April 18, 2014

0 Sleep duration, asthma and obesity

Logo of nihpa
J Asthma. Author manuscript; available in PMC Nov 15, 2013.
Published in final edited form as:
J Asthma. Nov 2013; 50(9): 10.3109/02770903.2013.831871.
Published online Sep 20, 2013. doi:  10.3109/02770903.2013.831871
PMCID: PMC3828450
NIHMSID: NIHMS511826

Sleep duration, asthma and obesity


Abstract

Background

Obesity is more prevalent in asthmatics. Short sleep duration is a novel risk factor for obesity in general populations.

Objective

We tested the association of sleep duration and asthma characteristics with obesity.

Methods

Methods


Adults at tertiary clinics were surveyed on asthma symptoms and habitual sleep duration. Medical records were used to assess asthma severity step (1-4), extract height and weight, current medications and diagnosed comorbid conditions. BMI≥30 kg/m2 defined obesity. Habitual sleep was categorized as - 6 (very short), 6 to - 7h (short), 7-8h (normal), >8 to - 9h (long) and >9h (very long). Inhaled corticosteroid doses were categorized as low, moderate and high.

Results

Among 611 participants (mean BMI 30±8), 249 (41%) were obese. After adjustment for covariates, obesity was associated with short and very long sleep: as compared to normal sleepers, the odds of being obese were on average 66% higher ([95% Confidence Interval: 1.07-2.57], p=0.02) among short and 124% higher ([1.08-1.65], p=0.03) among very long sleepers, and the association with very short sleep approached significance (1.74 [0.96-3.14], p=0.06). Obesity was also significantly related to highest asthma step (1.87 [1.09-3.21], p=0.02) and psychopathology (1.64 [1.08-2.48], p=0.02), and a trend was seen with high dose inhaled corticosteroids (1.82 [0.93-3.56], p=0.08).

Conclusions

Obesity in asthmatics is associated with shorter and very long sleep duration, worse asthma severity, psychopathology, and high dose inhaled corticosteroids. Although this cross-sectional study cannot prove causality, we speculate that further investigation of sleep may provide new opportunities to reduce the rising prevalence of obesity among asthmatics.
Keywords: asthma, sleep duration, obesity


Formats:

0 Potential Masking of Airway Eosinophilic Inflammation by Combination Therapy in Asthma




Allergy Asthma Immunol Res > v.6(2); Mar 2014
Brief Communication  Open Access


     

Allergy Asthma Immunol Res. 2014 Mar;6(2):175-178. English.
Published online 2013 November 05.  http://dx.doi.org/10.4168/aair.2014.6.2.175 
Copyright © 2014 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease

Byung-Jae Lee,1 Yun-Jin Jeung,1 Jin-Young Lee,2 Mi-Jung Oh,3 and Dong-Chull Choi1
1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Center for Health Promotion, Samsung Medical Center, Seoul, Korea.
3Department of Internal Medicine, Bundang Jaeseng Hospital, Seongnam, Korea.

 Correspondence to: Dong-Chull Choi, MD, PhD, Division of Allergy, Department of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3422; Fax: +82-2-3410-3849; Email: dcchoi@skku.edu 
Received August 01, 2012; Revised February 19, 2013; Accepted April 03, 2013.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose
Long-acting β2 agonists (LABA) may mask ongoing bronchial inflammation, leaving asthmatic patients at greater risk of severe complications. The aim of this study was to compare the effect of combination therapy using low-dose inhaled corticosteroids (ICS) plus LABA on airway inflammation in asthma to the effect of medium-dose ICS alone.
Methods
Twenty-four patients with asthma not controlled by low-dose (400 µg per day) budesonide alone were enrolled in this prospective crossover study. Patients were randomized into 2 treatment phases: one receiving medium-dose (800 µg per day) budesonide (ICS phase), and the other receiving a combination therapy of low-dose budesonide/formoterol (360 µg/9 µg per day) delivered by a single inhaler (LABA phase). Each treatment phase lasted for 6 week, after which patients were crossed over. Asthma symptoms, lung function, and airway inflammation were compared between the 2 phases.
Results
Twenty-three patients completed the study; adequate sputum samples were collected from 17 patients. Asthma symptoms and lung function remained similar between the 2 phases. However, the mean sputum eosinophil percentage was higher in the LABA phase than in the ICS phase (5.07±3.82% vs. 1.02±1.70%; P - 0.01). Sputum eosinophilia (≥3%) was more frequently observed in the LABA phase than in the ICS phase (six vs. two).
Conclusion
Addition of LABA may mask airway eosinophilic inflammation in asthmatic patients whose symptoms are not controlled with low-dose ICS.
Keywords: Airwayinflammationasthmacorticosteroidsbeta2-agonists.


Formats:

0 T cell responses to viral infections – opportunities for peptide vaccination

REVIEW ARTICLE

Front. Immunol., 16 April 2014 | doi: 10.3389/fimmu.2014.00171


imageSietske Rosendahl HuberimageJosine van BeekimageJørgen de Jonge, imageWillem Luytjes and imageDebbie van Baarle*
  • Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
An effective immune response against viral infections depends on the activation of cytotoxic T cells that can clear infection by killing virus-infected cells. Proper activation of these T cells depends on professional antigen-presenting cells, such as dendritic cells (DCs). In this review, we will discuss the potential of peptide-based vaccines for prevention and treatment of viral diseases. We will describe features of an effective response against both acute and chronic infections, such as an appropriate magnitude, breadth, and quality and discuss requirements for inducing such an effective antiviral immune response. We will address modifications that affect presentation of vaccine components by DCs, including choice of antigen, adjuvants, and formulation. Furthermore, we will describe differences in design between preventive and therapeutic peptide-based vaccines. The ultimate goal in the design of preventive vaccines is to develop a universal vaccine that cross-protects against multiple strains of the virus. For therapeutic vaccines, cross-protection is of less importance, but enhancing existing T cell responses is essential. Although peptide vaccination is successful in inducing responses in human papillomavirus (HPV) infected patients, there are still several challenges such as choosing the right target epitopes, choosing safe adjuvants that improve immunogenicity of these epitopes, and steering the immune response in the desired direction. We will conclude with an overview of the current status of peptide vaccination, hurdles to overcome, and prospects for the future.

0 Marked improvement of Churg–Strauss syndrome neuropathy by intravenous immunoglobulin and cyclophosphamide


You have full text access to this OnlineOpen article

  • Akira Umeda1,*
  • Tateki Yamane1
  • Jin Takeuchi1
  • Yasuo Imai2
  • Keisuke Suzuki3and
  • Wako Yumura4
  • Article first published online: 14 APR 2014DOI: 10.1002/rcr2.56
    © 2014 The Authors. Respirology Case Reportspublished by John Wiley & Sons Ltd on behalf of The Asian Pacific Society of Respirology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

    Abstract

    A 42-year-old Japanese man developed Churg–Strauss syndrome 7 years after being diagnosed with chronic eosinophilic pneumonia. Prominent eosinophilia, subcutaneous nodules, and neuropathy in the left leg were seen. A pathological diagnosis of necrotizing vasculitis was determined by a biopsy of a subcutaneous nodule. The leg pain was severe and there was prominent atrophy of the thigh and calf, but the muscle weakness was mild. Serum anti-myeloperoxidase anti-neutrophil cytoplasmic antibody was positive. Because the initial treatment with an intravenous methylprednisolone pulse at 1 g/day for 3 days was not sufficient, a onetime treatment with intravenous cyclophosphamide at 15 mg/kg and intravenous immunoglobulin therapy (IVIG) at 400 mg/kg/day for 5 days were administered. Peripheral eosinophilia improved and the leg pain significantly improved. IVIG was repeated 1 month later and symptoms gradually improved further. The early diagnosis of Churg–Strauss syndrome and the early initiation of IVIG with cyclophosphamide were thought to be important.

    April 17, 2014

    0 Effects of Early Life Paracetamol Use on the Incidence of Allergic Disease and Sensitization: 5 Year Follow-Up of an Ethiopian Birth Cohort


    PLoS One. 2014; 9(4): e93869.
    Published online Apr 9, 2014. doi:  10.1371/journal.pone.0093869
    PMCID: PMC3981735

    Effects of Early Life Paracetamol Use on the Incidence of Allergic Disease and Sensitization: 5 Year Follow-Up of an Ethiopian Birth Cohort

    Junji Yodoi, Editor

    Abstract

    Introduction

    The hypothesis that paracetamol, one of the most widely used medicines, may increase the risk of asthma and allergic disease is of obvious importance but prospective cohort data looking at dose and timing of exposure are lacking.

    Objective

    The aim of the study is to investigate the role of paracetamol use in early life on the prevalence and incidence of wheeze, eczema, rhinitis and allergic sensitization, prospectively over 5 years in an Ethiopian birth cohort.

    Methods

    In 2005/6 a birth cohort of 1006 newborns was established in Butajira, Ethiopia. Questionnaire data on allergic disease symptoms, paracetamol use and numerous potential confounders were collected at ages 1, 3 and 5, and allergen skin sensitivity measured at ages 3 and 5. Multivariate logistic regression was used to determine independent effects of paracetamol exposure on the incidence of each outcome between ages 3 and 5, and prevalence at age 5.

    Findings

    Paracetamol use in the first 3 years of life was reported in 60% of children and was associated with increased incidence of wheeze, eczema, rhinitis and allergic sensitisation between ages 3 and 5 which was statistically significant for wheeze and eczema. High exposure (reported use in the past month at age 1 and 3) was associated with a more than 3-fold increased risk of new onset wheeze (adjusted odds ratio (OR) 3.64; 95% confidence interval, 1.34 to 9.90) compared to never users. Use in the past year at age 3 but not age 1 was associated with ORs at least as large as those for use in first year of life only. Significant positive dose-response effects of early life use were seen in relation to the prevalence of all outcomes at age 5.

    Conclusions

    Use of paracetamol in early life is a strong risk factor for incident allergic disease in childhood.

    Formats:

    0 Bifidobacterium breve and Lactobacillus rhamnosus treatment is as effective as budesonide at reducing inflammation in a murine model for chronic asthma

    Research

    Open Access

    Seil SagarMary E MorganSi ChenArjan P VosJohan GarssenJeroen van BergenhenegouwenLouis BoonNiki A GeorgiouAletta D Kraneveld and Gert Folkerts
    For all author emails, please log on.



    Respiratory Research 2014, 15:46  doi:10.1186/1465-9921-15-46
    Published: 16 April 2014

    Abstract (provisional)

    Background

    Asthma is estimated to affect as many as 300 million people worldwide and its incidence and prevalence are rapidly increasing throughout the world, especially in children and within developing countries. Recently, there has been a growing interest in the use of potentially beneficial bacteria for allergic diseases. This study is aimed at exploring the therapeutic effects of long-term treatment with two different beneficial bacterial strains (Bifidobacterium breve M-16 V and Lactobacillus rhamnosus NutRes1) and a glucocorticoid (budesonide), as a reference treatment, on inflammatory response in a murine model for chronic allergic asthma.

    Methods

    To mimic the chronic disease in asthmatic patients, we used the murine ovalbumin-induced asthma model combined with prolonged allergen exposure. Airway function; pulmonary airway inflammation; airway remodelling, mRNA expression of pattern recognition receptors, Th-specific cytokines and transcription factors in lung tissue; mast cell degranulation; in vitro T cell activation; and expression of Foxp3 in blood Th cells were examined.

    Results

    Lactobacillus rhamnosus reduced lung resistance to a similar extent as budesonide treatment in chronically asthmatic mice. Pulmonary airway inflammation, mast cell degranulation, T cell activation and airway remodelling were suppressed by all treatments. Beneficial bacteria and budesonide differentially modulated the expression of toll-like receptors (TLRs), nod-like receptors (NLRs), cytokines and T cell transcription factors. Bifidobacterium breve induced regulatory T cell responses in the airways by increasing Il10 and Foxp3 transcription in lung tissue as well as systemic by augmenting the mean fluorescence intensity of Foxp3 in blood CD4+ T cells.

    Conclusion

    These findings show that Bifidobacterium breve M-16 V and Lactobacillus rhamnosus NutRes1 have strong anti-inflammatory properties that are comparable to budesonide and therefore may be beneficial in the treatment of chronic asthma.

    The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

    0 Longterm follow-up in European respiratory health studies - patterns and implications

    Research article

    Open Access

    Ane JohannessenGiuseppe VerlatoBryndis BenediktsdottirBertil ForsbergKarl Franklin,Thorarinn GislasonMathias HolmChrister JansonRain JögiEva LindbergFerenc MacsaliErnst OmenaasFrancisco Gomez RealEirunn Waatevik SaureVivi Schlünssen,Torben SigsgaardTrude Duelien SkorgeCecilie SvanesKjell TorénMarie WaatevikRoy Miodini Nilsen and Roberto de Marco
    For all author emails, please log on.



    BMC Pulmonary Medicine 2014, 14:63  doi:10.1186/1471-2466-14-63
    Published: 16 April 2014

    Abstract (provisional)

    Background

    Selection bias is a systematic error in epidemiologic studies that may seriously distort true measures of associations between exposure and disease. Observational studies are highly susceptible to selection bias, and researchers should therefore always examine to what extent selection bias may be present in their material and what characterizes the bias in their material. In the present study we examined long-term participation and consequences of loss to follow-up in the studies Respiratory Health in Northern Europe (RHINE), Italian centers of European Community Respiratory Health Survey (I-ECRHS), and the Italian Study on Asthma in Young Adults (ISAYA).

    Methods

    Logistic regression identified predictors for follow-up participation. Baseline prevalence of 9 respiratory symptoms (asthma attack, asthma medication, combined variable with asthma attack and/or asthma medication, wheeze, rhinitis, wheeze with dyspnea, wheeze without cold, waking with chest tightness, waking with dyspnea) and 9 exposure-outcome associations (predictors sex, age and smoking; outcomes wheeze, asthma and rhinitis) were compared between all baseline participants and long-term participants. Bias was measured as ratios of relative frequencies and ratios of odds ratios (ROR).

    Results

    Follow-up response rates after 10 years were 75% in RHINE, 64% in I-ECRHS and 53% in ISAYA. After 20 years of follow-up, response was 53% in RHINE and 49% in I-ECRHS. Female sex predicted long-term participation (in RHINE OR (95%CI) 1.30(1.22, 1.38); in I-ECRHS 1.29 (1.11, 1.50); and in ISAYA 1.42 (1.25, 1.61)), as did increasing age. Baseline prevalence of respiratory symptoms were lower among long-term participants (relative deviations compared to total baseline population 0-15% (RHINE), 0-48% (I-ECRHS), 3-20% (ISAYA)), except rhinitis which had a slightly higher prevalence. Most exposure-outcome associations did not differ between long-term participants and all baseline participants, except lower OR for rhinitis among ISAYA long-term participating smokers (relative deviation 17% (smokers) and 44% (10-20 pack years)).

    Conclusions

    We found comparable patterns of long-term participation and loss to follow-up in RHINE, I-ECRHS and ISAYA. Baseline prevalence estimates for long-term participants were slightly lower than for the total baseline population, while exposure-outcome associations were mainly unchanged by loss to follow-up.

    The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

    Allergists on Social Media

     

    Allergy, Asthma and Immunology Copyright © 2011 - 2014