Browsing by Author "Ingram, Jennifer"

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    ItemOpen Access
    Asthma medication usage is significantly reduced following bariatric surgery.
    (Surgical endoscopy, 2019-06) Guerron, Alfredo D; Ortega, Camila B; Lee, Hui-Jie; Davalos, Gerardo; Ingram, Jennifer; Portenier, Dana

    Introduction

    Asthma is an important healthcare problem affecting millions in the United States. Additionally, a large proportion of patients with asthma suffer from obesity. These patients exhibit poor asthma control and reduced therapy response, increasing utilization of healthcare resources. Pulmonary symptoms improve after bariatric surgery (BS), and we hypothesized that asthma medication usage would decrease following BS.

    Methods

    A retrospective data analysis was performed in adult patients from a single institution's database. Patients with obesity using at least one asthma medication pre-operatively who underwent BS were studied for up to 3-years post-operation. Poisson generalized linear mixed models for repeated measures were used to evaluate the effects of time and procedure type on the number of asthma medication.

    Results

    Bariatric patients with at least one prescribed asthma medication (mean 1.4 ± 0.6) were included (n = 751). The mean age at time of operation was 46.8 ± 11.6 years, mean weight was 295.9 ± 57 lbs, and mean body mass index (BMI) was 49 ± 8.2 kg/m2; 87.7% were female, 33.4% had diabetes, 44.2% used gastroesophageal reflux disease (GERD) medication, and 64.4% used hypertension medication. The most common procedure was Roux-en-Y gastric bypass (79%), followed by sleeve gastrectomy (10.7%), adjustable gastric banding (8.1%), and duodenal switch (2.3%). The mean number of prescribed asthma medications among all procedures decreased by 27% at 30 days post-operation (p < 0.0001), 37% at 6 months (p < 0.0001), 44% at 1 year (p < 0.0001), and 46% at 3 years (p < 0.0001) after adjusting for risk factors. No significant differences in medication use over time between procedure types were observed. In the adjusted analysis, the mean number of asthma medications was 12% higher in patients using at least one GERD medication (p = 0.015) and 8% higher with 10-unit increase in pre-operative BMI (p = 0.006).

    Conclusion

    BS significantly decreases asthma medication use starting 30 days post-operation with a sustained reduction for up to 3 years.
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    Role of hyaluronan and hyaluronan-binding proteins in human asthma.
    (The Journal of allergy and clinical immunology, 2011-08) Liang, Jiurong; Jiang, Dianhua; Jung, Yoosun; Xie, Ting; Ingram, Jennifer; Church, Tony; Degan, Simone; Leonard, Maura; Kraft, Monica; Noble, Paul W

    Background

    The characteristics of human asthma are chronic inflammation and airway remodeling. Hyaluronan, a major extracellular matrix component, accumulates during inflammatory lung diseases, including asthma. Hyaluronan fragments stimulate macrophages to produce inflammatory cytokines. We hypothesized that hyaluronan and its receptors would play a role in human asthma.

    Objective

    To investigate the role of hyaluronan and hyaluronan-binding proteins in human asthma.

    Methods

    Twenty-one subjects with asthma and 25 healthy control subjects underwent bronchoscopy with endobronchial biopsy and bronchoalveolar lavage. Fibroblasts were cultured, and hyaluronan and hyaluronan synthase expression was determined at baseline and after exposure to several mediators relevant to asthma pathobiology. The expression of hyaluronan-binding proteins CD44, TLR (Toll-like receptor)-2, and TLR4 on bronchoalveolar lavage macrophages was determined by flow cytometry. IL-8 production by macrophages in response to hyaluronan fragment stimulation was compared.

    Results

    Airway fibroblasts from patients with asthma produced significantly increased concentrations of lower-molecular-weight hyaluronan compared with those of normal fibroblasts. Hyaluronan synthase 2 mRNA was markedly increased in asthmatic fibroblasts. Asthmatic macrophages showed a decrease in cell surface CD44 expression and an increase in TLR2 and TLR4 expression. Macrophages from subjects with asthma showed an increase in responsiveness to low-molecular-weight hyaluronan stimulation, as demonstrated by increased IL-8 production.

    Conclusion

    Hyaluronan homeostasis is deranged in asthma, with increased production by fibroblasts and decreased CD44 expression on alveolar macrophages. Upregulation of TLR2 and TLR4 on macrophages with increased sensitivity to hyaluronan fragments suggests a novel proinflammatory mechanism by which persistence of hyaluronan fragments could contribute to chronic inflammation and airway remodeling in asthma.