Summary Background Severe asthma is characterized by elevated levels of pro‐inflammatory cytokines and neutrophilic inflammation in the airways. Blood cytokines, markers of ‘systemic’ inflammation, may be a feature of amplified inflammation in severe asthma. Objective To detect differences in IL‐8, TNF‐α, IL‐16 and IL‐13 levels in the serum(s) of stable severe and mild–moderate asthmatics related to blood leucocytes proportion, airway calibre and exhaled nitric oxide (NO) levels. Methods We assessed cytokine serum levels by ELISA and blood leucocyte counts by an alkaline peroxidase method in 20 healthy controls, 22 mild–moderate [forced expiratory volume in 1 s (FEV 1 ) (%pred) : 89±3] and 14 severe asthmatics [FEV 1(%pred) : 49±2]. Results IL‐8 and TNF‐α levels were higher in severe asthmatics than in mild–moderate asthmatics or in controls ( P <0.05). No differences in IL‐16 and IL‐13 levels were detected. Severe asthmatics showed higher circulating neutrophil and eosinophil number than controls ( P <0.05). In severe asthmatics, exhaled NO levels were superior than in controls ( P <0.05), but inferior than in mild–moderate asthmatics ( P <0.05). We found positive correlation between TNF‐α levels and exhaled NO ( r =0.67; P =0.01) or circulating neutrophil counts ( r =0.57; P =0.03) in severe asthmatics. Conclusion sTNF‐α and sIL‐8 are markers of ‘systemic’ inflammation in severe asthmatics, in conjunction with augmented circulating neutrophils, suggesting the involvement of neutrophil‐derived cytokine pattern in severe asthma.
The prevalence of asthma and obesity, two often associated conditions, is influenced not only by age and gender but also by lifestyle factors. This study aimed to determine whether, in a Mediterranean northern Italian region, Liguria, an increased prevalence of obesity could be detected in asthmatic children and adolescents and to evaluate the possible relationship between body mass index (BMI) and the characteristics and/or severity of asthma. BMI was determined in 554 asthmatic subjects (2.2–16.1 years) and 625 age-matched controls; BMI was expressed as a continuous variable in standard deviation score (SDS) units, determined as difference between the individual observed value and the reference mean for age and sex, divided by the corresponding standard deviation (BMI-SDS). Overweight/obesity was set at BMI-SDS of 2 or more. BMI-SDS was significantly higher in controls than in asthmatics (p = 0.04); however, the proportion of overweight/obesity subjects (BMI-SDS ≥ 2) was similar in controls and in asthmatic patients (p = 0.08). Evaluation of the asthmatic group revealed that BMI-SDS was independent of gender (p = 0.57), atopic sensitization (p = 0.69), and comorbidity with other allergic symptoms (p = 0.60). By contrast, BMI-SDS was lower in preschool-age children than in school-age children and adolescents (p < 0.0001), in subjects with a high rate of acute respiratory tract infections (p = 0.04), and in those not treated with inhaled corticosteroids (IGCs) (p = 0.02). Although an increase in the prevalence of overweight/obesity was not detected in asthmatic children and adolescents, the results reported here suggest a preventive surveillance of calorie intake and a promotion of physical activity in children requiring long-term treatment with inhaled glucocorticosteroids.
To the Editor,Asthma control is currently the cornerstone strategy in the management of asthmatics (1). Actually, uncontrolled and severe asthma significantly affect patients and society (2). Uncon...
Due to different social and epidemiological factors, the eligibility criteria to receive palivizumab prophylaxis may be different between countries, especially in "otherwise healthy" late preterm infants. We analyzed an Italian database of young children referred to emergency departments for acute lower respiratory tract infection (ALRI) during the RSV season over a four year period, when the use of palivizumab as prophylaxis for RSV disease was not widespread in premature infants. The demographic and environmental characteristics and the RSV positivity (RSV+) in hospitalized and not-hospitalized patients were compared. In the data analysis we divided children according to their chronologic age (age) and their week gestational age (wGA). Out of the 100 children evaluated, 68 were infants (≤12 month-age): 7.5 and 20.6 % were in the <29 and 29- < 32 wGA groups respectively, and 72.0 % in the 32- < 35 wGA group. Positive hospitalized-to-not-hospitalized ratios were found in all three wGA groups, progressively decreasing (from 4.0 to 1.2), with increasing wGA (p = 0.35). The percentage of hospitalized infants that were also RSV+ was also progressively decreasing (from 40.0 to 28.6 % and 18.4 %) with increasing wGA (p = 0.43). In the >12 month-age group (N = 32), there was positive hospitalized-to-not-hospitalized ratio only in the <29 wGA group with a low RSV+ frequency (<29 %) in all wGA groups. In the ≤12 month-age group, 41 infants were evaluated with a ≤6 month-age and 27 with a >6–12 month-age. A positive hospitalized-to-not-hospitalized ratios was found in all wGA groups in ≤6 month-age infants, despite a low RSV+ frequency in the 29- < 32 and 32- < 35 wGA group. In the >6-12 month-age group, all infants with a <29 and 29- < 32 wGA were hospitalized with a relatively high RSV+ frequency whilst the 32- < 35 wGA group showed a negative hospitalized-to-not-hospitalized ratio with a lower RSV+ frequency. The hospitalized-to-not-hospitalized ratios and RSV+ frequency in the first 12 months of age in infants born prematurely confirm the vulnerability of these children for clinically important RSV infection, most notably in the <32 wGA category.
