Journal of Asthma and Allergy最新文献

{"title":"Nonlinear Relationship Between Body Mass Index Z-Scores and Lung Function Parameters in Asthmatic Children: A Cross-Sectional Study.","authors":"Jing Wang, Jinmao Gao, Yuling Han, Lu Cheng, Xiang Ma","doi":"10.2147/JAA.S549235","DOIUrl":"10.2147/JAA.S549235","url":null,"abstract":"<p><strong>Introduction: </strong>To assess the relationship between body mass index (BMI) and BMI z-scores with lung function parameters in children with asthma, aiming to provide scientific evidence for individualized treatment and management strategies.</p><p><strong>Methods: </strong>We enrolled 328 children with asthma during acute exacerbation. The BMI and BMI z-scores were analyzed in relation to lung function parameters, including maximum vital capacity (VCmax), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow rate (MMEF), and instantaneous flows at 25%, 50%, and 75% of maximal expiratory flow (MEF25, MEF50, MEF75). Both linear regression and piecewise regression models were used to identify linear associations and potential threshold effects.</p><p><strong>Results: </strong>BMI showed significant positive linear correlations with VCmax, FVC, FEV1, MEF50, MEF75, and MMEF, while BMI z-scores demonstrated positive linear associations with VCmax, FVC, FEV1, MEF25, MEF50, and MMEF. After adjusting for age, sex, immunoglobulin E (IgE), eosinophil count (EOS), fractional exhaled nitric oxide (FeNO), and asthma severity, both BMI and BMI z-scores remained positively associated with VCmax, FVC, and FEV1. Piecewise regression analysis revealed significant threshold effects in the relationships between BMI z-scores and VCmax, FVC, FEV1, PEF, MEF25, MEF50, MEF75, and MMEF. Below a z-score of ~2.3-3.9, BMI z-score was positively associated with pulmonary function. Above this threshold, the association reversed; for instance, FEV1 decreased by 9.7% (β = -9.69, 95% CI: -18.93 to -0.46) and PEF decreased by 12.2% (β = -12.17, 95% CI: -21.12 to -3.22) for every unit increase in BMI z-score beyond 3.945.</p><p><strong>Conclusion: </strong>A nonlinear relationship exists between BMI z-scores and lung function parameters in children with asthma. Weight-guided interventions may enhance lung function and asthma control.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1455-1465"},"PeriodicalIF":3.0,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12570971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Nrf2 as a Potential Biomarker in Asthma: Links to Hypoxia, Oxidative Stress, and Ferroptosis in a Cross-Sectional Study.","authors":"Yupeng Li, Xinkai Ma, Yanqing Xing, Chuanchuan Dong, Liting Feng, Rujie Huo, Fei Hu, Xinrui Tian","doi":"10.2147/JAA.S520012","DOIUrl":"10.2147/JAA.S520012","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore the potential role of Nrf2 as a biomarker in asthma and its associations with hypoxia, oxidative stress, and ferroptosis-related indicators in a cross-sectional study.</p><p><strong>Patients and methods: </strong>This study involved the collection of peripheral blood samples from participants to isolate serum and peripheral blood mononuclear cells (PBMCs). Enzyme-linked immunosorbent assay (ELISA) and other assay kits was performed to quantify the levels of Nrf2, HIF-1α, SOD, and MDA in PBMCs, alongside the activities of SOD and GSH-Px, and serum concentrations of IL-4 and IL-13. Quantitative Real-time PCR (qRT-PCR) was used to assess the expression levels of GPX4, NCOA4, SCL7A11, and HMGB1 in PBMCs. Clinical data were collected and analyzed statistically. Receiver operating characteristic (ROC) curve analysis was employed to assess the diagnostic performance of these indicators.</p><p><strong>Results: </strong>Compared with the control group, asthma patients showed significantly lower levels of Nrf2 and SOD in PBMCs, as well as reduced expression of GPX4, SCL7A11, and NCOA4 (P < 0.05). In contrast, levels of HIF-1α and MDA, as well as the expression of HMGB1, were significantly elevated in the asthma group (P < 0.05). Correlation analysis indicated that Nrf2, HIF-1α, and MDA levels in PBMCs were associated with certain clinical indicators in asthma patients. ROC curve analysis further demonstrated that these indicators exhibited a certain diagnostic performance for asthma and severe asthma. Additionally, in asthma patients, Nrf2 expression in PBMCs was negatively correlated with HIF-1α levels and eosinophil counts, but positively correlated with SOD and GPX4 levels.</p><p><strong>Conclusion: </strong>The interplay between hypoxia, oxidative stress, and ferroptosis may be involved in asthma pathogenesis. Based on the findings, Nrf2 may have potential as a biomarker for asthma. However, given the study's limitations, further research is needed to confirm these associations and fully understand the role of Nrf2 in asthma diagnosis and progression.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1439-1453"},"PeriodicalIF":3.0,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12561605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145401042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Asthma Severity and Exacerbation Frequency on Burden of Disease Related Costs in Finland.","authors":"Mariann I Lassenius, Juhani Aakko, Sara Hallberg, Mary Dillon, Kaisa Nieminen, Hannu Kankaanranta, Arja Viinanen, Paula Kauppi, Lauri Lehtimäki","doi":"10.2147/JAA.S546092","DOIUrl":"10.2147/JAA.S546092","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluating productivity loss and healthcare costs among working-aged individuals with asthma is critical for comprehending the economic burden and guiding healthcare policy decisions. An optimized care of asthma could result in substantial societal benefits by improving workforce participation and reducing healthcare resource use. Recent data on the impact of both asthma severity and exacerbation frequency on overall costs are scarce.</p><p><strong>Patients and methods: </strong>In this retrospective study from Finland, 89,606 working aged patients with asthma were followed from national registers for four years from 2017 to 2020 with the objective to assess the impact of asthma severity and exacerbation frequency on the overall costs arising from direct healthcare resource utilization (visits and drug purchases) and productivity loss (long term sick leaves and disability pensions) with gamma regression models.</p><p><strong>Results: </strong>Severe asthma, noted in 10% of patients, increased healthcare resource utilization and productivity loss costs by 30% and frequent exacerbations, noted in 13% of patients, by 25%, independently of each other and of age, sex and Charlson comorbidity index. The annual overall cost per patient was € 14,359 for severe asthma with frequent exacerbations, followed by €11,802 in those with non-severe asthma and frequent exacerbations. Most costs were related to productivity losses (60%) compared to direct healthcare costs (40%). The prevalence of asthma increased from 2.7% to 3.0% over the four-year period, an increase was also observed in the subgroup of those with severe asthma.</p><p><strong>Conclusion: </strong>A substantial disease burden associated with frequent exacerbations in both patients with asthma and severe asthma leads to increased productivity loss and direct healthcare costs. The estimated the total annual cost of working-aged patients with asthma was €715 million in Finland, with 25% of additional costs associated with frequent exacerbations, indicating the potential savings that could be achievable through improved disease control.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1425-1437"},"PeriodicalIF":3.0,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12558724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145401085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin Prick Test and Patch Test: Environmental and Chemical Allergen Reactivity Pattern Among Yemeni Patients in Sana'a City, Yemen.","authors":"Abdulbasit A Al-Ghoury, Jamil M A S Obaid, Waheed A Ali, Mohammed A Al-Shaybani","doi":"10.2147/JAA.S538601","DOIUrl":"10.2147/JAA.S538601","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of hypersensitivity reactions to different allergens varies according to the population studied and is subject to environmental and lifestyle factors. Early and delayed hypersensitivity are diagnosed with skin prick test and patch test.</p><p><strong>Objective: </strong>This study aimed to identify the common environmental and chemical allergens sensitizing Yemeni allergic patients.</p><p><strong>Subjects and methods: </strong>A retrospective study was conducted using registries of patients who attended Elaj Medical Center in Sana'a city, Yemen, from January 1^st to December 31^st 2023. The collected data included sex, age, and the clinical laboratory test results of the skin prick test and the patch test.</p><p><strong>Results: </strong>The skin prick test was performed on sixty-five patients compared to twenty-two who were tested with a patch test. Most of the positive participants were male, aged between 18 and 40 years. The most frequent environmental allergens causing immediate hypersensitivity were <i>Dermatophagoides farinae</i> and <i>Dermatophagoides pteronyssinus</i> mites (64.6% and 69.2%, respectively), Aspergillus (47.7%), cat dander and dog dander (43.1% and 35.4%, respectively). <i>Dermatophagoides farinae</i> mites mostly sensitized females with an odds ratio of 3.43 (95% CI, 1.13-10.42, p=0.05). The most common chemical allergens that caused delayed hypersensitization were paraphenylenediamine (45.5%), potassium bichromate (45.5%), cobalt sulfate (36.4%), thiuram mix (27.3%), Vaseline (27.3%), and nickel sulfate (27.3%). Polysensitization was more frequent. The age of patients was directly proportional to the number of allergens responsible for immediate hypersensitivity (r-0.298, p=0.016).</p><p><strong>Conclusion: </strong>Yemeni patients exhibited high sensitization to aeroallergens and chemical allergens. Females showed a higher propensity for polysensitization. The pattern of sensitization to environmental and chemical allergens in Yemen differs somewhat from neighboring Arab and Asian countries. Further multi-center studies are needed to support and establish a standard country-specific allergens panel for testing.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1413-1424"},"PeriodicalIF":3.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12554318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Detailed Characterization of Asthma Manifestations and Their Associations with Dietary Intakes in a Singapore Cohort of Young Chinese Adults: A Cross-Sectional Study.","authors":"Jun Jie Lim, Zong Xun Huang, Evelyn Xiu Ling Loo, Mei Hui Liu, Fook Tim Chew","doi":"10.2147/JAA.S538254","DOIUrl":"10.2147/JAA.S538254","url":null,"abstract":"<p><strong>Purpose: </strong>Asthma is a heterogeneous disease with phenotypic variations potentially influenced by dietary factors. This cross-sectional study aimed to estimate the prevalence of current allergic asthma (AA), characterize its phenotypic variants, and examine dietary associations with asthma manifestations among young Chinese adults in Singapore.</p><p><strong>Patients and methods: </strong>We assessed 10,544 young Chinese participants (mean age 22.3 ± 5.5 years; male: female = 0.74) using a standardized, investigator-administered questionnaire adapted from the International Study of Asthma and Allergies in Childhood. Current AA was defined as a history of doctor diagnosis with symptoms in the past 12 months and having allergic sensitization to common house dust mites. Dietary intake across 16 food groups was assessed using a semi-quantitative food frequency questionnaire. Multivariable logistic regression, adjusted for sociodemographic and lifestyle factors, examined dietary associations with AA outcomes.</p><p><strong>Results: </strong>The prevalence of current AA was 5.24%. Among those with current AA, 67.0% (370/552) had mild, 21.7% (120/552) moderate, and 11.2% (62/552) severe asthma. Asthma was well-controlled in 60.7% (319/552), partly controlled in 39.3% (217/552), and poorly controlled in 2.9% (16/552). Common phenotypes included cough-variant (57.6%), wheezy variant (55.1%), and exercise-induced asthma (31.5%), with overlapping symptoms. Frequent intake (most or all days) of pulses (Adjusted odds ratio [AOR]: 0.65; 95% confidence intervals [CI]: 0.47-0.89; p < 0.001), probiotic drinks (AOR: 0.69; 95% CI: 0.50-0.94; p < 0.001), fruits (AOR: 0.47; 95% CI: 0.31-0.71; p = 0.001), and vegetables (AOR: 0.58; 95% CI: 0.35-0.99; p = 0.003) was associated with protective odds of current AA. Pulses were also associated with reduced odds of exacerbated and wheezy AA, while occasional (once or twice per week) intake of probiotic drinks was associated with reduced odds of cough-variant and wheezy AA.</p><p><strong>Conclusion: </strong>While certain plant-based foods and probiotic drinks were associated with reduced odds of AA and its phenotypes, these findings should be interpreted with caution given the cross-sectional design. Longitudinal or interventional studies are needed to clarify causality and underlying mechanisms.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1399-1412"},"PeriodicalIF":3.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12535299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron Deficiency Drives Th2-Mediated Immunity in Pediatric Atopic Dermatitis Through DNA Hypermethylation and TIGIT Suppression in IL-10-Producing Breg Cells.","authors":"Xiaofei Gao, Zhaojuan Hou, Xidie Li, Tingting Ouyang, Shuying Yu, Yuwei Wang, Ge Zhang, Yangyang Luo, Xieling He, Wei Liao, Zhu Wei","doi":"10.2147/JAA.S544136","DOIUrl":"10.2147/JAA.S544136","url":null,"abstract":"<p><strong>Background: </strong>Pediatric atopic dermatitis (AD), a common chronic relapsing inflammatory skin disorder, often co-occurs with iron deficiency. However, the causal relationship and mechanisms linking iron homeostasis to AD pathogenesis remain unclear. This study investigates etiopathogenetic role of iron deficiency in childhood AD by analyzing molecular pathways and clinical impacts on disease progression.</p><p><strong>Methods: </strong>We have enrolled 298 pediatric AD patients based on the Hanifin and Rajka criteria to evaluate the relationship between peripheral iron and the severity of AD, as well as the levels of serum iron, ferritin, and transferrin in children with AD. The percentages of Th2 cells and IL-10-producing CD24⁺CD38⁺CD19⁺ regulatory B (Breg) cells were quantified by flow cytometry. RNA-sequencing and bioinformatic analysis were performed to explore the iron deficiency-sensitive genes in CD19⁺ B cells treated with Ciclopiroxolamine (CPX). The differentially expressed genes, including T cell immunoreceptor with immunoglobulin and tyrosine-based inhibitory motif (ITIM) domain (<i>TIGIT</i>) and <i>IL10</i>, were further confirmed by RT-qPCR. 5-mC level was determined to evaluate the effect of iron deficiency on DNA methylation. TIGIT was inhibited in CD19⁺ B cells using a blocking antibody to assess its regulatory role in Breg cells.</p><p><strong>Results: </strong>Children with severe AD have lower levels of iron ions in peripheral blood compared with the mild patients (<i>P<0.0001</i>). Children with AD exhibited decreased serum levels of iron (<i>P</i><0.01), ferritin (<i>P</i>< 0.01), and transferrin (<i>P</i><0.05), along with an elevated percentage of Th2 cells (<i>P</i><0.01) and reduced CD24⁺CD38⁺CD19⁺ Breg cells (<i>P</i><0.01). CPX-mediated iron chelation suppressed IL-10-producing Breg cells (<i>P</i><0.01) by inducing DNA methylation (<i>P</i><0.05) and downregulating TIGIT (<i>P</i><0.001), while promoting the expansion of IL-4-producing Th2 cells (<i>P</i><0.05).</p><p><strong>Conclusion: </strong>Iron deficiency contributes to Th2 cell expansion in pediatric AD via DNA methylation and TIGIT suppression in IL-10-producing Breg cells.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1385-1398"},"PeriodicalIF":3.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Misdiagnosed Hereditary Angioedema with Recurrent Abdominal Pain: A Novel <i>SERPING1</i> Frameshift Variant.","authors":"Rou Xie, Rui Wen, Yueming Li, Xiangling Tan, Siyuan Qu, Tingting Hou, Jiao Qin","doi":"10.2147/JAA.S536943","DOIUrl":"10.2147/JAA.S536943","url":null,"abstract":"<p><strong>Background: </strong>Hereditary angioedema (HAE) is typically autosomal dominant, though recessive cases exist. It is characterized by recurrent episodes of swelling affecting the subcutaneous tissues, oropharyngeal mucosa, and gastrointestinal tract. This report describes a misdiagnosed case with a novel \"SERPING1\" variant.</p><p><strong>Case presentation: </strong>A 22-year-old Chinese male presented with recurrent acute abdominal pain since March 2018, initially misdiagnosed as gastroenteritis or intestinal obstruction at multiple hospitals. During current hospitalization, detailed history revealed non-pitting eyelid edema in July 2019 that progressed to facial edema within 24 hours after a cold. Over the subsequent three years, he experienced recurrent subcutaneous edema involving face and extremities, typically resolving spontaneously within one week. Family history showed his father had similar self-limiting episodes of abdominal pain and edema between ages 20-30, with no recurrence after age 40. Physical examination demonstrated upper abdominal tenderness without rebound pain. Low C4 levels prompted C1INH testing and genetic analysis, confirming HAE due to C1INH deficiency type 1 (HAE-C1INH-Type1) with a novel <i>SERPING1</i> variant. Since initiating lanadelumab (300mg biweekly) on April 26, 2023, the patient has completed 11 injections and remains in good condition.</p><p><strong>Conclusion: </strong>HAE is a rare disease that is often misdiagnosed. Complement C4 remains a critical screening biomarker for patients with HAE. In addition, we reported a novel frameshift variant in the coding region of the <i>SERPING1</i> gene, and the specificity of the position offers a unique point of interest in the discussion of the disease's causative locus.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1367-1375"},"PeriodicalIF":3.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with Higher Exacerbation Burden and Eosinophil Counts are More Likely to Require Multiple Biologics for Asthma Control.","authors":"Alyson N Brown, Tanawin Nopsopon, Ayobami Akenroye","doi":"10.2147/JAA.S543815","DOIUrl":"10.2147/JAA.S543815","url":null,"abstract":"<p><strong>Background: </strong>Multiple biologics are now available for severe asthma, creating opportunities to switch between therapies.</p><p><strong>Purpose: </strong>To identify characteristics of patients with asthma who switch biologics.</p><p><strong>Methods: </strong>We examined biologic switching in 1611 patients with moderate-to-severe asthma on maintenance therapy who initiated a biologic between 2014 and 2023 within a large health system and had no alternate indication. Chart reviews were performed to determine reasons for switching. We compared the characteristics of patients who: 1) did not switch therapy versus switched due to suboptimal response, and 2) switched once versus switched multiple times using descriptive statistics. Exacerbation incidence rates were assessed using Poisson regression. Inverse-probability-weighted-logistic regression accounting for demographic and clinical variables was conducted to evaluate factors associated with switching.</p><p><strong>Results: </strong>Fourteen percent (230/1611) switched: 81% once, 19% ≥2 times. Suboptimal response accounted for >70% of switches. Higher pre-initiation exacerbation rates were associated with a stepwise increase in likelihood of switching (1.4 in non-switchers vs 2.3 in patients who switched twice; 2.8 switched twice; and 3.4 in patients switching ≥3 times). Patients using ≥3 biologics had more baseline exacerbations (2.9 vs 2.3 in one-time switchers, p=0.01) and higher maximum blood eosinophil counts (BEC) in the year prior to treatment (662 vs 334 cells/µL, p=0.02), though median baseline BEC did not differ (229 vs 244 cells/µL, p=0.60). In weighted analyses, exacerbations (odds ratio, OR: 1.03; 95% Confidence Intervals, CI: 1.01-1.04, p<0.001) and baseline BEC (OR, 2.0 for each 50 cells/mcl increase; 95% CI: 1.2-3.4, p=0.002) were significantly different between switchers and non-switchers. However, only higher baseline exacerbations differentiated those who switched once to those who switched two or more times (1.02, 1.00-1.05, p=0.04). Exacerbations declined significantly in non-switchers during the first treatment year (1.42 to 0.99, p<0.001) but not among switchers.</p><p><strong>Conclusion: </strong>Patients with more severe asthma and higher maximum eosinophil counts at biologic initiation were more likely to switch therapies, predominantly due to suboptimal response. These findings emphasize the importance of selecting the first biologic carefully and optimizing timing of initiation.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1377-1383"},"PeriodicalIF":3.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12514954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dupilumab Among Patients with Uncontrolled Severe Asthma in China: A Cost-Utility Analysis.","authors":"Zheng Liu, Maosheng Xu, Huifang Zhu, Jinzhen Huang, Xuhui Ye, Xintian Shen, Xiaomei Fan","doi":"10.2147/JAA.S545324","DOIUrl":"10.2147/JAA.S545324","url":null,"abstract":"<p><strong>Purpose: </strong>Dupilumab's recent approval in China as an add-on therapy for asthma provides a novel therapeutic alternative for severe asthma management, but its economic benefits remain unsubstantiated in China. This study aimed to adopt a cost-utility analysis to evaluate the economics of dupilumab in the treatment of uncontrolled severe asthma and provide an evidence-based reference for clinical decision-making and therapeutic regimen selection.</p><p><strong>Methods: </strong>From the healthcare perspective, a Markov model was developed to simulate costs and quality-adjusted life years (QALYs) over a five-year time horizon for uncontrolled severe asthma patients aged ≥12 years receiving either dupilumab add-on therapy or standard-of-care (SoC) therapy alone. The incremental cost-utility ratio (ICUR) served as the primary outcome and was compared with the willingness-to-pay (WTP) threshold based on per capita gross domestic product (GDP) of China ($13,444.68/QALY) to determine the economics of therapeutic alternatives. The robustness of the results was verified using sensitivity analysis, and the impact of the dupilumab price on outcomes was evaluated using scenario analysis.</p><p><strong>Results: </strong>Compared with SoC therapy, dupilumab add-on therapy incurred higher costs but provided greater utility gains, with an ICUR of $83,941.87 per QALY gained, which exceeded the WTP threshold. One-way sensitivity analysis identified the utility of controlled asthma as the predominant influential factor, followed by the price of dupilumab. Probabilistic sensitivity analysis showed that 98.8% of simulations were consistent with the base-case results, and SoC therapy had a higher probability of cost-utility acceptability than dupilumab add-on therapy. Scenario analysis revealed that reducing dupilumab's price to $70.38 would render its ICUR below the WTP threshold.</p><p><strong>Conclusion: </strong>Based on the current Chinese healthcare system, it was not cost-utility to apply dupilumab as an add-on therapy for patients aged ≥12 years with uncontrolled severe asthma. A substantial price reduction of dupilumab could improve affordability in this patient population.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1355-1366"},"PeriodicalIF":3.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal Clinically Important Difference of the Taiwan Smell Test in Patients with Bilateral Chronic Rhinosinusitis and Nasal Polyps Post-Sinus Surgery.","authors":"Pei-Wen Wu, Ping-Hung Shen, Yun-Shien Lee, Po-Hung Chang, Chi-Che Huang, Chien-Chia Huang","doi":"10.2147/JAA.S544120","DOIUrl":"10.2147/JAA.S544120","url":null,"abstract":"<p><strong>Objective: </strong>The impairment of smell has become a crucial evaluation in determining disease severity, control status, and therapeutic response in patients with chronic rhinosinusitis and nasal polyps (CRSwNP). This study aimed to evaluate the minimal clinically important difference (MCID) of the Taiwan Smell Identification Test (TWSIT) in patients with CRSwNP undergoing endoscopic sinus surgery (ESS).</p><p><strong>Methods: </strong>Patients with bilateral CRSwNP who underwent ESS were prospectively enrolled. The 22-item Sino-Nasal Outcome Test questionnaire and TWSIT were utilized to evaluate both subjective and objective olfactory function before surgery and 3 months postoperatively.</p><p><strong>Results: </strong>Eighty-six patients with bilateral CRSwNP (53 males, 33 females) were enrolled. Moderate-to-high correlations were observed between the subjective smell loss scores and baseline TWSIT scores <i>(r_s</i> = 0.709 before treatment and <i>r_s</i> = 0.413 after treatment, both P < 0.001). The change in patient-reported smell loss was also significantly correlated with the change in TWSIT score <i>(r_s</i> = 0.675, P < 0.001). A TWSIT change of 6.5 points yielded a sensitivity of 71.6%, specificity of 91.7%, and an AUC of 0.789 (P < 0.001). Using the distribution-based method, the MCID was estimated as 7.4 (half the baseline standard deviation, SD) and 6.9 (half the delta SD). Based on both distribution- and anchor-based analyses, a TWSIT change of ≥ 7 points was determined to be the MCID.</p><p><strong>Conclusion: </strong>This study established that a TWSIT score change ≥ 7 is clinically meaningful for patients with CRSwNP following sinus surgery. Bridging objective test results with subjective perceptions can help clinicians identify patients with suboptimal therapeutic outcomes and guide decisions regarding additional treatments.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"18 ","pages":"1347-1353"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}