Asthma, Chronic Obstructive Pulmonary Disease (COPD), and the Overlap Syndrome

Asthma, Chronic Obstructive Pulmonary Disease 

(COPD), and the Overlap Syndrome

1. Mohammad Obadah Nakawah, MD, 
2. Clare Hawkins, MD and
3. Farouk Barbandi, MD

+Author Affiliations

1. From Department of Family Medicine, San Jacinto Methodist Hospital, Baytown, TX.

1. Corresponding author: Mohammad Obadah Nakawah, MD, San Jacinto Methodist Hospital, 4301 Garth Road, Suite 300, Baytown, Texas 77521 (E-mail: Jdomon@tmhs.org).

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both are characterized by heterogeneous chronic airway inflammation and airway obstruction. In both conditions, chronic inflammation affects the whole respiratory tract, from central to peripheral airways, with different inflammatory cells recruited, different mediators produced, and thus differing responses to therapy. Airway obstruction is typically intermittent and reversible in asthma but is progressive and largely irreversible in COPD. However, there is a considerable pathologic and functional overlap between these 2 heterogeneous disorders, particularly among the elderly, who may have components of both diseases (asthma-COPD overlap syndrome). The definitions for asthma and COPD recommended by current guidelines are useful but limited because they do not illustrate the full spectrum of obstructive airway diseases that is encountered in clinical practice. Defining asthma and COPD as separate entities neglects a considerable proportion of patients with overlapping features and is largely based on expert opinion rather than on the best current evidence. The presence of different phenotypes or components of obstructive airway diseases, therefore, needs to be addressed to individualize and optimize treatment to achieve the best effect with the fewest side effects for the patient. Although specific interventions vary by disease, the treatment goals of obstructive airway diseases are similar and driven primarily by the need to control symptoms, optimize health status, and prevent exacerbations.

• Asthma
 
• Chronic Obstructive Airway Diseases
 
• COPD
• Overlap Syndrome

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  1. doi:10.3122/jabfm.2013.04.120256J Am Board Fam Med July-August 2013 vol. 26 no. 4470-477
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J Popul Ther Clin Pharmacol. 2013;20(2):e110-27. Epub 2013 May 3.

Pharmacogenomic Investigation of Adverse Drug Reactions(ADRs): The ADR Prioritization Tool, APT.

Shaw K, Amstutz U, Castro-Pastrana L, Loo TT, Ross CJ, Ito S, Reider MJ, Maher M, Macleod S, Koren G, Hayden MR, Carleton BC.

Abstract

 Background

The impact of genetic factors on the risk of adverse drug reactions (ADRs) is being increasingly recognized as clinically important. ADR Prioritization Tool (APT) was developed to facilitate the prioritization of drugs and their associated ADRs for future pharmacogenomic studies.ObjectivesTo describe a novel tool developed for the prioritization of pharmacogenomic investigation of ADRs and discuss the impact of specific scoring criteria.

Methods

APT scores were based on 25 key scientific and feasibility criteria relevant for clinical research evaluating the genetic basis of ADRs, with a maximum possible score of 60 points. The tool was independently applied to five ADRs (warfarin-induced bleeding/thrombosis, cisplatin-induced ototoxicity, methotrexate-induced neutropenia, carbamazepine-induced Stevens-Johnson syndrome, and abacavir-induced hypersensitivity) by two researchers. Scores were compared using the intraclass correlation coefficient (ICC) to determine level of agreement.

Results

Overall scores for target ADRs ranged from 19.5 to 44 points (33-73% of maximum possible score). Cisplatin-induced ototoxicity, a frequent and severe ADR, received the highest score (44). Lower scores were obtained for abacavir-induced hypersensitivity (19.5) and methotrexate-induced neutropenia (28). High agreement was observed between the scientific, feasibility, and total scores from two reviewers (ICC values = 0.895, 0.980, and 0.983, respectively).

Conclusion

Application of APT enables simple and direct comparison of potential study targets for research groups embarking on pharmacogenomic investigation of ADRs. Research teams will be able to identify which study targets are best suited for their research environment and discern how to optimize resource allocation for successful discovery and replication of clinically relevant biomarkers.

PMID:

 

23824325

 

[PubMed - in process] 

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http://www.jptcp.com/jptcp_13130_e110_e127_carleton-pdf-r193063

Clinical and follow up assessment of children in a program directed at the use of formulas for cow's milk protein allergy

Revista Paulista de Pediatria

Print version ISSN 0103-0582

Rev. paul. pediatr. vol.31 no.2 São Paulo June 2013

http://dx.doi.org/10.1590/S0103-05822013000200004 

ORIGINAL ARTICLE

Clinical and follow up assessment of children in a program directed at the use of formulas for cow's milk protein allergy

Ana Laissa O. Aguiar^I; Clarissa Marques Maranhão^I; Lívia Carvalho Spinelli^I; Roberta Marinho de Figueiredo^I; Jussara Melo C. Maia^II; Rosane Costa Gomes^III; Hélcio de Sousa Maranhão^IV

^IBolsista de Iniciação Científica da Faculdade de Medicina da UFRN, Natal, RN, Brasil
^IIDoutora em Ciências da Saúde pelo Programa de Pós-graduação em Ciências da Saúde da UFRN; Professora Adjunta do Departamento de Pediatria da UFRN, Natal, RN, Brasil
^IIIPós-Graduanda de Doutorado do Programa de Pós-graduação em Ciências da Saúde da UFRN; Professora – Assistente do Departamento de Pediatria da UFRN, Natal, RN, Brasil
^IVDoutor em Ciências pelo Programa de Pós-graduação em Pediatria da Universidade Federal de São Paulo (Unifesp); Professor Associado do Departamento de Pediatria da UFRN, Natal, RN, Brasil

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 Journal of Asthma and Allergy

Racial differences in the association of CD14 polymorphisms with serum total IgE levels and allergen skin test reactivity

Original Research

(442) Total Article Views

Authors: Wang ZY, Sundy JS, Foss CM, Barnhart HX, Palmer SM, Allgood SD, Trudeau E, Alexander KM, Levesque MC

Published Date June 2013 Volume 2013:6 Pages 81 - 92

DOI: http://dx.doi.org/10.2147/JAA.S42695

Received:	12 January 2013
Accepted:	08 April 2013
Published:	25 June 2013

ZongYao Wang,¹ John S Sundy,¹ Catherine M Foss,¹ Huiman X Barnhart,² Scott M Palmer,¹ Sallie D Allgood,³ Evan Trudeau,¹ Katie M Alexander,³ Marc C Levesque^3
1Division of Pulmonary, Allergy and Critical Care Medicine, ²Duke Clinical Research Institute,³Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA

Background: The CD14 C-159T single nucleotide polymorphism (SNP) has been investigated widely as a candidate genetic locus in patients with allergic disease. There are conflicting results for the association of the CD14 C-159T SNP with total serum immunoglobulin E (IgE) levels and atopy. There are limited data regarding the association of the CD14 C-159T SNP in subjects of African ancestry. The aim of the study was to determine whether the C-159T SNP and other CD14 SNPs (C1188G, C1341T) were associated with total serum IgE levels and with allergy skin test results in nonatopic and atopic subjects; as well as in Caucasian and African American subjects.
Methods: A total of 291 participants, 18–40 years old, were screened to determine whether they were atopic and/or asthmatic. Analyses were performed to determine the association between CD14 C-159T, C1188G, or C1341T genotypes with serum IgE levels and with the number of positive skin tests among Caucasian or African American subjects.
Results: We found no significant association of serum total IgE level with CD14 C-159T, C1188G, or C1341T genotypes within nonatopic or atopic subjects. Subjects with CD14-159 T alleles had significantly more positive allergen skin tests than subjects without CD14-159 T alleles (P = 0.0388). There was a significant association between the CD14 1188 G allele, but not the CD14 1341 T allele, with the number of positive skin-test results in Caucasians, but not in African Americans.
Conclusion: These results support a possible association between CD14 polymorphisms and atopy. CD14-159 T or CD14 1188 G alleles were associated with atopic disease. For subjects with CD14 1188 G alleles, the association with atopic disease was stronger in Caucasians compared to African Americans.

Keywords: total serum immunoglobulin E, IgE, skin prick test, SPT, CD14-159T, single nucleotide polymorphism, SNP, lipopolysaccharide, LPS, endotoxin



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Gastrin-Releasing Peptide-Expressing Nerves Comprise Subsets of Human Cutaneous Aδ and C Fibers that May Sense Pruritus

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Letter to the Editor

Journal of Investigative Dermatology advance online publication 11 July 2013; doi: 10.1038/jid.2013.194

Gastrin-Releasing Peptide-Expressing Nerves Comprise Subsets of Human Cutaneous Aδ and C Fibers that May Sense Pruritus
^JIDOpen

Theresa R Timmes^1,2, Robert Rothbaum^1,2,  Kirti¹, Claudine Y Silva¹, Jag Bhawan¹, Deborah L Cummins¹ and Deon Wolpowitz¹

¹Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts, USA

Correspondence: Deon Wolpowitz, E-mail: dewolpow@bu.edu

²These authors contributed equally to this work.

Abbreviations: 

CGRP, calcitonin gene–related peptide; DEJ, dermoepidermal junction; GRP, gastrin-releasing peptide; GRPR, gastrin-releasing peptide receptor; IENF, intraepidermal nerve fibre; NF200, neurofilament 200; PGP9.5, protein gene product 9.5; SP, substance P; TRPV1, transient receptor potential vanilloid 1

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Neonatal Host Defense against Staphylococcal Infections

Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 826303, 9 pages
http://dx.doi.org/10.1155/2013/826303

Review Article

Neonatal Host Defense against Staphylococcal Infections

Melanie R. Power Coombs,¹ Kenny Kronforst,^2,3 and Ofer Levy^4,5

¹Pathology, Dalhousie University, Halifax, NS, B3H 4R2, Canada
²Lurie Children's Hospital Chicago, IL 60611, USA
³Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
⁴Division of Infectious Diseases, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
⁵Human Biology & Translational Medicine, Harvard Medical School, Boston, MA, USA

Received 19 March 2013; Revised 14 May 2013; Accepted 14 May 2013

Academic Editor: Tobias R. Kollmann

Copyright © 2013 Melanie R. Power Coombs et al. This is an open access article distributed under theCreative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Preterm infants are especially susceptible to late-onset sepsis that is often due to Gram-positive bacterial infections resulting in substantial morbidity and mortality. Herein, we will describe neonatal innate immunity to Staphylococcus spp. comparing differences between preterm and full-term newborns with adults. Newborn innate immunity is distinct demonstrating diminished skin integrity, impaired Th1-polarizing responses, low complement levels, and diminished expression of plasma antimicrobial proteins and peptides, especially in preterm newborns. Characterization of distinct aspects of the neonatal immune response is defining novel approaches to enhance host defense to prevent and/or treat staphylococcal infection in this vulnerable population.

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A relapse of near-fatal thunderstorm-asthma in pregnancy

Vol 45, No 3 (2013) > D'Amato

A relapse of near-fatal thunderstorm-asthma in pregnancy

G. D'Amato, A. Corrado, L. Cecchi, et al.

Abstract

Thunderstorm-related asthma is a dramatic example of the allergenic potential of pollen antigens. Pollen allergic patientswho encounter the allergenic cloud of pollen during a thunderstorm are at higher risk of having an asthma attack. Relapse is also possible and we describe here the first case of relapse of near fatal thunderstorm-asthma occurred in a 36 years old, 20 weeks pregnant woman affected by seasonal asthma and sensitized to allergens released by Parietariapollen. Patients suffering from pollen allergy should be alerted of the danger of being outdoors during a thunderstorm in the pollen season and if they experienced an episode of severe thunderstorm-related asthma could be at risk of a relapse during a heavy precipitation event.

Keywords

Thunderstorm-asthma; Near fatal asthma; Asthma in pregnancy

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Mechanisms of Asthma and Implications for Its Prevention and Treatment: A Personal Journey

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|    Allergy Asthma Immunol Res. 2013 Jun;5:e174. English. Published online 2013 June 25.  Copyright © 2013 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease Mechanisms of Asthma and Implications for Its Prevention and Treatment: A Personal Journey Stephen T Holgate Faculty of Medicine University of Southampton, UK.  Correspondence to: Stephen T Holgate, MD, PhD, Clinical and Experimental Sciences, Mail Point, 810, Level F, South Block, Southampton General Hospital, Southampton, SO16 6YD, UK. Tel: +44-2380-796974; Fax: +44-2380-796992;Email: sth@soton.ac.uk  Received November 09, 2012; Accepted December 04, 2012. 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 My research career has focused on the causes of asthma and its treatment. After establishing the key role that mast cells play in the inflammatory response in asthma, attention was turned towards understanding disease chronicity and variability across the lifecourse. Through a combination of studies on airway biopsies and primary cell cultures we have established that asthma is primarily an epithelial disease driven by increased environmental susceptibility to injury and an altered repair response as depicted by sustained activation of the epithelial mesenchymal trophic unit (EMTU) that is invoked in foetal branching morphogenesis. Varied activation of the EMTU connects the origins of asthma to its progression over time with involvement of epithelial susceptibility through impaired barrier and innate immune functions and altered mesenchymal susceptibility as exemplified by polymorphisms of the metalloprotease gene, ADAM33. Taken together these observations have led to a fundamental re-evaluation of asthma pathogenesis. Rather than placing allergic inflammation as the prime abnormality, it is proposed that the airway epithelium lies at the center of asthma pathogenesis, and that in conjunction with the underlying mesenchyme, it is the principle orchestrator of both the induction of asthma and its evolution over the lifecourse. This concept has provided 'the basis for a new preventative and therapeutic approach focused more on increasing the airways resistance to environmental insults rather than suppressing downstream inflammation once it is established. Keywords: Asthma, management, prevention, treatment.