Helena Pité

Prevalence and classification of rhinitis in the elderly: a nationwide survey in Portugal.

Nationwide epidemiologic data on rhinitis in the elderly do not exist. This study aimed to estimate the prevalence of rhinitis in the population aged 65 years or above in mainland Portugal and to characterize and classify rhinitis in this age group.

Prevalence of asthma and its association with rhinitis in the elderly.

BACKGROUND Asthma and rhinitis are frequent respiratory diseases in children and adults. Despite the increase in the aging population, there are few epidemiologic data on both diseases in the elderly. So far, no population-based study has analyzed the association between asthma and rhinitis symptoms and severity in this age group. This study aimed to estimate the prevalence of physician-diagnosed asthma in the population aged ≥65 years in mainland Portugal and to evaluate its association with the presence and classification of rhinitis according to ARIA recommendations, in this age group. METHODS A cross-sectional, nationwide, population-based survey of individuals aged ≥65 years, living in mainland Portugal was performed. RESULTS Data were obtained from 3678 respondents. The prevalence of physician-diagnosed asthma was 10.9% (95% confidence interval (95%CI) 9.9-11.9). The frequency of asthma diagnosis increased with the number of nasal symptoms (p < 0.001). A strong association between asthma and rhinitis was found (odds ratio (OR) 13.86 (95%CI 10.66-18.02)). The strength of this association increased with the persistence and severity of rhinitis, being particularly high in elderly subjects with moderate-severe persistent rhinitis (OR 39.9 (95%CI 27.5-58.0)). CONCLUSIONS Asthma is common in the elderly and strongly associated with rhinitis. The OR for asthma is especially high in persistent and severe ARIA classification rhinitis types. This study strengthens the need for an integrated assessment of asthma together with rhinitis in the elderly.

Asthma-like symptoms, diagnostic tests, and asthma medication use in children and adolescents: a population-based nationwide survey

Abstract Objective: This study aimed to estimate the prevalence of asthma-like symptoms, current asthma (CA), asthma diagnostic tests, and inhaled medication use in a nationwide pediatric population (<18 years). Methods: Pediatric-specific data from a cross-sectional, population-based telephone survey (INAsma study) in Portugal were analyzed. CA was defined as lifetime asthma and (1) wheezing, (2) waking with breathlessness, or (3) asthma attack in the previous 12 months, and/or (4) taking asthma medication at the time of the interview. Results: In total, 716 children were included. The prevalence of asthma-like symptoms was 39.4% [95% confidence interval (95% CI): 35.7–43.3]. The most common symptoms were waking with cough (30.9%) and wheezing (19.1%). The prevalence of CA was 8.4% (95% CI: 6.6–10.7). Among children with CA, 79.9% and 52.9% reported prior allergy testing and pulmonary function testing (PFT), respectively. Inhaled medication use in the previous 12 months was reported by 67.6% (reliever inhalers, 40.1%; controller inhalers, 41.5%). Those who only used inhaled reliever medications experienced more asthma attacks [odds ratio (OR): 2.69]. Significantly fewer children with CA living in rural areas than those living in urban areas had undergone PFT or used inhaled medication (OR: 0.06 for PFT, 0.20 for medication]. Conclusions: The prevalence of CA in the Portuguese pediatric population was 8.4%. Only half of children with CA had ever undergone PFT; more than half did not use controller inhalers, and those who only used reliever inhalers reported more asthma attacks. These findings suggest that asthma management has been substandard, mainly in rural areas.

Lower airway flow influences peak nasal inspiratory flow in school-aged children

BACKGROUND Rhinitis and asthma frequently coexist. Peak nasal inspiratory flow (PNIF) objectively evaluates nasal obstruction. Lower airway flows impact on PNIF has seldom been analysed in children. We aimed to study the associations between PNIF and: 1)forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in children with allergic rhinitis and asthma and healthy controls; 2)allergic rhinitis and asthma control subjective evaluation. METHODS Sequential assessments of PNIF before and after nasal decongestion and spirometry with bronchodilation test were performed in 65 children (6-12 years) with allergic rhinitis and asthma, and 24 gender, age-matched healthy controls. The Control of Allergic Rhinitis and Asthma Test in children (CARATkids) was used for control assessment. Associations were investigated by multiple linear regression models. RESULTS Baseline and decongested PNIF correlated with baseline and post-bronchodilation FEV1 and PEF, observed independently of rhinitis and asthma diagnosis. The best model for PNIF included PEF, age and gender. No association was found between PNIF and CARATkids scores, except for nasal obstruction self-report. CONCLUSION In school-aged children, besides age and gender, PEF values should ideally be known to interpret PNIF values. PNIF can be complementary to subjective control assessment in children with allergic rhinitis and asthma.

Metabolomics in asthma: where do we stand?

Purpose of review Metabolomics has been used to uncover the metabolic signatures of asthma, both for biomarker identification and pathophysiologic mechanisms research. We aimed to review recent advances in this field, published since 2016, and discuss these findings implications to future research and application into clinical practice. Recent findings Experimental asthma models and clinical studies in both children and adults supported independent metabolic signatures of asthma. Common reported pathways included purine, glycerophospholipid, glutathione, fatty acids, and arginine and proline metabolism. Metabolomics-based studies identified candidate biomarkers related to asthma severity and corticosteroid resistance, and supported the definition of the obesity-related phenotype at the molecular level. A systematic review with meta-analysis and recent prospective studies favored exhaled volatile organic compounds as one of the most promising biomarkers in asthma diagnosis and monitoring. Summary Metabolomics has provided unique and novel insights into asthma profiling at the molecular level. Current challenges include procedures standardization and control of potentially confounding variables for external validation. Point-of-care technology developments bring metabolomics closer to clinical practice. In addition to biomarkers identification, relating metabolites to their biologic role will serve as critical foundations for understanding the biology underpinning asthma heterogeneity and for specific-targeted therapies. Video abstract http://links.lww.com/COPM/A22

Non-invasive Biomarkers in Asthma: Promises and Pitfalls

The asthma concept has evolved throughout the years: one major step in asthma management is the recognition of the chronic (airway) inflammation; another major step is further understanding of asthma heterogeneity and subsequent development of targeted therapies. While the concept of chronic inflammation, airway structural changes and their variability over time are widely accepted, their measurement and monitoring have gone through many hardships. In this chapter, we discuss the need for applicable biomarkers in asthma management and focus on the currently available and most promising totally non-invasive sam‐ plings and detection techniques, ranging from single biomarkers to biomarker panels and composite signatures, including molecular high-throughput “omics” technologies outcomes. Limitations of these biomarkers are compared with minimal-, semiand invasive techniques. Additionally, we discuss the benefits of an integrative systems medicine approach, considering asthma phenotypes based on cluster analysis of multidimensional biomarker datasets and its contribution to recent developments towards the promise of better understanding asthma and personalised asthma manage‐ ment.

Obstructive lung diseases and beta-blockers: Where do we stand?

Cardiovascular diseases are major public health problems. ßblockers therapy is indicated for the majority of patients with heart failure and coronary artery disease (Class I, Level of Evidence: A). These drugs are also first-line therapy for atrial fibrillation. However, ß-blocker use continues to be less than optimal, principally in patients with concomitant chronic obstructive lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD). Historically, studies suggested that ß-blockers increased airway hyperresponsiveness and competed with ß2-agonists, thus theoretically increasing the risk of adverse pulmonary outcomes. Cardioselective ß-blockers have been designed to target ß1-adrenoreceptors (AR) while avoiding ß2AR in the lung and elsewhere. However, these so called cardioselective ß-blockers are only relatively selective and exert significantß2 antagonismat therapeutic doses, though to a lesser extent than non-selective ß-blockers. Thus, it might seem counterintuitive to prescribe both ß-blockers and ß-agonists in the same patient, even when they are targeting different organs. As a result, ß-blockers are often withheld or discontinued from patients with asthma or COPD, especially in the setting of acute exacerbations. Despite these concerns, evidence supports that chronic use of cardioselective ß-blockers do not cause an increase of exacerbations, reduction in airway function or worsening of quality of life in patients with cardiovascular and obstructive pulmonary diseases. A meta-analysis of randomized controlled trials evaluating acute ßblocker exposure in asthma showed that selective ß-blockers caused a mean reduction in forced expiratory volume in one second (FEV1) of −6.9% (95% confidence interval (CI), −8.5 to−5.2) [1]. However, this change in FEV1 did not translate into symptoms. A dose–response relationship was demonstrated for atenolol, bisoprolol and metoprolol. Additionally, subgroup analysis suggested heterogeneity in treatment effect of different selective ß-blockers, as celiprolol did not cause statistically significant changes in FEV1 [1]. Another systematic review of 22 randomized trials to evaluate the effects of cardioselective ß-blockers in patients with COPD showed no significant change in respiratory symptoms or spirometry parameters, when these drugs were given in a single dose or for a longer duration

Wheezing Phenotypes in Childhood - Is it Already Asthma?

Wheezing in early childhood is common but highly heterogeneous. Distinguishing early wheeze phenotypes to predict long-term asthma persistence is of major clinical relevance. The comprehensive analysis of longitudinal datasets, including novel ‘unbiased’ statistical approaches to detect clusters from objective data, may allow better comparisons in different population settings. The recognition of such distinct outcome groups is valuable for parents’ informed counselling and a prerequisite for phenotype-specific tailored interventional measures to reduce asthma burden from paediatric age until adulthood.