene expression and epigenetic modifications and responses to environmental factors, including SARS-CoV-2 infections, are associated with differences in asthma incidence, prevalence and symptoms. We review the role of sex hormones, genetics and epigenetics, and their interactions with the environment in the clinical manifestations and therapeutic response of asthma.
Topics: Adult; Asthma; COVID-19; Child; Female; Gonadal Steroid Hormones; Humans; Male; Pregnancy; Prevalence; SARS-CoV-2; Sex Factors
PubMed: 34789462
DOI: 10.1183/16000617.0067-2021 -
Allergy and Asthma Proceedings Nov 2019Asthma is a chronic inflammatory disorder of the airways that results, physiologically, in hyperreactivity and, clinically, in recurrent episodes of wheezing, chest... (Review)
Review
Asthma is a chronic inflammatory disorder of the airways that results, physiologically, in hyperreactivity and, clinically, in recurrent episodes of wheezing, chest tightness, or coughing. Airway inflammation, smooth-muscle contraction, epithelial sloughing, mucous hypersecretion, bronchial hyperresponsiveness, and mucosal edema contribute to the underlying pathophysiology of asthma. Diagnostic tests such as methacholine or mannitol challenges or spirometry (pre- and postbronchodilator responses) help to identify such underlying pathophysiology assessments of bronchial hyperreactivity and lung mechanics but are imperfect and, ultimately, must be viewed in the context of a patient's clinical presentation, including response to pharmacotherapy. Asthma can be classified into either intermittent or persistent, and the latter is either mild, moderate, or severe. Some patients change, in either direction, from intermittent to persistent asthma. In addition, patients with asthma may be classified as allergic (immunoglobulin E mediated), nonallergic (often triggered by viral upper respiratory tract infections or no apparent cause), occupational, aspirin-exacerbated respiratory disease, potentially fatal, exercise-induced, and cough variant asthma. In the latter, the patients have a nonproductive cough that responds to treatment for asthma but not with antibiotics, expectorants, mucolytics, antitussives, or beta₂-adrenergic agonists, and to treatment for acid reflux and rhinosinusitis. Thus, cough variant asthma is in the differential diagnosis of chronic cough.
Topics: Asthma; Bronchial Hyperreactivity; Bronchial Provocation Tests; Cough; Diagnosis, Differential; Humans; Methacholine Chloride; Spirometry
PubMed: 31690376
DOI: 10.2500/aap.2019.40.4253 -
Indian Journal of Pediatrics Apr 2022Asthma is the most common disease of childhood globally and acute asthma is the most significant risk factor for asthma-related death and chronic complications. This... (Review)
Review
Asthma is the most common disease of childhood globally and acute asthma is the most significant risk factor for asthma-related death and chronic complications. This article will aim to synthesize the most up-to-date research and translate it into a more practical guide to managing acute asthma on a more daily basis. The use of clinical severity score is reviewed alongside the use of history and clinical findings in making objective assessments of patients presenting with acute asthma. Practical evidence-based pathways and a stepwise approach are provided for management of acute asthma in the home, outpatient, emergency, and intensive care settings. In doing so, popular myths are dispelled and practices in relation to management of acute asthma and use of asthma related medications are clarified. Having a standardized approach to management of acute asthma will bring us one step closer to reducing exacerbations and achieving the goal of having zero tolerance towards exacerbations.
Topics: Acute Disease; Asthma; Child; Humans
PubMed: 35147928
DOI: 10.1007/s12098-021-04051-6