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Journal articleWang M, He Y, Hu H, et al., 2026,
Protective role of fatty acid oxidation against epithelial barrier dysfunction in allergic asthma.
, Redox Rep, Vol: 31BACKGROUND: Fatty acid oxidation (FAO) is implicated in lung diseases, but its role in bronchial asthma is not fully understood. We investigated its effect on airway epithelial barrier integrity. METHODS: Using a house dust mite (HDM)-induced murine asthma model and HDM, IL-4, IL-13, or TNF-α stimulated human primary bronchial epithelial cells (BECs) and bronchial epithelial (Beas-2b) cells, we modulated FAO with L-carnitine (agonist) and Etomoxir (inhibitor). BECs and Beas-2b cells were infected with lentivirus-mediated CPT1A shRNA prior to stimulation. Barrier function, mitochondrial oxidative stress, inflammation, and metabolism were assessed. RESULTS: FAO level in lungs negatively correlated with increased inflammation and tissue injury in HDM-induced asthmatic mice (all p < 0.05), while positively regulating tight junction protein expression. In BECs and Beas-2b cells, Etomoxir treatment and CPT1A knockdown exacerbated the impairment of FAO caused by various stimulants (all p < 0.05). Furthermore, FAO negatively regulated HDM/cytokine-induced epithelial barrier damage, hyperactive inflammatory response, and mitochondrial dysfunction in Beas-2b cells (all p < 0.05). In contrast, treatment with L-carnitine significantly alleviated these pathophysiological features in both in vivo and in vitro models. CONCLUSION: FAO plays a protective role in the occurrence and development of asthma by maintaining airway epithelial cell homeostasis and barrier function.
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Journal articleJiménez-Saiz R, Iborra S, Blanco C, et al., 2026,
Understanding the Type 2 Immunity: An Evolving View Beyond Allergic Diseases.
, AllergyType 2 (T2) immunity is classically associated with defense against helminths and environmental threats, from a physiological perspective, and with allergies and eosinophilic inflammatory diseases, in a pathological sense. However, growing evidence reveals that T2 pathways also support other essential homeostatic functions, including tissue protection and repair. There are major clues from the early evolution of T2 responses for protection against massive tissue damage and positive selection for survival against parasites starting over 500 million years ago. These responses likely co-evolved stepwise with immune-regulatory circuits, culminating in the emergence of the fully functional human-type IgG4 in the great apes (Hominidae) within the last ~10 million years. The involvement of body barriers along with the strong influence of local epithelial cells and their interaction with the microbiome and the immune system is a common characteristic of T2 inflammation. An expanding list of new T2 diseases is being reported, characterized by epithelial cell and immune system activation, epithelial barrier damage, and microbial dysbiosis, including opportunistic pathogen colonization and loss of commensals. This evolving understanding coincides with the clinical success of biologics targeting key T2 mediators such as IL-4, IL-5, IL-13, IL-31, TSLP, and IgE, which have transformed the management of severe allergic diseases and other T2-driven pathologies. However, the contribution of T2 immunity to homeostatic programs raises questions about the long-term consequences of sustained T2 suppression. In this review, we examine the dual role of T2 immunity in health and disease, revisit its evolutionary origins, highlight its protective functions beyond allergy, and discuss the potential implications of prolonged T2 pathway blockade.
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Journal articlePiccirilli E, Troia SG, Fontanella S, et al., 2026,
Growing Folds: Fetal MR Imaging Anatomy of the Hippocampal Head Digitations.
, AJNR Am J Neuroradiol, Vol: 47, Pages: 2416-2423BACKGROUND AND PURPOSE: The adult hippocampal head (HH) is characterized by sulci and digitations visible both histologically and on MRI. The aim of the study was to describe the emergence and progression of HH digitations in the fetal brain across different gestational ages (GAs) using MRI. MATERIALS AND METHODS: A retrospective assessment was performed on 383 fetal brain MRIs (19-39 weeks' GA) acquired on 1.5T (n = 351) and 3T (n = 32) scanners. Imaging included single-shot fast spin-echo T2, T1-weighted sequences, and axial DWI. The fetal HH was identified on coronal T2 images, and HH morphologic variants were classified using an established adult classification system: class 0 (no sulci, 1 digitation), class 1 (1 sulcus, 2 digitations), and class 2 (2 sulci, 3 digitations). MRIs with brain anomalies identified prenatally or postnatally, abnormal sulcation, or severe artifacts were excluded. Variant frequencies in both hemispheres were grouped by GA. Correspondence analysis and cumulative link mixed models were used to assess the association between GA and class distribution. RESULTS: Two hundred seventy-one fetuses were included, grouped into 8 GA categories. Overall frequencies were 33.6% for class 0, 48.9% for class 1, and 17.5% for class 2. With increasing GA, class 0 frequency decreased, while classes 1 and 2 increased. Between 23 and 25 weeks' GA, detection of more digitated HH variants rose sharply from 1% to 64%. Follow-up in 30 fetuses showed an increase in HH digitations, with no observed reductions. Regression analysis revealed greater digitation complexity in the right hemisphere. CONCLUSIONS: Digitations in the fetal HH begin to appear around 24 weeks' GA, reaching frequencies similar to those observed in adults by the later stages of gestation. The right hemisphere shows higher complexity, possibly reflecting faster growth. These findings contribute to the understanding of hippocampal development and may ser
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Journal articleBaraldi F, Mah JSY, Almuhanna A, et al., 2026,
Mucus plug formation is associated with eosinophilic activation in chronic obstructive pulmonary disease.
, Am J Respir Crit Care Med, Vol: 212, Pages: 2071-2074 -
Journal articleBush A, Chotirmall SH, Han MK, et al., 2026,
To the airway and beyond: introduction to an AJRCCM special section on airway disease.
, Am J Respir Crit Care Med, Vol: 212, Pages: 1879-1881 -
Journal articleBilska AG, Chaszczewska-Markowska M, Gajdanowicz P, et al., 2026,
Polystyrene nanoplastics induce mitochondrial dysfunction and stress responses in human PBMCs.
, Ecotoxicol Environ Saf, Vol: 322Plastics continuously fragment into micro- and nanoplastics (MPs/NPs), which are increasingly recognized as emerging environmental contaminants of global concern. Human exposure to nanoplastics through air, food, and water is becoming unavoidable; however, their direct effects on human immune cells remain poorly understood. Due to their small size, NPs can enter the circulation and directly interact with immune cells, yet their cellular effects in humans remain poorly understood. In this study, we investigated the impact of polystyrene NPs on human peripheral blood mononuclear cells (PBMCs) using an integrated approach that combined imaging, mitochondrial stress testing, basophil activation assays, and single-cell RNA sequencing. Confocal microscopy confirmed efficient cytoplasmic internalization of 25-nm NPs. Optical diffraction tomography revealed that even short-term (1 h) exposure induced pronounced biophysical remodeling, including reduced cell volume and dry mass alongside increased intracellular density and refractive index. Seahorse metabolic profiling demonstrated substantial suppression of mitochondrial respiration across major immune subsets, reflected in reduced basal and maximal respiration, ATP-linked oxygen consumption, and spare respiratory capacity. Basophil activation remained unaffected by NP exposure. Single-cell transcriptomics identified a distinct NP-induced "stress-cell" population, characterized by upregulation of heat-shock and proteostasis pathways and concomitant downregulation of mitochondrial-encoded transcripts. Together, these data show that NPs rapidly disrupt mitochondrial function and activate proteotoxic stress programs in human immune cells. By situating these mechanisms within the One Health framework (human, animal and the planet health), our findings highlight how environmental nanoplastic pollution may translate into immune dysregulation and inform integrated environmental-public health risk assessments.
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Journal articleShih Y-S, Han C-L, Lee YL, et al., 2026,
Extreme temperature and airway dehydration: current understanding and integrative insights into respiratory vulnerability.
, Expert Rev Respir Med, Vol: 20, Pages: 1055-1066INTRODUCTION: Climate change has significantly increased the frequency and intensity of extreme temperature events, posing growing threats to respiratory health. Among the underlying mechanisms, airway dehydration is a critical yet underrecognized pathway that disrupts the airway surface liquid (ASL), which is essential for mucociliary clearance, epithelial integrity, and immune defense. AREAS COVERED: This article examines evidence linking airway dehydration to respiratory disease during temperature extremes. We discuss how hot, dry air and cold, low-humidity conditions disrupt airway hydration balance, leading to impaired mucociliary clearance and increased susceptibility to infection and inflammation. The review summarizes the impacts of airway dehydration on vulnerable populations, including individuals with pre-existing respiratory conditions (asthma, allergic rhinitis, chronic obstructive pulmonary disease (COPD), and cystic fibrosis), children, older adults, outdoor workers, and socioeconomically disadvantaged groups. EXPERT OPINION: Airway dehydration represents a unifying mechanism linking climate extremes to respiratory vulnerability but remains underrepresented in clinical practice and public health strategies. We advocate for greater recognition of airway hydration in disease prevention, development of practical measurement tools, and targeted interventions for at-risk populations. Emphasizing airway dehydration as a key mediator offers opportunities to improve clinical management and develop effective climate adaptation strategies for respiratory health protection.
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Journal articleSiddiqui S, Ding B, Dolin P, et al., 2026,
Epidemiology, clinical management, and outcomes in patients with eosinophilic granulomatosis with polyangiitis in England: A retrospective observational cohort study.
, J Allergy Clin Immunol Glob, Vol: 5BACKGROUND: Data on the clinical burden of eosinophilic granulomatosis with polyangiitis (EGPA) are limited. OBJECTIVE: We sought to evaluate the epidemiology and clinical burden of EGPA in England using real-world evidence. METHODS: Patients diagnosed with EGPA between January 1, 2006, and February 28, 2019, who had ≥1 year of data before diagnosis (index date) were identified using the Clinical Practice Research Datalink Aurum database. Epidemiology, diagnosis, mortality, treatment, and clinical outcomes were assessed. RESULTS: The incident and prevalent EGPA cohorts comprised 486 and 729 patients, respectively. The overall incidence and prevalence of EGPA were 3.04 (95% CI: 2.77-3.32) cases per million person-years and 2.7 (95% CI: 2.5-2.9) cases per 100,000 persons, respectively. Overall, 76.3% and 26.1% of patients had a Five Factor Score of 0 on the 1996 and 2009 versions. In the incident cohort (mean age 57.9 ± 15.2 years), most patients (97.1%) had ≥1 comorbidity; 79.8% had asthma coded. The median time from first major manifestation to EGPA diagnosis was 44.0 (Q1-Q3: 20.0-56.0) months. The death rate was 37.1 per 1000 person-years (95% CI: 30.1-45.2); the standardized mortality ratio for all-cause deaths was 2.3 (95% CI: 1.9-2.8). The 5-year survival rate was 82.3% (95% CI: 78.1%-85.7%). Most patients (86.2%) received oral glucocorticoids, of whom 27.0% successfully tapered. Six months post index date, 26.1% of patients had a new EGPA manifestation. CONCLUSION: This study emphasizes the substantial clinical burden and reliance on glucocorticoids in EGPA, highlighting the need for improved diagnosis of this disorder.
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Journal articlePiga NN, Portelli MA, Shrine N, et al., 2026,
Genome-wide association study of asthma with high treatment burden and/or worse outcomes defined using electronic healthcare data in UK Biobank.
, ERJ Open Res, Vol: 12, ISSN: 2312-0541BACKGROUND: In ∼10% of asthma patients, symptoms remain uncontrolled despite maximal treatment, representing an unmet clinical need. The causal variants, genes and pathways underlying genetic risk factors have not been fully elucidated, and it is unclear whether there are unique genetic risk factors for this asthma subtype. METHODS: We used electronic healthcare records linked to UK Biobank to identify asthma patients with high treatment burden and/or worse outcomes. We performed a genome-wide association study (GWAS) with this case population and healthy controls. We sought replication for associated (p≤5×10-6) signals in four independent studies (12 152 cases and 32 316 controls). Replicated signals were fine-mapped and linked to genes and pathways. RESULTS: In total, 7681 participants met our case definition and showed enrichment for adult-onset asthma, female gender and higher body mass index compared to asthma individuals not meeting case criteria. GWAS with 7681 cases and 38 405 controls revealed 21 reproducible association signals that had previously been associated with asthma, but had a larger effect size in our study. Variant-to-gene mapping highlighted 85 candidate genes, five of which were considered high confidence (BACH2, D2HGDH, IL1RL1, RPS26, SMAD3). CONCLUSION: We present the first use of electronic healthcare records in UK Biobank to identify a subtype of asthma enriched for patients with high treatment burden and/or worse outcomes. Our findings support the role of known asthma genes, highlighting genetic risk variants with stronger effect in these groups of patients. The prioritised genes provide potential therapeutic opportunities for this difficult-to-treat patient population.
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Journal articleShamji MM, Rider NL, Adcock I, et al., 2026,
PRACTALL 2025: Artificial intelligence-application of allergy and immunology to patient care.
, J Allergy Clin Immunol, Vol: 158, Pages: 694-714Artificial intelligence (AI), first defined in 1955 by John McCarthy, has transformed daily life across industries through applications such as chatbots, autonomous vehicles, and navigation systems. The 2022 release of ChatGPT marked a pivotal moment, highlighting AI's rapidly expanding potential. The health care industry is increasingly embracing AI-enabled tools across oncology, pathology, and radiology to augment disease screening and clinical workflows. Ambient listening technologies support clinical documentation, reduce administrative burden, and improve patient-physician interactions. Large language models combined with natural language processing are being evaluated for generating clinical summaries managing patient portal messaging and converting freehand notes to electronic health records, while also uncovering patterns in patient data to support more personalized treatments. Forward-thinking health systems are establishing informatics departments to optimize these models. Notably, with 1 in 6 adults sourcing health information from AI, rising to nearly one-quarter among individuals younger than 30 years, there is a growing need to ensure that these technologies provide accurate and reliable information to safeguard patient safety and support appropriate clinical use. PRACTALL, a collaboration between the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy & Clinical Immunology, aims to equip allergist-immunologists with essential AI insights highlighting tools for clinical practice, education, and research. By addressing potential pitfalls and biases, PRACTALL illustrates how AI can enhance efficiency, improve patient care, and alleviate administrative burdens in health care.
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Journal articleSaunders LC, Collier GJ, Smith LJ, et al., 2026,
Longitudinal 1H and 129Xe Lung MRI in Patients With Post-COVID Residual Lung Abnormalities.
, J Magn Reson Imaging, Vol: 64, Pages: 669-682BACKGROUND: It is unclear how lung function may recover in patients with residual lung abnormalities (RLAs) following COVID-19 pneumonia. PURPOSE: To evaluate lung function trends over time in patients with RLAs following hospitalization due to COVID-19. STUDY TYPE: Prospective, multicenter longitudinal cohort study. POPULATION: Twenty-four participants hospitalized due to COVID-19 with RLAs identified on CT ≥ 3 months postdischarge (median [IQR] age 69 (15) years; 3 female) underwent at least one MRI at 6 months (n = 16), 1 year (n = 19), or 2 years (n = 14). FIELD STRENGTH/SEQUENCE: 1.5 T. Dynamic contrast enhanced (DCE) 3D spoiled gradient echo, 129Xe steady state free precession (ventilation), 129Xe 3D spoiled gradient echo multiple b-value (diffusion-weighted), 129Xe 4-echo flyback 3D radial (dissolved phase). ASSESSMENT: Pulmonary blood flow, volume, and mean transit time (MTT) were calculated from DCE MRI. The fraction of 129Xe signal in the red blood cells to membrane (RBC:M) was calculated from the dissolved phase 129Xe acquisition. Ventilation defect percentage (VDP) was calculated from the 129Xe ventilation acquisition. Mean diffusive length scale (LmD) was calculated from the 129Xe diffusion-weighted acquisition. STATISTICAL TESTS: Changes in metrics with time and associations between metrics were assessed using mixed-effect linear regression. Correlations were tested using Spearman's correlation coefficient. Regional differences were assessed using a Friedman's test with a Bonferroni adjustment. p < 0.05 was considered significant. RESULTS: Pulmonary blood flow and MTT improved significantly over time (MTT: 6 months, 15.3 (IQR, 2.0); 1 year, 15.6 (1.4); 2 years, 15.0 (5.3); pulmonary blood flow: 6 months, 75.4 (IQR, 22.0); 1 year, 83.2 (47.4); 2 years, 107.3 (51.1)). RBC:M z-score was low at all three visits (
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Journal articleMatīsa D, Bansal AT, Rink S, et al., 2026,
Managing multimorbidity in severe asthma: comparison of resources and perspectives between severe asthma specialists and general respiratory physicians across Europe.
, ERJ Open Res, Vol: 12, ISSN: 2312-0541BACKGROUND: Multimorbidity refers to the presence of multiple coexisting conditions, but is often underappreciated in the context of severe asthma (SA) management. We sought to identify differences in approaches to multimorbidity management in SA, variability in access to multidisciplinary team (MDT) resources, and whether physician perspectives on multimorbidity differ between SA specialists and general respiratory physicians. METHODS: The Severe Heterogeneous Asthma Registry, Patient-centred (SHARP) Clinical Research Collaboration circulated an online physician survey via European national respiratory societies to assess 1) available resources to address multimorbidity and 2) physician perspectives on multimorbidity in SA. RESULTS: 495 responses from 25 European countries included 48% SA specialists and 52% general respiratory physicians. SA specialists had more experience with SA patients (20% were seeing >60 patients per month) compared to general respiratory physicians. SA specialists had greater access to multidisciplinary care - including better access to MDTs, allied health professionals and referrals to external specialists, and therefore more routinely assessed comorbidities and considered them greater influences on their practice. They also considered multimorbidity to a greater degree and rated its impact on their patients' asthma outcomes (and general health outcomes) as more substantial. CONCLUSIONS: Alongside more experience of treating SA, SA specialists have increased awareness of multimorbidity and better resources to manage it. However, access to MDTs remains a significant gap for both SA specialists and general respiratory physicians. Furthermore, both groups identified a high need for further education and training about multimorbidity. These findings highlight key areas for improvement in clinical practice, resources and training.
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Journal articleTorres MJ, Atanaskovic Marković M, Gelincik A, et al., 2026,
EAACI Spring Meeting 2026: Prevention as Treatment-A New Paradigm.
, Allergy -
Journal articleMassen G, Jenkins G, Stewart I, et al., 2026,
Temporal trends in single and multiple organ fibrosis prevalence and primary care consultations: a population based cohort study of 5·8 million individuals in England
, BMJ Open, ISSN: 2044-6055ObjectiveTo understand how prevalence estimates of single and multiple organ fibrosis have changed from 2012 to 2022.DesignRetrospective population-based cohort studySettingData from primary (Clinical Practice Resource Datalink Aurum) and secondary care (Hospital Episode Statistics Admitted Patient Care) electronic health records were used to conduct this study.ParticipantsAdults age 18 years and over whose primary and secondary care records were available for research.Main outcome measureFibrotic conditions previously determined from a Delphi survey of clinicians; diagnoses were found in either primary or secondary care records. The primary analysis estimated the prevalence of both single and multiple organ fibrosis prevalence. A secondary analysis used Cox proportional hazards models to investigate the association between the time-updated number of fibrotic conditions and risk of death adjusting for age and sex.ResultsThe cohort consisted of 5,839,459 people with at least one fibrotic condition and a denominator of 18,784,962 people. Over the study period prevalence of fibrotic conditions increased by 6.72%, as of 2022, 19·95% (95%CI:19·92 to 19·98) of adults had at least one fibrotic condition. Prevalence of multiple organ fibrosis increased from 4·78% (95%CI:4·76 to 4·79) in 2012 to 8·51% (95%CI:8·50 to 8·53) in 2022. In the year preceding diagnosis of single organ fibrosis, the median number of primary care consultations was 14 compared with 21 consultations for people with multiple organ fibrosis. Compared with people with single organ fibrosis, people with two fibrotic conditions had a mortality hazard ratio of 2.90 (95%CI: 2.87-2.93), whilst people with three fibrotic conditions had a mortality hazard ratio of 5.22 (95% CI:5.14-5.30).ConclusionsPrevalence of single and multiple organ fibrosis has substantially increased over a decade. People with multiple organ fibrosis access healthcare more tha
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Journal articleKc S, Hopkinson NS, Neves AL, et al., 2026,
Impact of Patient Portals on Asthma and Chronic Obstructive Pulmonary Disease-Related Quality-of-Care Outcomes: Systematic Review.
, Online J Public Health Inform, Vol: 18, ISSN: 1947-2579BACKGROUND: Patient portals are increasingly used to support self-management and facilitate care coordination in people with chronic diseases. Although some asthma quality-of-care gains and modest chronic obstructive pulmonary disease (COPD) improvements have been reported in wider digital health studies, a comprehensive review of patient portal-specific evidence is lacking. OBJECTIVE: This study aimed to systematically synthesize evidence on the impacts of patient portals on adult asthma and COPD outcomes across 6 quality-of-care domains (effectiveness, patient-centeredness, equity, efficiency, safety, and timeliness). METHODS: We searched 5 databases (MEDLINE/PubMed, Embase, PsycINFO, CINAHL, and Google Scholar) for quantitative evaluations published up to March 2026 (CRD42022316044). The Newcastle-Ottawa Scale and Cochrane Risk of Bias-2 tool were used for quality assessments, and certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Findings were narratively synthesized using the SWiM (Synthesis Without Meta-analysis) framework. RESULTS: We identified 4038 records, and 16 papers published between 2007 and 2024 met the inclusion criteria (asthma=13, COPD=2, both=1). Three were randomized controlled trials, all rated high risk of bias. Of the other studies, 5 had low risk, 6 had moderate risk, and 2 had high risk of bias. Effectiveness and patient-centeredness were most frequently reported, with 12 papers each. Eight papers were on equity, 5 each on efficiency and safety, and 4 on timeliness. In asthma, modest disease control improvements were reported in 27.8% (42/151) of participants using patient portals with home visit support versus portal use alone (35/150, 23.3%). In COPD, one large, interrupted time series study (N=909,724) reported post-implementation reductions in hospitalizations (slope change from 1.33 to -4.38 per 10,000 patients per month; P<.001) but no mortality benefit
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Journal articleWang R, Chen Y, Liu X, et al., 2026,
Extracellular vesicles in senescence-associated chronic lung diseases.
, Chin Med J (Engl), Vol: 139, Pages: 2392-2408Chronic lung diseases, such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, obstructive sleep apnea, asthma, bronchiectasis, and lung cancer, are intricately linked to the aging process. These diseases are characterized by a high prevalence rate and a paucity of effective treatment options. Emerging evidence highlights the critical role of extracellular vesicles (EVs) in the pathogenesis and progression of these diseases. EVs, released by senescent cells, mediate intercellular communication and modulate immune responses through their cargo of microRNAs, proteins, and other molecules. These vesicles contribute to disease progression by promoting inflammation, fibrosis, tissue remodeling, and cellular senescence. Specifically, certain microRNAs, such as miR-21, miR-34a, and miR-570-3p, along with several proteins in EVs, have been identified as key factors influencing these processes. Additionally, EVs play significant roles in immune regulation and have potential anti-inflammatory effects, making them promising candidates for therapeutic applications. Recent advances in the use of EVs as therapeutic agents, including their application in nanotechnology for targeted drug delivery, have demonstrated potential in reducing inflammation, modulating immune responses, and enhancing tissue repair. Understanding the role of EVs in these diseases offers insights into potential therapeutic targets to mitigate disease progression and improve patient outcomes. Future research should focus on standardizing EV isolation and characterization methods, verifying the safety and efficacy of EV-based therapies in clinical trials, and elucidating the complex biological mechanisms of EVs in aging and disease.
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Journal articleHillson K, Hay S, Gore M, et al., 2026,
High oral corticosteroid use during acute attacks of preschool wheeze irrespective of clinical phenotype
, Archives of Disease in Childhood, ISSN: 0003-9888Objective: This study aims to evaluate the burden of oral corticosteroid (OCS) use and any relationship to clinical phenotype in preschool children presenting with acute wheeze attacks.Methods: Single centre prospective study in which children with recurrent, severe preschool wheeze (PSW) who were referred to a tertiary respiratory centre, had symptom questionnaire, point-of-care blood eosinophil count (BEC) and aeroallergen sensitisation tests, undertaken on the same day as their outpatient clinic appointment. Results: 100 children with PSW (median age 3.5 years; interquartile range (IQR) 2.8-4.9 years; 51% male) were recruited. Clinical atopy, based on parental reporting, was present in 42%, while objective sensitisation, confirmed by testing, was observed in 35%. Median lifetime OCS courses per child was 10 (IQR 6-18), and 5 (IQR 3-7) during the preceding 12 months. Regardless of which definition of atopy was used, atopic children had higher BEC when well, compared to non-atopic children: using clinical atopy classification, median BEC was 0.65 vs 0.3×10⁹/L, (p=0.003) and using objective atopy, median BEC was 0.7 vs 0.3 ×10⁹/L, (p<0.0001). There was no difference in the use of OCS in the acute setting between higher and lower BEC, between clinical or objective atopy, or a combination of these, either over the child’s lifetime or during the previous 12 months. Conclusion: Children with severe, recurrent PSW are being treated with large numbers of OCS courses despite the lack of evidence of significant efficacy. There is an urgent need for trials which include phenotyping of acute attacks to guide OCS treatment.
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Journal articleGerth van Wijk R, Mahler V, Albrecht M, et al., 2026,
Factors for Success and Failure of Allergen Immunotherapy (AIT) Trial Design in the Light of Evidence-Based Medicine: Current Aspects 2026.
, AllergyAllergen immunotherapy (AIT) has been acknowledged as the only disease-modifying treatment for respiratory diseases since its introduction in 1911. Although the efficacy and safety have convincingly been established in numerous randomized clinical trials (RCTs), the AIT study results may vary substantially. Several factors that may influence the outcome of RCTs will be addressed. First, the choice of the primary endpoint is essential. Lack of validated endpoints with proven clinical relevance may contribute to the variation in study results. Secondly, heterogeneity of the patient population affects the study outcome, thereby raising the question of whether current selection criteria should be further optimized to capture those patients who will benefit from immunotherapy. Thirdly, variability and particularly low allergen exposure may lead to unsuccessful AIT trials. Fourthly, unsuccessful trials may stem from large placebo effects. Furthermore, discrepancies between Phase II and III studies are asking for cautious interpretation of Phase II studies when planning Phase III studies. Flaws in trial design, inadequate reporting of the clinical trial protocol and data may hamper the interpretation of study results. In addition, this review addresses specific aspects of AIT trial design in children and asthmatic patients. To improve future AIT trials, innovative solutions are urgently needed, including the establishment of an internationally accepted minimal clinically important difference (MCID), the validation of primary endpoints, the integration of field studies and allergen exposure chamber studies, and the publication of negative study results.
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Journal articleBush A, Ramsey B, 2026,
Cystic fibrosis in 2026: Game over, or game on? Introduction to an AJRCCM special section on cystic fibrosis.
, Am J Respir Crit Care Med -
Journal articleVassileva SM, Khamas SS, Dyhre-Petersen N, et al., 2026,
The impact of benralizumab and dupilumab on exhaled volatile organic compound profiles of severe asthma patients - a preliminary analysis.
, Respir Med, Vol: 262Volatile organic compounds (VOCs) in exhaled breath reflect biological processes in the lungs. Exploring VOC profiles in severe asthma patients starting biologics may reveal treatment-related biological changes over time. This study aimed to assess the performance and feasibility of applying a sparse partial least squares-discriminant analysis (sPLS-DA) analytical approach in detecting longitudinal changes in exhaled VOCs of patients with severe asthma initiating biologic treatment. Exhaled breath was collected in the 3 TR-ABC study, a multicenter observational prospective cohort study, at baseline and 4 months after starting biologics (benralizumab or dupilumab). VOCs were trapped on thermal desorption tubes and analyzed by gas chromatography-mass spectrometry. Paired sPLS-DA was used to distinguish baseline from post-treatment VOC profiles, and Kendall rank correlation assessed associations with clinical parameters at baseline. Data from two sites (Amsterdam and Copenhagen) were available of 25 severe asthma patients. The sPLS-DA resulted in a model containing five VOCs (methyl isobutyl ketone, 2-ethyl-1-hexanol, 5-methyl octadecane, 2-methylundecane and 1,1'-oxybis(decane)) with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval: 0.79-0.99) for distinguishing baseline and 4 months post treatment. At baseline, a positive correlation was observed between 2-ethyl-1-hexanol and asthma control (Asthma Control Questionnaire); τ = 0.40, p < 0.01. A negative correlation was found between 1,1'- oxybis(decane) and blood eosinophil counts (τ = -0.30, p = 0.04). Based on our results, the proposed analytical approach appears feasible for analyzing longitudinal data in patients with severe asthma initiating biologics. Further validation in larger cohorts is warranted to confirm robustness and generalizability.
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