Asthma Treatment News: Metabolomics brings diagnosis a step closer

/ June 3rd, 2011/ Posted in Asthma / No Comments »

Allergic asthma on the breath: Metabolomics brings diagnosis a step closer

Allergic asthma, a sub-type of asthma, is a growing health problem affecting all age groups. The symptoms do not differ between the allergic and non-allergic condition, although the causes do.

The allergens responsible are encountered commonly everyday. They include house dust mites, mould spores, airborne pollen, faeces of the cockroach and dust mite, and food or food preservatives.

They trigger allergic asthma by entering the airways, causing the immune system to overreact. The airways become inflamed and filled with mucus, bringing on coughing, wheezing, shortness of breath and tightening of the chest. The effects range from mild to serious and can result in hospitalisation.

Currently, it has been estimated that 90% of children with asthma have allergies, compared with 50% of adults. They are diagnosed via their symptoms and, in some cases, by measuring biomarkers such as immunoglobulin E. Unfortunately, these markers are non-specific, so moves are taking place in research centres around the world to devise more sensitive and specific diagnoses.

A team of researchers based in Portugal has taken the view that the exhaled breath of a patient is a good place to start, since the disease affects the airways directly. It is also a non-invasive sampling method which children find easy to perform without discomfort.

Silvia Maria da Rocha and colleagues from the University of Aveiro, the University of Madeira and the Children’s Hospital D. Pedro, Aveiro, developed a method using GC/MS to analyse the volatile compounds in breath.

Asthma volatiles identified

Breath samples were collected in gas sampling bags for 22 children with allergic asthma and a further 13 children with the combination of allergic asthma and allergic rhinitis. The allergens of 26 were known to be dust mite (19 patients), dust mite plus cat fur (3), dust mite plus grass pollen (3) and dust mite plus cat fur plus grass pollen (1). Breath from healthy children was also collected as controls for comparison.

The compounds in the breath were sampled by headspace solid-phase microextraction using a divinylbenzene-carboxen-polydimethylsiloxane fibre in an optimised procedure. The fibre was inserted into the injection port of the gas chromatograph and the trapped compounds were thermally desorbed onto a high-polarity nitroterephthalic acid-modified polyethylene glycol column.

The eluting compounds were analysed by electron ionisation in full-scan mode and identified from their retention times and by comparing the mass spectra with those from the NIST mass spectral library.

A total of 44 compounds were identified, the vast majority being straight-chain and branched alkanes. Other classes included terpenoids, aldehydes, ketones, fatty acids and aromatic hydrocarbons. Many of these had been identified in earlier studies of exhaled breath.

The relative amounts of each compound were quantified from their GC peak areas. An analysis of variance (ANOVA) revealed no significant intra-individual variations throughout each day or between days. However, a partial least squares-discriminant analysis (PLA-DA) uncovered some variations that were attributed to the effects of diet and circadian rhythm.

Products of oxidative stress characterise allergic asthma

A subset of 28 volatiles was selected for multivariate analysis, ruling out any compounds which were not present on the breath of all the children and those which are known solvents or airborne contaminants. The 28 were not unique to children with allergic asthma but were observed to greater or lesser degrees in healthy children too.

The PLA-DA procedure was used to identify those compounds that best distinguished between healthy children and those with allergic asthma. A successful classification rate of 88% was achieved, the most indicative compounds being those linked to oxidative stress, such as aldehydes and alkanes. So, lipid peroxidation appears to be an important feature in allergic asthma.

The PLA-DA plots also largely discriminated between children with allergic asthma alone and those with allergic asthma and allergic rhinitis. The volatile composition was altered because allergic rhinitis is concentrated in the nose, producing a different profile.

The areas in the plots associated with allergic rhinitis were also positively correlated with cases that had shown positive prick tests.

The volatile profiles also displayed some correlation with the type of treatment received by the patients. Those given corticosteroids and leukotriene receptor agonists to treat the disease were distinguished from those receiving corticosteroids with antihistamines or corticosteroids with bronchodilators.

The results from this study are promising but the researchers acknowledge that the sample size is small. They are now extending the process to a larger number of healthy and allergic asthmatic children to see if the method really can provide a rapid and non-invasive diagnostic tool.

If successful, it will “provide a novel methodological approach to characterise allergic asthma as a function of its metabolomics patterns, which will open new strategies to early diagnosis, therapy monitoring and understanding the asthma pathogenesis that affects millions around the world.”

Asthma Treatment Can Lead to Osteoporosis

If you have asthma, you may be at increased risk of developing the bone disease osteoporosis. Asthma is a chronic condition that makes breathing difficult. During an asthma attack, tissues inside the airways swell and produce extra mucus, which clogs the airways. At the same time, the muscles surrounding the airways can clamp down and make airways even smaller. These things combine to make it hard for the air to move into and out of the lungs.
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There is no cure for asthma, but many asthma symptoms can be controlled using a variety of medications. Some of the most effective medications are corticosteroids or glucocorticoids, which can be taken as a pill or can be inhaled. Unfortunately, these medications can also cause damage to your bones and lead to osteoporosis.

Osteoporosis is a condition that makes bones brittle and weak. Healthy bone is a combination of bone and small holes that looks similar to a honeycomb. Bone with osteoporosis has larger than normal holes with weak, brittle bone in between. The mineral calcium is a building block for bone. In a healthy person, new bone is constantly being grown to replace old bone. But when the body is low on calcium, bone growth slows as the mineral is pulled out of bones. This can leave bones weak and more likely to break.

When corticosteroids used to treat asthma are taken by mouth, they interfere with the body’s ability to absorb calcium from foods. They also cause the kidneys to flush more calcium out of the body and limit the amount of bone that is produced. Corticosteroids used as inhalers are safer, but can still cause damage to bones.

In addition to the use of medications, other factors can also make someone with asthma more prone to osteoporosis. Some people with asthma believe milk and other dairy products can trigger an asthma attack. As a result, they avoid calcium rich foods that could help protect their bones. Research has shown that dairy is not a risk for most people with asthma, unless they are allergic to dairy products. Children in particular need calcium because strong bones early in life add some protection against osteoporosis later in life.

How to Treat Asthma with Aromatherapy

This sounds like irony, since generally asthmatics have difficulty with smells and such. But aromatherapy is being utilized to aid those with this type of breathing problem to surmount it.

Asthma is a severe condition that bears upon the breathing of the individual. When an asthma attack is set off, the bronchial passages become inflamed. This inflammation causes them to swell, leaving only a narrow space for air to travel through.

An asthmatic might feel like they can not catch their breath. Wheezing is frequently a characteristic as they try harder and harder to move air. Another consequence of an asthma attack is the smaller passageways in the lungs called bronchioles are likewise congested.

The lungs produce mucus to help engulf the irritant and push it out of the lungs. Only, the inflammation makes it difficult for the mucus to pass.

Asthma is set off by many of the same things that can cause allergic reactions to become unbearable. It may be food, nerve-wracking situations, allergens (dust, pollen, grass) or different causes. Either way, histamine is triggered off in the body and it leads to particular reactions like constriction of the airways. Add to that the inflammation and an asthmatic may scarcely move air.

One way that asthma attacks are being addressed is naturally with aromatherapy. Aromatherapy is a complementary medicine that utilizes different aromatic oils to give rise to positive effects inside the body.

Before beginning any aromatherapy treatment, confer with your physician. If you experience asthma, you’re likely being treated with inhalers and different medicine already. Make certain that none of the complementary treatments will interfere with your medicines. In the event of an asthma attack, always turn to your rescue meds for treatment.

Aromatherapy is one way to help relax the lungs while no attack is in progress or close at hand. If you would like to give this technique an attempt, that’s the finest time. Tell your aromatherapist if any type of aroma is an actual trigger for your asthma attacks.

These oils may be utilized in much the same way as medicines only without the side effects. Here is a good example. Lavender is well-known to relax the mind and alleviate stress. For the asthmatic, it may likewise be used to relax breathing passages, reducing spasms that cause the lungs to contract during an attack. Adding lavender essential oil to a humidifier or vaporizer may promote freer breathing. The results are faster if it’s added to hot water and the steam is inhaled.

Peppermint oil is likewise good for opening the lungs. Make a chest rub with a couple of drops of it to promote deeper breathing at nighttime. Including lavender will likewise steady your nerves.

Have you ever inhaled eucalyptus? You likely thought a freight train could run through your nose after that. It’s a potent oil that has to be used judiciously to relax the bronchioles and permit air to pass.

Aromatherapy may be utilized to help asthmatics savor freer respiration between asthma attacks. Several can even assist in shortening an attack, only that decision is best left up to your physician.

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UK doctors begin pioneering asthma treatment

Doctors in Manchester and Glasgow have begun treating NHS asthma patients with a pioneering treatment described as “melting away” muscle in the airways.

Instead of using drugs such as steroids, a wire probe is inserted into the lungs and then heats the tissue.

Currently, the procedure – called bronchial thermoplasty – is not being used anywhere else in Europe.

The technique uses 10-second bursts of radio waves which heat the lining of the lungs to 65 degrees Celsius.

That destroys some of the muscle tissue which constricts during an asthma attack, making breathing difficult.

Dr Rob Niven, senior lecturer in Respiratory Medicine at the University Hospital of South Manchester, who led the team carrying out the procedure at Wythenshawe Hospital, said “bronchial thermoplasty is the first non-drug treatment for asthma and it may be a new option for patients with severe asthma who have symptoms despite use of drug therapies.”

“The operation went according to plan and our patient has responded well. It will be a little while before we are able to say it’s been a complete success, but I am cautiously optimistic,” he said.

Normal airway
Airway of asthma patient has thickened muscle walls restricting the opening
Bronchoscope containing small wire probe passed into lungs
Probe is expanded so it touches walls of airways
Probe is then heated, reducing thickness of muscle tissue. Process is repeated along the airway to increase capacity

The procedure follows six years of trials in the UK, Canada and South America. Patients in the United States have been receiving the treatment for some months already.

Bronchial thermoplasty will not be used on children, says Dr Niven, and its effectiveness decreases as patients age.

Tens of thousands of patients across the UK with the most severe forms of asthma stand to benefit most from the treatment.

Symptoms can worsen to begin with, as the heat also causes damage to the sensitive lung lining. But once this is repaired doctors say asthmatics can be helped for up to five years.

However, cost is a potential problem – it costs around £10,000 per patient, although savings could be made in the longer term through fewer hospital admissions and reductions in the costs of medicines.

It will be up to the local NHS bodies, which buy care for patients, to decide on whether to fund it, possibly on a case-by-case basis.

According to the campaign group Asthma UK, 5.4 million people in the UK have asthma and around 250,000 of these have severe asthma.

The group’s Chief Medical Adviser, Professor Ian Pavord, said of bronchial thermoplasty: “In some people with severe asthma, the symptoms of their asthma have been improved and the risk of them having an asthma attack has been reduced, so it is encouraging to see that the technique has now been carried out outside of clinical trials.”

“However, this kind of procedure will not work for everyone so we would encourage people with asthma to discuss various treatment options with their GP to find the best way for them to keep their asthma managed and under control.”

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