المؤلفون: Andrew Bush, Catherine A. Byrnes, Kate C. Chan, Anne B. Chang, Juliana C. Ferreira, Karl A. Holden, Stephanie Lovinsky-Desir, Gregory Redding, Varinder Singh, Ian P. Sinha, Heather J. Zar

المصدر: European Respiratory Review, Vol 33, Iss 172 (2024)

مصطلحات موضوعية: Diseases of the respiratory system, RC705-779

الوصف: Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.

وصف الملف: electronic resource

العلاقة: http://err.ersjournals.com/content/33/172/230222.fullTest; https://doaj.org/toc/0905-9180Test; https://doaj.org/toc/1600-0617Test

الوصول الحر: https://doaj.org/article/71a8e928b2344600be69bbf5b4d9890aTest

المؤلفون: David White, Andrew Bush, Alan R. Smyth, Jayesh Mahendra Bhatt

المصدر: Breathe, Vol 19, Iss 4 (2023)

مصطلحات موضوعية: Diseases of the respiratory system, RC705-779

الوصف: E-cigarettes are products delivering nicotine via inhalation and are devised to mimic tobacco smoking. While they were initially introduced as a device putatively to aid with smoking cessation, their use is now far broader than that. Use by children is significantly increasing. There is growing evidence of the potential harms of vaping. E-liquids used for e-cigarettes contain a wide range of harmful substances, and the clinical consequences of this are now being increasingly demonstrated, such as the rise in cases of e-cigarette- or vaping-associated lung injury. In addition, early use may result in long-term nicotine addiction. Vaping companies utilise marketing methods that distinctly target young people, and weak legislation in the UK allows them free rein to expose children to vaping. In this review we demonstrate why children must be protected from vaping. We must have stringent legislation to prevent easy access to e-cigarettes, including banning the convenience and affordability disposable vapes provide, and prevent marketing that does not warn about the potential health effects. The Australia approach of prescription or pharmacy only access for smoking cessation should be considered to limit exposure of children and minimise use by nonsmokers.

وصف الملف: electronic resource

العلاقة: http://breathe.ersjournals.com/content/19/4/230141.fullTest; https://doaj.org/toc/1810-6838Test; https://doaj.org/toc/2073-4735Test

الوصول الحر: https://doaj.org/article/54bf290d4712474fbda7a9fb4ff0ec18Test

المؤلفون: Anne Canny, Eddie Donaghy, Victoria Murray, Leo Campbell, Carol Stonham, Andrew Bush, Brian McKinstry, Heather Milne, Hilary Pinnock, Luke Daines

المصدر: Health Expectations, Vol 26, Iss 1, Pp 307-317 (2023)

مصطلحات موضوعية: asthma diagnosis, clinical decision support system (cdss), GPs and asthma nurses, patient perspectives, primary care, Medicine (General), R5-920, Public aspects of medicine, RA1-1270

الوصف: Abstract Introduction Making a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient‐facing mode, could change how information is shared between patients and healthcare professionals and improve the diagnostic process. Methods Participants diagnosed with asthma within the last 5 years were recruited from general practices across four UK regions. In‐depth interviews were used to explore patient experiences relating to their asthma diagnosis and to understand how a CDSS could be used to improve the diagnostic process for patients. Interviews were audio recorded, transcribed verbatim and analysed using a thematic approach. Results Seventeen participants (12 female) undertook interviews, including 14 individuals and 3 parents of children with asthma. Being diagnosed with asthma was generally considered an uncertain process. Participants felt a lack of consultation time and poor communication affected their understanding of asthma and what to expect. Had the nature of asthma and the steps required to make a diagnosis been explained more clearly, patients felt their understanding and engagement in asthma self‐management could have been improved. Participants considered that a CDSS could provide resources to support the diagnostic process, prompt dialogue, aid understanding and support shared decision‐making. Conclusion Undergoing an asthma diagnosis was uncertain for patients if their ideas and concerns were not addressed by clinicians and were influenced by a lack of consultation time and limitations in communication. An asthma diagnosis CDSS could provide structure and an interface to prompt dialogue, provide visuals about asthma to aid understanding and encourage patient involvement. Patient and Public Contribution Prespecified semistructured interview topic guides (young person and adult versions) were developed by the research team and piloted with members of the Asthma UK Centre for Applied Research Patient and Public Involvement (PPI) group. Findings were regularly discussed within the research group and with PPI colleagues to aid the interpretation of data.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1369-6513Test; https://doaj.org/toc/1369-7625Test

الوصول الحر: https://doaj.org/article/7b67ca54dffe43139c392bce4f383caeTest

المؤلفون: Sara Warraich, Andrew Bush, Thomas Semple

المصدر: Breathe, Vol 19, Iss 3 (2023)

مصطلحات موضوعية: Diseases of the respiratory system, RC705-779

الوصف: Appreciating the importance of correct interpretation of radiological studies, the need for space for further education and experience, and the recognition that interpretative errors often occur, we present below a case series highlighting situations where all may not be as it first appears.

وصف الملف: electronic resource

العلاقة: http://breathe.ersjournals.com/content/19/3/230049.fullTest; https://doaj.org/toc/1810-6838Test; https://doaj.org/toc/2073-4735Test

الوصول الحر: https://doaj.org/article/a3ca604bc726410988dcee9287d5d1c7Test

المؤلفون: Sara Warraich, Andrew Bush, Mark L. Levy, Louise Fleming

المصدر: Breathe, Vol 19, Iss 3 (2023)

مصطلحات موضوعية: Diseases of the respiratory system, RC705-779

الوصف: Over the past 20 years, the concept of asthma weaning plans on discharge after an attack has crept into common practice, although the precise origin of these plans is unclear. High use of short-acting β2-agonists (SABAs) may result in tolerance to their bronchodilator effects, thus diminishing their efficacy, particularly when they are most needed at the time of an acute attack. Furthermore, key warning signs of a deterioration in asthma control may be masked and the weaning plan may encourage the over-use and over-reliance on SABAs. Side-effects from over-use may also occur, including lactic acidosis, downregulation of the β2-adrenoreceptor, increased allergen response and pro-inflammatory effects. The need for asthma education at discharge, a personal asthma action plan and vigilance about prescribing and ensuring adherence to maintenance therapy are definitely important. However, the current authors conclude that the benefit of prescribing regular salbutamol (up to 10 puffs every 4 h) at discharge after an acute asthma attack is a myth, and a very dangerous one.

وصف الملف: electronic resource

العلاقة: http://breathe.ersjournals.com/content/19/3/230054.fullTest; https://doaj.org/toc/1810-6838Test; https://doaj.org/toc/2073-4735Test

الوصول الحر: https://doaj.org/article/c653bad49005415ab477eb869753011dTest

المؤلفون: Chris Griffiths, Andrew Bush, Anna De Simoni, Louise Fleming, Gaby Judah, Jasmine Hine, Bohee Lee

المصدر: BMJ Open, Vol 13, Iss 7 (2023)

مصطلحات موضوعية: Medicine

الوصف: Objectives The objectives of this systematic review are to identify studies that assess the effectiveness of patient-directed financial incentive interventions to improve asthma management behaviours, determine overall effectiveness of financial incentives, identify design characteristics of effective interventions and assess the impact on longer-term outcomes in the context of asthma.Design Systematic review with narrative synthesis.Data sources Electronic databases (MEDLINE, Embase, Global Health, PsycINFO, CINAHL, PubMed and Web of Science) and grey literature sources (NHS Digital, CORE, ProQuest, Clinical Trials Register and EU Clinical Trials Register) were searched in November 2021 and updated March 2023.Eligiblity criteria Eligible articles assessed financial incentives to improve asthma management behaviours (attendance at appointments, medication adherence, tobacco smoke/allergen exposure, inhaler technique and asthma education) for patients with asthma or parents/guardians of children with asthma. Eligible study design included randomised controlled, controlled or quasi-randomised trials and retrospective/prospective cohort, case-controlled or pilot/feasibility studies.Synthesis A narrative synthesis was conducted; eligible studies were grouped by asthma management behaviours and financial incentive framework domains.Results We identified 4268 articles; 8 met the inclusion criteria. The studies were from the USA (n=7) and the UK (n=1). Asthma management behaviours included attendance at appointments (n=4), reduction in smoke exposure (n=1) and medication adherence (n=3). Five studies demonstrated positive behaviour change, four of which were significant (attendance at appointments (n=3) showed significant differences between intervention and control: 73% and 49% in one study, 46.3% and 28.9% in another, and 35.7% and 18.9%, respectively; medication adherence (n=1) showed significant change from 80% during intervention to 33% post intervention). These four significant studies used ‘positive gain’, ‘certain’, ‘fixed’ financial incentives of smaller magnitude, given for ‘all’ instances of behaviour.Conclusion There is some evidence that patient-directed financial incentives improve asthma management behaviours. However, in view of the wide heterogeneity in study design and measured outcomes, determining overall effectiveness was challenging.PROSPERO registration number CRD42021266679.

وصف الملف: electronic resource

العلاقة: https://bmjopen.bmj.com/content/13/7/e070761.fullTest; https://doaj.org/toc/2044-6055Test

الوصول الحر: https://doaj.org/article/9cdf1bcd05c042c2afb4043f2abdca5cTest

المؤلفون: Umberto Basile, Giuseppe Santini, Cecilia Napodano, Giuseppe Macis, Krizia Pocino, Francesca Gulli, Mario Malerba, Andrew Bush, Ian M. Adcock, Paolo Montuschi

المصدر: Frontiers in Pharmacology, Vol 14 (2023)

مصطلحات موضوعية: asthma, inflammation, free light chains, biomarkers, personalised medicine, Therapeutics. Pharmacology, RM1-950

الوصف: Background: Inflammation plays a pivotal role in the pathophysiology of asthma. Free light chains (FLC) can cause inflammation by mast cell antigen-activation. Serum immunoglobulin (Ig) FLC κ, but not λ, were shown elevated in adult males with asthma. We sought to investigate if serum Ig FLC concentrations are affected by asthma severity and their relationships with inflammatory outcomes.Methods: By using immunoassays, we measured serum κ and λ Ig FLCs in 24 severe persistent asthma patients, 15 patients with moderate persistent asthma, 15 steroid-naïve mild persistent asthma patients and 20 healthy control subjects in a cross-sectional observational study. Total and specific serum IgE concentrations, fractional exhaled nitric oxide (FENO), lung function, peripheral blood eosinophils and neutrophils, and C reactive protein (CRP) were also measured.Results: Serum κ FLC concentrations were elevated in severe asthma patients compared mild asthma patients (p < 0.05) and healthy subjects (p < 0.05). Serum λ FLCs were higher in severe asthma patients than in healthy subjects (p < 0.05) and correlated with blood eosinophil counts (percentage, κ: r = 0.51, p = 2.9678−6; λ: r = 0.42, p = 1.7377−4; absolute values, κ: r = 0.45, p = 6.1284−5; λ: r = 0.38, p = 7.8261−4), but not with total or specific serum IgE. In severe asthma patients, serum Ig FLC correlated with serum CRP (κ: r = 0.33; p = 0.003; λ: r = 0.38, p = 8.8305−4) and blood neutrophil cell counts (percentage, κ: r = 0.31; p = 0.008; λ: r = 0.29, p = 0.01; absolute values, κ: r = 0.40; p = 3.9176−4; λ: r = 0.40, p = 4.5479−4), were elevated in subjects with blood eosinophilia (≥300 cells/µL) (n = 13) compared with non-eosinophilic subjects (n = 10) (κ: 19.2 ± 1.2 mg/L versus 12.1 ± 1.3 mg/L, p < 0.001; λ: 27.2 ± 2.6 mg/L versus 16.8 ± 2.5 mg/L, p < 0.01), but were similar in atopic (n = 15) versus nonatopic subjects (n = 9) (κ: p = 0.20; λ: p = 0.80). Serum FLC were negatively correlated with lung function tests, including forced expiratory volume in one second (FEV1) (κ: r = −0.33; p = 0.0034; λ: r = −0.33; p = 0.0035), and FEV1/forced vital capacity ratio (κ: r = −0.33; p = 0.0034; λ: r = −0.33; p = 0.0036).Conclusion: Serum Ig FLCs are elevated in severe asthma adults and might represent new surrogate markers of inflammation. The pathophysiological implications of these findings require further research. This study was approved by the ethics committee of the University Hospital Agostino Gemelli Foundation and Catholic University of the Sacred Heart (approval number P/1034/CE2012).

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fphar.2023.1126535/fullTest; https://doaj.org/toc/1663-9812Test

الوصول الحر: https://doaj.org/article/236651abdd18495aa4f89d80c48fdc07Test

المؤلفون: Ekaterina Khaleva, Anna Rattu, Chris Brightling, Andrew Bush, Arnaud Bourdin, Apostolos Bossios, Kian Fan Chung, Rekha Chaudhuri, Courtney Coleman, Ratko Djukanovic, Sven-Erik Dahlén, Andrew Exley, Louise Fleming, Stephen J. Fowler, Atul Gupta, Eckard Hamelmann, Gerard H. Koppelman, Erik Melén, Vera Mahler, Paul Seddon, Florian Singer, Celeste Porsbjerg, Valeria Ramiconi, Franca Rusconi, Valentyna Yasinska, Graham Roberts

المصدر: ERJ Open Research, Vol 9, Iss 3 (2023)

مصطلحات موضوعية: Medicine

الوصف: Background Biologics have proven efficacy for patients with severe asthma but there is lack of consensus on defining response. We systematically reviewed and appraised methodologically developed, defined and evaluated definitions of non-response and response to biologics for severe asthma. Methods We searched four bibliographic databases from inception to 15 March 2021. Two reviewers screened references, extracted data, and assessed methodological quality of development, measurement properties of outcome measures and definitions of response based on COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). A modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach and narrative synthesis were undertaken. Results 13 studies reported three composite outcome measures, three asthma symptoms measures, one asthma control measure and one quality of life measure. Only four measures were developed with patient input; none were composite measures. Studies utilised 17 definitions of response: 10 out of 17 (58.8%) were based on minimal clinically important difference (MCID) or minimal important difference (MID) and 16 out of 17 (94.1%) had high-quality evidence. Results were limited by poor methodology for the development process and incomplete reporting of psychometric properties. Most measures rated “very low” to “low” for quality of measurement properties and none met all quality standards. Conclusions This is the first review to synthesise evidence about definitions of response to biologics for severe asthma. While high-quality definitions are available, most are MCIDs or MIDs, which may be insufficient to justify continuation of biologics in terms of cost-effectiveness. There remains an unmet need for universally accepted, patient-centred, composite definitions to aid clinical decision making and comparability of responses to biologics.

وصف الملف: electronic resource

العلاقة: http://openres.ersjournals.com/content/9/3/00444-2022.fullTest; https://doaj.org/toc/2312-0541Test

الوصول الحر: https://doaj.org/article/c9344bc69fde4a8d913ebd3dd5f62d8bTest

المؤلفون: Umberto Basile, Giuseppe Santini, Cecilia Napodano, Giuseppe Macis, Krizia Pocino, Francesca Gulli, Mario Malerba, Andrew Bush, Ian M. Adcock, Paolo Montuschi

مصطلحات موضوعية: Pharmacology, Basic Pharmacology, Clinical Pharmacology and Therapeutics, Clinical Pharmacy and Pharmacy Practice, Pharmaceutical Sciences, Pharmacogenomics, Toxicology (incl. Clinical Toxicology), Pharmacology and Pharmaceutical Sciences not elsewhere classified, asthma, inflammation, free light chains, biomarkers, personalised medicine

الوصف: Background: Inflammation plays a pivotal role in the pathophysiology of asthma. Free light chains (FLC) can cause inflammation by mast cell antigen-activation. Serum immunoglobulin (Ig) FLC κ, but not λ, were shown elevated in adult males with asthma. We sought to investigate if serum Ig FLC concentrations are affected by asthma severity and their relationships with inflammatory outcomes. Methods: By using immunoassays, we measured serum κ and λ Ig FLCs in 24 severe persistent asthma patients, 15 patients with moderate persistent asthma, 15 steroid-naïve mild persistent asthma patients and 20 healthy control subjects in a cross-sectional observational study. Total and specific serum IgE concentrations, fractional exhaled nitric oxide (F E NO), lung function, peripheral blood eosinophils and neutrophils, and C reactive protein (CRP) were also measured. Results: Serum κ FLC concentrations were elevated in severe asthma patients compared mild asthma patients (p < 0.05) and healthy subjects (p < 0.05). Serum λ FLCs were higher in severe asthma patients than in healthy subjects (p < 0.05) and correlated with blood eosinophil counts (percentage, κ: r = 0.51, p = 2.9678 −6 ; λ: r = 0.42, p = 1.7377 −4 ; absolute values, κ: r = 0.45, p = 6.1284 −5 ; λ: r = 0.38, p = 7.8261 −4 ), but not with total or specific serum IgE. In severe asthma patients, serum Ig FLC correlated with serum CRP (κ: r = 0.33; p = 0.003; λ: r = 0.38, p = 8.8305 −4 ) and blood neutrophil cell counts (percentage, κ: r = 0.31; p = 0.008; λ: r = 0.29, p = 0.01; absolute values, κ: r = 0.40; p = 3.9176 −4 ; λ: r = 0.40, p = 4.5479 −4 ), were elevated in subjects with blood eosinophilia (≥300 cells/µL) (n = 13) compared with non-eosinophilic subjects (n = 10) (κ: 19.2 ± 1.2 mg/L versus 12.1 ± 1.3 mg/L, p < 0.001; λ: 27.2 ± 2.6 mg/L versus 16.8 ± 2.5 mg/L, p < 0.01), but were similar in atopic (n = 15) versus nonatopic subjects (n = 9) (κ: p = 0.20; λ: p = 0.80). Serum FLC were negatively correlated with lung function tests, including ...

العلاقة: https://figshare.com/articles/presentation/Presentation1_Elevated_serum_polyclonal_immunoglobulin_free_light_chains_in_patients_with_severe_asthma_pdf/23529435Test

الإتاحة: https://doi.org/10.3389/fphar.2023.1126535.s016Test
https://figshare.com/articles/presentation/Presentation1_Elevated_serum_polyclonal_immunoglobulin_free_light_chains_in_patients_with_severe_asthma_pdf/23529435Test

المؤلفون: Astrid Madsen Ring, Nicolaus Schwerk, Nural Kiper, Ayse Tana Aslan, Paul Aurora, Roser Ayats, Ines Azevedo, Teresa Bandeira, Julia Carlens, Silvia Castillo-Corullon, Nazan Cobanoglu, Basil Elnazir, Nagehan Emiralioğlu, Tugba Sismanlar Eyuboglu, Michael Fayon, Tugba Ramaslı Gursoy, Claire Hogg, Karsten Kötz, Bülent Karadag, Vendula Látalová, Katarzyna Krenke, Joanna Lange, Effrosyni D. Manali, Borja Osona, Spyros Papiris, Marijke Proesmann, Philippe Reix, Lea Roditis, Sune Rubak, Nisreen Rumman, Deborah Snijders, Florian Stehling, Laurence Weiss, Ebru Yalcın, Fazilcan Zirek, Andrew Bush, Annick Clement, Matthias Griese, Frederik Fouirnaies Buchvald, Nadia Nathan, Kim Gjerum Nielsen

المصدر: ERJ Open Research, Vol 9, Iss 2 (2023)

مصطلحات موضوعية: Medicine

الوصف: Background Paediatric diffuse alveolar haemorrhage (DAH) is a rare heterogeneous condition with limited knowledge on clinical presentation, treatment and outcome. Methods A retrospective, descriptive multicentre follow-up study initiated from the European network for translational research in children's and adult interstitial lung disease (Cost Action CA16125) and chILD-EU CRC (the European Research Collaboration for Children's Interstitial Lung Disease). Inclusion criteria were DAH of any cause diagnosed before the age of 18 years. Results Data of 124 patients from 26 centres (15 counties) were submitted, of whom 117 patients fulfilled the inclusion criteria. Diagnoses were idiopathic pulmonary haemosiderosis (n=35), DAH associated with autoimmune features (n=20), systemic and collagen disorders (n=18), immuno-allergic conditions (n=10), other childhood interstitial lung diseases (chILD) (n=5), autoinflammatory diseases (n=3), DAH secondary to other conditions (n=21) and nonspecified DAH (n=5). Median (IQR) age at onset was 5 (2.0–12.9) years. Most frequent clinical presentations were anaemia (87%), haemoptysis (42%), dyspnoea (35%) and cough (32%). Respiratory symptoms were absent in 23%. The most frequent medical treatment was systemic corticosteroids (93%), hydroxychloroquine (35%) and azathioprine (27%). Overall mortality was 13%. Long-term data demonstrated persistent abnormal radiology and a limited improvement in lung function. Conclusions Paediatric DAH is highly heterogeneous regarding underlying causes and clinical presentation. The high mortality rate and number of patients with ongoing treatment years after onset of disease underline that DAH is a severe and often chronic condition. This large international study paves the way for further prospective clinical trials that will in the long term allow evidence-based treatment and follow-up recommendations to be determined.

وصف الملف: electronic resource

العلاقة: http://openres.ersjournals.com/content/9/2/00733-2022.fullTest; https://doaj.org/toc/2312-0541Test

الوصول الحر: https://doaj.org/article/583cf26a81df4619a065611a08f4083bTest