Inflammation, Allergy and Asthma, Complex Immune Origin Diseases: Mechanisms and Therapeutic Agents.

Recent Pat Inflamm Allergy Drug Discov. 2012 Nov 7;

Authors: Naik SR, Wala SM

Abstract
Inflammation, Allergy and Asthma are the manifestation of multitude reactions of biological, cellular and immunological events. The various associated biological, cellular, and molecular events with inflammation, allergy and asthma participate to induce increased vascular permeability, vasodilatation, cellular migration, increased mucus secretion, broncho-constriction, structural changes of airway architecture, decline in pulmonary functions, release of intracellular mediators, increased formation of reactive oxygen species, cartilage degradation and loss of function. The participation of variety of effectors cells viz. leukocytes, neutrophils, eosinophils, basophils, monocytes, macrophages, mast cells, dendritic cells, T-cells, B-cells, NK-cells, lead to cascade of events trigger of intracellular mediators (cytokines, chemokines etc.) activating diverse biological effects and immune responses. Eicosanoids are major precursors in cyclooxygenase and lipooxygenase pathways and play an important role in inflammation, allergy and asthma. Such biological and cellular events are further enhanced by stress related effects. The wide varieties of synthetic and natural compounds have been showed to act on different molecular targets (receptor, enzymes, mediators, and cells) involved in inflammation, allergy and asthma and to alter produce specific/definite therapeutic activity. The present review describes pathogenesis and etiological aspects of inflammation, allergy and asthma with few relevant patents which would be immensely useful for researchers in the field of immunology and molecular pharmacology to explore new avenues/strategies for development of new generation of therapeutically active agents for treatment of inflammation and allergic disorders.

PMID: 23140569 [PubMed - as supplied by publisher]

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Use of Antibiotics during Pregnancy Increases the Risk of Asthma in Early Childhood.

J Pediatr. 2012 Nov 6;

Authors: Stensballe LG, Simonsen J, Jensen SM, Bønnelykke K, Bisgaard H

Abstract
OBJECTIVES: To investigate the hypothesis that mother's use of antibiotics in pregnancy could influence asthma and eczema in early life. STUDY DESIGN: Subjects were included from the Copenhagen Prospective Study on Asthma in Childhood cohort of children born of mothers with asthma (N = 411). Severe asthma exacerbations and eczema were diagnosed by research unit physicians. Replication was sought in children from the Danish National Birth Cohort (N = 30 675). Asthma outcomes were hospitalization and use of inhaled corticosteroids. Eczema was defined by an algorithm developed from cases of clinically verified eczema. All children were followed to age 5 years in a cohort study design. RESULTS: The Copenhagen Prospective Study on Asthma in Childhood data showed increased risk of asthma exacerbation (hazard ratio 1.98 [95% CI 1.08-3.63]) if mothers had used antibiotics during third trimester. The Danish National Birth Cohort confirmed increased risk of asthma hospitalization (hazard ratio 1.17 [1.00-1.36]), and inhaled corticosteroids (1.18 [1.10-1.27]) in the children if mothers used antibiotics any time during pregnancy. In the subgroup of mothers using antibiotics for nonrespiratory infection, the children also had increased risk of asthma. CONCLUSION: We found increased risk of asthma associated with maternal antibiotic use in a clinical study of a birth cohort with increased risk of asthma and replicated this finding in an unselected national birth cohort, and in a subgroup using antibiotics for nonrespiratory infections. This supports a role for bacterial ecology in pre- or perinatal life for the development of asthma.

PMID: 23140881 [PubMed - as supplied by publisher]

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The role of inhaled corticosteroids in management of asthma in infants and preschoolers.

Curr Opin Pulm Med. 2012 Nov 8;

Authors: Castro-Rodriguez JA, Pedersen S

Abstract
PURPOSE OF REVIEW: This review analyses published data on the treatment of wheezing in infants and preschoolers with inhaled corticosteroids (ICS), including the effect in subgroups of patients such as 'multiple trigger wheeze' and 'episodic viral wheeze'. RECENT FINDINGS: Therapy with ICS at daily doses of 100-200 μg results in significant clinical improvements in several outcomes in preschoolers and infants suspected of having asthma (multiple trigger wheeze). Such treatment is normally considered well tolerated. Although not well studied, higher daily doses may be associated with measurable effects on growth, which are not cumulative with continued treatment. In children who only wheeze in association with viral infections (episodic viral wheeze), preemptive treatment with high doses of ICS has demonstrated significant clinical effects on several outcomes, whereas lower doses seem to have little effect. Intermittent use of high doses of ICS has been associated with significant reductions in height and weight gain over 1 year. SUMMARY: The review illustrates the complexity of treating wheezing in infants and preschoolers and interpreting the study results. It emphasizes the need for more studies in clinical subgroups, more long-term studies and dose-response studies to assess the optimal doses and safety of intermittent as well as regular ICS treatment.

PMID: 23143197 [PubMed - as supplied by publisher]

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Medication adherence in asthma patients.

Curr Opin Pulm Med. 2012 Nov 8;

Authors: Sumino K, Cabana MD

Abstract
PURPOSE OF REVIEW: Although current asthma guidelines stress the importance of assessing and enhancing adherence to asthma treatment, medication adherence rates in asthma patients are consistently low in practice. In this review, we summarize current literature on method of measurement, prevalence, outcome and intervention of medication adherence in asthma patients. RECENT FINDINGS: Nonadherence to prescribed treatment continues to be a frequent problem in patients with asthma even in recent years. Objective measurement of adherence should be implemented whenever possible. Review of pharmacy refill data or electronic monitoring of inhaler actuation may be a preferred method to assess adherence. Educational programmes should be specifically designed to address the unmet need and specific reasons for nonadherence for the target population. Large, well designed clinical trials to assess the efficacy of remote electronic monitoring and reminder systems to improve adherence are needed. SUMMARY: There is an urgent clinical need for systematic, proven methods to assess and address medication nonadherence in asthma patients.

PMID: 23143198 [PubMed - as supplied by publisher]