Overweight and obesity are associated with one of the severe phenotypes of asthma, with an increased rate of exacerbations, low level of lung function, and reduced response to corticosteroid therapy. The present study focused on identifying useful biomarkers of severity in overweight patients with adult-onset asthma using real-world data. Patients and Methods: A total of 56 patients with adult-onset asthma who visited Saga University Hospital between 2018 and 2019 were retrospectively reviewed. Overweight was defined as a body mass index (BMI) greater than 25 kg/m 2. Blood eosinophils, cytokines, and chemokines were compared between non-overweight asthma and overweight asthma patients. Results: Overweight asthma patients had a higher annual exacerbation rate, lower pulmonary function even when treated frequently with high-dose inhaled corticosteroids, and a significantly lower percentage of eosinophils and lower eosinophil count compared to nonoverweight asthma patients (p<0.01, p=0.03). Moreover, the percentage of eosinophils was significantly negatively correlated with BMI (ρ=−0.38, p<0.01) (Figure 1). On serum cytokine and chemokine analyses, the overweight asthma group included significantly more patients with a lower level of tissue growth factor α (TGF-α) (1.1 pg/mL) and higher levels of hsIL-6 (2.5 pg/mL), RANTES/CCL5 (298.5 pg/mL), and vascular endothelial growth factor A (VEGF-A) (63.7 pg/mL), than the non-overweight asthma group (p=0.02, p<0.01, p=0.02, p=0.01, respectively). Conclusion: The present study showed that overweight patients with adult-onset asthma were characterized by a higher rate of annual exacerbations and worse lung function despite treatment with high-dose inhaled corticosteroids and lower blood eosinophil counts than nonoverweight patients with asthma. On blood cytokine and chemokine analyses, a low level of TGF-α and high levels of hsIL-6, RANTES/CCL5, and VEGF-A might be biomarkers reflecting the pathophysiology in overweight patients with asthma.
Background Exacerbations are critical events in chronic pulmonary obstructive disease (COPD). The frequency of COPD exacerbations is associated with the prognosis, including mortality, but no useful biomarker has been established. Methods The present retrospective study investigated 481 COPD patients. Clinical features in the stable period were compared between patients who experienced severe exacerbation (n = 88, 18.3%) and those who never experienced severe exacerbation (n = 393, 81.7%). In the patients who experienced exacerbations, clinical features were also compared between frequent exacerbators (exacerbation rate ≥ 2 times/year, n = 27, 30.7%) and infrequent exacerbators (1 time/year, n = 61, 69.3%). Results Compared to COPD patients who never experienced exacerbations, body mass index (BMI), serum albumin, and pulmonary functions were significantly lower, and the cardiovascular disease comorbidity rate, COPD assessment test score, modified Medical Research Council dyspnea scale, and use of long-term oxygen therapy, long-acting β2 adrenergic agonist therapy, inhaled corticosteroid therapy, and macrolide therapy were significantly higher in COPD patients with exacerbations (all p < 0.01). In patients who experienced exacerbations, frequent exacerbators had significantly lower % forced expiratory volume in 1.0 s and a higher risk of critical exacerbations, percentage of blood eosinophils, history of mechanical ventilation use, and use of long-term oxygen therapy and of macrolide therapy than infrequent exacerbators (all p < 0.01). On multivariate analysis, the percentage of blood eosinophils was the parameter most correlated with exacerbation frequency (β value [95% confidence interval] 1.45 [1.12–1.88], p < 0.01). Conclusion Blood eosinophil in the stable period is the factor most correlated with the frequency of severe exacerbations. Trial registration: The patients in this study was registered retrospectively
In December 1989, fascioliasis was diagnosed in thirty-three 18-month-old fattening cattle from the same cowshed in Fukuoka prefecture. They showed anorexia and emaciation. Fecal examination revealed many fasciola eggs. The highest egg content (EPG) was about 1,300. At autopsy, hyperplasia of the liver and bile duct wall was observed, and many young migrating flukes and adult flukes were recognized in the liver. Histopathologically, fibroplasia, necrosis, abscess, hemorrhage and infiltration of eosinophils were detected in the liver.
A 37-year-old man with fever, cough, and dyspnea with no medical history developed an eosinophilic pleural effusion and blood eosinophilia. No evidence of malignancy or pathogens was detected in the pleural effusion, and the pleural specimen obtained by thoracoscopy showed eosinophilic infiltration with inflammatory granulation tissue without fibrinoid necrosis or malignant cells. Since a myeloproliferative disorder was also excluded, the diagnosis was idiopathic eosinophilic pleurisy. Corticosteroid treatment was started and then slowly tapered, and the eosinophilic pleural effusion resolved. Considering the various etiologies of eosinophilic pleurisy, a practical clinical approach to the investigation and diagnosis of eosinophilic pleurisy is presented.
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