Current Respiratory Medicine Reviews - Volume 13, Issue 1, 2017

Background: Changes in sex hormone levels, occurring both in premenstrual phase and in menstrual cycle, can affect pulmonary function and inflammation, favoring, the onset of premenstrual asthma (PMA). However, to date, due to the lack of consistent data, this clinical entity is not well characterized. Objective: This systematic review aims to analyze the latest data and advances on the PMA. Methods: Following PRISMA guidelines, a literature search of PubMed and Science Direct for peerreviewed journal articles in English through January 2000 with updates through to October 2016 was conducted. Relevant publications were reviewed that included pediatric and adult populations. Information about the study design, sample, intervention, comparators, outcome, time frame, and risk of bias was collected for each article. Results: Out of 57 reviewed reports, 18 were included in this systematic review. Due to the lack of consistent and unanimous literature data, the definition, prevalence, underlying pathogenic mechanisms, and treatment of PMA are not well characterized. In fact, whether some authors required only the patient’s subjective manifestation to make PMA diagnosis, others authors needed objective criteria, such as pulmonary function tests. Whether changes in sex hormones levels were considered as the major risk factors associated with PMA, other authors did not confirm the strength of this relationship. Moreover, treatment regimens for PMA are still inconclusive. Conclusion: Multicenter studies are needed to better develop an evidence-based approach to pathophysiology, prevalence, diagnosis and natural history of the disease.

Background: HMGB1 is a marker of inflammation that belongs to the alarmins family promoting an immediate activation of the innate immune response, such as chemotaxis and proinflammatory cytokine release, in response to tissue damage. The aim of this mini review is summarized what is known about the role of HMGB1 in onset and development of allergic and not allergic respiratory disorders. Methods: A literature search of electronic database was udertaken for the major studies published from 2012 to date. The databases searched were: PubMed and Science Direct. We used the keywords: "HMGB1, respiratory diseases, airway diseases, allergic respiratory diseases, rhinitis, nasal polyposis, asthma, infectious diseases, COPD, cystic fibrosis " Results: Of 207 reviewed reports, 43 were included in this systematic review. Studies look at HMGB1 as a new molecule orchestrating a homeostatic defensive response essential for the occurrence, progression, and persistence both of allergic and not allergic respiratory diseases. In particular, HMGB1 has been implicated in the pathophysiology both of allergic rhinitis and asthma as well as in chronic rhinitis, nasal polyposis, infectious diseases and cystic fibrosis. Conclusion: HMGB1, as causal molecule for several diseases, has stimulated an increasing interest in the field of inflammation research, providing new useful data for understanding disease processes as well as opening scenarios for new therapeutic strategies.

Allergic diseases have substantially increased in all western countries and the cause of this increase would appear to be related to both environmental changes and the western lifestyle. There is a complex interaction between genetic and environmental factors that can influence the onset of allergic diseases. The activation of the innate immune system, caused by microbial stimulation, seems to have a key role in normal immune maturation. Several studies showed that the activities of intestinal microflora have a metabolic, trophic, and protective function also affecting immune tolerance. Particularly, the probiotics, live microbial food ingredients, are able to confer health benefits on the consumers. The aim of this review is summarized what is known in regard to the critical role of the probiotic on onset of allergic diseases.

Anti-IgE treatment represents a major breakthrough in the therapeutic management of severe allergic asthma. Omalizumab is the unique biologic treatment registered for asthma therapy in children. The clinical efficacy and safety of omalizumab treatment in the pediatric population has been extensively documented in specific trials and consistently expanded from real-life studies. In addition, new experimental evidence suggests that omalizumab may also interfere with the cellular and molecular mechanisms underlying airway remodeling. Novel investigational anti-IgE monoclonal antibodies with improved pharmacodynamic properties are in the pipeline, potentially offering alternative mechanisms of modulating IgE pathway. The aim of this review is to update current knowledge on anti-IgE therapy in pediatric respiratory diseases.

Background: Recurrent respiratory infections (RRIs) are very common in early life, and constituting a social problem concerning the family, the paediatrician and pharma-economy. Although the relation between atopy and RRIs has been evaluated in several studies, the data are not still conclusive. Objectives: The aim of the study were: (i) to determine the type, the number and the total duration of RRIs recorded during follow-up study in atopic and non-atopic groups; (ii) the multiplicity and strength of sensitization as a further risk factor for developing RRIs. Patients and Methods: 10,200 children were prospectively and consecutively monitored when they were 12 years old. All children were assessed for SPT, serum total and specific IgE levels for common food and inhalant allergens. Parental report of each physician-diagnosed respiratory illness was also analyzed. Results: Of the 10,200 children who started the study, information was obtained until the end of the study for 7,568 (74.2%). Of these, 3,294 children (43.52%) resulted affected by RRIs. Atopy was found in 1888 of 3294 children (57.31%). RRIs symptoms occurred more frequently in atopic children than in non atopic ones (p<0.0001). Atopic group showed longer duration of RRIs (6.43±1.41days) in comparison with the non-atopic group (3.9±1.41 days) (p< 0.0001). In addition, in evaluating sensitive, multi-sensitive children showed higher number (p=0.011) and longer duration (7.82±2.82 days) than mono-sensitive children (4.57±0.70 days) (p= 0.027). Conclusions: Our results provide evidence that atopy and the multiplicity and strength of sensitization modify the risk respiratory infections.

Background: Anti-IgE treatment represents a major breakthrough in the therapeutic management of severe allergic asthma. To date, omalizumab is the only biological drug currently licensed as add-on therapy in children aged ≥ 6 years with moderate-to-severe and severe allergic asthma uncontrolled after treatment with high dose of inhaled corticosteroids plus long-acting inhaled beta2-agonist. The clinical efficacy and safety of omalizumab treatment in the pediatric population has been extensively documented in specific trials and consistently expanded from real-life studies. Our aim is to describe the impact of omalizumab on asthma management, by reporting the results of the first Italian multicenter observational study conducted in children and adolescents with severe allergic asthma. Methods: The study was a 1-year real-life multicenter survey conducted in 13 pediatric allergy and pulmonology tertiary centers in Italy. All patients with confirmed severe allergic asthma from whom Omalizumab add-on treatment was initiated between 2007 and 2015 were included in the study. Results: Forty-seven patients with severe allergic asthma were included in the study. A significant reduction in the number of asthma exacerbations was observed during treatment with omalizumab, when compared with the previous year (1.03 vs 7.2 after 6 months (p<0.001) and 0.8 after 12 months (p<0.001), respectively). Hospital admissions were reduced by 96%. At 12 months , forced expiratory volume in 1 s improved and a corticosteroid sparing effect was observed. No serious adverse events were reported during the follow-up period of 12 months. Conclusion: The results of the first Italian multicenter observational study confirmed that omalizumab is an effective and safe add-on therapy in uncontrolled severe allergic asthma in children.

Background: Asthma is characterized by chronic airway inflammation that is controlled by a complex cytokine network. Inhaled corticosteroid and short acting β2-agonists treatment improve asthma control. Objective: The aim of the study is to evaluate if a combination of fluticasone and formoterol is effective to assure a protective effect against EIB 15 min and 4 hours after administration in adolescent with persistent asthma. Method: In this study we selected 20 adolescents age 8 and 19 years affected by mild to moderate persistent asthma and EIB. At screening the following were assessed: eligibility, demography, medical history, medications, spirometry and clinical examination. During the study all the patients continued to regularly take a low dose of inhaled steroids; albuterol as rescue medication has been discontinued 8 hours before the exercise test. Results: Formoterol plus fluticasone offered good protection against EIB in 18 patients (90%), the mean maximum percent fall in FEV1 after formoterol was 7.1 ± 4.9% at 15 min (p<0.001). The combination formoterol plus fluticasone was more effective after 4 hours protecting against bronchoconstriction 19 patients (95%) and the mean maximum percent fall in FEV1 after formoterol plus fluticasone was 4.3 ± 4.2% at 4 h (p < 0.001). Conclusions: This study suggests that fluticasone 100 mcg + formoterol 10mcg by MDI + spacer is effective in protecting asthmatic adolescents as early as 15 min after dosing. Furthermore, the data confirm the long duration of its protective effect and the absence of any significant adverse effects after administration.

Background: The clinical presentation of lower respiratory tract illness in children frequently resembles more than one disease entities of those described in textbooks. Not uncommonly, terms like “bronchiolitis”, “bronchitis”, “asthma exacerbation”, “bronchopneumonia” and “pneumonia”are used interchangeably. Methods: In this article, a didactic simplified algorithm for the management of the child from the community presenting with cough and fever is described after systematic review of the literature. Results: In step 1 of the algorithm, findings from the physical examination are used to localize the diseased anatomic part(s) of the lower respiratory tract i.e. trachea, bronchi, bronchioles or alveoli. In step 2, speculations are made regarding the infectious agent most likely affecting the lower respiratory tract based on the patient's symptoms and past medical history and the known epidemiology of respiratory disorders. In step 3, the appropriate treatment plan is selected taking under consideration the affected anatomic part(s) and the speculated pathogen. Finally, in step 4, clinical response is evaluated and the diagnostic assumptions and treatment strategy are modified accordingly. Conclusion: When findings from the physical examination are matched with information from the current and past medical history and the known epidemiology of respiratory disorders, speculations regarding the most likely etiologic agents can be made and appropriate treatment interventions can be selected.

Background: Intrathoracic Gossypiboma refers to a retained surgical sponge in the thoracic cavity. It is a rare entity which is capable of producing serious complications. Objective: The aim of this study was to review case reports in the English literature on diagnosed and undiagnosed intrathoracic gossypibomas to heighten the awareness of this entity and decrease the rate of future misdiagnosis. Method: In reviewing the literature, 37 cases were reported. The reports indicated cough, sputum expectoration, dyspnea, and chest pain as common symptoms. Hemoptysis was rarely reported with massive hemoptysis being reported in only two patients. Results: There were 17 patients who had cardiovascular surgery and 18 patients who had a thoracotomy, all found to have an intrathoracic gossypiboma. Two patients had a history of spinal operation, and abdominal cholecystectomy. Radiograph of the chest, MRI, and PET were not found to be useful as diagnostic tools. Chest tomography (CT) scan demonstrated heterogeneous, hypodense masses in all the patients scanned and due to difficult and confusing diagnosis of intrathoracic gossypibomas, 28 out of 37 (75.68%) patients remained undiagnosed. In our case, chest CT scan findings favored benign lesions, calcified granuloma, calcified carcinoid, and calcified hamartoma. Conclusion: An intrathoracic gossypiboma usually goes undiagnosed. Patients usually need surgery for removal of the retained sponge. Gossypibomas can cause medicolegal implications for surgeons and should be in the differential diagnosis in all patients with a lung mass and history of a thoracic surgery.