Astma Kinderen Wetenschap

The effect of passive smoking on exhaled nitric oxide in asthmatic children.
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The effect of passive smoking on exhaled nitric oxide in asthmatic children.

Nitric Oxide. 2019 Feb 16;:

Authors: Bobrowska-Korzeniowska M, Stelmach I, Brzozowska A, Jerzyńska J, Mitał M, Stelmach W

Abstract
To date, some studies suggest that passive smoking (PS) may be an important determinant of FeNO levels in children but sill there is a need of investigations using objective methods of PS exposure. The aim of our study was to examine the effect of PS, measured by urine cotinine levels, on FeNO and lung function (FEV1) in allergic and non-allergic asthmatic children. METHODS: It was a prospective, non-interventional study. 140 children, aged 4-17, newly diagnosed with asthma were recruited into two study groups (exposed group, unexposed group), according to smoking exposure/unexposure based on the questionnaire. There was one study visit. Subjects underwent a medical history (including history of atopy), physical examination, spirometry, FeNO and urinary cotinine measurement. RESULTS: 70 individuals had been exposed to tobacco smoke. The patients exposed to tobacco smoke were characterized by statistically significantly higher urine concentration of cotinine, 10,80 ng/mL, than their counterparts who had not been exposed to tobacco smoke, 1,56 ng/mL (P = 0,019). In the group of individuals unexposed to tobacco smoke the mean value of FeNO was 34,99 ppb, while in the group of patient who had been exposed to tobacco smoke, the corresponding mean value was significantly lower, it amounted to 22,41 ppb (P = 0,001) (Table 1). As regards to FEV1 measurements, there were not any statistically significant differences by study groups unexposed/exposed to tobacco smoke (P = 0,179 and P = 0,074, respectively). FeNO levels (ppb) in the studied patients allergic to cat, grass or trees, exposed to tobacco smoke were significantly lower than in those children unexposed to tobacco smoke. Our results suggest a clinically important issue, that FeNO results should be interpreted in the context of environmental tobacco smoke exposure. Additionally allergy to cat dander, grass or tree may be potential confounding factor, which should be taken into consideration.

PMID: 30779991 [PubMed - as supplied by publisher]



Tobacco Use Worldwide: Legislative Efforts to Curb Consumption.
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Tobacco Use Worldwide: Legislative Efforts to Curb Consumption.

Ann Glob Health. 2018 Nov 05;84(4):571-579

Authors: Perez-Warnisher MT, De Miguel MDPC, Seijo LM

Abstract
Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest public health challenges. Secondhand smoke, declared carcinogenic by the International Agency for Research on Cancer in 2004, is also a major source of morbidity and premature death in nonsmokers, particularly children. Negative health effects associated with exposure to secondhand smoke have been well documented and include lung cancer, cardiovascular disease, asthma, and other respiratory diseases. International and national policies to implement cost-effective strategies to curtail smoking will have a significant impact on population health and will protect nonsmokers. Effective interventions, such as a combination of smoke-free laws, tobacco price increases, easy access to tobacco cessation treatments, and anti-tobacco media campaigns, should continue. Reducing tobacco use would be a major step towards the goal of decreasing health disparities by 2030 as 80% of the projected tobacco-related deaths will occur in low- and middle-income countries.

PMID: 30779502 [PubMed - in process]



Asthma with multiple allergic comorbidities is associated with complete response to omalizumab.
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Asthma with multiple allergic comorbidities is associated with complete response to omalizumab.

Clin Exp Allergy. 2019 Feb 18;:

Authors: Sesé L, Schneider M, Bourgoin M, Saint-Pierre P, Lambert N, Guiddir T, Couderc R, Amat F, Just J

Abstract
Patients with severe asthma constitute a heterogeneous population, and different phenotypes have been identified both in adults and children. Severe asthma affects 4.5% of children with current asthma. Several studies have shown that omalizumab, a humanized anti-IgE monoclonal antibody, is effective in exacerbations and asthma control, and well tolerated in children with severe allergic asthma. However, as biotherapy response varies among patients, it is important to clearly define which children will benefit the most from treatment. This article is protected by copyright. All rights reserved.

PMID: 30779241 [PubMed - as supplied by publisher]



The role of oral magnesium supplements for the management of stable bronchial asthma: a systematic review and meta-analysis.
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The role of oral magnesium supplements for the management of stable bronchial asthma: a systematic review and meta-analysis.

NPJ Prim Care Respir Med. 2019 Feb 18;29(1):4

Authors: Abuabat F, AlAlwan A, Masuadi E, Murad MH, Jahdali HA, Ferwana MS

Abstract
Asthma is a chronic lung disease characterized by airway inflammation and hyper-responsiveness of airway smooth muscles. There is growing evidence that magnesium may have a role in managing asthma through its dual effect as an anti-inflammatory and bronchodilating agent. To assess the efficacy of oral magnesium supplements in chronic asthmatic patients. In addition to searching through Clinicaltrials.gov/ and references for oral magnesium supplement studies, we performed a database search in Medline, CINAHL, CENTRAL, and Embase. We contacted the authors of the included trials to ask for additional information. We included randomized controlled trials that compared oral magnesium supplements versus placebo, in addition to standard asthma treatment in mild-moderate asthmatic adults and children (older than 6 years). Two reviewers independently performed the study selection, data abstraction, and the assessment of the risk of bias. Eight trials at moderate risk of bias enrolling a total of 917 patients were included. Oral magnesium improved FEV1 at week 8 (5.69 (L/min); 95% CI: 1.92, 9.46; I2: 45%). There was no significant improvement in FEV1 at other follow up periods. There was no significant change in FVC, Methacholine challenge test, the frequency of bronchodilator use, or symptoms score. There were no data on mortality or quality of life. Oral magnesium supplements may lead to improvement in FEV1 that was only demonstrated at eight weeks; but no effect on any other outcome. Until future evidence emerges, oral magnesium cannot be recommended as adjuvants to standard treatment for mild to moderate asthmatic individuals.

PMID: 30778086 [PubMed - in process]



Impact of two oral doses of 100,000 IU of vitamin D3 in preschoolers with viral-induced asthma: a pilot randomised controlled trial.
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Impact of two oral doses of 100,000 IU of vitamin D3 in preschoolers with viral-induced asthma: a pilot randomised controlled trial.

Trials. 2019 Feb 18;20(1):138

Authors: Ducharme FM, Jensen M, Mailhot G, Alos N, White J, Rousseau E, Tse SM, Khamessan A, Vinet B

Abstract
BACKGROUND: New evidence supports the use of supplemental vitamin D in the prevention of exacerbation of asthma; however, the optimal posology to sufficiently raise serum levels while maximising adherence is unclear. The objective was to ascertain the efficacy of high-dose vitamin D3 in increasing serum vitamin D in preschoolers with asthma and provide preliminary data on safety and efficacy outcomes.
METHODS: We conducted a 7-month, triple-blind, randomised, placebo-controlled, pilot trial of children aged 1-5 years with viral-induced asthma. Participants were allocated to receive two oral doses of 100,000 IU vitamin D3 (intervention) or identical placebo (control) 3.5 months apart, once in the fall and once in the winter. Serum 25-hydroxyvitamin D (25OHD) was measured by tandem mass spectrometry at baseline, 10 days, 3.5 months, 3.5 months + 10 days, and 7 months. The main outcome was the change in serum 25OHD from baseline (Δ25OHD) over time and at 3.5 and 7 months; other outcomes included the proportion of children with 25OHD ≥ 75 nmol/L, safety, and adverse event rates.
RESULTS: Children (N = 47) were randomised (intervention, 23; control, 24) in the fall. There was a significant adjusted group difference in the Δ25OHD (95% confidence interval) of 57.8 (47.3, 68.4) nmol/L, p < 0.0001), with a time (p < 0.0001) and group*time interaction effect (p < 0.0001), in favour of the intervention. A significant group difference in the Δ25OHD was observed 10 days after the first (119.3 [105.8, 132.9] nmol/L) and second (100.1 [85.7, 114.6] nmol/L) bolus; it did not reach statistical significance at 3.5 and 7 months. At 3.5 and 7 months, respectively, 63% and 56% of the intervention group were vitamin D sufficient (≥ 75 nmol/L) compared to 39% and 36% of the control group. Hypercalciuria, all without hypercalcaemia, was observed in 8.7% of intervention and 10.3% of control samples at any time point. Exacerbations requiring rescue oral corticosteroids, which appear as a promising primary outcome, occurred at a rate of 0.87/child.
CONCLUSION: Two oral boluses of 100,000 IU vitamin D3,once in the fall and once in the winter, rapidly, safely, and significantly raises overall serum vitamin D metabolites. However, it is sufficient to maintain 25OHD ≥ 75 nmol/L throughout 7 months in only slightly more than half of participants.
TRIAL REGISTRATION: ClinicalTrials.gov, NCT02197702 (23 072014). Registered on 23 July 2014.

PMID: 30777118 [PubMed - in process]



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