Prevalence of allergic rhinitis and its associated morbidity in adults with asthma: A multicentre study

Objectives To assess the prevalence of allergic rhinitis in adult patients with asthma in Hong Kong, and to compare the morbidity endured by asthma patients with and without allergic rhinitis. Design Cross-sectional study. Setting Respiratory clinics of four major public hospitals in Hong Kong. Patients A total of 600 adults with asthma were recruited from March to May 2007. Main outcome measures Doctors and patients completed separate questionnaires evaluating symptoms, treatment, and health care utilisation. Spirometry data were obtained for a subgroup of patients at the time of survey completion. Results The patients consisted of 267 males and 333 females, with 251 having spirometry data. The mean pre-bronchodilator 1-second forced expiratory volume predicted among those who had spirometry performed was 88% (standard deviation, 28%). In all, 50% of the patients had intermittent and 50% had persistent asthma. Over three quarters (463/600; 77%) of patients had experienced allergic rhinitis symptoms in the past 12 months, of whom 96% had a previous diagnosis of allergic rhinitis. Asthmatics without allergic rhinitis symptoms had higher rates of visits to doctors, pharmacy visits, emergency department attendances, and hospitalisations for asthma than those with both conditions. Among subjects with asthma and allergic rhinitis, those taking nasal steroid (226/463; 49%) had lower rates of emergency department visits (13 vs 25%, P=0.002) and hospitalisations (7 vs 13%, P=0.045) for asthma than those who were not. Conclusion Allergic rhinitis is a common co-morbid condition of asthma in this hospital clinic cohort. Treatment of allergic rhinitis with intra-nasal steroid was associated with less health care utilisation for asthma.published_or_final_versio

Elevated plasma adiponectin levels in patients with chronic obstructive pulmonary disease

BACKGROUND: Adiponectin is an anti-inflammatory adipokine that may play a role in chronic obstructive pulmonary disease (COPD) pathogenesis. OBJECTIVE: To investigate the relationship between adiponectin, interleukin (IL) 6, IL-8 and C-reactive protein (CRP) and COPD by evaluating these biomarkers in ever-smokers with or without the disease. METHOD: Plasma levels of adiponectin, IL-6, IL-8 and CRP were measured using commercially available kits in COPD patients (n = 71), healthy ever-smokers (n = 62) and non-smokers (n = 51). RESULTS: There were significant increases in plasma adiponectin, IL-6 and CRP in COPD patients (median [IQR] 4.39 μg/ml [2.68-6.98], 4.19 pg/ml [<2.40-6.40], 8.75 mg/l [4.26-40.63], respectively) compared to healthy ever-smokers (1.90 μg/ml [0.86-2.86], <2.40 pg/ml [<2.40-2.77], 3.71 mg/l [1.97-10.37 mg/l], respectively, P < 0.001) and non-smokers (1.76 μg/ml [1.34-2.52], <2.40 pg/ml [<2.40-2.78], 3.12 mg/l [2.11-5.71], respectively, P < 0.001). COPD patients had lower plasma IL-8 levels than healthy ever-smokers. Among ever-smokers with or without COPD, plasma adiponectin, IL-6 and CRP levels were inversely correlated with forced expiratory volume in 1 second (% predicted) after adjustment for age, body mass index, smoking status and pack-years. CONCLUSION: Our findings suggest that in COPD patients, adiponectin might be associated with COPD pathogenesis. © 2010 The Union.postprin

‘High risk’ clinical and inflammatory clusters in COPD of Chinese descent

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordIntroduction COPD is a heterogeneous disease demonstrating inter-individual variation. A high COPD prevalence in Chinese populations is described but little is known about disease clusters and prognostic outcomes in the Chinese population across South-East Asia. We aim to determine if clusters of Chinese patients with COPD exist and their association with systemic inflammation and clinical outcomes. Methods Chinese patients with stable COPD were prospectively recruited into two cohorts (derivation and validation) from six hospitals across three South-East Asian countries (Singapore, Malaysia and Hong Kong; n=1,480). Each patient was followed over two-years. Clinical data (including co-morbidities) were employed in unsupervised hierarchical clustering (followed by validation) to determine the existence of patient clusters and their prognostic outcome. Accompanying systemic cytokine assessments were performed in a subset (n=336) of COPD patients to determine if inflammatory patterns and associated networks characterised the derived clusters. Results Five patient clusters were identified including (1) Ex-tuberculosis (2) Diabetic (3) Low co-morbidity: low-risk (4) Low co-morbidity: high-risk and (5) cardiovascular. The ‘cardiovascular’ and ‘ex-tuberculosis’ clusters demonstrate highest mortality (independent of GOLD assessment) and illustrate diverse cytokine patterns with complex inflammatory networks. Conclusions We describe novel ‘clusters’ of Chinese COPD patients, two of which represent ‘high-risk’ clusters. The ‘cardiovascular’ and ‘ex-tuberculosis’ patient clusters exhibit high mortality, significant inflammation and complex cytokine networks. Clinical and inflammatory risk stratification of Chinese patients with COPD should be considered for targeted intervention to improve disease outcomes.Singapore Ministry of Health - National Medical Research CouncilSingapore Ministry of EducationNanyang Technological University, SingaporeEngineering and Physical Sciences Research Council (EPSRC

A milti-centre study of the prevalence of allergic rhinitis and its associated morbidity among adults with asthma

Poster Abstracts: no. PD 10-20BACKGROUND/PURPOSE: Allergic rhinitis (AR) is a common co-morbid condition of asthma. This study aimed to assess the prevalence of AR in adult patients with asthma in Hong Kong. In addition, the morbidity of patients with asthma and concomitant AR was compared against asthma patients without AR. METHODS: A cross-sectional study of 600 adults with asthma recruited from the respiratory clinics of four major public hospitals. Doctors and patients completed separate questionnaires evaluating symptoms, treatment and health care utilization. Spirometry data were obtained for a subgroup of patients at the time of survey completion. RESULTS: Altogether 267 males and 333 females were recruited; 251 with spirometry data. The mean pre-bronchodilator FEV1 % predicted among those who had spirometry performed was 87.9 (SD28.1) %. Of the 600 subjects, 49.5 and 50.5% had intermittent and persistent asthma respectively, while 463 (77.2%) had AR symptoms in the past 12 months, vast majority (96%) of whom had a previous diagnosis of AR. Asthmatics without AR symptoms had higher rates of visits to doctors, pharmacy visits, emergency department attendances and hospitalizations for asthma than those with asthma and AR. Among subjects with asthma and AR, those taking nasal steroid (226 out of 463 subjects [48.8%]) had lower rates of emergency department visits (13.3 vs 24.5%, p = 0.002) and hospitalizations (7.1 vs 12.7%, p = 0.045) for asthma than those who were not. CONCLUSIONS: AR is a common co-morbid condition of asthma in this hospital clinic cohort with 77.2% of the asthma subjects having AR symptoms in the past 12 months

Year in review 2016: Chronic obstructive pulmonary disease and asthma

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Polymorphisms in manganese superoxide dismutase and catalase genes: Functional study in Hong Kong Chinese asthma patients

Background: Reactive oxygen species may contribute to the pathogenesis of asthma. Functional genetic polymorphisms of antioxidant enzymes, superoxide dismutase (SOD) and catalase are good candidates for asthma susceptibility. Objective: To investigate the association of the manganese-containing form of SOD (MnSOD) gene at amino acid position 16 (Val16Ala) and catalase gene in the promoter at A-21T and C-262T polymorphisms and asthma in a Hong Kong Chinese population. Methods: The association study was conducted in a case-control design in asthma patients (n=251) and healthy controls (n=316) by genotyping. The functional significance was assessed by determining erythrocyte SOD and catalase activity. Results: The Val allele of MnSOD at Val16Ala and the A allele of catalase gene at A-21T were not different between patients and controls, while the C allele of catalase gene at C-262T was found to be significantly different between patients and controls (P=0.033). The less frequent variant of catalase gene (-262T) was found to be protective from the development of asthma in a Hong Kong Chinese non-smoking population (adjusted odds ratio=0.35, 0.15-0.85; P=0.017). Asthma patients had elevated erythrocyte SOD and catalase activities in comparison with healthy controls (P<0.01). However, their activities were not associated with different genotypes within healthy controls or asthma patients. Conclusion: This is the first report showing that SOD and catalase functional activities are not associated with their respective genetic polymorphisms but related to the presence of asthma in a Hong Kong Chinese population. © 2006 Blackwell Publishing Ltd.link_to_subscribed_fulltex