Nocturnal temperature controlled laminar airflow for treating atopic asthma: a randomised controlled trial

   Objective To determine whether environmental control using nocturnal temperature controlled laminar airflow (TLA) treatment could improve the quality of life of patients with persistent atopic asthma. &lt;br&gt; &lt;br&gt;Design Randomised, double-blind, placebo-controlled, parallel-group trial. &lt;br&gt; &lt;br&gt;Setting Nineteen European asthma clinics. &lt;br&gt; &lt;br&gt;Participants 312 patients aged 7-70 with inadequately controlled persistent atopic asthma. &lt;br&gt; &lt;br&gt;Main outcome measure Proportion of patients with an increase of &amp;gt;= 0.5 points in asthma quality of life score after 1 year of treatment. &lt;br&gt; &lt;br&gt;Results TLA devices were successfully installed in the bedrooms of 282 (90%) patients included in the primary efficacy analysis. There was a difference in treatment response rate between active (143 of 189, 76%) and placebo (56 of 92, 61%) groups, difference 14.8% (95% CI 3.1 to 26.5, p=0.02).(3) In patients aged &amp;gt;= 12, on whom the study was powered, the difference in response rate was similar-active 106 of 143 (74%), placebo 42 of 70 (60%), difference 14.1% (0.6 to 27.7, p=0.059). There was a difference between groups in fractional exhaled nitric oxide change of -7.1 ppb (-13.6 to -0.7, p=0.03). Active treatment was associated with less increase in cat-specific IgE than placebo. There was no difference in adverse event rates between treatment groups. &lt;br&gt; &lt;br&gt;Conclusion Inhalant exposure reduction with TLA improves quality of life, airway inflammation and systemic allergy in patients with persistent atopic asthma. TLA may be a treatment option for patients with inadequately controlled persistent atopic asthma.funding agencies|Airsonett AB||National Institute for Health Research||National Institute for Health Research Biomedical Research Centre||MRC||Asthma UK Centre in Allergic Mechanisms of Asthma||</p

Exhaled nitric oxide in schoolchildren with asthma

Background The fraction of nitric oxide in exhaled air (FENO) is believed to reflect the degree of allergic inflammation present in the lower airways. The diffusing capacity of NO in the airways (DawNO) and the concentration of this gas in the airway wall (FawNO) can be evaluated by determining FENO with different exhalation flow-rates. FENO measurements could be used for studies of the link between nasal and bronchial inflammation in children with allergic rhinitis and asthma. Aims The aims of studies I and II were to determine the optimal exhalation flow-rate for measurement of FENO, as well as the levels of DawNO and FawNO in healthy and asthmatic schoolchildren of different ages. Studies III and IV were designed to investigate the possible effects (as reflected by FENO values) of either a nasal challenge with an allergen or nasal treatment with a steroid on bronchial inflammation in allergic schoolchildren suffering from mild-to moderate asthma and rhinitis. Methods 15 schoolchildren with asthma and 15 healthy controls participated in studies I and 11; 19 asthmatic children allergic to cats and 10 healthy controls were examined in study III; and 40 children with allergies to animal dander, asthma and mild-to moderate rhinitis participated in study IV. In study III the children were challenged by inserting a cat allergen extract into their nose; while in study IV the subjects were randomly allocated to receive nasal treatment with either mometasone furoate or a placebo. FENO was measured using chemi luminescence at different exhalation flow-rates in studies I and 11 and at a standardised flow-rate of 50 ml/s in studies III and IV. In studies III and IV allergic inflammation was also assessed by measuring the percentage of eosinophils among blood leukocytes and the ECP level in nasal lavage. Results In order to achieve optimal reproducibility and maximal ability to discriminate between allergic and healthy children, together with patient comfort, the effect of varying the exhalation flowrate on measurement of FENO was tested and a standard flow-rate of 50 ml/s chosen for routine use. Elevated levels of DawNO and FawNO were observed in the asthmatic children, while a positive correlation between DawNO and the volume of the respiratory dead space was seen only in healthy children. The FENO values were correlated with the percentage of blood eosinophils in both studies III and IV. We did not observe any increase in FENO following nasal challenge with an allergen. Nor was FENO decreased by nasal treatment with steroids, even though there was a decrease in the level of ECP in nasal lavage in this treated group. Conclusions An exhalation flow-rate of 50 ml/s should be used routinely in connection with measurement of FENO during a single-breath exhalation by schoolchildren. The increased DawNO value in asthmatic children may be related to the total area of the mucosal surface releasing NO, so that allergic inflammation in the peripheral airways might be associated with an increase in this parameter. The exhaled level of NO was not influenced by nasal challenge with an allergen or nasal treatment with steroids. Thus, our present findings do not support a direct relationship between nasal and bronchial inflammation in mild-to-moderate allergic airway disease

Uncontrolled asthma predicts severe COVID-19: a report from the Swedish National Airway Register

Background: Severe asthma increases the risk of severe COVID-19 outcomes such as hospitalization and death. However, more studies are needed to understand the association between asthma and severe COVID-19. Methods: A cohort of 150,430 adult asthma patients were identified in the Swedish National Airway Register (SNAR) from 2013 to December 2020. Data on body mass index, smoking habits, lung function, and asthma control test (ACT) were obtained from SNAR, and uncontrolled asthma was defined as ACT ⩽19. Patients with severe COVID-19 were identified following hospitalization or in death certificates based on ICD-10 codes U07.1 and U07.2. The Swedish Prescribed Drug register was used to identify comorbidities and data from Statistics Sweden for educational level. Multivariate logistic regression analyses were used to estimate associations with severe COVID-19. Results: Severe COVID-19 was identified in 1067 patients (0.7%). Older age (OR = 1.04, 95% CI = 1.03–1.04), male sex (1.42, 1.25–1.61), overweight (1.56, 1.27–1.91), obesity (2.12, 1.73–2.60), high-dose inhaled corticosteroids in combination with long-acting β-agonists (1.40, 1.22–1.60), dispensed oral corticosteroids ⩾2 (1.48, 1.25–1.75), uncontrolled asthma (1.64, 1.35–2.00), cardiovascular disease (1.20, 1.03–1.40), depression (1.47, 1.28–1.68), and diabetes (1.52, 1.29–1.78) were associated with severe COVID-19, while current smoking was inversely associated (0.63, 0.47–0.85). When comparing patients who died from COVID-19 with those discharged alive from hospital until 31 December 2020, older age, male sex, and current smoking were associated with COVID-19 death. Conclusion: Patients with uncontrolled asthma and high disease burden, including increased asthma medication intensity, should be identified as risk patients for severe COVID-19. Furthermore, current smoking is strongly associated with COVID-19 death in asthma

Uncontrolled asthma predicts severe COVID-19 : a report from the Swedish National Airway Register

Background: Severe asthma increases the risk of severe COVID-19 outcomes such as hospitalization and death. However, more studies are needed to understand the association between asthma and severe COVID-19. Methods: A cohort of 150,430 adult asthma patients were identified in the Swedish National Airway Register (SNAR) from 2013 to December 2020. Data on body mass index, smoking habits, lung function, and asthma control test (ACT) were obtained from SNAR, and uncontrolled asthma was defined as ACT ⩽19. Patients with severe COVID-19 were identified following hospitalization or in death certificates based on ICD-10 codes U07.1 and U07.2. The Swedish Prescribed Drug register was used to identify comorbidities and data from Statistics Sweden for educational level. Multivariate logistic regression analyses were used to estimate associations with severe COVID-19. Results: Severe COVID-19 was identified in 1067 patients (0.7%). Older age (OR = 1.04, 95% CI = 1.03–1.04), male sex (1.42, 1.25–1.61), overweight (1.56, 1.27–1.91), obesity (2.12, 1.73–2.60), high-dose inhaled corticosteroids in combination with long-acting β-agonists (1.40, 1.22–1.60), dispensed oral corticosteroids ⩾2 (1.48, 1.25–1.75), uncontrolled asthma (1.64, 1.35–2.00), cardiovascular disease (1.20, 1.03–1.40), depression (1.47, 1.28–1.68), and diabetes (1.52, 1.29–1.78) were associated with severe COVID-19, while current smoking was inversely associated (0.63, 0.47–0.85). When comparing patients who died from COVID-19 with those discharged alive from hospital until 31 December 2020, older age, male sex, and current smoking were associated with COVID-19 death. Conclusion: Patients with uncontrolled asthma and high disease burden, including increased asthma medication intensity, should be identified as risk patients for severe COVID-19. Furthermore, current smoking is strongly associated with COVID-19 death in asthma