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Antunes, M. Pereira, L. Rodrigues, D. Organista, A. Cysneiros, F. Paula, B. Nunes, P. Barbosa, C. Bárbara, A. Escoval, A. Diniz, F. Froes" "autores" => array:12 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Antunes" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Pereira" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Rodrigues" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Organista" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Cysneiros" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "Paula" ] 6 => array:2 [ "nombre" => "B." "apellidos" => "Nunes" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Barbosa" ] 8 => array:2 [ "nombre" => "C." "apellidos" => "Bárbara" ] 9 => array:2 [ "nombre" => "A." "apellidos" => "Escoval" ] 10 => array:2 [ "nombre" => "A." "apellidos" => "Diniz" ] 11 => array:2 [ "nombre" => "F." "apellidos" => "Froes" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043720300969?idApp=UINPBA00004E" "url" => "/25310437/0000002600000005/v1_202009020805/S2531043720300969/v1_202009020805/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2531043720301331" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2020.05.016" "estado" => "S300" "fechaPublicacion" => "2020-09-01" "aid" => "1503" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Pulmonol. 2020;26:259-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Pulmonology (is) on the air" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "259" "paginaFinal" => "260" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Robalo Cordeiro" "autores" => array:1 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Robalo Cordeiro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043720301331?idApp=UINPBA00004E" "url" => "/25310437/0000002600000005/v1_202009020805/S2531043720301331/v1_202009020805/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comment</span>" "titulo" => "COVID-19 and asthma: To have or not to have T2 inflammation makes a difference?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "261" "paginaFinal" => "263" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Morais-Almeida, J. Bousquet" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Morais-Almeida" "email" => array:1 [ 0 => "mmoraisalmeida@netcabo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Bousquet" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Allergy Centre, CUF Descobertas, Lisbon and Portuguese Association of Asthmatics (APA), Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "MACVIA-France, Montpellier, France" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">During this pandemic, there has been some data discrepancy about whether patients with asthma have a lower risk of becoming infected or seriously ill from coronavirus disease 2019 (COVID-19)<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> but there is no information about the real impact of SARS-CoronaVirus-2 (SARS-CoV-2) on asthma control. Recent reports from the United States of America suggest that asthma is more common in children and adults with mild to severe COVID-19 than was previously reported in Asia and in Europe, but the prevalence is no higher than that described in the same population.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">SARS-CoV-2 binds mainly to angiotensin converting enzyme 2 (ACE2) receptors in host cells which are abundant in the lungs, heart, blood vessels and intestine and, after more than a decade of research, there are still no specific treatments or effective vaccines for coronavirus.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">COVID-19 mainly presents with respiratory symptoms, from mild to severe and a significant percentage of patients develop acute respiratory disease syndrome (ARDS); these severe symptoms are associated with a true cytokine storm, in particular IL-6, and death can occur.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Old age and underlying morbidities, such as cardiovascular diseases (in particular hypertension), metabolic disorders (obesity and diabetes), and respiratory system diseases were identified as significant risk factors for COVID-19 morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Even though respiratory viruses are one of the most common triggers for asthma exacerbations, not all of these viruses affect patients equally. In asthma exacerbations the human rhinovirus was identified as the main individual contributor and coronavirus does not seem to frequently induce asthma exacerbations.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> In a literature review concerning virus detection during asthma exacerbations, Zheng et al. confirmed that exacerbations were mainly associated with rhinovirus infection.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In previous SARS outbreaks, patients with asthma, in particular children, appeared to be less susceptible to the coronavirus: the rate of asthma exacerbations described is low and prognosis good.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,8</span></a> In contrast, during influenza epidemics, asthma is involved in more severe cases, some needing mechanical ventilation, including patients of paediatric age.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> The exact reasons for this remain unknown, but it has been confirmed during the current coronavirus pandemic with children having a better prognosis, although as likely as adults are to get infected with SARS-CoV-2.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> Different ACE2 expression or maturation, innate immunity memory and a constitutional high lymphocyte count in children may be part of the explanation.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">From the recent COVID-19 literature, no information can be extrapolated about asthma phenotypes, specifically about whether asthma was allergic or not. In a recent study that included paediatric and adult patients with asthma from three different cohorts, it was found that ACE2 expression was lowest in those with high levels of allergic sensitization, but non-atopic asthma was not associated with this reduced expression.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> Given that ACE2 serves as the receptor for SARS-CoV-2, these data suggest that this expression may be a potential contributor, among several other factors, to reduced COVID-19 severity in patients with T2 inflammation,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> namely in patients with allergic asthma but also with other allergic diseases, such allergic rhinitis, which are more prevalent in all age groups.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Additionally, considering that the virus cell entry also depends on S protein priming by host cell proteases, including transmembrane protease serine 2 (TMPRSS2), there is some early evidence coming from the Severe Asthma Research Programme-3 (SARP), that inhaled corticosteroid therapy is also associated with reduction in ACE2 and TMPRSS2 gene expression from sputum.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> Although gene expression for ACE2 and TMPRSS2 did not differ in healthy people and in asthmatics, the author's report that males, African Americans, and patients with diabetes mellitus have increased expression of ACE2 and TMPRSS2 in their sputum cells that can be associated with a poor prognosis when infected with the SARS-CoV-2.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Dong et al.,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> described eleven selected cases of patients with COVID-19, children and adults, demonstrating the profile complexity and different clinical presentations, from asymptomatic cases to patients with mild to severe symptoms. Patients with common allergic diseases, such as rhinitis or atopic dermatitis, did not develop distinct symptoms and severe clinical courses, suggesting a role of type 2 immune regulation in COVID-19 pathogenesis.</p><p id="par0050" class="elsevierStylePara elsevierViewall">During this outbreak it is more likely for a person with asthma to have an exacerbation caused by other triggers, including allergens or other virus exposures. New data are emerging daily, rapidly updating our understanding of this novel coronavirus, but it is crucial that patients with asthma and other allergic diseases maintain their controller medication, from inhaled steroids to biologics,<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">14–16</span></a> including allergen immunotherapy.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> Self-dose adjustments or stopping medication may lead to higher risk of asthma exacerbations, increased OCS use and higher probability of recourse to emergency room and hospitalization which themselves represent risk factors for coronavirus exposure and spread.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Asthma may worsen the disease course of COVID-19, should infection occur, namely if rescue OCS are prescribed,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> as was suggested in previous coronavirus outbreaks when systemic steroids were associated with a higher viral load.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">19,20</span></a> Clinicians must be aware and recognize the differences between hypoxic respiratory failure and bronchospasm on physical examination to carefully judge the need for a course of OCS.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Compliance with ethics</span><p id="par0060" class="elsevierStylePara elsevierViewall">This study involves a comment on the literature and did not involve any studies with human or animal subjects performed by the authors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authorship</span><p id="par0065" class="elsevierStylePara elsevierViewall">The named authors met the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">No funding was received in the publication of this letter.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "xpalclavsec1267634" "titulo" => "Keywords" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Compliance with ethics" ] 2 => array:2 [ "identificador" => "sec0010" "titulo" => "Authorship" ] 3 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 4 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1267634" "palabras" => array:6 [ 0 => "Allergy" 1 => "Asthma" 2 => "COVID-19" 3 => "Risk factors" 4 => "SARS-CoV-2" 5 => "T2 inflammation" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection?" 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Year/Month | Html | Total | |
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2024 October | 73 | 28 | 101 |
2024 September | 64 | 28 | 92 |
2024 August | 121 | 40 | 161 |
2024 July | 106 | 40 | 146 |
2024 June | 86 | 54 | 140 |
2024 May | 117 | 38 | 155 |
2024 April | 99 | 51 | 150 |
2024 March | 115 | 22 | 137 |
2024 February | 82 | 23 | 105 |
2024 January | 132 | 40 | 172 |
2023 December | 108 | 19 | 127 |
2023 November | 138 | 89 | 227 |
2023 October | 86 | 45 | 131 |
2023 September | 76 | 58 | 134 |
2023 August | 70 | 25 | 95 |
2023 July | 90 | 37 | 127 |
2023 June | 76 | 26 | 102 |
2023 May | 104 | 41 | 145 |
2023 April | 107 | 33 | 140 |
2023 March | 174 | 27 | 201 |
2023 February | 87 | 30 | 117 |
2023 January | 92 | 22 | 114 |
2022 December | 129 | 33 | 162 |
2022 November | 121 | 41 | 162 |
2022 October | 126 | 47 | 173 |
2022 September | 96 | 45 | 141 |
2022 August | 99 | 48 | 147 |
2022 July | 140 | 67 | 207 |
2022 June | 105 | 41 | 146 |
2022 May | 144 | 56 | 200 |
2022 April | 147 | 48 | 195 |
2022 March | 192 | 68 | 260 |
2022 February | 135 | 60 | 195 |
2022 January | 175 | 61 | 236 |
2021 December | 143 | 59 | 202 |
2021 November | 102 | 51 | 153 |
2021 October | 116 | 67 | 183 |
2021 September | 159 | 61 | 220 |
2021 August | 189 | 56 | 245 |
2021 July | 192 | 45 | 237 |
2021 June | 288 | 75 | 363 |
2021 May | 712 | 113 | 825 |
2021 April | 1415 | 233 | 1648 |
2021 March | 891 | 96 | 987 |
2021 February | 730 | 54 | 784 |
2021 January | 1327 | 122 | 1449 |
2020 December | 1645 | 122 | 1767 |
2020 November | 879 | 124 | 1003 |
2020 October | 983 | 138 | 1121 |
2020 September | 1008 | 226 | 1234 |
2020 August | 418 | 96 | 514 |
2020 July | 666 | 143 | 809 |
2020 June | 269 | 78 | 347 |
2020 May | 38 | 12 | 50 |