Reproducibility of exhaled nitric oxide measurements in overweight and obese adults

Exhaled nitric oxide is a noninvasive measure of airway inflammation that can be detected by a handheld device. Obesity may influence the reproducibility of exhaled nitric oxide measurements, by - for instance - decreased expiratory reserve volume. We analyzed triple exhaled nitric oxide measurements from 553 participants (aged 45 to 65 years with a body mass index ≥27 kg/m2) of the Netherlands Epidemiology of Obesity Study. The interclass correlation coefficient (single measurement reliability) was 0.965 (95% CI: 0.960, 0.970). We conclude that for assessment of exhaled nitric oxide in large cohorts of overweight and obese adults a single measurement suffice

Correction: Protocol of the Healthy Brain Study:An accessible resource for understanding the human brain and how it dynamically and individually operates in its bio-social context

[This corrects the article DOI: 10.1371/journal.pone.0260952.]

Pulmonary function, exhaled nitric oxide and symptoms in asthma patients with obesity: a cross-sectional study

Abstract Background Obesity is a risk factor for the development of asthma. In patients with obesity the diagnosis of asthma is often based on symptoms, but without objective measurements. Nevertheless, obesity-associated asthma is recognized as a distinct asthma phenotype. Therefore, this study explores lung function and symptoms in asthma patients with and without obesity. Methods The Netherlands Epidemiology of Obesity (NEO) study is a population-based cohort study with 6671 participants (aged 45–65 years) of whom 472 had asthma. Of this latter group, linear regression analysis was used to examine differences in lung function and symptoms between asthma patients with (n = 248) and without obesity (n = 224), and between asthma patients with and without increased FeNO. Analyses were adjusted for confounders. Results Asthma patients with obesity had lower predicted FEV1 and FVC values than patients without obesity [adjusted mean difference (MD) -3.3% predicted, 95% CI -6.5, −0.2; adjusted MD −5.0% predicted, 95% CI -7.8, −2.1]. The prevalence of symptoms was higher in patients with obesity. Asthma patients with obesity and with increased FeNO had lower FEV1 and FEV1/FVC values compared with those with low FeNO (adjusted MD −6.9% predicted, 95% CI -11.7, −2.0; −2.4%, 95% CI -4.6, −0.2). Conclusion Asthma patients with obesity had lower FEV1 and FVC values than patients without obesity. This suggests that patients with obesity have restrictive lung function changes, rather than obstructive changes. Asthma patients with obesity and increased FeNO showed more obstructive changes. FeNO might help to identify patients with eosinophilic inflammation-driven asthma, whereas patients with low FeNO might have an obesity-associated asthma phenotype in which symptoms are partly caused by the obesity

Nasal Levels of Antimicrobial Peptides in Allergic Asthma Patients and Healthy Controls: Differences and Effect of a Short 1,25(OH)₂ Vitamin D3 Treatment

<div><p>Background</p><p>Allergy is often accompanied by infections and lower levels of antimicrobial peptides (AMPs). Vitamin D has been shown to increase expression of selected AMPs. In this study we investigated whether antimicrobial peptide levels in nasal secretions of allergic asthma patients are lower than in healthy controls, and whether administration of the active form of vitamin D (1,25(OH)₂D3) affects these antimicrobial peptide levels.</p><p>Methods</p><p>The levels of antimicrobial peptides in nasal secretions were compared between 19 allergic asthma patients and 23 healthy controls. The effect of seven days daily oral treatment with 2 μg 1,25(OH)₂D3 on antimicrobial peptides in nasal secretions was assessed in a placebo-controlled cross-over clinical study.</p><p>Results</p><p>Levels of neutrophil α-defensins (human neutrophil peptides 1–3; HNP1-3) and lipocalin 2 (LCN2; also known as NGAL) were significantly lower in asthmatics, but no differences in LL-37 and SLPI were detected. Treatment with a short-term 1,25(OH)₂D3 caused a small increase in HNP1-3, but not when the asthma and control groups were analyzed separately. LL-37, LCN2 and SLPI did not change after treatment with 1,25(OH)₂D3.</p><p>Conclusion</p><p>Levels of the antimicrobial peptides HNP1-3 and LCN2 are lower in nasal secretions in asthmatics and are not substantially affected by a short-term treatment with active vitamin D.</p></div

Procalcitonin-Guided Antibiotic Prescription in Patients With COVID-19:A Multicenter Observational Cohort Study

BACKGROUND: Despite the low rate of bacterial coinfection, antibiotics are very commonly prescribed in hospitalized patients with COVID-19. RESEARCH QUESTION: Does the use of a procalcitonin (PCT)-guided antibiotic protocol safely reduce the use of antibiotics in patients with a COVID-19 infection? STUDY DESIGN AND METHODS: In this multicenter cohort, three groups of patients with COVID-19 were compared in terms of antibiotic consumption, namely one group treated based on a PCT-algorithm in one hospital (n = 216) and two control groups, consisting of patients from the same hospital (n = 57) and of patients from three similar hospitals (n = 486) without PCT measurements during the same period. The primary end point was antibiotic prescription in the first week of admission. RESULTS: Antibiotic prescription during the first 7 days was 26.8% in the PCT group, 43.9% in the non-PCT group in the same hospital, and 44.7% in the non-PCT group in other hospitals. Patients in the PCT group had lower odds of receiving antibiotics in the first 7 days of admission (OR, 0.33; 95% CI, 0.16-0.66 compared with the same hospital; OR, 0.42; 95% CI, 0.28-0.62 compared with the other hospitals). The proportion of patients receiving antibiotic prescription during the total admission was 35.2%, 43.9%, and 54.5%, respectively. The PCT group had lower odds of receiving antibiotics during the total admission only when compared with the other hospitals (OR, 0.23; 95% CI, 0.08-0.63). There were no significant differences in other secondary end points, except for readmission in the PCT group vs the other hospitals group. INTERPRETATION: PCT-guided antibiotic prescription reduces antibiotic prescription rates in hospitalized patients with COVID-19, without major safety concerns

Baseline AMPs, in nasal secretions.

<p>HNP1-3, LL-37, LCN2 and SLPI in nasal secretions from atopic asthma patients and healthy controls.</p

Effect of 1,25(OH)₂D3 treatment on levels of AMPs in nasal secretions.

<p>Change in levels of HNP1-3, LL-37, LCN2 and SLPI in nasal secretions from asthma patients and controls during placebo or 1,25(OH)₂D3 treatment. The horizontal bars represent the median AMP level before and after treatment.</p