Asthma phenotypes in adults and clinical implications

Fajt, Merritt L.; Wenzel, Sally E.

doi:10.1586/ers.09.57

Cited by 13 publications

(6 citation statements)

References 225 publications

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“…Initially, it was believed that these adverse reactions were attributable to fungal antigen–induced IgE antibodies, which caused clinical symptoms through effector cells such as mast cells. It is now known that the asthmatic inflammation may be brought about by a variety of mechanisms involving the innate as well as the adaptive immune systems (Fajt and Wenzel, ; Holt and Sly, ). It is also known that a number of agents in the fungal cell wall, such as β‐glucan, chitin, and peptides, may induce an inflammatory response through effects on the innate immune system.…”

Section: Introductionmentioning

confidence: 99%

Airborne fungal cell fragments in homes in relation to total fungal biomass

2012

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Fungal exposure may induce respiratory symptoms. The causative agents are compounds in the fungal cell wall. Fragments of microbes may be present in air samples but are not measurable using conventional spore counting or by the determination of viable organisms. This study assesses the proportion of fungal cell biomass and endotoxin in different particle size fractions in air samples from homes. Air samples were collected from 15 homes using a cyclone sampler, collecting particles in three aerodynamic size fractions: <1.0, 1.0–1.8, and >1.8 μm. N‐Acetylhexosaminidase (NAHA) was determined as a marker of fungal cell biomass. Endotoxin was determined using the Limulus amebocyte lysate method. NAHA and endotoxin in the size range <1.0 μm comprised up to 63% (mean 22.7%) and 96.3% (mean 22.6%) of the total concentrations, respectively. There were significant relationships between the amounts of NAHA and endotoxin in the total amount and in the size fraction >1.8 μm but not in the smaller fractions. The results demonstrate significant amounts of fungal cell biomass and endotoxin in particles <1.0 μm. Homes with reported mold damage had a lower concentration of NAHA in particles <1.0 μm than homes without mold damage. To assess airborne exposure for diagnostic and preventive purposes, measurement techniques that include this fraction should be considered.

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Section: Introductionmentioning

confidence: 99%

Airborne fungal cell fragments in homes in relation to total fungal biomass

2012

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“…Asthma is a heterogeneous syndrome, an “umbrella concept,” that comprises a collection of different phenotypes with different underlying pathophysiologies, rather than a single disease [43,44]. A previous meta-analysis found that vitamin C may alleviate exercise-induced bronchoconstriction [24] and the current study revealed that vitamin C may alleviate common cold-induced asthma exacerbations.…”

Section: Discussionmentioning

confidence: 64%

Vitamin C and common cold-induced asthma: a systematic review and statistical analysis

Hemilä

2013

All Asth Clin Immun

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BackgroundAsthma exacerbations are often induced by the common cold, which, in turn, can be alleviated by vitamin C.ObjectiveTo investigate whether vitamin C administration influences common cold-induced asthma.MethodsSystematic review and statistical analysis of the identified trials. Medline, Scopus and Cochrane Central were searched for studies that give information on the effects of vitamin C on common cold-induced asthma. All clinically relevant outcomes related to asthma were included in this review. The estimates of vitamin C effect and their confidence intervals [CI] were calculated for the included studies.ResultsThree studies that were relevant for examining the role of vitamin C on common cold-induced asthma were identified. The three studies had a total of 79 participants. Two studies were randomized double-blind placebo-controlled trials. A study in Nigeria on asthmatics whose asthma attacks were precipitated by respiratory infections found that 1 g/day vitamin C decreased the occurrence of asthma attacks by 78% (95% CI: 19% to 94%). A cross-over study in former East-Germany on patients who had infection-related asthma found that 5 g/day vitamin C decreased the proportion of participants who had bronchial hypersensitivity to histamine by 52 percentage points (95% CI: 25 to 71). The third study did not use a placebo. Administration of a single dose of 1 gram of vitamin C to Italian non-asthmatic common cold patients increased the provocative concentration of histamine (PC20) 3.2-fold (95% CI: 2.0 to 5.1), but the vitamin C effect was significantly less when the same participants did not suffer from the common cold.ConclusionsThe three reviewed studies differed substantially in their methods, settings and outcomes. Each of them found benefits from the administration of vitamin C; either against asthma attacks or against bronchial hypersensitivity, the latter of which is a characteristic of asthma. Given the evidence suggesting that vitamin C alleviates common cold symptoms and the findings of this systematic review, it may be reasonable for asthmatic patients to test vitamin C on an individual basis, if they have exacerbations of asthma caused by respiratory infections. More research on the role of vitamin C on common cold-induced asthma is needed.

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“…Asthma is a heterogeneous disorder with numerous presentations based on the pattern of symptoms, the triggering factors, the response to treatment, and/or the level and type of inflammation [45]. Several phenotypes of persistent asthma have been described in adults [46], and this has led to the concept of individualized management of asthmatic patients.…”

Section: The Rationale For the Use Of Feno In Asthma: The Need For Anmentioning

confidence: 99%

Exhaled Nitric Oxide in Asthma in Adults: The End is the Beginning?

Κostikas

Minas²,

Papaioannou³

et al. 2011

CMC

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Approximately 20 years after the initial report of the measurement of exhaled nitric oxide (NO) in the exhaled air of humans, numerous publications have evaluated the possible applications of the fraction of exhaled NO (FeNO) in patients with asthma. The aim of the present review is to evaluate the technical issues and confounding factors related to FeNO measurements, as well as the role of FeNO in the diagnosis of asthma, the evaluation of asthmatic patients and the guidance of treatment. Several other issues, including the pursuit for "normal" and best personal values, the prediction of clinically relevant asthma outcomes and the identification of asthma phenotypes and future directions are discussed. FeNO represents the only exhaled biomarker that has reached clinical practice even in primary care settings and this review provides a critical view of the possible applications of this biomarker, both for the basic researcher and the clinician.

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Asthma phenotypes in adults and clinical implications

Cited by 13 publications

References 225 publications

Airborne fungal cell fragments in homes in relation to total fungal biomass

Airborne fungal cell fragments in homes in relation to total fungal biomass

Vitamin C and common cold-induced asthma: a systematic review and statistical analysis

Exhaled Nitric Oxide in Asthma in Adults: The End is the Beginning?

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