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Severe Asthma Research - December 2015

Christina E Ciaccio, MD, MSc

Christina E Ciaccio, MD, MSc
Allergist/Immunologist
Assistant Professor of Pediatrics
University of Chicago Medicine
Comer Children’s Hospital
Chicago, Illinois, United States

Improved asthma control in patients with severe, persistent allergic asthma after 12 months of nightly temperature-controlled laminar airflow

Reducing exposure to allergic triggers is an important component of the treatment of severe, allergic asthma. This study sought to determine if nightly temperature-controlled laminar airflow (TLA), a device which displaces allergens from the breathing zone, would improve asthma symptoms. This non-randomized, uncontrolled, pre-post observational study was performed at 10 German asthma centers. Thirty-two patients with severe asthma participated. Five patients did not complete this 12-month study. The number of asthma exacerbations fell from an average 3.6 to 1.3 (p<0.001). Emergency Department visits for asthma fell from 72% to 23%. The proportion of patients with controlled asthma also significantly decreased. Although a randomized, controlled study is needed to further validate this option, the addition of an effective, non-pharmaceutical treatment would be a welcome addition to the market by both patients and asthma physicians.

Schauer U, Bergmann KC, Gerstlauer M, Lehmann S, Gappa M et al. Improved asthma control in patients with severe, persistent allergic asthma after 12 months of nightly temperature-controlled laminar airflow: an observational study with retrospective comparisons. European Clinical Respiratory Journal 2015;2: July. (doi: 10.3402/ecrj.v2.28531)

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Phosphoinositide 3-kinase-delta regulates fungus-induced allergic lung inflammation through endoplasmic reticulum stress.

PI3K-delta is an important component to many immune functions and has been shown to mediate steroid resistance in neutrophil predominant chronic respiratory disorders. In this study, the investigators sought to determine if PI3K-delta plays a role in steroid resistant, eosinophilic, fungal associated lung inflammation in a murine model. The investigators found that PI3K-delta modulates endoplasmic reticulum stress and PI3K-delta inhibition improves Aspergillus fumigatus-induced allergic lung. In addition, eosinophils from Broncho alveolar lavage (BAL) were reduced after selective inhibition of PI3K-delta. Dexamethasone failed to improve Aspergillus fumigatus-induced allergic inflammation and endoplasmic reticulum stress. The authors went on to find that inhibition of NF-kappa B mediated endoplasmic reticulum stress improved Aspergillus fumigatus-induced inflammation. Finally, the authors found that selective inhibition of PI3K-delta improves Aspergillus fumigatus-induced oxidative stress. These data show that PI3K-delta may be an important target for drug development for steroid resistant eosinophilic lung disease.

Lee KS, Jeong JS, Kim SR, Cho SH, Kolliputi N et al. Phosphoinositide 3-kinase-δ regulates fungus-induced allergic lung inflammation through endoplasmic reticulum stress. Thorax 2015; published online ahead of print, November 5. (doi:10.1136/thoraxjnl-2015-207096)

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