Asthma remains a significant global health challenge. While both the incidence and mortality rates have shown a decline, older individuals with asthma exhibit not just more severe symptoms but also demonstrate an elevated mortality rate. This phenomenon could be attributed to the presence of chronic comorbidities that exert an influence on clinical outcomes among adult patients with asthma. This review aims to present various aspects of asthma comprehensively, including the prevalence, incidence, mortality rates, and causes of death in adult patients with asthma. Additionally, this review delves into the impact of chronic comorbidities that contribute to the morbidity and mortality of patients with asthma on a global scale, encompassing conditions such as chronic kidney disease, diabetes mellitus, lung cancer, obesity, and cardiovascular disease, concerning asthma. Furthermore, the manuscript reviews the distinctions between asthma and asthma chronic obstructive pulmonary disease overlap and adds perspective on asthma as an occupational lung disease. Thus, this review aims to enhance clinicians’ awareness of the significance of chronic comorbidities in the management of patients with asthma. It seeks to provide insights that contribute to a more comprehensive approach to managing patients with asthma who also have comorbid conditions.

The prevalence of obesity among asthma patients has surged in recent years, posing a significant risk factor for uncontrolled asthma. Beyond its impact on asthma severity and patients' quality of life, obesity is associated with reduced lung function, increased asthma exacerbations, hospitalizations, heightened airway hyperresponsiveness, and elevated asthma-related mortality. Obesity may lead to metabolic dysfunction and immune dysregulation, fostering chronic inflammation characterized by increased pro-inflammatory mediators and adipocytokines, elevated reactive oxygen species, and reduced antioxidant activity. This chronic inflammation holds the potential to induce airway remodeling in individuals with asthma and obesity. Airway remodeling encompasses structural and pathological changes, involving alterations in the airway's epithelial and subepithelial layers, hyperplasia and hypertrophy of airway smooth muscle, and changes in airway vascularity. In individuals with asthma and obesity, airway remodeling may underlie heightened airway hyperresponsiveness and increased asthma severity, ultimately contributing to the development of persistent airflow limitation, declining lung function, and a potential increase in asthma-related mortality. Despite efforts to address the impact of obesity on asthma outcomes, the intricate mechanisms linking obesity to asthma pathophysiology, particularly concerning airway remodeling, remain incompletely understood. This comprehensive review discusses current research investigating the influence of obesity on airway remodeling, to enhance our understanding of obesity's role in the context of asthma airway remodeling.

Background: Coronavirus Disease (COVID-19) emerge as a new global health crisis. COVID-19 has a wide range of clinical feature, from mild cough to severe respiratory failure. This study aims to learn more about clinical feature of COVID-19. Methods: This cross sectional analytic descriptive study includes all COVID-19 patients that yield positive result through GeneXpert-SARS-CoV-2 or Polymerase Chain Reaction (PCR). All data was taken from inpatient form March 12th –June 30th 2020. Results: There were 103 patients with 58 men and 45 women. Patients with male sex tend to experience severe pneumonia than women. It was also found that patients exposed to cigarette smoke tended to experience severe pneumonia symptoms. Patients with more than 1 comorbid tend to develop severe pneumonia symptoms. The dominant clinical symptoms in the patient were cough (84.5%), fever / history of fever (70.9%), and shortness of breath (67.9%). Hematological parameters that correlate with the degree of severity are leucocytes, thrombocyts, lymphocytes, neutrophils, CRP, LDH, creatinine, procalcitonin, SGOT, and SOFA Score. The most common radiological picture obtained was bilateral infiltrate (78.2%). The most common complication was sepsis (38.9%). The mortality rate for COVID-19 patients treated at RSSA tends to be high (26.2%). Discussion: clinical characteristics such as gender, smoking history, comorbides, clinical symptoms (fever, shortness of breath and cough), laboratory (leukocytes, % lymphocytes, % neutrophils and neutrophil counts, CRP, LDH, procalcitonin, creatinine, SGOT, and SOFA scores) has a significant effect on the severity of Covid infection 19 Conclusion: The clinical characteristics of COVID-19 patients affects the severity of the disease.

Background: Comorbidity is a major factor in determining the outcome of COVID-19. However, existing studies regarding comorbidities and the disease severity and mortality of COVID-19 are mostly based on studies in the whole community, and not on those admitted to hospitals. This study aims to determine the demographic profile of comorbidities among COVID-19 patients hospitalized in tertiary care referral hospitals and its association with disease severity and mortality. Methods: We analyzed the data from 60 laboratory-confirmed patients in our hospital in Malang City, East Java, Indonesia from March 12th, 2020 to June 5th, 2020. We describe the demographic profile of the patients and perform statistical analysis to determine its relationship to disease severity and mortality. Results: The majority of the study samples (66.7%) were categorized as having a severe disease. Thirty-seven samples (61.7%) had at least one comorbidity. The mortality rate among the study population is 30.0%, and 37.8% among those with comorbidities. The most prevalent comorbidity was hypertension (40.0%), followed by heart failure (35.0%) and diabetes (25.0%). There is a statistically significant relationship between the presence of comorbidities and disease severity and between disease severity and mortality (p<0.05). Diabetes was the only comorbidity with a significant relationship towards mortality in our study (p<0.05, OR 4.0 95% CI 1.16-13.74). Conclusion: Comorbidities are associated with worse disease severity and death in hospitalized COVID-19 patients.

Background: Tocotrienols exhibit antioxidant and anti-inflammatory activities. RhoA, a small GTPase protein, plays a crucial role in regulating contractility in airway smooth muscle (ASM). Previous studies have demonstrated that γ-tocotrienols reduce ASM proliferation and migration by inhibiting the activation of RhoA. In this present study, we investigate the effect of another vitamin E isoform, β-tocotrienols, on human ASM cell proliferation and migration stimulated by platelet-derived growth factor-BB (PDGF-BB). Methods: Human ASM cells were pre-treated with β-tocotrienol prior to being stimulated with PDGF-BB to induce ASM cell proliferation and migration. The proliferation and migration of PDGF-BB-induced human ASM cells were assessed using colorimetric and transwell migration assays. The intracellular ROS assay kit was employed to quantify reactive oxygen species (ROS) in human ASM cells. Additionally, we explored the effect of β-tocotrienols on the signaling pathways involved in PDGF-BB-induced ASM proliferation and migration. Results: β-tocotrienol inhibited PDGF-BB-induced ASM cell proliferation and migration by reducing RhoA activation and ROS production. However, in this present study, β-tocotrienol did not affect the signaling pathways associated with cyclin D1, phosphorylated Akt1, and ERK1/2. Conclusions: In conclusion, the inhibition of RhoA activation and ROS production by β-tocotrienol, resulting in the reduction in human ASM proliferation and migration, suggests its potential as a treatment for asthma airway remodeling.

Introduction: Lung cancer (LC) is the world's second leading cause of death due to malignancy. In Indonesia, LC is one of the top three malignancies. Volatile organic compounds (VOCs) from the respiratory reflect changes in metabolism caused by disease and may be a biomarker of LC. Interleukin-23 (IL-23) has been known as a pro-inflammatory cytokine in the development and progression of cancer. This study aimed to identify levels of IL-23 and VOCs in LC patients. Methods: This study involved 40 LC patients and 42 controls. VOCs were taken by the subject exhaling their third deep breath into the sample bag, which was immediately analyzed using an E-nose-based device. As for the IL-23, the cytokine was taken from the blood serum and then analyzed using the ELISA method. Kolmogorov-Smirnov and Shapiro-Wilk tests were performed to test data normality. Mann-Whitney and Kruskal Wallis tests were conducted for variables. Spearman correlation and heat map were used to find the correlation between the observed gases and IL-23. Results: The concentration of ozone (p = 0.000), ethanol (p = 0.000), formaldehyde (p = 0.000), toluene (p = 0.000), acetone (p = 0.000), ammonia (p = 0.000), ammonium (p = 0.001), nitrogen (p = 0.001) and methane (p = 0.000) in LC group differed with controls. The same outcome was also observed in comparing LC patients and control groups of IL-23 (p = 0.000). Spearman correlation analysis revealed a positive correlation between serum IL-23 with formaldehyde (p = 0.029), toluene (p = 0.014), and ammonia (p = 0.028) and a negative correlation with nitrogen (p = 0.011). Compared to the control group, all types of LC were observed to have higher levels of IL-23. A weak positive correlation was found in formaldehyde (Cv = 0.23), toluene (Cv = 0.23), and ammonia (Cv = 0.13). A weak negative correlation was obtained in acetone (Cv = -0.12), ammonium (Cv = -0.11), and nitrogen dioxide (Cv = 0.23). Conclusion: Weak linear correlations were obtained between the cytokine and formaldehyde, toluene, ammonia, ammonium, and nitrogen dioxide. A higher IL-23 concentration was observed in the LC group than in the control group. The volatile concentration was significantly different between LC and control groups.