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(PDF) Relationship of Circulating Hyaluronic Acid Levels to Disease Control in Asthma and Asthmatic Pregnancy
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Hyaluronic acid (HA), a potential peripheral blood marker of tissue fibrosis in various diseases, promotes eosinophil survival and plays a role in asthmatic airway inflammation" /> <meta name="twitter:image" content="http://a.academia-assets.com/images/twitter-card.jpeg" /> <meta property="fb:app_id" content="2369844204" /> <meta property="og:type" content="article" /> <meta property="og:url" content="https://www.academia.edu/82548734/Relationship_of_Circulating_Hyaluronic_Acid_Levels_to_Disease_Control_in_Asthma_and_Asthmatic_Pregnancy" /> <meta property="og:title" content="Relationship of Circulating Hyaluronic Acid Levels to Disease Control in Asthma and Asthmatic Pregnancy" /> <meta property="og:image" content="http://a.academia-assets.com/images/open-graph-icons/fb-paper.gif" /> <meta property="og:description" content="Uncontrolled asthma is a risk factor for pregnancy-related complications. 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Hyaluronic acid (HA), a potential peripheral blood marker of tissue fibrosis in various diseases, promotes eosinophil survival and plays a role in asthmatic airway inflammation" /> <title>(PDF) Relationship of Circulating Hyaluronic Acid Levels to Disease Control in Asthma and Asthmatic Pregnancy</title> <link rel="canonical" href="https://www.academia.edu/82548734/Relationship_of_Circulating_Hyaluronic_Acid_Levels_to_Disease_Control_in_Asthma_and_Asthmatic_Pregnancy" /> <script async src="https://www.googletagmanager.com/gtag/js?id=G-5VKX33P2DS"></script> <script> window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'G-5VKX33P2DS', { cookie_domain: 'academia.edu', send_page_view: false, }); gtag('event', 'page_view', { 'controller': "single_work", 'action': "show", 'controller_action': 'single_work#show', 'logged_in': 'false', 'edge': 'unknown', // Send nil if there is no A/B test bucket, in case some records get 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false window.loswp.willEdgeCache = false; window.loswp.work = {"work":{"id":82548734,"created_at":"2022-07-04T10:34:29.944-07:00","from_world_paper_id":209768532,"updated_at":"2024-11-23T06:49:03.903-08:00","_data":{"publisher":"Public Library of Science (PLoS)","grobid_abstract":"Uncontrolled asthma is a risk factor for pregnancy-related complications. Hyaluronic acid (HA), a potential peripheral blood marker of tissue fibrosis in various diseases, promotes eosinophil survival and plays a role in asthmatic airway inflammation as well as in physiological processes necessary to maintain normal pregnancy; however the level of circulating HA in asthma and asthmatic pregnancy is unknown. We investigated HA levels in asthmatic patients (N = 52; asthmatic pregnant (AP) N = 16; asthmatic non-pregnant (ANP) N = 36) and tested their relationship to asthma control. Serum HA level was lower in AP than in ANP patients (27 [24.7-31.55] vs. 37.4 [30.1-66.55] ng/mL, p = 0.006); the difference attenuated to a trend after its adjustment for patients' age (p = 0.056). HA levels and airway resistance were positively (r = 0.467, p = 0.004), HA levels and Asthma Control Test (ACT) total score inversely (r = 20.437, p = 0.01) associated in ANP patients; these relationships remained significant even after their adjustments for age. The potential value of HA in the determination of asthma control was analyzed using ROC analysis which revealed that HA values discriminate patients with ACT total score $20 (controlled patients) and ,20 (uncontrolled patients) with a 0.826 efficacy (AUC, 95% CI: 0.69-0.97, p = 0.001) when 37.4 ng/mL is used as cutoff value in ANP group, and with 0.78 efficacy (AUC, 95% CI: 0.65-0.92, p = 0.0009) in the whole asthmatic cohort. In conclusion circulating HA might be a marker of asthma control, as it correlates with airway resistance and has good sensitivity in the detection of impaired asthma control. Decrease of HA level in pregnancy may be the consequence of pregnancy induced immune tolerance.","publication_date":"2014,,","publication_name":"PLoS ONE","grobid_abstract_attachment_id":"88225469"},"document_type":"paper","pre_hit_view_count_baseline":null,"quality":"high","language":"en","title":"Relationship of Circulating Hyaluronic Acid Levels to Disease Control in Asthma and Asthmatic Pregnancy","broadcastable":false,"draft":null,"has_indexable_attachment":true,"indexable":true}}["work"]; window.loswp.workCoauthors = [38468981]; window.loswp.locale = "en"; window.loswp.countryCode = "SG"; window.loswp.cwvAbTestBucket = ""; window.loswp.designVariant = "ds_vanilla"; window.loswp.fullPageMobileSutdModalVariant = "control"; window.loswp.useOptimizedScribd4genScript = false; window.loginModal = {}; window.loginModal.appleClientId = 'edu.academia.applesignon'; window.userInChina = "false";</script><script defer="" src="https://accounts.google.com/gsi/client"></script><div class="ds-loswp-container"><div class="ds-work-card--grid-container"><div class="ds-work-card--container js-loswp-work-card"><div class="ds-work-card--cover"><div class="ds-work-cover--wrapper"><div class="ds-work-cover--container"><button class="ds-work-cover--clickable js-swp-download-button" data-signup-modal="{"location":"swp-splash-paper-cover","attachmentId":88225469,"attachmentType":"pdf"}"><img alt="First page of “Relationship of Circulating Hyaluronic Acid Levels to Disease Control in Asthma and Asthmatic Pregnancy”" class="ds-work-cover--cover-thumbnail" src="https://0.academia-photos.com/attachment_thumbnails/88225469/mini_magick20220704-25462-12riia0.png?1656975855" /><img alt="PDF Icon" class="ds-work-cover--file-icon" src="//a.academia-assets.com/images/single_work_splash/adobe_icon.svg" /><div class="ds-work-cover--hover-container"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span><p>Download Free PDF</p></div><div class="ds-work-cover--ribbon-container">Download Free PDF</div><div class="ds-work-cover--ribbon-triangle"></div></button></div></div></div><div class="ds-work-card--work-information"><h1 class="ds-work-card--work-title">Relationship of Circulating Hyaluronic Acid Levels to Disease Control in Asthma and Asthmatic Pregnancy</h1><div class="ds-work-card--work-authors ds-work-card--detail"><a class="ds-work-card--author js-wsj-grid-card-author ds2-5-body-md ds2-5-body-link" data-author-id="38468981" href="https://independent.academia.edu/VeronikaMuller"><img alt="Profile image of Veronika Muller" class="ds-work-card--author-avatar" src="//a.academia-assets.com/images/s65_no_pic.png" />Veronika Muller</a></div><div class="ds-work-card--detail"><p class="ds-work-card--detail ds2-5-body-sm">2014, PLoS ONE</p><div class="ds-work-card--work-metadata"><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">visibility</span><p class="ds2-5-body-sm" id="work-metadata-view-count">…</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">description</span><p class="ds2-5-body-sm">6 pages</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">link</span><p class="ds2-5-body-sm">1 file</p></div></div><script>(async () => { const workId = 82548734; 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if (!viewCountBody) { throw new Error('Failed to find work views element'); } viewCountBody.textContent = `${commaizedViewCount} views`; } catch (error) { // Remove the whole views element if there was some issue parsing. document.getElementById('work-metadata-view-count')?.parentNode?.remove(); throw new Error(`Failed to parse view count: ${viewCount}`, error); } }; // If the DOM is still loading, wait for it to be ready before updating the view count. if (document.readyState === "loading") { document.addEventListener('DOMContentLoaded', () => { updateViewCount(viewCount); }); // Otherwise, just update it immediately. } else { updateViewCount(viewCount); } })();</script></div><p class="ds-work-card--work-abstract ds-work-card--detail ds2-5-body-md">Uncontrolled asthma is a risk factor for pregnancy-related complications. Hyaluronic acid (HA), a potential peripheral blood marker of tissue fibrosis in various diseases, promotes eosinophil survival and plays a role in asthmatic airway inflammation as well as in physiological processes necessary to maintain normal pregnancy; however the level of circulating HA in asthma and asthmatic pregnancy is unknown. We investigated HA levels in asthmatic patients (N = 52; asthmatic pregnant (AP) N = 16; asthmatic non-pregnant (ANP) N = 36) and tested their relationship to asthma control. Serum HA level was lower in AP than in ANP patients (27 [24.7-31.55] vs. 37.4 [30.1-66.55] ng/mL, p = 0.006); the difference attenuated to a trend after its adjustment for patients' age (p = 0.056). HA levels and airway resistance were positively (r = 0.467, p = 0.004), HA levels and Asthma Control Test (ACT) total score inversely (r = 20.437, p = 0.01) associated in ANP patients; these relationships remained significant even after their adjustments for age. The potential value of HA in the determination of asthma control was analyzed using ROC analysis which revealed that HA values discriminate patients with ACT total score $20 (controlled patients) and ,20 (uncontrolled patients) with a 0.826 efficacy (AUC, 95% CI: 0.69-0.97, p = 0.001) when 37.4 ng/mL is used as cutoff value in ANP group, and with 0.78 efficacy (AUC, 95% CI: 0.65-0.92, p = 0.0009) in the whole asthmatic cohort. In conclusion circulating HA might be a marker of asthma control, as it correlates with airway resistance and has good sensitivity in the detection of impaired asthma control. Decrease of HA level in pregnancy may be the consequence of pregnancy induced immune tolerance.</p><div class="ds-work-card--button-container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--work-card","attachmentId":88225469,"attachmentType":"pdf","workUrl":"https://www.academia.edu/82548734/Relationship_of_Circulating_Hyaluronic_Acid_Levels_to_Disease_Control_in_Asthma_and_Asthmatic_Pregnancy"}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--work-card","attachmentId":88225469,"attachmentType":"pdf","workUrl":"https://www.academia.edu/82548734/Relationship_of_Circulating_Hyaluronic_Acid_Levels_to_Disease_Control_in_Asthma_and_Asthmatic_Pregnancy"}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div><div class="ds-signup-banner-trigger-container"><div class="ds-signup-banner-trigger ds-signup-banner-trigger-control"></div></div><div class="ds-signup-banner ds-signup-banner-control"><div id="ds-signup-banner-close-button"><button class="ds2-5-button ds2-5-button--secondary ds2-5-button--inverse"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">close</span></button></div><div class="ds-signup-banner-ctas" data-impression-entity-id="82548734" data-impression-entity-type="2" data-impression-source="signup-banner"><img src="//a.academia-assets.com/images/academia-logo-capital-white.svg" /><h4 class="ds2-5-heading-serif-sm">Sign up for access to the world's latest research</h4><button class="ds2-5-button ds2-5-button--inverse ds2-5-button--full-width js-swp-download-button" data-signup-modal="{"location":"signup-banner"}">Sign up for free<span class="material-symbols-outlined" style="font-size: 20px" translate="no">arrow_forward</span></button></div><div class="ds-signup-banner-divider"></div><div class="ds-signup-banner-reasons"><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Get notified about relevant papers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Save papers to use in your research</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Join the discussion with peers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Track your impact</span></div></div></div><script>(() => { // Set up signup banner show/hide behavior: // 1. 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Methods: The study involved 40 pregnant asthmatic women over a total of 113 medical visits. On each occasion the participants had a pulmonary function test and a clinical evaluation to assess the level of asthma control. In addition, the ACT was carried out with the obstetrician being blinded to its results. Results: The most accurate cut-off point was 16, with a sensitivity of 95.4%, specificity of 68.8%, a negative predictive value of 91.7% and a positive predictive value of 80.5%. The positive and negative likelihood ratios were 3.052 and 0.067 respectively. The questionnaire was found to be highly effective for discriminating between controlled and uncontrolled asthma, with an area under the receiver operating characteristic (ROC) curve of 0.846 (95%CI: 0.748 e0.92). Reliability assessed in patients with the same clinical classification resulted in an intra-class correlation coefficient of 0.86 (95%CI: 0.75e0.93). Improved clinical conditions corresponded to a significant increase in the ACT score (p < 0.005), indicating good responsiveness to changes in clinical status.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Validation of the Asthma Control Test in pregnant asthmatic women","attachmentId":44738916,"attachmentType":"pdf","work_url":"https://www.academia.edu/13982249/Validation_of_the_Asthma_Control_Test_in_pregnant_asthmatic_women","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/13982249/Validation_of_the_Asthma_Control_Test_in_pregnant_asthmatic_women"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="1" data-entity-id="59537864" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/59537864/Asthmatic_Pregnant_Females">Asthmatic Pregnant Females</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="60817957" href="https://independent.academia.edu/SulaymanWaquar">Sulayman Waquar</a></div><p class="ds-related-work--metadata ds2-5-body-xs">The Professional Medical Journal</p><p class="ds-related-work--abstract ds2-5-body-sm">Background: Maternal asthma throughout pregnancy unfavorably alters pregnancy outcomes but evaluation of the causes, and the ability to assess interventions, is restricted having inadequate knowledge of complex interactions between underlying inflammation, oxidativestress and structural changes in asthmatic airways. Methods: Total 100 patients were included in study. Fifty ascontrols. Clinically diagnosed asthmatic pregnant females coming to GyneaUnit of Jinnah hospital were included.Females on any medication or suffering from any congenital disease were excluded out of the current study. Matrix metalloproteinase's, TNF-α, 8OHdG, 4-HNE and Isoprostanes are measured by ELISA. Results: Results shows that MMP-7 and MMP-9 have positive correlation with proinflammatory cytokine TNF-α but MMP-8 have significantly positive correlation with it (TNF-α Vs. MMP-8 r=0.946. On the other hand MMP-7 has significant correlation besides other MMPS (MMP-7 Vs.8OHdG r=0.719) indicating a positive correlation between proteinases and marker of DNA damage indicating epithelial shedding in case of Asthma. Conclusion: The sole objective of effective asthma management in pregnancy is to prevent exacerbations. Antioxidants should be added in diet so to ovoid oxidative stress caused to airway epithelial and structural cells and MMP inhibitors may be used as therapeutic agents as well as measuring MMP levels as diagnostic or prognostic markers.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Asthmatic Pregnant Females","attachmentId":73409305,"attachmentType":"pdf","work_url":"https://www.academia.edu/59537864/Asthmatic_Pregnant_Females","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/59537864/Asthmatic_Pregnant_Females"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="2" data-entity-id="61141777" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/61141777/Acute_asthma_in_pregnancy">Acute asthma in pregnancy</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32608360" href="https://bcm.academia.edu/NicolaHanania">Nicola Hanania</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Critical Care Clinics, 2004</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Acute asthma in pregnancy","attachmentId":74284122,"attachmentType":"pdf","work_url":"https://www.academia.edu/61141777/Acute_asthma_in_pregnancy","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/61141777/Acute_asthma_in_pregnancy"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="3" data-entity-id="20849247" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/20849247/Asthma_in_pregnancy_from_immunology_to_clinical_management">Asthma in pregnancy - from immunology to clinical management</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="42005307" href="https://sote.academia.edu/HorvathIldiko">Ildiko Horvath</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Multidisciplinary respiratory medicine, 2010</p><p class="ds-related-work--abstract ds2-5-body-sm">Asthma is one of the most common chronic medical conditions that may complicate pregnancy. Asthma influences the outcome of pregnancy and, vice versa, pregnancy affects asthma severity, but the underlying immunological mechanisms of this interaction are not fully understood. As a sign of pregnancy-induced immunotolerance, attenuation of allergic responses can be detected in controlled asthmatic pregnant patients; however non controlled asthmatic pregnant women show significant asthma-associated immune reactions that may, beside other factors, influence fetal growth. Generally, although uncontrolled asthma may increase the risk of adverse perinatal outcomes, women with well-controlled and adequately treated disease during pregnancy do not develop maternal or fetal complications.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Asthma in pregnancy - from immunology to clinical management","attachmentId":41596766,"attachmentType":"pdf","work_url":"https://www.academia.edu/20849247/Asthma_in_pregnancy_from_immunology_to_clinical_management","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/20849247/Asthma_in_pregnancy_from_immunology_to_clinical_management"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="4" data-entity-id="103721221" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/103721221/Monitoring_Asthma_in_Pregnancy_Diagnosis_and_Treatment">Monitoring Asthma in Pregnancy: Diagnosis and Treatment</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="249928297" href="https://independent.academia.edu/PranavNair90">Pranav Nair</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Clinical Pulmonary Medicine, 2020</p><p class="ds-related-work--abstract ds2-5-body-sm">Asthma is one of the most common problems that complicate pregnancy. Several maternal and fetal complications make it difficult for the physician to treat asthmatic pregnant women. Asthma not only affects the maternal quality of life but also increases the risk of adverse perinatal outcomes. Managing asthma along with proper diagnosis should be given special emphasis during pregnancy. Pregnant asthmatic patients are at an increased risk of preterm birth, congenital malformations, respiratory disorders, and other complications. Thus, optimum management of asthma along with appropriate pharmacological therapies during pregnancy helps in improving asthmatic exacerbations. This review provides insights with regard to the diagnosis, management, and safety of commonly used medications of asthma during pregnancy.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Monitoring Asthma in Pregnancy: Diagnosis and Treatment","attachmentId":103651886,"attachmentType":"pdf","work_url":"https://www.academia.edu/103721221/Monitoring_Asthma_in_Pregnancy_Diagnosis_and_Treatment","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/103721221/Monitoring_Asthma_in_Pregnancy_Diagnosis_and_Treatment"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="5" data-entity-id="108279350" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/108279350/Asthma_during_Pregnancy">Asthma during Pregnancy</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="159721284" href="https://independent.academia.edu/FaranakFiroozi">Faranak Firoozi</a></div><p class="ds-related-work--metadata ds2-5-body-xs">2010</p><p class="ds-related-work--abstract ds2-5-body-sm">Asthma is known as one of the most frequent chronic diseases encountered during pregnancy with prevalence estimated between 4 and 8%. The high prevalence of asthma during pregnancy results in some concerns about the impact of pregnancy on maternal asthma and also the impact of maternal asthma on perinatal outcomes. The literature presents conflicting results concerning the impact of maternal asthma during pregnancy on perinatal outcomes, such as preterm birth, low-birth-weight (LBW) infant and smallfor-gestational-age (SGA) infant. Also, scientific evidence is scarce regarding the impact of asthma severity and control during pregnancy on these perinatal outcomes. We thus conducted a research project composed of five studies to achieve the following objectives: 1. to develop and validate two database indexes, one to measure the control of asthma and the other to measure asthma severity; 2. to evaluate the effect of fetal gender on maternal asthma exacerbations and the use of asthma m...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Asthma during Pregnancy","attachmentId":106703368,"attachmentType":"pdf","work_url":"https://www.academia.edu/108279350/Asthma_during_Pregnancy","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/108279350/Asthma_during_Pregnancy"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="6" data-entity-id="125956180" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/125956180/Control_and_severity_of_asthma_during_pregnancy_are_associated_with_asthma_incidence_in_offspring_two_stage_case_control_study">Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case-control study</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="35367452" href="https://independent.academia.edu/PerreaultSylvie">Sylvie Perreault</a></div><p class="ds-related-work--metadata ds2-5-body-xs">The European respiratory journal, 2009</p><p class="ds-related-work--abstract ds2-5-body-sm">The extent to which childhood asthma incidence is influenced by asthma control and severity during pregnancy is unknown. We have studied this association during the child's first 10 yrs of life. A two-stage, case-control study, nested in a cohort of 8,226 children of asthmatic mothers, was conducted using three interlinked databases of Quebec, Canada, and mailed questionnaires. A total of 2,681 asthmatic children and 30,318 age-matched controls were selected (f20 controls?case-1 ; stage 1), and 3,254 selected mothers were mailed questionnaires to obtain additional information (stage 2). Asthma control and severity was defined using validated indexes and childhood asthma incidence based on at least one asthma-related diagnosis and prescription received within 2 yrs. A total of 44 confounders were considered. Compared with children of mild controlled asthmatic mothers, children whose mothers had moderate-to-severe uncontrolled asthma during pregnancy had an increased risk of asthma (adjusted OR 1.27, 95% CI 1.06-1.52). No increased risk was observed for children of mild uncontrolled and moderate-to-severe controlled mothers. Based on one of the largest studies of children of asthmatic mothers, a significant increase in asthma risk was demonstrated among children whose mothers had poor control and increased severity of asthma during pregnancy, indicating that this element should be added to the expanding list of determinants of childhood asthma. As it constitutes a risk factor where pregnant asthmatic females can intervene, it is of great importance for physicians to optimally treat asthmatic females during pregnancy and to encourage females to be adherent to the prescribed asthma medications.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case-control study","attachmentId":119908396,"attachmentType":"pdf","work_url":"https://www.academia.edu/125956180/Control_and_severity_of_asthma_during_pregnancy_are_associated_with_asthma_incidence_in_offspring_two_stage_case_control_study","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/125956180/Control_and_severity_of_asthma_during_pregnancy_are_associated_with_asthma_incidence_in_offspring_two_stage_case_control_study"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="7" data-entity-id="13572785" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/13572785/Surface_markers_of_lymphocyte_activation_in_pregnant_asthmatics">Surface markers of lymphocyte activation in pregnant asthmatics</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32755732" href="https://independent.academia.edu/%C3%89vaP%C3%A1llinger">Éva Pállinger</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Inflammation Research, 2010</p><p class="ds-related-work--abstract ds2-5-body-sm">Problem Pregnancy-associated immunologic alterations may improve the course of asthma. Severe maternal asthma with an exacerbation impairs fetal growth. Method of study Lymphocyte activation was estimated by flow cytometry analysis of surface markers in non-pregnant healthy and mild or moderate persistent asthmatic women and healthy as well as mild or moderate persistent asthmatic, third trimester pregnant women. Results Compared with non-pregnant healthy subjects (n = 12) activated pools within CD4 and CD8 T cells were larger and the number of NK T cells were increased both in non-pregnant asthmatic (n = 12) and in healthy pregnant (n = 13) subjects (all p \ 0.05). No further lymphocyte activation was observed in pregnant asthmatics (n = 21) compared either with non-pregnant asthmatic, or pregnant healthy women. Average birth weight of newborns was lower (p \ 0.05) in the asthmatic than in the healthy pregnant group. Conclusion Pregnancy is a state of wide-spread lymphocyte activation but it may blunt lymphocyte activation which characterizes bronchial asthma.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Surface markers of lymphocyte activation in pregnant asthmatics","attachmentId":45200347,"attachmentType":"pdf","work_url":"https://www.academia.edu/13572785/Surface_markers_of_lymphocyte_activation_in_pregnant_asthmatics","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/13572785/Surface_markers_of_lymphocyte_activation_in_pregnant_asthmatics"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="8" data-entity-id="103363321" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/103363321/Management_of_asthma_in_pregnancy_guided_by_measurement_of_fraction_of_exhaled_nitric_oxide_a_double_blind_randomised_controlled_trial">Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a double-blind, randomised controlled trial</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="43959193" href="https://independent.academia.edu/MurphyVanessa">Vanessa Murphy</a></div><p class="ds-related-work--metadata ds2-5-body-xs">The Lancet, 2011</p><p class="ds-related-work--abstract ds2-5-body-sm">Background Asthma exacerbations during pregnancy are common and can be associated with substantial maternal and fetal morbidity. Treatment decisions based on sputum eosinophil counts reduce exacerbations in non-pregnant women with asthma, but results with the fraction of exhaled nitric oxide (F E NO) to guide management are equivocal. We tested the hypothesis that a management algorithm for asthma in pregnancy based on F E NO and symptoms would reduce asthma exacerbations. Methods We undertook a double-blind, parallel-group, controlled trial in two antenatal clinics in Australia. 220 pregnant, non-smoking women with asthma were randomly assigned, by a computer-generated random number list, before 22 weeks' gestation to treatment adjustment at monthly visits by an algorithm using clinical symptoms (control group) or F E NO concentrations (active intervention group) used to uptitrate (F E NO >29 ppb) or downtitrate (F E NO <16 ppb) inhaled corticosteroid dose. Participants, caregivers, and outcome assessors were masked to group assignment. Longacting β2 agonist and minimum dose inhaled corticosteroid were used to treat symptoms when F E NO was not increased. The primary outcome was total asthma exacerbations (moderate and severe). Analysis was by intention to treat. This study is registered with the Australian and New Zealand Clinical Trials Registry, number 12607000561482. Findings 111 women were randomly assigned to the F E NO group (100 completed) and 109 to the control group (103 completed). The exacerbation rate was lower in the F E NO group than in the control group (0•288 vs 0•615 exacerbations per pregnancy; incidence rate ratio 0•496, 95% CI 0•325-0•755; p=0•001). The number needed to treat was 6. In the F E NO group, quality of life was improved (score on short form 12 mental summary was 56•9 [95% CI 50•2-59•3] in F E NO group vs 54•2 [46•1-57•6] in control group; p=0•037) and neonatal hospitalisations were reduced (eight [8%] vs 18 [17%]; p=0•046). Interpretation Asthma exacerbations during pregnancy can be signifi cantly reduced with a validated F E NO-based treatment algorithm.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a double-blind, randomised controlled trial","attachmentId":103390129,"attachmentType":"pdf","work_url":"https://www.academia.edu/103363321/Management_of_asthma_in_pregnancy_guided_by_measurement_of_fraction_of_exhaled_nitric_oxide_a_double_blind_randomised_controlled_trial","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/103363321/Management_of_asthma_in_pregnancy_guided_by_measurement_of_fraction_of_exhaled_nitric_oxide_a_double_blind_randomised_controlled_trial"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="9" data-entity-id="20843881" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/20843881/Incidence_and_risk_factors_for_exacerbations_of_asthma_during_pregnancy">Incidence and risk factors for exacerbations of asthma during pregnancy</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="42193090" href="https://independent.academia.edu/ZarqaAli">Zarqa Ali</a><span>, </span><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="42147437" href="https://ku-dk.academia.edu/CharlotteUlrik">Charlotte Ulrik</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of Asthma and Allergy, 2013</p><p class="ds-related-work--abstract ds2-5-body-sm">Background: Asthma is one of the most common chronic diseases among pregnant women. Acute exacerbations of asthma during pregnancy have an unfavorable impact on pregnancy outcome. This review provides an overview of current knowledge of incidence, mechanisms, and risk factors for acute exacerbations of asthma during pregnancy. Methods: A narrative literature review was carried out using the PubMed database. Results: During pregnancy, up to 6% of women with asthma are hospitalized for an acute exacerbation. The maternal immune system is characterized by a very high T-helper-2:T-helper-1 cytokine ratio during pregnancy and thereby provides an environment essential for fetal survival but one that may aggravate asthma. Cells of the innate immune system such as monocytes and neutrophils are also increased during pregnancy, and this too can exacerbate maternal asthma. Severe or difficult-to-control asthma appears to be the major risk factor for exacerbations during pregnancy, but studies also suggest that nonadherence with controller medication and viral infections are important triggers of exacerbations during pregnancy. So far, inconsistent findings have been reported regarding the effect of fetal sex on exacerbations during pregnancy. Other risk factors for exacerbation during pregnancy include obesity, ethnicity, and reflux, whereas atopy does not appear to be a risk factor. Discussion: The incidence of asthma exacerbations during pregnancy is disturbingly high. Severe asthma -better described as difficult-to-control asthma -nonadherence with controller therapy, viral infections, obesity, and ethnicity are likely to be important risk factors for exacerbations of asthma during pregnancy, whereas inconsistent findings have been reported with regard to the importance of sex of the fetus.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Incidence and risk factors for exacerbations of asthma during pregnancy","attachmentId":41593646,"attachmentType":"pdf","work_url":"https://www.academia.edu/20843881/Incidence_and_risk_factors_for_exacerbations_of_asthma_during_pregnancy","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/20843881/Incidence_and_risk_factors_for_exacerbations_of_asthma_during_pregnancy"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div></div></div><div class="ds-sticky-ctas--wrapper js-loswp-sticky-ctas hidden"><div class="ds-sticky-ctas--grid-container"><div class="ds-sticky-ctas--container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--sticky-ctas","attachmentId":88225469,"attachmentType":"pdf","workUrl":null}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--sticky-ctas","attachmentId":88225469,"attachmentType":"pdf","workUrl":null}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div></div></div><div class="ds-below-fold--grid-container"><div class="ds-work--container js-loswp-embedded-document"><div class="attachment_preview" data-attachment="Attachment_88225469" style="display: none"><div class="js-scribd-document-container"><div class="scribd--document-loading js-scribd-document-loader" style="display: block;"><img alt="Loading..." src="//a.academia-assets.com/images/loaders/paper-load.gif" /><p>Loading Preview</p></div></div><div style="text-align: center;"><div class="scribd--no-preview-alert js-preview-unavailable"><p>Sorry, preview is currently unavailable. 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