Evaluation of the effectiveness of Tadalafil on improving pulmonary function and asthma severity in severe asthmatic patients: a randomized controlled trial study

Phosphodiesterase inhibitors elevate the levels of cyclic adenosine monophosphate and cyclic guanosine monophosphate, which have been associated with various anti-inflammatory effects that can help alleviate asthma symptoms. This study aims to assess the impact of Tadalafil, a selective phosphodiesterase inhibitor, on pulmonary function in patients with asthma. This study was a randomized, double-blind clinical trial conducted in 2021 at Imam Khomeini Hospital in Ahvaz, Iran. The study enrolled 44 patients with severe asthma, who were divided equally into a Tadalafil group and a placebo group. The Tadalafil group received 20 mg/day of Tadalafil, while the placebo group received a placebo at the same dose. The patients' spirometry tests, asthma quality of life questionnaire, 6-minute walk distance, and quality of life were measured at the beginning of the study and one month later. The study results indicated that there was no statistically significant difference between the Tadalafil group and the placebo group in terms of pulmonary parameters (p>0.05). Furthermore, the scores for patients' quality of life (p=0.167) and the 6-minute walk test (p=0.148) at the end of the study did not show any statistically significant improvement compared to the placebo group. Results showed that the use of Tadalafil (20 mg) once daily for one month in patients with severe asthma did not affect clinical and laboratory outcomes.

Genetic association study of CTLA4 and FCεRIα polymorphisms in asthmatic patients in the southwestern region of Iran.

Asthma is a heterogeneous chronic pulmonary disease that develops due to the interaction of genetic and environmental factors. This study aimed to investigate the polymorphisms of CTLA4(SNP-318C > T, SNP + 49A > G) and FCεRIα(SNP-344T > C) genes in asthmatic patients in Southwest Iran. The study enrolled 200 patients with asthma of Arab and Bakhtiary descent and 200 healthy controls, where asthmatic patients and healthy controls were selected based on a spirometry test. Genomic DNA from whole blood samples using the TaqMan assay was used to study the genotypes of patients and healthy controls.The results indicated no statistically significant difference between cases and controls for the SNP-344C > T of the FCεR1α gene and the SNP + 49A > G, SNP-318C > T of the CTLA4 gene. There was a significant correlation between the CTLA4-318C > T allele frequency in both the case and control groups (OR = 1.83; 95%CI, 1.14-2.94; P = 0.01). We stratified genotypes according to age, gender, ethnicity, and smoking status and discovered a significant suggestive association between the SNP + 49A > G of the CTLA4 gene and smoking. Additionally, SNP + 49A > G was found to be associated with gender and age. The results indicated that the SNP-318C > T polymorphism in the CTLA4 gene might contribute to the development of asthma in the studied population. Meanwhile, smoking can exacerbate asthma in individuals with SNP + 49A > G of the CTLA4 gene.Supplemental data for this article is available online at https://doi.org/10.1080/15257770.2021.1964525 .

Investigating the effect of sildenafil on improving lung function and quality of life in the patients with severe asthma.

INTRODUCTION: Phosphodiesterase inhibitors (PDEs) increase intracellular cyclic adenosine monophosphate, which results in a wide range of anti-inflammatory effects and pathologically leads to improve asthma disease. Because no human study has surveyed the effect of PDEs on pulmonary function, except some case reports and animal researches, we decided to perform a pilot study for evaluating the effect of sildenafil (PDE5) on pulmonary function in patients with severe asthma. METHODS: This randomized controlled trials study was conducted on 20 patients with severe asthma in 2019 in Iran. For case group, was prescribed sildenafil (50 mg) daily and the control group received the placebo. In the beginning of the study and one month later, volume parameters, 6-minute walk distance (6MWD), and the quality-of-life questionnaire were measured and compared in the two groups. RESULTS: Twenty patients were entered into this study. 8 patients (40%) were male and 12 (60%) were female. The results showed that mean forced vital capacity 1 in the sildenafil group turned from 1259 ± 170 to 1603 ± 527, while in the placebo group it changed from 1135 ± 125 to 1365 ± 251 (P-value = 0.215). There is no statistically significant difference between two groups. In addition, in comparison with placebo, sildenafil did not show any significant improvement in the volume parameters, the quality-of-life questionnaire scale, and 6MWD at the end of the study. CONCLUSION: According to present result can be concluded that sildenafil does not improve the severity of asthma and the quality of life in patients with severe asthma.

Forced Expiratory Flow at 25-75% as a Marker for Airway Hyper Responsiveness in Adult Patients with Asthma-like Symptoms.

BACKGROUND: The aim of the present study was threefold: to assess the association between baseline FEF25-75 and Airway Hyper-responsiveness (AHR), to specify whether a decrease in FEF25-75 may reflect severe hyper-responsiveness, and finally to confirm a FEF 25-75 cut-off value. MATERIALS AND METHODS: In a cross sectional study in Imam Khomeini Hospital, Ahvaz, patients suffering from respiratory symptoms due the 2013 autumn rainfall with normal FEV1 and FEV1/FVC were evaluated by methacholine challenge test. Those with PD20<1000, 10002000 µg were classified as severe, moderate and mild AHR, respectively. Data were analyzed using Chi-square, Independent t-test, One-way ANOVA and Receiver Operating Characteristic (ROC) curve. RESULTS: Among the 234 patients, mean baseline FEF25-75 was 84.2±22.7% for 54 patients having a negative bronchial provocation test result and 70.9±19.2% for 179 patients with a positive bronchial provocation test result (P < 0.0001). No change was observed in the median PD20 among patients with a higher baseline FEF25-75. ROC analysis showed that FEF25-75 could potentially be a predictor of AHR, but it could not confirm the cut-off value of FEF25-75 for these patients. CONCLUSION: When asthma begins, AHR could be predicted by impaired FEF25-75 with normal FEV1 and FEV1/FVC. However, we could not determine a cut-off value, and no association was found between a greater impairment of FEF25-75 and a more severe AHR.

The effect of the training program on the quality of life in patients with asthma based on the Precede model in Ahvaz, Iran.

AIM: The aim of the study was to determine the effect of the training program based on the Precede model and its main components on improving the quality of life in patients with asthma. MATERIAL AND METHODS: It was a randomized quasi-experimental study done on 120 patients with asthma who were referred to the Imam Khomeini hospital in Ahvaz who were selected using the convenience sampling method and were randomly divided into intervention and control groups. The data collection tool consisted of two questionnaires. The first questionnaire evaluated the quality of life in patients with asthma and the other one was developed by the researcher based on the structures of the Precede model. Training intervention was conducted during four sessions twice a week and each session was carried out for an hour based on the structures of the Precede model. In order to achieve the results, SPSS software, even t-test, and χ2 were used. RESULTS: The results showed that after the training intervention in the experimental group, the mean scores of predisposing factors (p < 0.001), enabling factors, reinforcing factors and behavioral factors were significantly increased (p < 0.001) as compared to the control group. A significant difference was observed in the mean scores of quality of life in two groups after the intervention (p < 0.001), and the quality of life of patients in the experimental group was improved after the training intervention. CONCLUSIONS: The design and implementation of the training program based on the Precede model can have a positive effect on the improvement of quality of life in patients with asthma.