Condition Watch: Asthma

Pharmacy TimesApril 2024
Volume 90
Issue 4

Researchers Find Connection Between Frailty, Chronic Lung Conditions

Chronic obstructive pulmonary disease (COPD) and asthma are leading causes of global mortality and morbidity, and they have increased in prevalence due to population aging and exposure to risk factors. Although frailty and obstructive lung conditions are linked, it is unclear how significant the association is.

Health and medicine - Young girl using blue asthma inhaler to prevent an asthma attack. - Image credit: DALU11 |

Image credit: DALU11 |

In a study published in Archives of Gerontology and Geriatrics, investigators used a bidirectional, 2-sample Mendelian randomization (MR) approach to evaluate the relationship between frailty and prominent obstructive lung diseases. The meta-analysis investigated both the effect of the frailty index (FI) score on COPD and asthma risk as well as the effect of COPD and asthma on FI score.

The definitions of COPD and asthma were based on analyses that were adjusted for age, sex, 10 principal components, and a genotype batch using mixed-model logistic regression. FI scores were determined based on self-reported items on symptoms, disabilities, and diagnosed diseases, with resulting scores ranging from 0 to 27. MR is dependent on the naturally random assortment of genetic variants during conception to yield impartial estimations of their impact of an exposure on an outcome.

The MR analysis results presented significant positive associations between genetically predicted FI and both COPD (OR, 1.75; 95% CI, 1.29-2.36) and asthma (OR, 2.10;95% CI, 1.44-3.16), according to the investigators. In addition, reverse direction analyses have provided evidence that suggests genetic susceptibility to COPD (b, 0.06; 95% CI, 0.01-0.10) and asthma (b, 0.08; 95% CI, 0.06-0.11) is linked to higher FI. The investigators note that the findings suggest a bidirectional, causal relationship between frailty and obstructive lung diseases.

Qu J, Liang Y, Rao Y, et al. Causal relationship between frailty and chronic obstructive pulmonary disease or asthma: a two sample bidirectional Mendelian randomization study. Arch Gerontol Geriatr. 2024;118:105310. doi:10.1016/j.archger.2023.105310

Immune Cells Allow Developments for Asthma, COPD Treatments

Researchers find published in Science Immunology indicate that immune cells play an active role in directing the growth of lung tissue during development. The findings offer insights to better understand and treat respiratory conditions such as chronic obstructive pulmonary disease and asthma.

The study shows coordination between the immune and respiratory symptoms present in early fetal development. Using multiple techniques such as single-cell sequencing and experiments with lung cell cultures, the researchers determined whether the immune system influences how the lungs grow. In the study, investigators looked at immune cells in early human lungs from 5 to 22 weeks of development.

The study authors identified key regulators of lung development, such as interleukin (IL)-1β and IL-13, which facilitate the coordination of lung stem cell differentiation into specialized mature cell types. Further, the authors detected that an infiltration of innate cells—innate lymphoid cells, natural killer cells, myeloid cells, and progenitor cells—was followed by adaptive immune cells.

According to the authors, the findings significantly change the understanding experts have of the immune and epithelial interactions necessary for lung maturation. In addition, the investigators note that early immune disturbances can manifest as lung diseases in pediatric patients. The study findings have the potential to contribute to the development of new therapeutic approaches for regenerating lung tissue that was previously damaged, as well as the restoration of lung function.

Immune cells shape lung before birth and provide new avenues for treating respiratory diseases. News release. EurekAlert! December 15, 2023. Accessed January 2, 2024.

Adalimumab Biosimilar Shows Efficacy in Noninfectious Uveitis

A study published in World Allergy Organization Journal examined the use of biologics in patients with asthma–chronic obstructive pulmonary disease syndrome (ACOS) by comparing clinical outcomes such as inflammatory markers, lung function, symptom control, and exacerbation rates among patients with asthma and ACOS.

The prospective, observational, multicenter cohort study enrolled 94 patients with severe asthma in both Korea and the United Kingdom. The enrolled patients were between the ages of 18 and 80 years and were classified as having severe asthma. Of the 94 participants, 13 had ACOS and 81 had pure asthma.

ACOS was defined as asthma with postbronchodilator airway flow limitation measured by forced expiratory volume in 1s/forced vital capacity (FEV1/FVC < 0.7) and smoking history of 10 pack-years or more. Based on results from skin prick tests, blood eosinophils, sputum eosinophils, and fractional exhaled nitric oxide (FeNO) levels, patients were classified as having type 2 (T2)–high or T2-low asthma.

The study results demonstrated that both the ACOS and pure asthma groups showed positive treatment responses to biologics, including improvements in FEV1 and asthma control test scores, reductions in inhaled corticosteroid/oral corticosteroids doses, FeNO levels, blood and sputum eosinophil counts, and exacerbation frequency. However, patients in the ACOS group exhibited lower blood eosinophil counts and less atopy compared with patients with pure asthma. Among the biologics used, dupilumab was more frequently used in the ACOS group than in the pure asthma group, whereas omalizumab and benralizumab were not used in the ACOS group at all.

Shim JS, Kim H, Kwon JW, et al. A comparison of treatment response to biologics in asthma-COPD overlap and pure asthma: findings from the PRISM study. World Allergy Organ J. 2023;16(12):100848. doi:10.1016/j.waojou.2023.100848
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