Effects of Guben Fangxiao Beverage （固本防哮饮） on Lung Tissue Oxidative Stress and AMPK/Nrf2/HO-1 Pathway in Mice with Bronchial Asthma in Remission / 中医杂志

ObjectiveTo investigate the possible mechanism of Guben Fangxiao Beverage （固本防哮饮） for the prevention and treatment of chronic airway inflammation during asthma remission. MethodsThirty-six female Balb/c mice were randomly divided into normal group， model group， low-， medium-， and high-dose of Guben Fangxiao Beverage group and montelukast sodium group， with 6 mice in each group. Except for the normal group， ovalbumin and respiratory syncytial virus were used in other groups to establish a mouse model of bronchial asthma in remission stage. After molding， the low-， medium-， and high-dose groups of Guben Fangxiao Beverage were respectively given 12， 24， and 36 g/（kg·d）， the montelukast sodium group was given montelukast sodium granule 2.6 mg/（kg·d）， and the mice in the normal group and model group were given 20 ml of double-distilled water， all by gavage， once a day for 28 days. The levels of interleukin 4 （IL-4） and interleukin 5 （IL-5） in the lung tissue of mice were detected； HE staining was used to observe the pathology of the lung tissue and to score the inflammation； DHE staining was used to observe the level of reactive oxygen species （ROS） in the lung tissue， and the activities of mitochondrial respiratory chain complexes Ⅰ， Ⅱ， Ⅲ， Ⅳ， and Ⅴ in the lung tissue were detected； the levels of serum superoxide dismutase （SOD）， catalase （CAT）， malondialdehyde （MDA） and adenosine triphosphate （ATP） were detected； the protein expression levels of phosphorylated adenosine monophosphate-activated protein kinase （p-AMPK）， nuclear factor erythroid 2-related factor 2 （Nrf2）， haem oxygenase 1 （HO-1） and cAMP responsive element binding protein （CREB） in the lung tissues of the model group were detected by Western blot. ResultsCompared with the normal group， the histopathological results of the lungs of mice in the model group showed an increase in inflammatory cells around the airways and an increase in inflammatory score； DHE staining showed an increase in the level of ROS， and an increase in the levels of IL-4 and IL-5 in the lung tissues； the levels of serum SOD， CAT， and ATP were reduced， and the level of MDA was elevated； the activities of the mitochondrial respiratory chain complexes Ⅰ， Ⅱ， Ⅲ， Ⅳ， and Ⅴ of the lung tissues were reduced， and the activities of p-AMPK， Nrf2， CREB protein expression decreased （P＜0.05）. Compared with the model group， the lung tissue inflammatory cells and inflammation scores of mice in each Guben Fangxiao Beverage dose group and montelukast sodium group were reduced； the levels of ROS， IL-4 and IL-5 in the lung tissue were reduced； the levels of CAT and ATP in the serum increased， and the content of MDA was reduced； and the activities of mitochondrial respiratory chain complexes Ⅰ and Ⅱ， as well as the expression of CREB protein， were elevated in the lung tissue （P＜0.05）. Compared with the high-dose group， the MDA level of the medium-dose Guben Fangxiao Beverage group decreased （P＜0.05）. The activity of mitochondrial respiratory chain complex V in the medium-dose group was higher than that in the montelukast sodium group， and the activity of mitochondrial respiratory chain complex Ⅳ in the medium- and high-dose groups was higher than that in the low-dose group （P＜0.05）. ConclusionGuben Fangxiao Beverage can inhibit oxidative stress and improve mitochondrial function to relieve chronic airway inflammation in bronchial asthma model mice during asthma remission， and its mechanism may be related to the activation of AMPK/Nrf2/HO-1 signaling pathway.

Beneficios que reciben los pacientes asmáticos tras la aplicación de un tratamiento fisioterapéutico y rehabilitador

El asma bronquial sigue siendo la enfermedad crónica más frecuente en la infancia. Su prevalencia continúa aumentando a pesar de que en la actualidad se disponen de eficaces manuales terapéuticos para el correcto manejo de los principales síntomas de la enfermedad. El tratamiento no farmacológico de este padecimiento se fundamenta en tres pilares esenciales: la educación sobre la enfermedad, las guías para profesionales y pacientes y la fisioterapia respiratoria. Los pacientes que tienen un tratamiento fisioterapéutico y rehabilitador de manera habitual, tienen una mejoría significativa en el control del asma, especialmente si estos se practican bajo la supervisión de un fisioterapeuta. Los beneficios que los pacientes asmáticos logran con la fisioterapia y la rehabilitación son numerosos y uno de los efectos más importante es el impacto positivo sobre la calidad de vida.

Bronchial asthma continues to be the most common chronic disease in childhood. Its prevalence continues to increase despite the fact that effective therapeutic manuals are currently available for the correct management of the main symptoms of the disease. The non-pharmacological treatment of this condition is based on three pillars: education about the disease, guides for professionals and patients, and respiratory physiotherapy. Patients who have regular physiotherapy and rehabilitation treatment have a significant improvement in asthma control, especially if these are practiced under the supervision of a physiotherapist. The benefits that asthmatic patients achieve with physiotherapy and rehabilitation are numerous and one of the most important effects is the positive impact on quality of life.

Concurrence of Bronchial Asthma, PCOS in Young Adolescent and its Management by Siddha Therapeutics - A Case Study

Growing evidence suggests that polycystic ovarian syndrome (PCOS) and Bronchial asthma coexist thanks to their common pathogenicity route. Both PCOS and Bronchial asthma has been associated with chronic low grade inflammation which results in hormonal disparity. One such case of a young woman with a medical history of Bronchial asthma presented with complaints of irregular menstrual cycle with amenorrhea and episodes of asthmatic attack once a month. The laboratory investigations including both blood and sonographic studies revealed the elevated absolute eosinophilic count, serum IgE and bilateral polycystic ovarian cyst. The Patient has been treated with internal medications and was advised to continue the physical activity such as walk for once a day and Pranayama (breathing exercise) as an adjunct to the treatment. After the treatment period of about 10 months, the outcome was assessed by both clinical prognosis as well as with USG report. The case study is about managing PCOS as well as bronchial asthma by Siddha therapeutic intervention and efficacy of the chosen drugs towards the ailments has also been explained with the help of preclinical studies conducted on the individual herbs of the formulation included in the study. This study could help to explore the therapeutic potential of Siddha medicine towards alleviating the low grade inflammation and hormonal imbalances associated with both Bronchial asthma as well as PCOS.

Comparison of impulse oscillometry and pulmonary function test in assessment of bronchial asthma control in children / 中华实用儿科临床杂志

Objective:To compare and analyze the effects of impulse oscillometry (IOS) and pulmonary function test (PFT) in the assessment of asthma control in children.Methods:A cross-sectional study of 323 children with bronchial asthma who visited the outpatient pediatric clinic of Shandong Provincial Hospital Affiliated to Shandong First Medical University from March to December 2020 was conducted.The patients were divided into the control group (123 cases) and the uncontrolled group (200 cases) according to the Childhood Asthma Control Test (C-ACT) score.In both groups, PFT and IOS were performed.The PFT test included the forced expiratory volume in one second (FEV 1), force expiratory volume in one second/forced vital capacity (FEV 1/FVC), peak expiratory flow (PEF), the instantaneous forced expiratory flow at 50% of forced vital capacity (FEF 50), the instantaneous forced expiratory flow at 75% of forced vital capacity (FEF 75), and maximum mid expiratory flow (MMEF). In the IOS test, the total respiratory impedance at 5 Hz (Z5), respiratory resistance at 5 Hz (R5), respiratory resistance at 20 Hz (R20), reactance at 5 Hz (X5), respiratory resistance at 5 Hz-respiratory resistance at 20 Hz (R5-R20), reactance area (AX), and resonance frequency (Fres) were measured.The data obtained were analyzed statistically using SPSS 25.0 software. ANOVA or Mann- Whitney U rank-sum test was used to compare data between groups.Receiver′s operating characteristic (ROC) curves were drawn to determine the predictive value of PFT and IOS parameters for uncontrolled asthma. Results:(1) According to the comparison results of PFT indexes between the two groups of children with asthma, the levels of FEV 1, FEV 1/FVC, PEF, FEF 50, FEF 75, MMEF in the control group were all higher than those in the uncontrolled group [(104.41±12.38)% vs.(98.89±16.61)%, 100.50 (94.40, 103.50)% vs.96.00 (89.83, 101.88)%, (100.29±15.31)% vs.(93.19±18.43)%, 85.60(70.60, 96.60)% vs.72.35 (57.08, 91.10)%, 67.20 (53.60, 81.70)% vs.56.80 (41.10, 74.73)%, 80.70 (66.80, 95.10)% vs.69.50 (54.03, 90.05)%] (all P<0.01). (2) According to the comparison results of IOS indices between the two groups, the levels of Z5, R5, R20, R5-R20, X5, AX and Fres in the control group were lower than those in the uncontrolled group {68.58 (63.29, 77.43)% vs.81.27(70.93, 91.96)%, 68.91(62.94, 77.60)% vs.80.61 (70.02, 89.29)%, 75.78 (67.50, 87.55)% vs.82.97 (71.50, 95.50)%, 0.51 (0.43, 0.59) [kPa/(L·S)] vs.0.62 (0.53, 0.74) [kPa/(L·S)], 69.31 (59.93, 79.14)% vs.86.48 (70.00, 102.48)%, 1.11 (0.76, 1.60) kPa/L vs.2.14 (1.42, 2.85) kPa/L, 18.21 (16.06, 19.56) Hz vs.20.56 (18.92, 22.81) Hz} (all P<0.01). (3) In the control group, 31 children (25.20%) had pulmonary dysfunction.(4) In the uncontrolled group, 95 children (47.50%) had pulmonary ventilation dysfunction.Only 20 children (10.00%) had a R5 larger than 120% of the predicted value and/or a R20 larger than 120% of the predicted value.(5) According to the ROC analysis results of the IOS indices for predicting asthma exacerbations, all of the areas under the ROC (AUC) of Z5, R5, R5-R20, X5, AX and Fres were greater than 0.7.AX had the highest value in predicting asthma exacerbations (AUC=0.785, 95% CI: 0.735-0.835), with sensitivity of 78.50% and specificity of 64.20%.All of the AUCs of PFT indices were smaller than 0.7.FEF 50 and MMEF had the largest AUC. Conclusions:PFT and IOS have good sensitivity in evaluating the level of asthma control in children, and IOS has good value in predicting asthma exacerbations.AX has the highest predictive value for asthma exacerbations.Asthma control levels of children should be evaluated using not only subjective (such as C-ACT score) but also objective (e.g.PFT, IOS) indices.

The role of Huaiqihuang Granules in the long-term management of bronchial asthma in young children: a multicenter real-world study / 中华实用儿科临床杂志

Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.

Progress of pendrin in airway epithelia / 国际儿科学杂志

Pendrin is an electroneutral anion exchanger transporter, residing in the apical region of airway epithelium cells.It is responsible for the reabsorption of chloride(Cl -) and the exchange of bicarbonate(HCO 3－)or thiocyanate(SCN -) to the lumen.It is mainly involved in regulating the pH and thickness of airway surface liquid(ASL), mucin secretion, and airway defense, which is of great significance for maintaining the stability of the airway surface microenvironment.The expression of pendrin is significantly up-regulated in bronchial asthma, which is closely related to the pathological processes of the lung in bronchial asthma, such as airway hyperresponsiveness, neutrophil infiltration, and increased mucin secretion.Inhibiting the function of pendrin may be a new target for the treatment of bronchial asthma.

Control stability analysis of long-term standardized treatment and management for children aged under 6 years with asthma / 国际儿科学杂志

Objective:To evaluate the outcome and stability of control statuses in children under 6 years old with bronchial asthma(abbreviated asthma)who were received long-term standardized treatment and management, and to analyze the factors affecting the control stability.Methods:Using the case registration study, a total of 173 asthmatic children under 6 years old were selected from January 2014 to December 2020 in the department of allergy of Beijing Children′s Hospital.All the patients were received asthma long-term standardized treatment and management for 1 year to 2 years.Control statuses were evaluated at 1 year and 2 years follow up visits respectively.According to the changes of stage evaluations of control statuses, the control stabilities were decided, and patients were divided into stable control group and unstable control group.The parameters of exacerbation, repeated respiratory tract infection, pneumonia, concomitant diseases, allergen sensitization, pulmonary function, initial treatment level, delivery mode, feeding method and family history of allergic diseases were compared between the two groups at 1 year and 2 years respectively.Results:Of the 173 patients included, 17.9%(31/173)were younger than 3 years old and 82.1%(142/173)were 3 to 5 years old.After treatment and management for 1 year and 2 years, the proportions of asthma control levels assessed as good control were 51.6%(16/31)and 70.0%(21/30)respectively in the patients younger than 3 years old, and they were 74.6%(106/142)and 76.7%(79/103)respectively in the patients aged 3 to 5 years old.At 1 year and 2 years of treatment and management, the proportions of stable control and unstable control in 173 patients were 28.9%(50/173), 71.1%(123/173)and 26.3%(35/133), 73.7%(98/133), respectively.Asthma control stability status assessment and analysis showed that in the stable control group than that in the unstable control group, at 1 year and 2 years follow up visits, the percentages of exacerbations were lower(28.0% and 54.3% vs 64.2% and 72.4%), and the differences were statistically significant( χ2=18.768 and 3.889, all P<0.05).At 1 year follow up visits, the egg sensitization rate was higher(53.1% vs 32.9%), and the difference was statistically significant( χ2=3.921, P<0.05); the initial treatment level was higher, and the proportions of level 2, 3, 4 initial treatment were(4.0%, 22.0% and 74.0% vs 20.3%, 34.1% and 45.5%), and the difference was statistically significant( Z=-3.608, P<0.05).At 2 years follow up visits, the egg and milk sensitization rates were higher(61.9% and 42.9% vs 26.2% and 18.0%), and the differences were statistically significant( χ2=8.698 and 5.220, all P<0.05).There were no significant differences on the distributions in repeated respiratory tract infection, pneumonia, concomitant diseases, pulmonary function, delivery mode, feeding method and family history of allergic diseases. Conclusion:Stable asthma control is more likely to be achieved in children aged under 6 years with asthma who are manifesting no asthma exacerbation, presenting food sensitization and using the initial treatment at a high level.

Advances in pulmonary rehabilitation for children with bronchial asthma / 浙江大学学报·医学版

Bronchial asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness. With the development of the whole-life-cycle health concept, the focus of treatment for bronchial asthma in children has gradually shifted from initial pharmacological control to an integrated management model of functional rehabilitation and pharmacological assistance. As a non-pharmacological integrated approach, pulmonary rehabilitation plays an equally important role in the management of childhood asthma as pharmacological treatment. Studies have shown that breathing techniques such as Buteyko breathing, pursed lip breathing, diaphragmatic breathing training, threshold-pressure inspiratory muscle training and yoga breathing can improve lung function indicators such as FEV1, FVC, PEF and MVV in children. The comprehensive pre-exercise assessment, the development of exercise prescriptions, and the implementation and evaluation of exercise effects can improve the physical fitness, neuromuscular coordination and self-confidence of children with asthma. The comprehensive interventions of health education, psychological support and nutritional intervention can improve the compliance and effectiveness of rehabilitation training. This article reviews the research progress on respiratory training, physical exercise and comprehensive interventions in the pulmonary rehabilitation of asthmatic children, to provide theoretical basis and practical guidance for the scientific and rational management of pulmonary rehabilitation of asthmatic children in clinical settings.

Sibilancia recurrente en pediatría

Introducción: los episodios de obstrucción bronquial a temprana edad constituyen un problema frecuente en pediatría. Se realizó un estudio descriptivo, longitudinal, retrospectivo. Objetivo: caracterizar el comportamiento de la sibilancia recurrente en los niños menores de 5 años pertenecientes al municipio Bayamo, del Hospital Provincial Pediátrico Docente "General Milanés "en el año 2019. Métodos: la muestra fue de 63 pacientes y se estudiaron las variables edad, sexo, lactancia materna, ingresos previos, procedencia, género de vida y posibles factores de riesgo. El análisis estadístico se realizó a través de las estimaciones de las frecuencias absolutas y relativas. Resultados: predominaron los niños de 1 a 5 años con 52 casos (82.6%) y el sexo masculino, 29 de ellos pertenecieron a este grupo etáreo ( 80.6%); los ingresos previos de menos de 3 días en 37 casos (66.1%) y 56 casos no recibieron lactancia materna exclusiva, 37 de ellos representó el 66.1%; 44 casos tuvieron un género de vida malo ( 69.8%) y de los 43 casos que procedían de la zona urbana 28 pertenecían a ese género de vida(65.1%); los antecedentes patológicos familiares de alergia o asma y la atopia fueron los más significativos con 63 y 52 casos(100 y 82.5%) respectivamente. Conclusiones: se comprobó que la edad de 1 a 5 años, el sexo masculino, los ingresos de menos de tres días, sin lactancia materna , el género de vida malo, la procedencia urbana fueron los que predominaron en el estudio, así como los antecedentes patológicos familiares y la atopia como factores de riesgo que exacerbaron la enfermedad.

Introduction: episodes of bronchial obstruction at an early age are a frequent problem in pediatrics. A descriptive, longitudinal, retrospective study was conducted. Objective: to characterize the behavior of recurrent wheezing in children under 5 years of age belonging to the Bayamo municipality, of the "General Milanés" Teaching Pediatric Provincial Hospital in 2019. Methods: the sample consisted of 63 patients and the variables age, sex, breastfeeding, previous income, origin, gender of life and possible risk factors were studied. Statistical analysis was performed through estimates of absolute and relative frequencies. Results: there was a predominance of children aged 1 to 5 years with 52 cases (82.6%) and males, 29 of them belonged to this age group (80.6%); previous admissions of less than 3 days in 37 cases (66.1%) and 56 cases did not receive exclusive breastfeeding, 37 of them accounted for 66.1%; 44 cases had a bad lifestyle (69.8%) and of the 43 cases that came from the urban area, 28 belonged to that kind of life (65.1%); Family pathological history of allergy or asthma and atopy were the most significant wit. Conclusions: it was found that age from 1 to 5 years, male sex, income of less than three days, without breastfeeding, poor lifestyle, urban origin were those that predominated in the study, as well as family pathological history and atopy as risk factors that exacerbated the disease.

Introdução: episódios de obstrução brônquica em idade precoce são um problema frequente em pediatria. Trata-se de um estudo descritivo, longitudinal e retrospectivo. Objetivo: caracterizar o comportamento da sibilância recorrente em crianças menores de 5 anos pertencentes ao município de Bayamo, do Hospital Provincial Pediátrico Universitário "General Milanés", em 2019. Métodos: a amostra foi composta por 63 pacientes e estudadas as variáveis idade, sexo, aleitamento materno, renda prévia, procedência, sexo de vida e possíveis fatores de risco. A análise estatística foi realizada por meio de estimativas de frequências absolutas e relativas. Resultados: houve predomínio de crianças de 1 a 5 anos com 52 casos (82,6%) e do sexo masculino, sendo que 29 deles pertenciam a essa faixa etária (80,6%); internações anteriores inferiores a 3 dias em 37 casos (66,1%) e 56 casos não receberam aleitamento materno exclusivo, sendo que 37 deles corresponderam a 66,1%; 44 casos tinham estilo de vida ruim (69,8%) e dos 43 casos provenientes da zona urbana, 28 pertenciam a esse tipo de vida (65,1%); História anatomopatológica familiar de alergia ou asma e atopia foram as mais significativas, com 63 e 52 casos (100 e 82,5%), respectivamente. Conclusões: verificou-se que idade de 1 a 5 anos, sexo masculino, renda inferior a três dias, ausência de aleitamento materno, estilo de vida ruim, origem urbana foram os que predominaram no estudo, assim como história patológica familiar e atopia como fatores de risco que exacerbaram a doença.

Yiqi Wenyang Huwei Decoction Regulates PI3K/Akt/mTOR Pathway to Treat Bronchial Asthma in Rats / 中国实验方剂学杂志

ObjectiveTo observe the regulatory effects of Yiqi Wenyang Huwei decoction （YWHD） on autophagy and phosphatidylinositol 3-kinase （PI3K）/protein kinase B（Akt）/mammalian target of rapamycin （mTOR） signaling pathway in asthmatic rats and bronchial epithelial cells （16HBE） and further reveal the mechanism of YWHD in treating bronchial asthma （BA）. MethodForty-eight rats were randomly assigned into normal group， model group， dexamethasone group， and low-， medium-， and high-dose YWHD groups， with 8 rats in each group. The rat model of BA was established by intraperitoneal injection with ovalbumin （OVA） + aluminum hydroxide suspension and atomizing inhalation with OVA for 2 weeks. The normal group was administrated with an equal dose of normal saline. The bronchial maximum airway resistance （Max Rrs） induced by methacholine chloride （Mch） was determined by an animal lung function evaluation system. Enzyme-linked immunosorbent assay （ELISA） was employed to measure the levels of interleukin （IL）-4， IL-13， IL-6， IL-33， IL-25， tumor necrosis factor-α （TNF-α）， and immunoglobulin E （IgE） in the bronchial alveolar lavage fluid. Hematoxylin-eosin （HE） and Masson staining were used for observation of the pathological changes of bronchi in the lung tissue. The immunofluorescence assay was employed to measure the levels of the autophagy-associated proteins LC3B and Beclin1. The IL-13-induced autophagy of 16HBE cells exposed to the YWHD-containing serum was observed， and the autophagy level was traced by mRFP-GFP-LC3 adenovirus infection. The protein levels of LC3Ⅱ/Ⅰ， p-PI3K， p-Akt and p-mTOR were determined by Western blot. ResultCompared with the normal group， the model group showed increased Max Rrs （P<0.01） and elevated levels of IL-4， IL-13， IL-6， IL-33， IL-25， TNF-α， and IgE in the bronchial alveolar lavage fluid （P<0.05，P<0.01）. The modeling caused focal infiltration of inflammatory cells and lymphocytes around bronchus and blood vessels， epithelial goblet cell metaplasia， and increased subepithelial collagen deposition. Furthermore， it up-regulated the protein levels of LC3B and Beclin1 （P<0.01）， promoted the autophagy flux of GFP to mRFP in 16HBE cells induced by IL-13， down-regulated the protein levels of p-PI3K， p-Akt， and p-mTOR， and increased the LC3Ⅱ/Ⅰ ratio （P<0.01）. Compared with the model group， medium- and high-dose YWHD decreased Max Rrs （P<0.01）， lowered the levels of IL-4， IL-13， IL-6， IL-33， IL-25， TNF-α， and IgE in the bronchial alveolar lavage fluid （P<0.05， P<0.01）， and reduced lymphocyte and granulocyte infiltration in bronchi of the lung tissue， epithelial goblet cell metaplasia， and subepithelial collagen deposition. Moreover， they down-regulated the protein levels of LC3B and Beclin1 （P<0.05， P<0.01）， decreased the autophagy flux of GFP to mRFP， up-regulated the protein levels of p-PI3K， p-Ak， and p-mTOR， and decreased the LC3Ⅱ/Ⅰ ratio （P<0.05， P<0.01）. ConclusionYWHD ameliorates airway hyperresponsiveness and airway inflammation and inhibits the autophagy of airway epithelial cells in the lung tissue of BA rats by activating the PI3K/Akt/mTOR signaling pathway.

Research progress on effect and mechanism of diesel exhaust particles on asthma / 环境与职业医学

As a source of traffic-related air pollution, diesel particulate matter (DPM) associate with a variety of lung-related diseases, but there is no systematic review of the relationship between DPM and the development and progression of asthma. This article reviewed the relationship between DPM and asthma, the effect and mechanism of DPM on airway inflammation and remodeling in asthma, and illustrated that DPM exposure may participate in airway inflammation and remodeling through oxidative stress, immune regulation and regulation of lung and intestinal microecology, so as to promote the development and progression of asthma.

Changes of FeNO, CRP and PCT levels in patients with bronchial asthma complicated with sleep apnea syndrome in Shanghai / 公共卫生与预防医学

Objective The changes and risk factors of FeNO, CRP and PCT in patients with bronchial asthma complicated with sleep apnea syndrome (SAS) in Shanghai area were analyzed to provide theoretical basis for the prevention and treatment of SAS in patients with bronchial asthma. Methods A total of 436 patients with bronchial asthma admitted to our hospital from January 2019 to June 2022 were selected and divided into control group and experimental group according to whether SAS occurred during hospitalization. The experimental group was divided into three subgroups according to the apnea hypopnea index (AHI) values: mild group (AHI>15 times /h or 15 times /h or 28 kg/m2(OR=5.629),allergic rhinitis(OR=6.166)and neck circumference>40 cm(OR=5.265)were independent risk factors for SAS in patients with bronchial asthma(P<0.05);Pearson correlation analysis showed that AHI was positively correlated with serum FeNO,CRP and PCT levels in patients with bronchial asthma and SAS(r=0.471,0.436,0.502,P<0.05). Conclusions Patients with old bronchial asthma in Shanghai area have a higher risk of SAS, and the severity of the disease is positively correlated with the levels of FeNO, CRP and PCT. In particular, obese patients with allergic rhinitis should be given early intervention to reduce the risk of SAS.

Association of Serum Level of Vitamin D3 and Pulmonary Function in Bronchial Asthma Patients in A Tertiary Care Hospital of South Gujarat, India

Introduction: Asthma is a chronic lung disease characterised by reversible airway obstruction, cellular infiltration, and airway inflammation. The reaction is characterised by the interaction of genetic and environmental variables, as well as the activation of cells in the innate and adaptive immune systems. Method: The study was conducted in the Department of General medicine, in Tertiary Care Center, to study association of serum level of Vitamin D3 and pulmonary function in bronchial asthma patients. As per inclusion and exclusion criteria ,137 patients of bronchial asthma were included in the study. Result: In cases having serum vitamin D3 level <20 ng/ml mean value of FVC, FEV1, FEV1/FVC ratio, was 108.10�.89, 68.56�.40, and 62.35�17. In cases having serum vitamin D3 20-29 ng/ml, mean value of FVC, FEV1, and FEV1/FVC ratio was 109.72�.22, 72.34�.48, and 64.39�97. In cases having serum vitamin D3 >30 ng/ml mean value of FVC, FEV1, and FEV1/FVC ratio, was 115.0�27, 81.0�09, and 70.52�00. Conclusion: Vitamin D3 deficiency was highly prevalent in asthmatic patients, there was a strong correlation between asthma severity and vitamin D3 concentrations and there was a direct and a positive significant correlation between vitamin D3 levels and pulmonary function test in asthmatic patients.

Ayurvedic Management of Tamaka Swasa w.s.r to Bronchial Asthma

Bronchial asthma is one of the most distressing chronic illness in all socio- economic status people, affecting all age groups. Changing in lifestyle, demographic factors, urbanization, environmental charges are the triggering factors of bronchial asthma. Tamaka swasa is characterized by paraoxysmal attacks of breathlessness, cough, coryza, due to chest tightness, rapid respiration, distress inability to expectorate and prolonged expiration. Methods: This is a single case study of a 34 year male patient, came with the complaints of difficulty in Breathing since 5 years. He also complaints of abdominal distension and decreased appetite. According to patient, he was apparently well before 5 years. Gradually he developed breathing difficulty because of his smoking habit. Patient also c/o abdominal distension and decreased appetite at that time. In the case study patient was given Sadhyo vaman first followed by Snehapana with Brahmi ghrta was given along with Internal medications. Result: Patient showed remarkable improvement in severity of symptoms and as well as time period between 2 successive episodes of dyspnea is increased. During this course we observed that the patient had partial relief of symptoms. Lesser the chronicity greater the relief and improvement in chronic condition was observed. Interpretations and Conclusion: The patient was given Sadhyovamana, followed by Snehapana with Brahmi ghrtam for Virechana. The contents of Brahmi ghrtham are Ghee, Brahmi, Shankapushpi, Trikatu, Shweta trivrt, Krishna Trivrt, Vidanga, Nipadruma, Saptala, Danti, followed by Virechana with Trivrt lehaya. Tamake tu virechana In this condition Virechana is advised as the best line of treatment, and in the above mentioned case after Virechana patient feels better and got much more relief from symptoms.

Detection Of Treatment Adherence, Disease Control and Its Predictors in Asthma Patients by Rural Community Level Health Workers

Background: Despite the availability of effective therapy, disease control in Asthma remains suboptimal with high morbidity. Objectives: To assess treatment adherence, asthma control and its influencing fac-tors.Methodology: A prospective, observational study was conducted among 152 adult asthma patients re-porting consecutively to a BPHC for twelve months. Patients were followed up by trained healthcare workers to assess their treatment adherence and disease control using a predesigned, pretested and val-idated questionnaire.Results: Mean age was 49.6 years (SD=+14.0), males reported more cases (73.7%), addiction to tobacco was high (48.7%). 40.8% patients had high treatment adherence. Only 37.5% patients reported good asthma control of which 68.4% showed high adherence. The mean Asthma Control Test (ACT) score was 18.75 ± 4.8 SD. Increasing age (aOR=0.96, 95% CI= 0.93-0.99), tobacco smoking (aOR=2.90, 95% CI=1.20-6.99), dust allergy (aOR= 7.92, CI =3.15-19.91) and low treatment adherence (aOR=5.33, 95% CI=2.22-12.82) were found to be significant predictors of poor disease control.Conclusions: Non adherence to treatment and poor disease control was high among rural asthma pa-tients. Patient education for tobacco cessation and treatment compliance along with periodic monitoring undertaken by trained health workers can be an effective strategy to reduce disease burden in the com-munity.

Técnicas fisioterapéuticas de entrenamiento muscular inspiratorio y Buteyko en niños con asma bronquial / Inspiratory and Buteyko muscular training physiotherapeutic techniques in children with bronchial asthma

El asma bronquial es una enfermedad respiratoria crónica que genera elevados índices de discapacidad, sobre todo en la población infantil. La aplicación de fisioterapia respiratoria constituye un coadyuvante en los esquemas terapéuticos de la enfermedad; en este sentido el entrenamiento muscular inspiratorio y el método Buteyko constituyen técnicas respiratorias que han sido reportadas como útiles en el tratamiento del asma bronquial. La presente investigación tuvo como objetivo describir las ventajas que ofrecen ambos métodos como esquemas terapéuticos de niños con asma bronquial. Como principales resultados se describen una serie de estudios que muestran las ventajas de la implementación de estos métodos para mejorar distintos componentes de la patogenia y manifestaciones clínicas del asma bronquial. Estos estudios muestran que la aplicación indistinta de uno o ambos métodos mejora diversos aspectos entre los que sobresalen mejorar volúmenes y capacidades pulmonares, función pulmonar, fuerza muscular ventilatoria y la mecánica respiratoria. Adicionalmente, mejoran algunos elementos relacionados con la mecánica respiratoria como es el uso de la respiración bucal. Se concluye que la realización de la fisioterapia respiratoria en niños con asma bronquial constituye una alternativa viable y eficaz en el mejoramiento de varios parámetros relacionados con esta enfermedad. Diversos estudios demuestran que la aplicación de estas técnicas respiratorias mejora la capacidad respiratoria, el tono y trofismo de músculos respiratorios y la mecánica respiratoria. Los resultados positivos evidencian la necesidad de aumentar la implementación del entrenamiento muscular inspiratorio y el método Buteyko como esquema terapéutico en niños con asma bronquial en unidades de atención pública y privada(AU)

Bronchial asthma is a chronic respiratory disease that generates high rates of disability, especially in children. The application of respiratory physiotherapy constitutes an adjunct in the therapeutic schemes of the disease; in this sense, inspiratory muscle training and the Buteyko method constitute respiratory techniques that have been reported as useful in the treatment of bronchial asthma. The present investigation aimed to describe the advantages offered by both methods as therapeutic regimens for children with bronchial asthma. The main results are a series of studies that show the advantages of the implementation of these methods to improve different components of the etiopathogenesis and clinical manifestations of bronchial asthma. These studies show that the indistinct application of one or both methods improves different aspects, among which the improvement of lung volumes and capacities, lung function, ventilatory muscle strength and respiratory mechanics stand out. Additionally, they improve some elements related to respiratory mechanics such as the use of mouth breathing. It is concluded that the performance of respiratory physiotherapy in children with bronchial asthma constitutes a viable and effective alternative in the improvement of various parameters related to this disease. Several studies show that the use of these respiratory techniques improves respiratory capacity, tone and trophism of respiratory muscles, and respiratory mechanics. The positive results demonstrate the need to increase the implementation of inspiratory muscle training and the Buteyko method as a therapeutic scheme in children with bronchial asthma in public and private care units(AU)

Til Tail (Sesamum Indicum): A Hidden Cause Behind Tamaka Shwasa (Bronchial Asthma): A Literary Review

Respiratory problems are very common due to the devastating pollution, irritants and infections. Asthma is one of the chronic inflammatory respiratory illnesses throughout the world and is characterized by breathlessness, chest tightness, wheeze and coughing. It occurs as a result of hypersensitivity reaction mainly due to allergens. These allergies mostly can be from the food. Like other allergies, sesame allergy is quite common yet unknown but it’s prevalence has been continuously increasing in recent years. A lot of modern researches proved Sesame as a food allergen causing airway inflammation and IgE mediated airway hyper responsiveness and finally causes asthma. In Ayurveda, asthma is well correlated as Tamaka shwasa. In classical texts of Ayurveda like Charaka Samhita and Sushrut Samhita similar etiological factors are described for Shwasa roga, in addition to that dietary factors (Aharaj Nidan) are also mentioned such as Nishpava, Masha, Til tail, Pinyak, Pishti, Aam ksheer etc. which vitiates the Doshas and finally causes Tamaka shwasa. This review article mainly focuses the role of Til tail (Sesamum indicum) in the etiopathogenesis of Tamaka shwasa and also, for better understanding of textual facts and may be used as an effective key to control the mortality and morbidity related to it.

A prospective and observational study on the variation in Hemoglobin A1c levels among asthmatic children using inhaled corticosteroids

Background: The studies in children regarding the effects of inhaled corticosteroids (ICS) on the carbohydrate metabolism are scant in India. This study was undertaken to determine if there is any effect of inhaled steroids on the glycemic control. Aims and Objectives: The aim of the study was to analyze the pattern of glycated hemoglobin (HbA1c) levels in children with persistent asthma, before and after using prophylactic doses of ICS and to evaluate and compare HbA1c levels separately in those taking budesonide and in those taking fluticasone or other steroids. Materials and Methods: It was a prospective and observational study, based on a study proforma. Children of 2–12 years of age, diagnosed with mild-to-moderate persistent asthma, attending the Asthma Clinic at Paediatrics Department of SAT Hospital, Government Medical College, Thiruvananthapuram were included in the study. The diagnosis of asthma and the severity was recorded according to Global Initiative for Asthma guidelines. The sample size was calculated to be 40. Type, dose, and frequency of administration of ICS and other coprescribed drugs were recorded on an asthma diary and entered into the study proforma. HbA1c levels were measured in children before they were started on ICS, on the same day of visit using high perfusion liquid chromatography technique and repeated after 6 months. Student’s t-test was used to compare mean values between two groups. Results: Mean age of patients is 5.75. About 62.5% of patients were males. About 72.5% of the patients had a diagnosis of moderate persistent asthma. The mean HbA1c before the treatment with ICS was 5.36 and after the treatment is 5.37 and the difference was not significant. Conclusions: There was no significant change in HbA1c levels with the use of ICS.

Factores de riesgo relacionados con la severidad del asma bronquial en el Servicio de Urgencias / Risk Factors Related to the Severity of Bronchial Asthma in an Emergency Service

Introducción: En la actualidad existen aproximadamente 300 millones de personas a nivel mundial con diagnóstico de asma y con una mortalidad de 250 mil cada año. Cuba no está ajena a esta realidad. Objetivo: Relacionar la frecuencia de presentación de factores de riesgo dependientes del huésped y del medio ambiente con el grado de severidad de las crisis en niños. Métodos: Se realizó un estudio descriptivo transversal en 600 niños de 1 a 18 años de edad, atendidos en el Servicio de Urgencias del Hospital Pediátrico Juan Manuel Márquez, de enero a diciembre del año 2018. Resultados: La mayoría de los pacientes atendidos fueron del sexo masculino (53 por ciento) y del grupo de edad de 5 a 9 años (46,3 por ciento). Dentro de los factores de riesgo que predominaron en el estudio fueron los más frecuente las infecciones virales (51,3 por ciento), los cambios de temperatura (58,2 por ciento) y la no adherencia al tratamiento (45,5 por ciento). Se encontraron antecedentes familiares de asma bronquial en 62,2 por ciento y antecedentes de atopia en 60 por ciento. Conclusiones: Existen factores de riesgo modificables en pacientes asmáticos, lo que implica que se puede disminuir la severidad del asma bronquial en urgencias(AU)

Introduction: Currently, there are around 300 million people in the world diagnosed with asthma and a mortality rate of 250 thousand every year. Cuba is not apart from this reality. Objective: To relate the frequency of presentation of host- and environment-dependent risk factors with the degree of severity of crises among children. Methods: A cross-sectional and descriptive study was carried out with 600 children aged 1-18 years, who receive attention in the emergency department of Juan Manuel Márquez Pediatric Hospital from January to December 2018. Results: Most of the patients who received attention were male (53 percent) and belonged to the age group of 5-9 years (46.3 percent). Among the predominating risk factors of the study, the most frequent were viral infections (51.3 percent), temperature changes (58.2 percent) and non-adherence to treatment (45.5 percent). Family history of bronchial asthma was found in 62.2 percent, together with a history of atopy, accounting for 60 percent. Conclusions: There are modifiable risk factors in asthma patients, which allows to decrease the severity of bronchial asthma in the emergency department(AU)

A randomized clinical trial on inhaled ciclesonide for managing acute asthma in the emergency room

ABSTRACT BACKGROUND: Use of inhaled corticosteroids for managing acute asthma exacerbations has been tested since the 1990s. OBJECTIVE: To compare high doses of inhaled ciclesonide with systemic hydrocortisone for managing acute asthma exacerbations in the emergency department. DESIGN AND SETTING: Double-blind, randomized clinical trial in the public healthcare system of the city of São Paulo. METHODS: Fifty-eight patients with moderate or severe asthma with peak flow < 50% of predicted were randomized into two groups. Over the course of four hours, one group received 1440 mcg of inhaled ciclesonide plus hydrocortisone-identical placebo (ciclesonide + placebo), while the other received 500 mg of intravenous hydrocortisone plus ciclesonide-identical placebo (hydrocortisone + placebo). Both groups received short-acting bronchodilators (fenoterol hydrobromide and ipratropium bromide). The research protocol included spirometry, clinical evaluation, vital signs and electrocardiogram monitoring. Data were obtained at 30 (baseline), 60, 90, 120, 180, and 240 minutes. We compared data from baseline to hour 4, between and within groups. RESULTS: Overall, 31 patients received ciclesonide + placebo and 27 received hydrocortisone + placebo. Inhaled ciclesonide was as effective as intravenous hydrocortisone for improving clinical parameters (Borg-scored dyspnea, P = 0.95; sternocleidomastoid muscle use, P = 0.55; wheezing, P = 0.55; respiratory effort, P = 0.95); and spirometric parameters (forced vital capacity, P = 0.50; forced expiratory volume in the first second, P = 0.83; peak expiratory flow, P = 0.51). CONCLUSIONS: Inhaled ciclesonide was not inferior to systemic hydrocortisone for managing acute asthma exacerbations, and it improved both clinical and spirometric parameters. TRIAL REGISTRATION: RBR-6XWC26 - Registro Brasileiro de Ensaios Clínicos (http://www.ensaiosclinicos.gov.br/rg/RBR-6xwc26/).