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Introduction
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Francis Rackemann, a distinguished Boston Physician, carried out a detailed longitudinal clinical study of asthma in the first half of the 20th century and was the first to highlight heterogeneity of asthma. He commented that: ‘surely it is hard to believe that the wheeze that comes to the young school girl for a day or two in the ragweed season is the same disease as that which develops suddenly in the tired business man or in the harassed housewife and pushes them down to the depths of depletion and despair. The problem is still wide open: the approach is not at all clear’. Rackemann described two clinical asthmatic phenotypes: extrinsic asthma, thought to be due to allergens from outside the body and associated with younger age of onset, environmental triggers, atopy and the presence of other allergic diseases; and intrinsic asthma, due to factors intrinsic to the body associated with older age at onset and the absence of atopy.
Sympathomimetic Amines: Actions and Uses
Published in Kenneth J. Broadley, Autonomic Pharmacology, 2017
β-Adrenoceptor agonists are recommended as the first-line treatment for mild bronchial asthma, according to the International Consensus Report on Diagnosis and Management of Asthma supported by the British Thoracic Society (1992). They owe their primary beneficial effect to relaxation of bronchial smooth muscle which relieves the bronchospasm that characterizes the asthma attack. Asthma is usually due to an allergy to inhaled antigenic material in the inspired air, such as house dust mites, Dermatophagiodes pteronyssinus, which are distributed in bedding, carpets and furniture and live off human skin scales. Other common antigens are grass pollens and the dander from animal fur, cats being the worst offenders. These patients are regarded as atopic and carry the appropriate antibody (IgE) in their plasma. They usually demonstrate other features of atopy, including a positive response to skin-prick testing with allergens. They frequently have a personal and family history of other forms of hypersensitivity such as eczema, hay fever and rhinitis. This is allergic or extrinsic asthma. Atopic patients may not always display symptoms of asthma. Where no obvious external trigger factor other than respiratory infection occurs, it is referred to as intrinsic asthma. Exacerbations of the bronchospasm (asthma attacks) may also be precipitated, in sensitive individuals, by exercise or breathing cold air.
Endotypes and Asthma
Published in Jonathan A. Bernstein, Mark L. Levy, Clinical Asthma, 2014
Pranabashis Haldar, Rachid Berair
This phenotype is characterized by onset in childhood (usually <12 years) and has a strong association with allergen sensitization and related atopic diseases, typically allergic rhinitis and eczema. This is the classical asthma phenotype and is synonymous with the phenotype of “extrinsic asthma” characterized by Rackemann.5 This is the most prevalent phenotype of asthma, particularly in groups with mild to moderate disease. Indeed, the identification of this acknowledged phenotype using unsupervised multivariate mathematical techniques has been argued to validate their role in this field.47
Healthcare resource utilization, expenditures, and productivity in patients with asthma with and without allergies
Published in Journal of Asthma, 2020
Patrick W. Sullivan, Miguel J. Lanz, Vahram H. Ghushchyan, Abhishek Kavati, Jason LeCocq, Benjamin Ortiz, Diego J. Maselli
Our findings of greater HCRU and expenditures in patients aged ≥12 years with allergy and persistent asthma are consistent with those from a previous study of newly-diagnosed patients (9). However, Lafeuille et al. used a different method to classify asthma with allergy, requiring a specific diagnosis of extrinsic (allergic) asthma (ICD-9 493.0x) AND a claim with an allergy-related comorbidity during the study period (9). In preliminary analyses of our study population, the diagnosis of allergic asthma (ICD-9 493.0x) was exceedingly rare (n = 41); this under-reporting of allergic asthma is very likely due to coding bias given the sizeable proportion of patients with PE-EA (n = 971). For example, in the study by Lafeuille et al., of the 2.67 million individuals with asthma (defined as having ≥2 diagnoses of asthma [ICD-9 493.x]), only 64 781 (approximately 2%) had ≥1 diagnosis of extrinsic asthma (ICD-9 493.0x) and ≥1 allergy-related comorbidity. To more accurately identify patients with persistent asthma and an allergic component, we used a more comprehensive definition of allergic asthma by taking advantage of having both survey responses and healthcare claims in the same population.
Exhaled breath profiling by electronic nose enabled discrimination of allergic rhinitis and extrinsic asthma
Published in Biomarkers, 2019
Silvano Dragonieri, Vitaliano N Quaranta, Pierluigi Carratu, Teresa Ranieri, Onofrio Resta
The analysis of volatile organic compounds (VOCs) by an electronic nose is an innovative technique that has shown its potential in the non-invasive diagnosis of several respiratory diseases, including asthma.Extrinsic asthma and allergic rhinitis frequently coexist and share epidemiology, pathophysiology and therapeutic interventions.Our results show that an e-nose can discriminate exhaled breath of patients with allergic rhinitis with and without extrinsic asthma, as well as from healthy controlsThe current data support the view of using exhaled molecular profiling to help diagnosing asthma also in patients with allergic rhinitis.
Anti-inflammatory effects of embelin in A549 cells and human asthmatic airway epithelial tissues
Published in Immunopharmacology and Immunotoxicology, 2018
In-Seung Lee, Dong-Hyuk Cho, Ki-Suk Kim, Kang-Hoon Kim, Jiyoung Park, Yumi Kim, Ji Hoon Jung, Kwanil Kim, Hee-Jae Jung, Hyeung-Jin Jang
Allergic asthma, also called as extrinsic asthma, is the most common type of asthma which is a disease that causes extra sensitivity to certain allergens, including wind-blown pollen, mold spores, animal dander, dust mite and cockroach feces1,2. Allergic asthma is characterized by intermittent reversible obstruction and chronic inflammation of the external airways induced by airway hyper-reactivity (AHR)3, which leads to symptoms including dyspnea, wheezing and coughing4. In addition, lymphocytes and eosinophils are infiltrated within the airway submucosa in allergic asthma5. Inhaled allergens play a role in triggering of allergic asthma. Allergic asthma is correlated with abnormally increased immunoglobulin E (IgE), which responds to the presence of allergens6,7. Allergic asthma affects over 50% of the 20 million patients who suffer from asthma. Furthermore, over 2.5 million children under the age of 18 suffer from allergic asthma. However, the reason for the increased prevalence of allergic asthma is not clearly understood. Indoor allergens, caused by changes in the residential environment, air pollution, indoor pollution due to smoking and gas fuels and even dietary changes have been hypothesized to be responsible for the increased frequency of allergic asthma.