Airway inflammatory biomarker: could it tailor the right medications for the right asthmatic patient?

Asthma is a heterogeneous disease, in which asthmatic patients present with different clinical phenotypes, variable endotypes, and different response to asthma medicines. Thus, we are faced with an asthma paradox; asthma is diagnosed subjectively by clinical history and treated with biologically active drugs. To solve this paradox, we need objective airway biomarkers to tailor the proper medications to the proper patient. Biomarkers should have one or more of the following characteristics: 1] could differentiate poor symptoms perceivers from over-perceivers, 2] could predict disease activity and hence disease outcome, 3] could clarify asthma phenotype responders from non-responders, and finally 4] could characterize different clinical asthma phenotypes. Therefore, we have conducted a review of literature trying to apply those four parameters to different airway inflammatory biomarkers. We found that FeNO fulfilled the four proposed clinical parameters of airway inflammatory biomarkers whereas; serum periostin was the single best systemic biomarker of airway luminal and tissue eosinophilia in severe uncontrolled TH2 asthma phenotype. Thus, this may be considered a trial towards tailoring the proper medication to the proper patient. However, application of biomarkers in clinical practice requires easier and cheaper techniques together with standardized methods for sample collection and analysis

Cytokine profile of obese asthma phenotype

The incidence of asthma and obesity is increasing worldwide. Understanding the causal directions between asthma and obesity could have important therapeutic implications. However, the mechanism connecting the two is not well defined. This study was undertaken to compare pulmonary function tests [PFTs], C-reactive protein [CRP] and inflammatory cytokines in obesity and asthma in Egyptian adolescents and to investigate whether obese asthmatics have a specific inflammatory phenotype than lean asthmatics. Fifty asthmatic and 30 control subjects were enrolled in the study and divided into 2 sub-groups: obese and non-obese. Serum levels of CRP, leptin, tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6], IL-5, body mass index [BMI] and PFTs were done for asthmatics and controls. Serum levels of IL-6, TNF-alpha and leptin in obese individuals whether asthmatic or not showed significant increase compared to lean ones [P < 0.01]. Body mass index [BMI] showed positive linear correlations with serum levels of IL-6, TNF-alpha, leptin and CRP. Serum IL-5 showed significantly higher levels in all asthmatics versus all controls [P < 0.01]. Also serum IL-5 showed non-significant difference between lean and obese asthmatics and it showed significant negative correlations with FEVl/FVC% and PEF. Serum levels oflL-6, TNF-alpha and leptin could be considered surrogate markers for obesity, whereas serum IL-5 is considered a marker of airway inflammation in bronchial asthma. Thus obesity and asthma have been shown to coexist together but systemic and airway inflammation appears to operate independent of each other

Tension gastrothorax: a case report and review of literature

Tension gastrothorax develops when the stomach, herniates through a congenital diaphragmatic defect into the thorax and is massively distended by trapped air. We report a case of tension gastrothorax and review the literature. A previously healthy 8 months old female, presented with severe respiratory distress, misdiagnosed as tension pneumothorax. Intercostal tube was inserted. The tube was noted to drain food as well as air. The patient was investigated by radio-contrast swallow, which demonstrated the presence of the stomach in the chest. The patient was operated upon and the stomach, transverse colon and spleen were reduced back to the abdomen. The defects in the stomach and diaphragm were closed. Tension gastrothorax is a life-threatening condition leading to acute and severe respiratory distress. The presence of air filled structure in left hemithorax in a previously healthy child presenting with acute respiratory distress should prompt the inclusion of tension gastrothorax in the differential diagnosis

Eosinophil cationic protein [ECP] and skin prick tests in children with steroid-responsive nephritic syndrome [SRNS]

To assess the atopic state in patients with SRNS, serum ECP levels were measured by chemiluminescent enzyme immunornetric assay and skin prick tests were done in 32 children with SRNS and 10 age- and sex-matched healthy children without evidence of atopy. Out of the nephrotic patients, 19 children had active disease [Group I] and 13 were in remission [Group II]. Among group I, 7 children were frequent relapsers [FR] while 12 were infrequent relapsers [IR] or non-relapsers [NR]. We found that 37.5% of our patients had positive skin prick tests. Serum ECP levels were elevated in group I patients [= 25.3 and Interquartile range [IQR] = 13.8-33.6 ng /ml] and group II patients [median = 14.2 and IQR = 12.0-20.2 ng/ml] compared to controls [median = 9.1 and IQR = 7.2-13.5 ng/ml, P < 0.0001 and 0.006 respectively]. Similarly, patients with negative skin prick tests in group land group II had higher ECP levels compared to controls [P = 0.007 and 0.07 respectively]. Among group I, ECP levels were higher in patients with positive skin prick tests to those with negative tests [P < 0.0001] and in FR compared to IR and NR [P = 0.05]. Moreover, there was an association between the development of frequent relapses and positivity of skin prick tests [Fishers Exact = 0.07 relative risk = 6.4 and confidence interval = 1.0-41.2]. In conclusion, serum ECP levels are elevated in children with active SRNS. ECP could be considered as one of the neutralizing cations involved in the pathogenesis of proteinuria in these patients. Atopy could be assumed as a risk factor for the development of frequent relapses, so the value of a course of non-steroidal anti-inflammatory drug [as ketotifen] infrequently relapsing nephrotic children should be evaluated