Aleksandra Wardzyńska

Comorbidities in elderly patients with asthma: Association with control of the disease and concomitant treatment.

The incidence of concomitant conditions increases with age. In elderly patients, the presence of comorbidities has been related to the course and severity of asthma. The aim of the present study was to assess the impact of comorbidities and concomitant treatment on asthma control and severity in older adults.

Associations of allergic sensitization and clinical phenotypes with innate immune response genes polymorphisms are modified by house dust mite allergen exposure

Introduction Polymorphisms within innate immunity genes are associated with allergic phenotypes but results are variable. These associations were not analyzed with respect to allergen exposure. We investigated associations of TLR and CD14 polymorphisms with allergy phenotypes in the context of house dust mite (HDM) exposure. Material and methods Children, aged 12-16 years (n=326), were recruited from downtown and rural locations and assessed by allergist. Skin prick tests, total and HDM-specific sIgE measurements were done. HDM allergen concentrations in dust were measured. Genetic polymorphisms were identified using restriction fragment length polymorphism (RFLP). Results Allergic rhinitis, asthma and atopy were more prevalent in urban area. Although HDM allergen concentrations were higher in rural households, sIgE were present more frequently in urban children. In the whole population no association was found between HDM exposure and sensitization. In children with CD14/−159CC, CD14/−159TT and TLR9/2848GA genotypes increased exposure to HDM was associated with reduced incidence of allergic rhinitis. Significant associations of increased HDM exposure with reduced incidence of atopy were found for the whole population and subjects with CD14/−159CC, CD14/−1359GT, TLR4/896AA and TLR9/2848GA genotypes. Among children with CD14/−159CC and CD14/−1359GG significant positive correlation between HDM allergen concentrations in household and sensitization to HDM was observed. In contrast, protective effect of high HDM allergen exposure against specific sensitization was seen in subjects with TLR4/896 AG. Conclusions Development of specific sensitization and allergy may be associated with innate immune response genes polymorphisms and is modified by allergen exposure.

Clinical Trials of Aspirin Treatment After Desensitization in Aspirin-Exacerbated Respiratory Disease.

The clinical efficacy of aspirin treatment after desensitization in patients with respiratory disease exacerbated by nonsteroidal anti-inflammatory drugs has been documented in observational studies and in double-blind placebo-controlled trials. There is no general agreement with regard to the optimal maintenance dose or duration of treatment with acetylsalicylic acid after desensitization, thus further studies are necessary to offer clear guidelines to clinicians. This article summarizes data from noncontrolled, active-control, and placebo-controlled trials assessing clinical effectiveness and reporting on safety of treatment with acetylsalicylic acid in desensitized patients with respiratory disease exacerbated by nonsteroidal anti-inflammatory drugs.

Association of House Dust Allergen Concentrations With Residential Conditions in City and in Rural Houses

BackgroundThe aim of the study was to evaluate the relationship between house dust mite, cat and dog allergen levels with household characteristics in the houses of children living in urban and rural areas in central Poland.MethodsDust samples were collected from 141 urban and 191 rural houses. Der f1 + Der p1, Can f 1, and Fel d1 levels were measured and associated with residential conditions and atopy-related health outcomes assessed by clinical examination and skin prick testing.ResultsConcentrations of mite allergens were lower, and cat and dog allergen levels were higher in urban houses. Fel d1 and Can f1 levels depended on the presence of a respective animal in the house. In urban houses, Der p1 + Der f1 concentration was lower in households with central heating, whereas Can f1 concentration was related to building age. Multivariate analyses revealed that the concentrations of house dust mite and dog allergens were associated with relative humidity, number of people in the household, and the presence of a dog at home. There was no significant association between allergen level and sensitization or atopic diseases.ConclusionsConcentrations of indoor allergens in urban and rural houses differ significantly, and residential conditions associated with allergen levels seem to be different in both environments.

Periostin in Exhaled Breath Condensate and in Serum of Asthmatic Patients: Relationship to Upper and Lower Airway Disease

Purpose Periostin is considered a biomarker for eosinophilic airway inflammation and have been associated with NSAID-Exacerbated Respiratory Disease (NERD) and chronic rhinosinusitis (CRS). In this study, we aimed to evaluate periostin in exhaled breath condensate (EBC) and in serum of patients with various asthma phenotypes. Methods The study included 40 asthmatic patients (22 with NERD) and 17 healthy controls. All the procedures (questionnaire, spirometry, FeNO, nasal swabs, EBC collecting, and blood sampling) were performed on the same day. Periostin concentrations were measured using an ELISA kit. Results Periostin was detected in EBC from 37 of 40 asthmatics and in 16 from 17 of controls. The concentration of periostin in EBC did not differ between the study groups and was not associated with NERD or asthma severity. However, the EBC periostin was significantly higher in asthmatics with CRS as compared to those without (3.1 vs 2 ng/mL, P=0.046). Patients with positive bacterial culture from nasal swabs had higher EBC periostin concentrations than those without (3.2 vs 2.1 ng/mL; P=0.046). The mean serum periostin level was higher in asthmatics with a 1-year history of exacerbation than in those without (3.2 vs 2.3 ng/mL, P=0.045). Asthmatics with skin manifestation of NSAIDs hypersensitivity had higher serum periostin levels as compared to those without (3.5 vs 2.3 ng/mL; P=0.03). Conclusions EBC periostin levels seem to reflect intensity of upper airway disease in asthmatics, while serum levels of periostin are associated with asthma activity (exacerbations or FeNO) or NERD subphenotypes.

Serum but not exhaled breath condensate periostin level is increased in competitive athletes

Periostin is a matricellular protein expressed by many tissues. Its release may be enhanced, among others, through mechanical stimulation of muscles and bones as well as by cytokines of allergic inflammation.

Cytomegalovirus DNA is highly prevalent in the blood of patients with asthma and is associated with age and asthma traits

Cytomegalovirus (CMV) IgG antibodies have been associated with inflammaging and immunosenescence. We aimed to assess the presence of CMV DNA in the blood of adult and elderly patients with bronchial asthma to establish potential association of CMV DNAemia with asthma and asthma characteristics. Eighty‐five elderly asthmatics, 74 younger asthma patients, and 114 age‐matched controls were recruited. The CMV DNA was detected using commercial artus assay in 10.7% of asthma patients, but was negative in all control individuals. The secondary assay identified CMV DNA in 41.5% of asthmatics and 13.3% of control subjects (P < .001). Presence of CMV DNA was associated with an increased risk of asthma and CMV DNA copy numbers correlated with some asthma traits, including respiratory parameters and exhaled breath nitric oxide. We conclude that CMV infection is associated with asthma and may contribute to the pathogenesis of asthmatic inflammation.

Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)-a EAACI position paper

NSAID‐exacerbated respiratory disease (N‐ERD) is a chronic eosinophilic, inflammatory disorder of the respiratory tract occurring in patients with asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP), symptoms of which are exacerbated by NSAIDs, including aspirin. Despite some progress in understanding of the pathophysiology of the syndrome, which affects 1/10 of patients with asthma and rhinosinusitis, it remains a diagnostic and therapeutic challenge. In order to provide evidence‐based recommendations for the diagnosis and management of N‐ERD, a panel of international experts was called by the EAACI Asthma Section. The document summarizes current knowledge on the pathophysiology and clinical presentation of N‐ERD pointing at significant heterogeneity of this syndrome. Critically evaluating the usefulness of diagnostic tools available, the paper offers practical algorithm for the diagnosis of N‐ERD. Recommendations for the most effective management of a patient with N‐ERD stressing the potential high morbidity and severity of the underlying asthma and rhinosinusitis are discussed and proposed. Newly described sub‐phenotypes and emerging sub‐endotypes of N‐ERD are potentially relevant for new and more specific (eg, biological) treatment modalities. Finally, the document defines major gaps in our knowledge on N‐ERD and unmet needs, which should be addressed in the future.

Geroprotectors as a therapeutic strategy for COPD – where are we now?

Although current therapies in chronic obstructive pulmonary disease (COPD) improve the quality of life, they do not satisfactorily reduce disease progression or mortality. There are still many gaps in knowledge about the cellular, molecular, and genetic mechanisms contributing to pathobiology of this disease. However, increasing evidence suggests that accelerated aging, chronic systemic inflammation, and oxidative stress play major roles in pathogenesis in COPD, thus opening new opportunities in therapy. Therefore, the aim of our review was to describe and discuss some of the most widely used therapeutics that affect the root cause of aging and oxidative stress (metformin, melatonin, sirolimus, statins, vitamin D, and testosterone) in context of COPD therapy.

Risk factors associated with frequent infections in the elderly

Background Aging is associated with structural and functional changes in the immune system which may be responsible for a higher incidence of infection in the elderly. The aim of the study was to assess the prevalence of infections among elderly students of the Academy of Healthy Ageing and to establish factors associated with frequent infections. Methods The questionnaire including questions about infections, medication, comorbidities and socio-economic background was filled by 157 students (83% women and 17% men, mean age 68.2) of Academy of Healthy Ageing, one of the initiatives of the Healthy Ageing Research Centre. Univariate and multivariate logistic regression analysis was used to establish factors associated with frequent respiratory, urinary and cutaneous infections. Results At least one infections of respiratory system during last year were reported by 71% of elderly students. The mean number of infections was 3.2 per patient. Herpes simplex infection was reported by 40% of students (mean number 0.9) and 32% study participants had urinary tract infections (mean number 0.74). Frequent respiratory, urinary and cutaneous infections were reported by of 45.2%, 10.2% and 14% of students respectively. 37% of elderly were treated with antibiotics at least once during past year, and only 2% of study subjects were hospitalized due to infection. The risk factors for frequent (defined as more than 3 per year) respiratory infections in multivariate analysis were inflammatory arthritides (RA, gout) OR=1.64 (CI95% 1.01-2.67) and polytherapy (more than 5 prescription drugs) (OR=1.93 (CI95% 1.11-3.36). Multivariate analysis did not reveal the risk factors for frequent infections of urinary tract or Herpes simplex infection. In univariate analysis frequent urinary tract infections were associated with diabetes (OR=2.32 (CI95% 1.26-4.27)) and anti-diabetic treatment (OR=2.35(CI95%1.21-4.6)). Conclusions Frequent infections among elderly students of the Academy of Healthy Ageing are associated with certain comorbidities and medications used.