New asthma management (APGAR) tools improve outcomes

Researchers analyzed to see if a set of asthma management tools called APGAR(Activities, Persistent, triGGers, Asthma medications, Response to therapy) tools helps decrease asthma-related visits to the emergency department, urgent care or hospital and improves patients’ asthma control. The study results are published in journal Annals of Family Medicine.

A randomized controlled study was conducted in 18 family medicine and pediatric practices across the US, which compared outcomes in more than 1,000 patients with persistent asthma aged 4 to 45 years using Asthma APGAR tools versus usual care. The study results showed that in the group which used APGAR tools had a significantly lower proportion (11%) asthma emergencies compared to the usual management group (21%).  At one-year intervention group had improved asthma control and showed better control scores and improved quality of life.

Intervention practices also significantly increased their adherence to three or more elements of the National Asthma Education and Prevention Program guidelines compared to usual care practices. Participating practices reported that changing practice to incorporate the Asthma APGAR tools was challenging, but the tools themselves were perceived as useful and efficient.

The authors suggest that the Asthma APGAR tools are effective for asthma management in the primary care practice setting.

Citation: Yawn, Barbara P., Peter C. Wollan, Matthew A. Rank, Susan L. Bertram, Young Juhn, and Wilson Pace. “Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial.” The Annals of Family Medicine 16, no. 2 (2018): 100-10. doi:10.1370/afm.2179.

Adapted from press release by American Academy of Family Physicians.

Role of Vitamin D in acute respiratory infections

Vitamin D supplements protect against acute respiratory infections including colds and flu, according to a study led by the Queen Mary University of London.

The study provides the most robust evidence yet that vitamin D has benefits beyond bone and muscle health, and could have major implications for public health policy, including the fortification of foods with vitamin D to tackle high levels of deficiency in the UK. The results, published in the BMJ, are based on a new analysis of raw data from around 11,000 participants in 25 clinical trials conducted in 14 countries including the UK, USA, Japan, India, Afghanistan, Belgium, Italy, Australia and Canada.

Individually, these trials yielded conflicting results, with some reporting that vitamin D protected against respiratory infections, and others showing no effect.

Lead researcher Professor Adrian Martineau from Queen Mary University of London said: “This major collaborative research effort has yielded the first definitive evidence that vitamin D really does protect against respiratory infections. Our analysis of pooled raw data from each of the 10,933 trial participants allowed us to address the thorny question of why vitamin D ‘worked’ in some trials, but not in others.”The bottom line is that the protective effects of vitamin D supplementation are strongest in those who have the lowest vitamin D levels, and when supplementation is given daily or weekly rather than in more widely spaced doses.

“Vitamin D fortification of foods provides a steady, low-level intake of vitamin D that has virtually eliminated profound vitamin D deficiency in several countries. By demonstrating this new benefit of vitamin D, our study strengthens the case for introducing food fortification to improve vitamin D levels in countries such as the UK where profound vitamin D deficiency is common.” Vitamin D – the ‘sunshine vitamin’ – is thought to protect against respiratory infections by boosting levels of antimicrobial peptides – natural antibiotic-like substances – in the lungs.

Overall, the reduction in risk of acute respiratory infection induced by vitamin D was on a par with the protective effect of injectable ‘flu vaccine against ‘flu-like illnesses. Vitamin D supplementation is safe and inexpensive, so reductions in acute respiratory infections brought about by vitamin D supplementation could be highly cost-effective.

Citation: Martineau, Adrian R., David A. Jolliffe, Richard L. Hooper, Lauren Greenberg, John F. Aloia, Peter Bergman, Gal Dubnov-Raz, Susanna Esposito, Davaasambuu Ganmaa, Adit A. Ginde, Emma C. Goodall, Cameron C. Grant, Christopher J. Griffiths, Wim Janssens, Ilkka Laaksi, Semira Manaseki-Holland, David Mauger, David R. Murdoch, Rachel Neale, Judy R. Rees, Steve Simpson, Iwona Stelmach, Geeta Trilok Kumar, Mitsuyoshi Urashima, and Carlos A. Camargo. “Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data.” Bmj, 2017, I6583. doi:10.1136/bmj.i6583.
Adapted from press release by the Queen Mary University of London.

New drug shows promise for COPD and other lung diseases

New research published online in The FASEB Journal reveals a potential drug to combat the life-threatening effects of chronic obstructive pulmonary disease (COPD).

Specifically, the study investigated the efficacy of a receptor for advanced glycan end-products (RAGE)-specific antagonist chemical compound, FPS-ZM1, in mice, and found that this compound reverses the inflammatory response and has a protective role in COPD. “RAGE disturbances in pulmonary disorders are precise and effective strategies with beneficial clinical effects,” said Se-Ran Yang, D.V.M., Ph.D., a researcher involved in the work and an associate professor at the Department of Thoracic and Cardiovascular Surgery in the School of Medicine at Kangwon National University in Gangwon, Korea.

“Blockade of RAGE as a novel clinical therapeutic for COPD ameliorates emphysema/COPD development and progression.” In their study, Yang and colleagues investigated the efficacy of RAGE-specific antagonist FPS-ZM1 administration in both in vivo and in vitro COPD models to determine the molecular mechanism by which RAGE influences COPD. The researchers injected mice with an in vivo COPD inducer and the RAGE antagonist FPS-ZM1. Then they assessed the infiltrated inflammatory cells and their production of cytokines.

Cellular expression of RAGE, initiating inflammatory response, and soluble RAGE, acting as a “Decoy,” was determined in protein, serum, and bronchoalveolar lavage fluid in the mice, as well as in the serum of human donors and patients with COPD. They analyzed downstream damage-associated molecular patterns and danger signals in vivo and in vitro and in patients with COPD, and found that RAGE was associated with the up-regulation of DAMP-related signaling pathways via Nrf2. FPS-ZM1 administration also significantly reversed emphysematous lung symptoms in mice.

“No one expected the pathogenic roots of COPD to be simple, and this study gives us an indication of the complexity involved.,” said Thoru Pederson, Ph.D., Editor-in-Chief of The FASEB Journal.

“The current pharmacological armamentarium is limited, and studies like this are thus extremely valuable as a foundation.”

Citation: Lee, Hanbyeol, Jeong-Ran Park, Woo Jin Kim, Isaac K. Sundar, Irfan Rahman, Sung-Min Park, and Se-Ran Yang. “Blockade of RAGE ameliorates elastase-induced emphysema development and progression via RAGE-DAMP signaling.” The FASEB Journal (2017): fj-201601155R.
DOI: 10.1096/fj.201601155R
Research funding: National Research Foundation of Korea , US National Institutes of Health, National Heart, Lung, and Blood Institute
Adapted from press release by Federation of the American Societies for Experimental Biology (FASEB).