Bassam Mahboub

Vitamin D deficiency and severe asthma.

Vitamin D has received tremendous amount of attention recently due to the ever-increasing reports of association between vitamin D deficiency and a wide range of conditions, from cancer to fertility to longevity. The fascination of disease association with vitamin D deficiency comes from the relatively easy solution to overcome such a risk factor, that is, either by increase in sun exposure and/or diet supplementation. Many reviews have been written on a protective role of vitamin D in asthma and related morbidities; here, we will summarize the epidemiological evidence supporting a role of vitamin D against hallmark features of severe asthma, such as airway remodeling and asthma exacerbations. Furthermore, we discuss data from in vitro and in vivo studies which provide insights on the potential mechanisms of how vitamin D may protect against severe asthma pathogenesis and how vitamin D deficiency may lead to the development of severe asthma. Approximately 5-15% of asthmatic individuals suffer from the more severe forms of disease in spite of aggressive therapies and they are more likely to have irreversible airflow obstruction associated with airway remodeling. At present drugs commonly used to control asthma symptoms, such as corticosteroids, do not significantly reverse or reduce remodeling in the airways. Hence, if vitamin D plays a protective role against the development of severe asthma, then the most effective therapy may simply be a healthy dose of sunshine.

Respiratory disorders in the Middle East: A review

The spectrum of pulmonary pathology in the Middle East is as versatile as its civilizations and cultures. In this review, we outline the key challenges confronting pulmonologists in the Middle East. We shed light on the diverse conditions commonly encountered in the region, from the centuries‐old illnesses of tuberculosis, to contemporary problems such as lung complications from chemical warfare. We specifically highlighted unique aspects related to respiratory illnesses in the Middle East, for example, climate factors in the desert region, cultural habits, for example, water‐pipe smoking and disorders unique to the region, such as Behçets disease. Pulmonologists are also faced with the consequences of modernization, including large immigrant population and associated social and health issues, rising incidence of obesity and sleep apnoea, and drug‐resistant tuberculosis. Tackling these health issues will require an integrated approach involving public health, primary care as well as specialist pulmonology input, taking into consideration the unique cultural and environmental factors to ensure effective management and compliance to medical care.

Population prevalence of asthma and its determinants based on European Community Respiratory Health Survey in the United Arab Emirates

BackgroundNo population study has explored the population distribution of adult asthma in the United Arab Emirates (UAE). The objective is to estimate asthma prevalence in general population in UAE.MethodsUsing standard European Community Respiratory Health Survey (ECRHS) questionnaires and tools, this is a cross-sectional assessment of a random sample of the population in established quotas of the seven Emirates in the UAE. We surveyed 1,220 participants, of which 63.2% were male, and 20.1% were UAE Nationals, with a mean (SD) age of 32.9 (14.1) years.ResultsPrevalence of individual respiratory symptoms from the ECRHS screening questionnaire in all participants were generally ranging 8 - 10%, while participants 20-44 years presented lower prevalence in all symptoms (p < 0.05). The expected male:female ratio of reported wheezing and asthma attacks and its treatment by age was not observed. Participating women reported more individual symptoms than men. Overall, there were 15.4% (95% C.I. 13.5 - 17.5) participants who fulfilled our screening criteria for asthma, while for consistency with ECRHS, there were 12.1% (95% C.I. 10.4 - 14.1) participants who fulfilled the ECRHS asthma definition, being 9.8% (95% C.I. 7.8 - 12.2) of those 20-44 years, that is 8.6% of male and 11.8% of female young adults participating.ConclusionWe conclude that asthma is common in the UAE, and gender differences are not observed in reported asthma symptoms in young adults. This being the first population based study exploring the prevalence of asthma and its determinants in the United Arab Emirates based on the ECRHS.

Eosinophils Induce Airway Smooth Muscle Cell Proliferation

Asthma is characterized by eosinophilic airway inflammation and remodeling of the airway wall. Features of airway remodeling include increased airway smooth muscle (ASM) mass. However, little is known about the interaction between inflammatory eosinophils and ASM cells. In this study, we investigated the effect of eosinophils on ASM cell proliferation. Eosinophils were isolated from peripheral blood of mild asthmatics and non-asthmatic subjects and co-cultured with human primary ASM cells. ASM proliferation was estimated using Ki-67 expression assay. The expression of extracellular matrix (ECM) mRNA in ASM cells was measured using quantitative real-time PCR. The role of eosinophil derived Cysteinyl Leukotrienes (CysLTs) in enhancing ASM proliferation was estimated by measuring the release of leukotrienes from eosinophils upon their direct contact with ASM cells using ELISA. This role was confirmed either by blocking eosinophil-ASM contact or co-culturing them in the presence of leukotrienes antagonist. ASM cells co-cultured with eosinophils, isolated from asthmatics, but not non-asthmatics, had a significantly higher rate of proliferation compared to controls. This increase in ASM proliferation was independent of their release of ECM proteins but dependent upon eosinophils release of CysLTs. Eosinophil-ASM cell to cell contact was required for CysLTs release. Preventing eosinophil contact with ASM cells using anti-adhesion molecules antibodies, or blocking the activity of eosinophil derived CysLTs using montelukast inhibited ASM proliferation. Our results indicated that eosinophils contribute to airway remodeling during asthma by enhancing ASM cell proliferation and hence increasing ASM mass. Direct contact of eosinophils with ASM cells triggers their release of CysLTs which enhance ASM proliferation. Eosinophils, and their binding to ASM cells, constitute a potential therapeutic target to interfere with the series of biological events leading to airway remodeling and Asthma.

Asthma insights and reality in the United Arab Emirates

BACKGROUND: The burden of asthma in the United Arab Emirates (UAE) and the extent to which guidelines are being followed for optimum asthma control are largely unknown. This survey assessed the current level of asthma control, the burden of the disease, and adherence to asthma guidelines by patients. METHODS: A face-to-face interview of 200 asthmatics in the UAE was conducted. In addition to the questionnaire administered by expert interviewers, each respondent self-completed an Asthma Control Test. The sample was stratified by region within the country and sampled proportionately. RESULTS: Sudden severe attacks of asthma were reported by 64% in the past year. Day time symptoms and night time symptoms were reported by 57.5% and 35.5%, respectively, in the past 4 weeks. Overall, 52.8% of the children and 17.1% of the adults missed school and work in the past year, respectively. The percentage of asthmatics that had emergency room visits within the past year was 27.5%, and 4% were hospitalized. Only 5.5% used inhaled corticosteroids in the past year and 47.5% were on short-acting beta-2 agonists. Only 17.8% ever owned a peak flow meter and only 30% ever had a lung function test. Only 17% had scheduled follow-up and 66% were followed-up by general practitioners. CONCLUSION: This survey shows that the current level of asthma control in the UAE is far from optimal. Therefore, it is necessary to increase the awareness among patients and update doctors about asthma control guidelines for attaining optimal asthma control, and thus reducing the burden of the disease.

Prevalence of symptoms and risk of sleep apnea in Dubai, UAE

Purpose The United Arab Emirates (UAE) ranks 18th on the 2007 Forbes list of fattest countries with 68.3% of its citizens with an unhealthy weight and it is well known that weight gain and obesity are important determinants in the progression of obstructive sleep apnea syndrome (OSAS). The purpose of this study is to estimate the prevalence of symptoms and risk of OSAS in the primary health care setting in Dubai, and the relationship between obesity and sleep apnea. Methods In this prospective survey, a trained medical nurse administered the Berlin Questionnaire to a consecutive random sample of patients in the age group older than 14 years, who attended the primary health care center in Dubai Health Authority, Dubai, UAE, from September 2011 to March 2012. Based on the questionnaire answers, individuals were classified into high risk and low risk groups for OSAS. Results Based on the responses and measurement of the Berlin Questionnaire of 1214 subjects studied, 58% (n = 704) of the respondents were female, while 42% (n = 510) were male. Two-hundred-fifty-four respondents met the criteria for the high risk scoring. This gives a prevalence rate of 20.9% (out of which 22.9% of the male respondents were high risk for OSAS, while 19.5% of the females were high risk for OSAS), while the remainder of the participants were classified as low risk. The overall mean age of the high risk for OSAS female respondents was 39.95 years (standard deviation [SD] 11.73 years) and was 41.18 years (SD 14.95 years) for male respondents The highest prevalence was observed between age 51 to 60 in both genders. Seventy percent of the high risk group had a body mass index (BMI) ≥ 30 kg/m2 and nearly 75% of the low risk group had a BMI < 30 kg/m2, and the mean BMI was 32.06 kg/m2 (SD 5.67 kg/m2) for males and 33.59 kg/m2 (SD 6.44 kg/m2) for females. Conclusion In the primary health care setting, the prevalence of symptoms of OSAS among adult UAE citizens is very high, and UAE patients are at risk for OSAS and may benefit from proper evaluation for OSAS.

Prevalence and triggers of allergic rhinitis in the United Arab Emirates

Background and objectivesAllergic rhinitis is a morbid condition that is frequently overlooked by patients and physicians. This type of atopy has not been adequately investigated in the United Arab Emirates.MethodsThis cross-sectional, population-based observational study was conducted in the seven Emirates (Abu Dhabi, Dubai, Sharjah, Ajman, Umm Al-Quwain, Ras Al-Khaimah, and Fujairah). It used the European Community Respiratory Health Survey (ECRHS II) to screen for allergic rhinitis in people living in this region.ResultsSymptoms of allergic rhinitis were present in 85 (7%) of the 1,229 study population. Only 33 (39%) patients received treatment. Seventy-six (89%) patients had asthma. Thirty-seven (44%) patients were poly-sensitized. Symptoms were aggravated by dust (59%), grass/pollens (44%) and proximity to animals (21%). Winter was the peak season (37%), followed by spring (30%), autumn (18%) and summer (15%). Grass/pollen allergies were clustered in the winter, spring and summer (p ≤ 0.001). Dust was non-seasonal (p ≥ 0.121) and animal allergy was worse in the winter (p = 0.024) and spring (p = 0.044). Spring symptoms were less common in people living in the inner city (p = 0.003).ConclusionsAt least 7% of the studied population had allergic rhinitis. Most (71%) of these patients had environmental triggers and remained untreated. Allergic rhinitis awareness and measures to control allergens and dust are needed. The impact of preventing allergic rhinitis on other common atopies in the region deserves future studies.

Cost of Asthma in Dubai, United Arab Emirates (UAE)

Background and Objectives: Asthma is one of the chronic respiratory diseases affecting both genders and all ages across the globe. The treatment and control of asthma imposes significant economic burden on patients as well as the healthcare system. Patients also report absenteeism from school/work and poor quality of life. There are very few studies evaluating the cost of asthma in UAE. The objective of this study is to evaluate the cost of asthma in Dubai region of United Arab Emirates. Material and Methods: Asthma prevalence and unit cost estimates were applied to the population of Dubai aged 5 years and above, based on the figures from the Dubai Statistic Center 2009 census. The asthma treatment profiles of the patients in Dubai as well as the days absent from school/work and quality of life data were obtained from the Asthma Insights and Reality for the Gulf and Near East (AIRGNE) study. The cost of drugs was procured from the purchase department of Dubai Health Authority (DHA) and cost of out-patient visits as well as hospital stay and emergency visits was also provided by the DHA. The cost of asthma in this study is the direct cost of drugs, hospital stay and visits as out-patient and ER visits, along with supplementary costs in terms of days lost from work or school. Results: The total direct cost of asthma in Dubai was about 88 million Dirhams (AED 87,917,202). The maximum contribution to this was from expenditure on out-patient visits (37% - AED 32,217,143), followed by that on hospital stays (23% - AED 23,587,008). The cost on medication and ER visits represented 20% and 16% of the direct cost respectively. Absenteeism from school was reported by 50% of asthmatic children, asthmatics also reported an average loss of 4 days of work per year due to asthma. Conclusion: There is a huge economic burden on the patients and healthcare services due to asthma. Taking into account the considerable expenditure on the out-patient visits, ER visits and hospital stay, efforts must be directed towards improved asthma control and patient education about their disease.

Environmental Exposure and Nonadherence with Medicines Directly Correlate with Exacerbations and Hospitalization for Asthma: A Population-Based Survey from UAE

Acute severe exacerbation of asthma is directly related with the uncontrolled asthma including noncompliance with the medicines and exposure to the environmental factors. To our knowledge, none of the community-based study has explored the prevalence of asthma and other factors (namely, pattern of symptoms, environmental/occupational/housing/behavioral pattern/misperception about asthma, and educational factors) contributing to the exacerbation of asthma. We also studied the nonadherence issues related to the management of asthma in the United Arab Emirates (UAE). By using European Community Respiratory Health Survey (ECRHS) questionnaires and pooled data from AIRGNE (UAE) study, we aimed to determine the above-mentioned factors in the general population by means of a cross-sectional assessment of a random sample of 1,229 participants of which 62.97% were male and 20.01% were UAE nationals, with a mean age (±SD) of 32.9 (±14.1) years. Prevalence of individual respiratory symptoms from the ECRHS questionnaire in all participants ranged from 8 to 10%, while those participants aged 20–44 years presented a lower prevalence in all symptoms (𝑃<0.05). Conclusion. Certain specific persistent environmental factor along with nonadherence to the controller medicines is a significant factor leading to uncontrolled asthma with consequent exacerbations, morbidity/mortality, and health care cost in UAE.

Prevalence of Vitamin D Deficiency in Obstructive Sleep Apnea Disorderin Dubai, UAE

Purpose: Sleep disorders have become epidemic throughout the worldwide, at the same time due to Multiple social changes, the same thing can be said for the vitamin D deficiency disorders, including the use of air conditioning and sunscreen, have produced a world-wide epidemic of vitamin D deficiency, then taking in consideration the proposed concept that since vitamin D plays an important role in the brainstem control of sleep, which is supported by the presence of vitamin D receptors in same areas are considered to play a role in the initiation and maintenance of sleep, this relation may not be strong as causative association but presence of either may have worsening effect on the other. Methods: The aim of our study was to investigate the prevalence of between serum 25-hydroxy [25 (OH)] vitamin D levels and severity of disease in patients with OSAS, among the cosmopolitan (multi-national) population of Dubai, United Arab Emirates. Two hundred and sixty nine (269) patients were included in the study, all who were referred to the sleep clinic at Rashid hospital – Dubai health Authority, during the period of three years from 2012 to 2014. Serum 1-25 Di Hydroxy Chole Caciferaol (vitamin D), were evaluated. Results: Among the 148 patients who had OSA; those who were vitamin D deficient represent 16.1% of the Mild OSA group, 7.3% of the moderate OSA group and 7.9% of the Severe OSA group, while at the same time those who were vitamin D insufficient represent 29% of the Mild OSA group, 39% of the moderate OSA group and 31.6% of the Severe OSA group. Conclusions: When the severity of OSA increases, then vitamin deficiencies, becomes more pronounced(but not significant), Thus subjects with more severe OSA indices tended to present lower vitamin D levels; furthermore Vitamin D deficiency may play a role and/or worsen OSA’s. We need to study more OSA adverse outcomes on glucose metabolism, in relation to vitamin D deficiency & insufficiency, as may be considered for supplementation treatment.