Alpine altitude climate treatment for severe and uncontrolled asthma: An EAACI position paper

Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro-immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways. Keywords: altitude; asthma; climate; environment; pulmonary rehabilitation

Leukocyte redistribution as immunological biomarker of corticosteroid resistance in severe asthma

Background: Earlier studies have suggested that the leukocyte redistribution can be considered as an immunological marker of the clinical response to corticosteroids (CS), representing an easy measurable potential biomarker in severe asthma. Objective: The aim of this study was to determinate the utility of the leukocyte redistribution as a biomarker of disease heterogeneity in patients with severe asthma and as a bioindicator of potential CS resistance. Methods: We developed an unbiased clustering approach based on the clinical data and the flow cytometry results of peripheral blood leukocyte phenotypes of 142 patients with severe asthma before and after systemic CS administration. Results: Based on the differences in the blood count eosinophils, neutrophils and lymphocytes, together with the flow cytometry measurements of basic T cell, B cell and NK cell subpopulations before and after systemic CS administration, we identified two severe asthma clusters, which differed in the cell frequencies, response to CS and atopy status. Patients in cluster 1 had higher frequency of blood eosinophils at baseline, were sensitized to less allergens and had better steroid responsiveness, measured as the pronounced leukocyte redistribution after the administration of systemic CS. Patients in cluster 2 were determined by the higher frequency of B-cells and stronger IgE sensitization status to the multiple allergens. They also displayed higher steroid resistance, as the clinical correlate for the lower leukocyte redistribution after administration of systemic CS. Conclusion: The flow cytometry-based profiling of the basic populations of immune cells in the blood and its analysis before and after systemic corticosteroid administration could improve personalized treatment approaches in patients with severe asthma. Keywords: asthma phenotypes; biological therapy; corticosteroids resistance; leukocyte redistribution; severe asthma; treatment asthm

Alpine altitude climate treatment for severe and uncontrolled asthma: an EAACI position paper

Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro-immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways

Precomposteo de residuos orgánicos y su efecto en la dinámica poblacional de Einsenia foetida

Composting and vermicomposting are processes used to transform organic solid residues into fertilizers (compost and vermicompost, respectively). The physical, chemical and biological properties of vermicompost result in improvement of soil fertility and growth of plants. However, both, throughout the process, release toxic substances to the environment. The vermicomposting process tends to result in higher levels of plant availability of most nutrients, as compared with a process of conventional composting. The substrate used to feed the worms must undergo a prior period of precomposting, which involves more time and cost of inputs, which increases the cost of vermicompost obtained, so it is necessary to establish minimum composting time as well as strategies to reduce this period, so that the organic residues can be used as a substrate in the production of the earthworm Eisenia spp. A precomposting process from 0 to 8 weeks, before the vermicomposting process, was evaluated. It was concluded that the conditions under which the experiment took place allowed the development of the worms in all periods of precomposting. Vermicomposting in layers significantly reduces the processing time to achieve complete decomposition of organic residues. For the presence of cocoons and juvenile forms, precomposting is not necessary. Overall, precomposting from 0 to 2 weeks promotes reproduction and precomposting from 3 to 7 weeks promotes individual growth of earthworms. The best treatment was precomposting of 2 weeks, because it facilitates reproduction and average weight gain of the worm. Precomposting is not necessary when vermicomposting piles are less than 50 cm in height, producing vermicompost in 30 days.El compostaje y el vermicompostaje son técnicas que se utilizan para transformar los residuos sólidos orgánicos en abonos orgánicos (composta y vermicomposta, respectivamente) cuyas características físicas, químicas y biológicas inciden directamente en el mejoramiento del suelo y en el crecimiento de las plantas; sin embargo, durante el proceso, se liberan desechos que agreden al ambiente. El sustrato utilizado para alimentar a las lombrices debe pasar por un periodo previo de compostaje, conocido como precompostaje. El vermicompostaje produce un material en el que la mayoría de los nutrimentos se encuentran en mayor disponibilidad para la planta, comparados con el material resultante de un proceso de compostaje convencional. El pre- compostaje involucra un mayor tiempo y gasto de insumos, lo que puede incrementar el costo de la vermicomposta, por lo que es necesario establecer el tiempo necesario de precompostaje para que los residuos orgánicos puedan emplear- se como sustrato en la producción de la lombriz Eisenia spp. Para la obtención de vermicomposta, los residuos se sometieron a un proceso de precompostaje de 0 a 8 semanas antes del proceso de vermicompostaje. Se concluyó que las condiciones en las que se desarrolló el experimento permitieron el desarrollo de las lombrices en todos los periodos de precompostaje. El ver- micompostaje en capas reduce significativamente el tiempo del proceso para lograr la completa descomposición de los residuos orgánicos. Para la presencia de cocones y juveniles no es necesario el precomposteo. En general el precomposteo de 0 a 2 semanas favorece la reproducción y el de 3 a 7 semanas favorece el crecimiento individual de las lombrices. El mejor tratamiento fue el precomposteo de 2 semanas, debido a que favorece la reproducción y el aumento del peso promedio de la lombriz. El precompostaje no es necesario cuando las pilas de vermicomposteo tienen menos de 50 cm de altura, al producir vermicomposta en 30 días

Precomposteo de residuos orgánicos y su efecto en la dinámica poblacional de "Einsenia foetida"

Composting and vermicomposting are processes used to transform organic solid residues into fertilizers (compost and vermicompost, respectively). The physical, chemical and biological properties of vermicompost result in improvement of soil fertility and growth of plants. However, both, throughout the process, release toxic substances to the environment. The vermicomposting process tends to result in higher levels of plant availability of most nutrients, as compared with a process of conventional composting. The substrate used to feed the worms must undergo a prior period of precomposting, which involves more time and cost of inputs, which increases the cost of vermicompost obtained, so it is necessary to establish minimum composting time as well as strategies to reduce this period, so that the organic residues can be used as a substrate in the production of the earthworm Eisenia spp. A precomposting process from 0 to 8 weeks, before the vermicomposting process, was evaluated. It was concluded that the conditions under which the experiment took place allowed the development of the worms in all periods of precomposting. Vermicomposting in layers significantly reduces the processing time to achieve complete decomposition of organic residues. For the presence of cocoons and juvenile forms, precomposting is not necessary. Overall, precomposting from 0 to 2 weeks promotes reproduction and precomposting from 3 to 7 weeks promotes individual growth of earthworms. The best treatment was precomposting of 2 weeks, because it facilitates reproduction and average weight gain of the worm. Precomposting is not necessary when vermicomposting piles are less than 50 cm in height, producing vermicompost in 30 days.El compostaje y el vermicompostaje son técnicas que se utilizan para transformar los residuos sólidos orgánicos en abonos orgánicos (composta y vermicomposta, respectivamente) cuyas características físicas, químicas y biológicas inciden directamente en el mejoramiento del suelo y en el crecimiento de las plantas; sin embargo, durante el proceso, se liberan desechos que agreden al ambiente. El sustrato utilizado para alimentar a las lombrices debe pasar por un periodo previo de compostaje, conocido como precompostaje. El vermicompostaje produce un material en el que la mayoría de los nutrimentos se encuentran en mayor disponibilidad para la planta, comparados con el material resultante de un proceso de compostaje convencional. El precompostaje involucra un mayor tiempo y gasto de insumos, lo que puede incrementar el costo de la vermicomposta, por lo que es necesario establecer el tiempo necesario de precompostaje para que los residuos orgánicos puedan emplearse como sustrato en la producción de la lombriz Eisenia spp. Para la obtención de vermicomposta, los residuos se sometieron a un proceso de precompostaje de 0 a 8 semanas antes del proceso de vermicompostaje. Se concluyó que las condiciones en las que se desarrolló el experimento permitieron el desarrollo de las lombrices en todos los periodos de precompostaje. El vermicompostaje en capas reduce significativamente el tiempo del proceso para lograr la completa descomposición de los residuos orgánicos. Para la presencia de cocones y juveniles no es necesario el precomposteo. En general el precomposteo de 0 a 2 semanas favorece la reproducción y el de 3 a 7 semanas favorece el crecimiento individual de las lombrices. El mejor tratamiento fue el precomposteo de 2 semanas, debido a que favorece la reproducción y el aumento del peso promedio de la lombriz. El precompostaje no es necesario cuando las pilas de vermicomposteo tienen menos de 50 cm de altura, al producir vermicomposta en 30 días