Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma is a common clinical refractory airway disease. Comprehensive treatment of nasal endoscopic surgery including nasal endoscopic surgery and medication, which can significantly improve nose-pulmonary symptoms and make sinusitis and asthma easier to be controlled by medication, has certain superiority. But the existence of disease heterogeneity of CRSwNP with asthma causes different reactions to the current treatment, which manifests as parts of polyps and asthma easy to recur and difficult to control. According to the research recently, the study of the heterogeneity of airway diseases, for example endotype, is a hot area of research. Endotype is a subtype of a condition, which is defined by a distinct functional or pathobiological mechanism. This is distinct from a phenotype, which is any observable characteristic or trait of a disease. Different Inflammatory subtypes often represent different pathophysiology and even different pathogenesis. The concept of inflammatory subtypes of airway diseases provides a new perspective for studies of airway diseases of endotype and the mechanism of combined airway diseases. This review summarizes recent advances in the clinical characterization and treatment of the CRSwNP with asthma. On this basis, we analyze and summarize the heterogeneity of CRSwNP and asthma separately from the perspective of inflammatory subtypes. Then according to the concept of the combined airway diseases and the common pathogenesis, we put forward the definition of inflammatory subtypes of the CRSwNP with asthma and preliminarily discuss the method of the definition.
Asthma ; complications ; Chronic Disease ; Endoscopy ; Humans ; Nasal Polyps ; complications ; Rhinitis ; complications ; diagnosis ; Sinusitis ; complications ; diagnosis

Allergic bronchopulmonary aspergillosis (ABPA), an asthmatic disease, is caused primarily by hypersensitivity to Aspergillus species. ABPA is rarely observed in the absence of asthma, which is, in fact, the principle criterion for its diagnosis. Here, we report the case of a 36-yr-old woman without a history of bronchial asthma, who manifested a localized pneumonic consolidation, coupled with broncholithiasis. Pathologic examinations of bronchoscopic biopsy specimens and resected surgical specimens revealed features typical of ABPA. This is a very rare case of ABPA coupled with broncholithiasis in a non-asthmatic individual.
Lithiasis/*complications/*diagnosis ; Humans ; Female ; Bronchial Diseases/*complications/*diagnosis ; Asthma ; Aspergillosis, Allergic Bronchopulmonary/*complications/*diagnosis ; Adult

Chronic cough is one of the most common reasons for referral to a respiratory physician. Although fatal complications are rare, it may cause considerable distress in the patient's daily life. Western and local data shows that in patients with a normal chest radiograph, the most common causes are postnasal drip syndrome, postinfectious cough, gastro-oesophageal reflux disease and cough variant asthma. Less common causes are the use of angiotensin-converting enzyme inhibitors, smoker's cough and nonasthmatic eosinophilic bronchitis. A detailed history-taking and physical examination will provide a diagnosis in most patients, even at the primary care level. Some cases may need further investigations or specialist referral for diagnosis.
Asthma ; complications ; diagnosis ; Chronic Disease ; Cough ; diagnosis ; etiology ; Diagnosis, Differential ; Gastroesophageal Reflux ; complications ; diagnosis ; Humans

Asthma ; Child ; Cough ; Humans ; Rhinitis, Allergic, Perennial ; complications ; diagnosis ; therapy

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown cause characterized by the presence of multiple submucosal osseous and/or cartilaginous nodules that protrude into the lumen of the trachea and large bronchi. A simultaneous diagnosis of TO and amyloidosis is rarely reported. In this report, a case initially suspected to be asthma bronchiole that could not be treated, was radiologically diagnosed as TO, and also secondary amyloidosis is presented. A 53 years, man patient reported a 3 years history of dyspnea. Pulmonary function tests (PFTs) showed an obstructive pattern. Chest X-rays revealed right middle lobe atelectasis. FOB and CT detected nodular lesions in the trachea and in the anterior and lateral walls of the main bronchi. AA amyloidosis was confirmed by endobronchial biopsy. In the abdominal fat pad biopsy, amyloidosis was not detected. Asthma bronchiole was excluded by PFTs. This case illustrates that it is possible for TO and amyloidosis to masquerade as asthma. TO and amyloidosis should be suspected in patients of older ages with asthma and especially with poorly treated asthmatic patients. Although nodular lesions in the anterior and lateral tracheobronchial walls are typical for TO, a biopsy should be obtained to exclude amyloidosis.
Amyloidosis/complications/*diagnosis/pathology ; Asthma/diagnosis ; Bronchial Diseases/complications/*diagnosis/radiography ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Tracheal Diseases/complications/*diagnosis/radiography

I n some patients, eosinophilic gastroenteritis(EG) occurs in those with food allergy. We experienced a non-atopic asthmatic who had an EG associated with food allergy to fish and eggs, and blood eosinophilia. A skin prick test and RAST to causative food allergens showed a negative result. A fiber-optic endoscopic biopsy from the gastric mucosa showed an intense eosinophilic infiltration. We could find symptomatic improvement and a disappearance of eosinophilic infiltration in gastric mucosa after complete avoidance from the causative food and oral cortcosteroid. It was suggested that fiber-optic endoscopic biopsy might be needed to identify coexisting EG if an allergic patient with blood eosinophilia complains of severe gastrointestinal symptoms.
Adrenal Cortex Hormones/therapeutic use ; Asthma/*complications/drug therapy ; Case Report ; Endoscopy ; Eosinophilia/*complications ; Food Hypersensitivity/*complications ; Gastric Mucosa/pathology ; Gastroenteritis/*complications/diagnosis/pathology ; Human ; Male ; Middle Age

Objective To investigate the risk factors of asthma attack.Methods In this open cohort study,74 492 initially healthy subjects aged 20 years or more in a longitudinal multi-center health management cohort in Shandong province from January 2007 to December 2015 were enrolled in this study. These subjects had no baseline bronchial asthma or other chronic airway disease and did not migrate to other provinces in the past 10 years. All subjects were followed up till 2016,and the asthma attack and its influencing factors were analyzed. The baseline data including sociodemographic data,smoking history,disease histories,and family disease histories were collected and analyzed by Poisson regression analysis.Results The regression analysis showed that age between 40 and 50 years(RR=3.3,95%CI=1.8-6.0),female(RR=1.6,95%CI=1.1-2.3),nasal polyps(RR=9.5,95%CI=2.3-39.6),pneumonia(RR=6.5,95%CI=3.7-11.2),bronchitis(RR=8.7,95%CI=5.1-14.7),and chronic obstructive pulmonary disease(RR=6.6,95%CI=3.1-13.8) significantly increased the risk of asthma attack.Conclusion Age,gender,and previous histories of certain respiratory tract diseases increase the risk of asthma attack.
Adult ; Age Factors ; Asthma ; diagnosis ; Bronchitis ; complications ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Nasal Polyps ; complications ; Pneumonia ; complications ; Pulmonary Disease, Chronic Obstructive ; complications ; Risk Factors ; Sex Factors

The association between allergic rhinitis and bronchial asthma, that is, whether it is a seqential process or independent diseases, has not been established. We confirmed that a 25 year-old woman with allergic rhinitis sensitized to Artemisia spp. pollens and house dust mites developed bronchial asthma during a 2 year follow-up period. Severe broncho-constriction was noted after inhalation of methacholine, and the bronchoprovocation test with extract of Korean Artemisia spp. pollen showed early bronchoconstiction. Total IgE and specific IgE antibodies to Artemisia absinthium increased, compared to the initial levels. It is suggested that some patients with allergic rhinitis progress to bronchial ashtma.
Adult ; Angiosperms ; Asthma/diagnosis/*etiology ; Bronchial Provocation Tests ; Case Report ; Female ; Hay Fever/*complications/diagnosis ; Human ; Korea ; *Pollen ; Skin Tests

OBJECTIVETo study the role of serum neutrophil elastase (NE) level in acute exacerbation of asthma in preschool children.

METHODSA total of 85 preschool children who were diagnosed with asthma between January 2008 and January 2010 were classified into acute exacerbation group (n=44) and non-acute exacerbation group (n=41). Thirty-five children who received physical examination served as the control group. The enzyme-linked immunosorbent assay was used to determine the serum levels of NE and interleukin-8 (IL-8). The receiver operating characteristic (ROC) curve was used for NE evaluation.

RESULTSBoth the acute and non-acute exacerbation groups had higher serum levels of NE and IL-8 than the control group, and the acute exacerbation group had significantly higher serum levels of NE and IL-8 than the non-acute exacerbation group (P<0.05). The serum level of NE was positively correlated with that of IL-8 (r=0.48, P<0.05). With serum NE level >27.73 μg/L as the cut-off value for diagnosing acute exacerbation of asthma, the sensitivity was 65.9%, the specificity was 95.1%, and the area under the ROC curve was 0.87 (P<0.01).

CONCLUSIONSThe determination of serum NE level in preschool children with asthma helps to diagnose the acute exacerbation of asthma.

Asthma ; blood ; complications ; diagnosis ; Child ; Child, Preschool ; Female ; Humans ; Interleukin-8 ; blood ; Leukocyte Elastase ; blood ; Male ; ROC Curve

OBJECTIVETo explore the biomarkers and inflammatory characteristics for microcosmic syndrome differentiation of cold-phlegm syndrome (CPS) and heat-phlegm syndrome (HPS) in patients with bronchial asthma.

METHODSPatients with bronchial asthma of chronic persistent condition were distributed into three groups according syndrome differentiation, the CPS group (27 patients), the HPS group (32 patients) and the non-cold/heat-phlegm syndrome group (NP group, 31 patients), besides, a control group was setup with 33 healthy persons. Percentages of neutrophils and eosinophils (NEU, EOS) in sputum sample (collected by induction) and peripheral blood were counted; and levels of interleukin-8, -5, and -4 (IL-8, IL-5 and IL-4), interferon-gamma (IFN-gamma), leukotriene B4 (LT-B4), eosinophil cationic protein (ECP), and C-reactive protein (CRP) in sputum supernatant and serum were determined by enzyme-linked immunosorbent assay.

RESULTSPercentage of NEU in sputum of HPS group was higher than that in the other three groups (P < 0.05); while percentages of EOS in serum and sputum of CPS group were higher than that in the other three groups (all P < 0.01). Level of ECP (a parameter closely associated with EOS) also was high in the CPS group, but IL-8 (a parameter closely associated with NEU) showed no significant difference in various groups (P > 0.05). Moreover, the CPS group showed a higher serum IL-4 (P < 0.05) but a lower IFN-gamma/IL-4 level as compared with those in the NP group (P < 0.01).

CONCLUSIONPhlegm, which is considered by Chinese medicine as an inveterate root of asthma, might be closely related with the inflammation in modern medicine. The inflammatory characteristics of asthma in patients with CPS partially present as increase of EOS, possibly show Th2 dominant trend, similar to that presented in eosinophilic asthma. Asthma with HPS embodies increase of NEU in respiratory tract. EOS and ECP might be the important markers for microcosmic syndrome differentiation of CPS, and NEU might be that for HPS.

Adolescent ; Adult ; Aged ; Asthma ; complications ; diagnosis ; pathology ; Biomarkers ; metabolism ; Case-Control Studies ; Diagnosis, Differential ; Eosinophil Cationic Protein ; metabolism ; Eosinophils ; pathology ; Female ; Humans ; Inflammation ; complications ; diagnosis ; pathology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Neutrophils ; pathology ; Young Adult