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Kuang L, Ren C, Liao X, Zhang X, Zhou X. Percent Recovery Index Predicts Poor Asthma Control and Exacerbation in Adults. J Asthma Allergy 2023; 16:711-722. [PMID: 37465370 PMCID: PMC10351680 DOI: 10.2147/jaa.s414164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Background Previous studies indicate that the percent recovery index (PRI: the percentage increase from the maximally reduced FEV1 after bronchodilator inhalation), one of the indexes of methacholine bronchial provocation, may predict acute asthma exacerbations in childhood and elderly asthmatics. It is known that childhood (<12) and elder (>60) asthmatics may be different to adult patients in many aspect including prognosis. However, in adults, a research for predicting value of PRI to exacerbation is still absence. Besides exacerbation, predicting value of PRI to poor asthma control is also unknown. We try to detect whether PRI can predict poor asthma control and exacerbation in adults in this research. Meanwhile, we try to detect whether treatment can influence PRI. Methods In 61 adults with asthma, baseline PRI was measured during enrollment. And then baseline PRI was evaluated as a predictor of exacerbation or poor asthma control at an upcoming 3-month follow-up. The covariates included age, sex, BMI, previous exacerbation, smoking status and baseline lung function. After treatment for 3 months, PRI was measured again and compared with baseline PRI. Results After the 3-month follow-up, we found that baseline PRI was significantly related to asthma exacerbation (P = 0.023), poor asthma control (ACT at 3 months, P = 0.014), decreased quality of life (decrease of MiniAQLQ, P = 0.010) and cumulative number of EDHO at 3 months (P = 0.039). Meanwhile, no significant correlation was observed between baseline PRI and inflammation factors (FENO, CaNO, and EOS). Finally, PRI was dramatically reduced after standard treatment for 3 months. Conclusion PRI is efficient in the prediction of poor asthma control and exacerbation in adults. The predictive value of PRI may rely on the inherent property of asthmatic airway smooth muscle (ASM) independent of inflammation factors. Effective treatment can alleviate PRI dramatically and that indicate PRI may also be valuable in evaluation of curative effect.
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Affiliation(s)
- Lisha Kuang
- Department of Health Management Center, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Cheng Ren
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Xiuqing Liao
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Xiaobin Zhang
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Xuegang Zhou
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
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Chan R, Lipworth BJ. Oscillometry bronchodilator response in adult moderate to severe eosinophilic asthma patients: A prospective cohort study. Clin Exp Allergy 2022; 52:1118-1120. [PMID: 35707948 PMCID: PMC9540425 DOI: 10.1111/cea.14185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School University of Dundee, Dundee, UK
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School University of Dundee, Dundee, UK
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3
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Sol IS, Kim YH, Kim SY, Choi SH, Kim HR, Kim KW, Sohn MH. Exhaled breath temperature as a tool for monitoring asthma control after an attack in children. Pediatr Pulmonol 2019; 54:230-236. [PMID: 30609317 DOI: 10.1002/ppul.24225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/05/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Exhaled breath temperature (EBT) has been suggested as a non-invasive marker of airway inflammation in asthma. There have been no studies examining longitudinal changes in EBT following asthma attacks. OBJECTIVE To investigate changes in EBT during and after an asthma attack and to relate these changes to changes in respiratory physiological measurements. METHODS We evaluated 38 hospitalized children aged 5-18 years diagnosed with an asthma attack. Spirometry was performed upon hospitalization. During hospitalization, EBT, peak expiratory flow rate (PEFR), and asthma score were measured daily. These tests were repeated 1 week and 1 month after discharge. The overall PEFR change, temporal changes in plateau values at the end of expiration, and time-dynamic associations were evaluated using linear mixed models. RESULTS FEV1 was lower at admission than at discharge (63.3 ± 24 vs 99.5 ± 14 percent of predicted, P < 0.001). The EBT was higher at admission than at 1 week after discharge (34.1°C [range: 33.9-34.8°C] vs 33.6°C [range: 33.0-34.2°C], P = 0.007); overall, EBTs decreased over time (P = 0.007). Among individual subjects, decreased EBT was correlated with increased PEFR over time. Furthermore, plateau values at the end of expiration had a time-dependent, dynamic association with the PEFR during hospitalization (P = 0.005) and between asthma attack onset and asthma status stabilization (P = 0.032). CONCLUSIONS The EBT was elevated during asthma attacks and gradually decreased until asthma was well controlled. The EBT may be a useful, non-invasive tool for monitoring asthma control in children.
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Affiliation(s)
- In Suk Sol
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Ha Choi
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Ran Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Buendía E, Zakzuk J, San-Juan-Vergara H, Zurek E, Ajami NJ, Caraballo L. Gut microbiota components are associated with fixed airway obstruction in asthmatic patients living in the tropics. Sci Rep 2018; 8:9582. [PMID: 29941875 PMCID: PMC6018556 DOI: 10.1038/s41598-018-27964-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/12/2018] [Indexed: 12/13/2022] Open
Abstract
Microbiome composition has been associated to several inflammatory diseases, including asthma. There are few studies exploring the relationships of gut microbiota with airway obstruction pheonotypes in adult asthma, especially those living in the tropics. We sought to evaluate the relationships of gut microbiota with the airway obstruction and other variables of interest in asthmatic patients living in the tropics according to three phenotypes: No Airway Obstruction (NAO), Reversible Airway Obstruction (RAO) or Fixed Airway Obstruction (FAO). We found that Streptococcaceae:Streptococcus and Enterobacteriaceae:Escherichia-Shigella consistently discriminated asthmatic individuals suffering FAO from NAO or RAO, plus Veillonellaceae:Megasphaera when comparing FAO and RAO (p < 0.05; FDR < 0.05). In the FAO, the network showing the genus relations was less complex and interconnected. Several Rumminococcaceae, Lachnospiraceae and Clostridiales were enriched in patients with low specific IgE levels to mites and Ascaris. All patients shared a common exposure framework; control medication usage and smoking habit were uncommon and equally distributed between them. In conclusion, in this tropical asthmatic population, components of human gut microbiota are associated with the presence of a FAO phenotype and lower specific IgE response to mites and Ascaris.
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Affiliation(s)
- Emiro Buendía
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | | | - Eduardo Zurek
- Department of System Engineering, Universidad del Norte, Barranquilla, Colombia
| | - Nadim J Ajami
- Alkek Center for Metagenomics and Microbiome Research, Baylor College, Houston, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia.
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5
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Sheen YH, Jee HM, Ha EK, Jang HM, Lee SJ, Lee S, Lee KS, Jung YH, Choi SH, Sohn MH, Han MY. Impulse oscillometry and spirometry exhibit different features of lung function in bronchodilation. J Asthma 2018; 55:1343-1351. [PMID: 29300537 DOI: 10.1080/02770903.2017.1418884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Bronchodilator responses (BDRs) from impulse oscillometry (IOS) are not interchangeable with those from spirometry. We aimed to identify the characteristics of children with small airway hyperresponsiveness and to determine whether BDR from IOS provides an important supplement to BDR from spirometry. METHODS The records of 592 children with asthma or suspected asthma who underwent spirometric and oscillometric BDRs were retrospectively reviewed. Oscillometric BDR was defined as positive when relative or absolute changes of Rrs5 or Xrs5 were beyond two standard deviations and spirometric BDR as positive when absolute change of forced expiratory volume in one second (FEV1) was ≥12%. Subjects were classified as positive for spirometric BDR only, positive for oscillometric BDR only, positive for both BDRs, or negative for both BDRs. RESULTS The results indicated that 101 (17.6%) subjects were positive for spirometric BDR only, 49 (8.5%) positive for oscillometric BDR only, 48 (8.3%) positive for both BDRs, and 377 (65.6%) negative for both BDRs. The agreement between spirometric and oscillometric BDRs was poor. Baseline FEV1, Rrs5, and Xrs5 values strongly influenced the BDRs. Subjects positive for oscillometric BDR only were found to be younger than those positive for spirometric BDR only (P < 0.001). Subjects positive for both BDRs were more likely to have asthma, atopic dermatitis, wheezing apart from cold, or decreased baseline lung function relative to those positive in either test (P < 0.001). CONCLUSIONS There was a low concordance between spirometric and oscillometric BDRs. Use of IOS to detect small airway hyperresponsiveness may add more information about a clinical profile of subjects with asthma.
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Affiliation(s)
- Youn Ho Sheen
- a Department of Pediatrics, CHA Gangnam Medical Center , CHA University , Seoul , South Korea
| | - Hye Mi Jee
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea.,c Department of Pediatrics, Graduate School , Yonsei University College of Medicine , Seoul , South Korea
| | - Eun Kyo Ha
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Ho Min Jang
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Seung Jin Lee
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Shinhae Lee
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Kyung Suk Lee
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Young-Ho Jung
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Sun Hee Choi
- d Department of Pediatrics , Kyung Hee University College of Medicine , Seoul , South Korea
| | - Myung Hyun Sohn
- e Department of Pediatrics , Yonsei University College of Medicine , Seoul , South Korea
| | - Man Yong Han
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
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6
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Karvonen T, Kankaanranta H, Saarelainen S, Moilanen E, Lehtimäki L. Comparison of feasibility and estimates of central and peripheral nitric oxide parameters by different mathematical models. J Breath Res 2017; 11:047102. [DOI: 10.1088/1752-7163/aa7cc0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Van Iterson EH, Snyder EM, Johnson BD. The Influence of 17 Hours of Normobaric Hypoxia on Parallel Adjustments in Exhaled Nitric Oxide and Airway Function in Lowland Healthy Adults. High Alt Med Biol 2017; 18:1-10. [PMID: 28135110 DOI: 10.1089/ham.2016.0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Van Iterson, Erik H., Eric M. Snyder, and Bruce D. Johnson. The influence of 17 hours of normobaric hypoxia on parallel adjustments in exhaled nitric oxide and airway function in lowland healthy adults. High Alt Med Biol. 18:1-10, 2017.-Currently, there is a disparate understanding of the role that normobaric hypoxia plays in affecting nitric oxide (NO) measured in exhaled air (eNO) and airway function in lowland healthy adults. Compared to normobaric normoxia, this study aimed to test the effect of 17 hours of normobaric hypoxia on relationships between eNO and airway function in healthy adults. In a crossover study including 2 separate visits, 26 lowland healthy Caucasian adults performed eNO and pulmonary function tests on visit 1 in normobaric normoxia, while repeating all tests on visit 2 following 17 hours of normobaric hypoxia (12.5% O2). Compared to normobaric normoxia, eNO (29 ± 24 vs. 36 ± 28 ppb), forced expiratory volume in one second (FEV1) (4.1 ± 0.7 vs. 4.3 ± 0.8 L), mean forced expiratory flow between 25% and 75% FVC (FEF25-75) (3.9 ± 1.0 vs. 4.2 ± 1.2 L/s), and forced expiratory flow at 75% FVC (FEF75) (2.0 ± 0.7 vs. 2.3 ± 0.8 L/s) increased in normobaric hypoxia, respectively (all p < 0.05). Correlations at normoxia between eNO and FEV1 (r = 0.39 vs. 0.44), FEF25-75 (r = 0.51 vs. 0.51), and FEF75 (r = 0.53 vs. 0.55) persisted as both parameters increased in hypoxia, respectively. For the first time, these data suggest that 17 hours of hypoxic breathing in the absence of low ambient pressure contribute to increased eNO and airway function in lowland healthy adults.
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Affiliation(s)
- Erik H Van Iterson
- 1 Department of Cardiovascular Diseases, Mayo Clinic College of Medicine , Rochester, Minnesota
| | - Eric M Snyder
- 2 Department of Kinesiology, University of Minnesota , Minneapolis, Minnesota
| | - Bruce D Johnson
- 1 Department of Cardiovascular Diseases, Mayo Clinic College of Medicine , Rochester, Minnesota
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8
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McGarry ME, Castellanos E, Thakur N, Oh SS, Eng C, Davis A, Meade K, LeNoir MA, Avila PC, Farber HJ, Serebrisky D, Brigino-Buenaventura E, Rodriguez-Cintron W, Kumar R, Bibbins-Domingo K, Thyne SM, Sen S, Rodriguez-Santana JR, Borrell LN, Burchard EG. Obesity and bronchodilator response in black and Hispanic children and adolescents with asthma. Chest 2015; 147:1591-1598. [PMID: 25742612 PMCID: PMC4451713 DOI: 10.1378/chest.14-2689] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/02/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity is associated with poor asthma control, increased asthma morbidity, and decreased response to inhaled corticosteroids. We hypothesized that obesity would be associated with decreased bronchodilator responsiveness in children and adolescents with asthma. In addition, we hypothesized that subjects who were obese and unresponsive to bronchodilator would have worse asthma control and would require more asthma controller medications. METHODS In the Study of African Americans, Asthma, Genes, and Environments (SAGE II) and the Genes-environments and Admixture in Latino Americans (GALA II) study, two identical, parallel, case-control studies of asthma, we examined the association between obesity and bronchodilator response in 2,963 black and Latino subjects enrolled from 2008 to 2013 using multivariable logistic regression. Using bronchodilator responsiveness, we compared asthma symptoms, controller medication usage, and asthma exacerbations between nonobese (< 95th% BMI) and obese (≥ 95th% BMI) subjects. RESULTS The odds of being bronchodilator unresponsive were 24% (OR, 1.24; 95% CI, 1.03-1.49) higher among obese children and adolescents compared with their not obese counterparts after adjustment for age, race/ethnicity, sex, recruitment site, baseline lung function (FEV1/FVC), and controller medication. Bronchodilator-unresponsive obese subjects were more likely to report wheezing (OR, 1.38; 95% CI, 1.13-1.70), being awakened at night (OR, 1.34; 95% CI, 1.09-1.65), using leukotriene receptor inhibitors (OR, 1.33; 95% CI, 1.05-1.70), and using inhaled corticosteroid with long-acting β2-agonist (OR, 1.37; 95% CI, 1.05-1.78) than were their nonobese counterpart. These associations were not seen in the bronchodilator-responsive group. CONCLUSIONS Obesity is associated with bronchodilator unresponsiveness among black and Latino children and adolescents with asthma. The findings on obesity and bronchodilator unresponsiveness represent a unique opportunity to identify factors affecting asthma control in blacks and Latinos.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California, San Francisco, CA.
| | - Elizabeth Castellanos
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA
| | - Neeta Thakur
- Department of Medicine, University of California, San Francisco, CA
| | - Sam S Oh
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, CA
| | - Adam Davis
- Children's Hospital and Research Center Oakland, Oakland, CA
| | - Kelley Meade
- Children's Hospital and Research Center Oakland, Oakland, CA
| | | | - Pedro C Avila
- Department of Allergy-Immunology, Northwestern University, Chicago, IL
| | - Harold J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | | | - Rajesh Kumar
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | - Shannon M Thyne
- Department of Pediatrics, University of California, San Francisco, CA
| | - Saunak Sen
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | | | - Luisa N Borrell
- Department of Health Sciences, Lehman College, City University of New York, Bronx, NY
| | - Esteban G Burchard
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA
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Deshane JS, Redden DT, Zeng M, Spell ML, Zmijewski JW, Anderson JT, Deshane RJ, Gaggar A, Siegal GP, Abraham E, Dransfield MT, Chaplin DD. Subsets of airway myeloid-derived regulatory cells distinguish mild asthma from chronic obstructive pulmonary disease. J Allergy Clin Immunol 2015; 135:413-424.e15. [PMID: 25420684 PMCID: PMC4323991 DOI: 10.1016/j.jaci.2014.08.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 08/07/2014] [Accepted: 08/21/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Subsets of myeloid-derived regulatory cells (MDRCs), which are phenotypically similar to the myeloid-derived suppressor cells found in patients with cancer, have recently been appreciated as critical regulators of airway inflammation in mouse models of asthma. OBJECTIVE We test the hypothesis that subsets of airway MDRCs contribute differentially to the inflammatory milieu in human asthma and chronic obstructive pulmonary disease (COPD). METHODS We used bronchoalveolar lavage to identify and characterize human airway MDRCs from 10 healthy subjects, 9 patients with mild asthma, and 8 patients with COPD, none of whom were treated with inhaled or systemic corticosteroids. We defined subsets of airway MDRCs using flow cytometry, the molecular mediators they produce, and their abilities to regulate proliferation of polyclonally activated autologous T lymphocytes. RESULTS We found substantial differences in the functional potential of MDRC subsets in healthy subjects, patients with asthma, and patients with COPD, with these differences regulated by the nitrosative and oxidative free radicals and cytokines they produced. Nitric oxide-producing MDRCs suppressed and superoxide-producing MDRCs enhanced proliferation of polyclonally activated autologous CD4 T cells. HLA-DR(+)CD11b(+)CD11c(+)CD163(-) superoxide-producing MDRCs, which stimulated proliferation of autologous T cells, comprised a high fraction of MDRCs in the airways of patients with mild asthma or COPD but not those of healthy control subjects. CD11b(+)CD14(+)CD16(-)HLA-DR(-) nitric oxide-producing MDRCs, which suppressed T-cell proliferation, were present in high numbers in airways of patients with mild asthma but not patients with COPD or healthy control subjects. CONCLUSION Subsets of airway MDRCs conclusively discriminate patients with mild asthma, patients with COPD, and healthy subjects from each other. The distinctive activities of these MDRCs in patients with asthma or COPD might provide novel targets for new therapeutics for these common disorders. [Corrected]
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Affiliation(s)
- Jessy S Deshane
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala; Department of Microbiology, University of Alabama at Birmingham, Birmingham, Ala; Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Ala; Comprehensive Arthritis, Musculoskeletal and Autoimmunity Center, University of Alabama at Birmingham, Birmingham, Ala.
| | - David T Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Ala; Comprehensive Arthritis, Musculoskeletal and Autoimmunity Center, University of Alabama at Birmingham, Birmingham, Ala
| | - Meiqin Zeng
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Marion L Spell
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
| | - Jaroslaw W Zmijewski
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala; Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Ala
| | - John T Anderson
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
| | - Rohit J Deshane
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Amit Gaggar
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala; Department of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, Ala
| | - Gene P Siegal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Ala; Department of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, Ala; Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Edward Abraham
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala; Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Ala
| | - Mark T Dransfield
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
| | - David D Chaplin
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Ala; Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Ala; Comprehensive Arthritis, Musculoskeletal and Autoimmunity Center, University of Alabama at Birmingham, Birmingham, Ala.
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10
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Galant SP, Morphew T, Guijon O, Pham L. The bronchodilator response as a predictor of inhaled corticosteroid responsiveness in asthmatic children with normal baseline spirometry. Pediatr Pulmonol 2014; 49:1162-9. [PMID: 24532409 DOI: 10.1002/ppul.22957] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 10/16/2013] [Indexed: 11/09/2022]
Abstract
RATIONALE Although inhaled corticosteroids (ICS) are considered first line controller therapy in children with persistent asthma, heterogeneity of the ICS response can be an important clinical problem. The purpose of this study is to determine the value of the bronchodilator response (BDR) in identifying the ICS responder and establish the optimal BDR cut-point that could be particularly useful in the clinic setting when baseline spirometry is normal. METHODS Mexican American asthmatic children, 5-18 years, with normal baseline spirometry who required low dose (step 2), or medium dose (step 3) ICS therapy were evaluated by skin prick test for atopy, and pre- and post-bronchodilator spirometry. ICS responders were defined by a ≥7.5% improvement in the FEV1 following 4-6 weeks of therapy. The optimal cut-point was determined by Receiver Operator Characteristic (ROC) curves as the best balance between sensitivity and specificity. RESULTS There were 34.8% of the 132 study patients who were ICS responders. ROC curves showed the BDR ≥10% to be an optimal cut-point with sensitivity 46%, specificity 76%, positive predictive value (PPV) 50%, and negative predictive value (NPV) 72%. Atopic females with a BDR ≥10% had a PPV of 73%. CONCLUSIONS The composite phenotype of female gender, atopic, and the BDR of ≥10% identified 73% as ICS responders compared to 50% in our overall population with a BDR of ≥10% alone, with minimal false positives. We suggest that the BDR in conjunction with gender and atopic status be considered as potentially useful predictors of the ICS responder, particularly when baseline spirometry is normal.
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Affiliation(s)
- Stanley P Galant
- Breathmobile, CHOC Children's Hospital, Orange County, Orange, California
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11
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Eckel SP, Linn WS, Berhane K, Rappaport EB, Salam MT, Zhang Y, Gilliland FD. Estimation of parameters in the two-compartment model for exhaled nitric oxide. PLoS One 2014; 9:e85471. [PMID: 24465571 PMCID: PMC3894971 DOI: 10.1371/journal.pone.0085471] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/27/2013] [Indexed: 01/13/2023] Open
Abstract
The fractional concentration of exhaled nitric oxide (FeNO) is a biomarker of airway inflammation that is being increasingly considered in clinical, occupational, and epidemiological applications ranging from asthma management to the detection of air pollution health effects. FeNO depends strongly on exhalation flow rate. This dependency has allowed for the development of mathematical models whose parameters quantify airway and alveolar compartment contributions to FeNO. Numerous methods have been proposed to estimate these parameters using FeNO measured at multiple flow rates. These methods—which allow for non-invasive assessment of localized airway inflammation—have the potential to provide important insights on inflammatory mechanisms. However, different estimation methods produce different results and a serious barrier to progress in this field is the lack of a single recommended method. With the goal of resolving this methodological problem, we have developed a unifying framework in which to present a comprehensive set of existing and novel statistical methods for estimating parameters in the simple two-compartment model. We compared statistical properties of the estimators in simulation studies and investigated model fit and parameter estimate sensitivity across methods using data from 1507 schoolchildren from the Southern California Children's Health Study, one of the largest multiple flow FeNO studies to date. We recommend a novel nonlinear least squares model with natural log transformation on both sides that produced estimators with good properties, satisfied model assumptions, and fit the Children's Health Study data well.
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Affiliation(s)
- Sandrah P. Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
| | - William S. Linn
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Kiros Berhane
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Edward B. Rappaport
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Muhammad T. Salam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Yue Zhang
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Frank D. Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
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Tse SM, Gold DR, Sordillo JE, Hoffman EB, Gillman MW, Rifas-Shiman SL, Fuhlbrigge AL, Tantisira KG, Weiss ST, Litonjua AA. Diagnostic accuracy of the bronchodilator response in children. J Allergy Clin Immunol 2013; 132:554-559.e5. [PMID: 23683464 PMCID: PMC3759549 DOI: 10.1016/j.jaci.2013.03.031] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/09/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The bronchodilator response (BDR) reflects the reversibility of airflow obstruction and is recommended as an adjunctive test to diagnose asthma. The validity of the commonly used definition of BDR, a 12% or greater change in FEV1 from baseline, has been questioned in childhood. OBJECTIVES We sought to examine the diagnostic accuracy of the BDR test by using 3 large pediatric cohorts. METHODS Cases include 1041 children with mild-to-moderate asthma from the Childhood Asthma Management Program. Control subjects (nonasthmatic and nonwheezing) were chosen from Project Viva and Home Allergens, 2 population-based pediatric cohorts. Receiver operating characteristic curves were constructed, and areas under the curve were calculated for different BDR cutoffs. RESULTS A total of 1041 cases (59.7% male; mean age, 8.9 ± 2.1 years) and 250 control subjects (46.8% male; mean age, 8.7 ± 1.7 years) were analyzed, with mean BDRs of 10.7% ± 10.2% and 2.7% ± 8.4%, respectively. The BDR test differentiated asthmatic patients from nonasthmatic patients with a moderate accuracy (area under the curve, 73.3%). Despite good specificity, a cutoff of 12% was associated with poor sensitivity (35.6%). A cutoff of less than 8% performed significantly better than a cutoff of 12% (P = .03, 8% vs 12%). CONCLUSIONS Our findings highlight the poor sensitivity associated with the commonly used 12% cutoff for BDR. Although our data show that a threshold of less than 8% performs better than 12%, given the variability of this test in children, we conclude that it might be not be appropriate to choose a specific BDR cutoff as a criterion for the diagnosis of asthma.
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Affiliation(s)
- Sze Man Tse
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Massachusetts General Hospital, Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Boston, Mass.
| | - Diane R Gold
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Joanne E Sordillo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Elaine B Hoffman
- Harvard School of Public Health, Department of Biostatistics, Boston, Mass
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
| | - Anne L Fuhlbrigge
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Kelan G Tantisira
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Scott T Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Augusto A Litonjua
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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Cristescu SM, Mandon J, Harren FJM, Meriläinen P, Högman M. Methods of NO detection in exhaled breath. J Breath Res 2013; 7:017104. [PMID: 23445766 DOI: 10.1088/1752-7155/7/1/017104] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
There is still an unexplored potential for exhaled nitric oxide (NO) in many clinical applications. This study presents an overview of the currently available methods for monitoring NO in exhaled breath and the use of the modelling of NO production and transport in the lung in clinical practice. Three technologies are described, namely chemiluminescence, electrochemical sensing and laser-based detection with their advantages and limitations. Comparisons are made in terms of sensitivity, time response, size, costs and suitability for clinical purposes. The importance of the flow rate for NO sampling is discussed from the perspective of the recent recommendations for standardized procedures for online and offline NO measurement. The measurement of NO at one flow rate, such as 50 ml s(-1), can neither determine the alveolar site/peripheral contribution nor quantify the difference in NO diffusion from the airways walls. The use of NO modelling (linear or non-linear approach) can solve this problem and provide useful information about the source of NO. This is of great value in diagnostic procedures of respiratory diseases and in treatment with anti-inflammatory drugs.
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Affiliation(s)
- S M Cristescu
- Life Science Trace Gas Facility, Molecular and Laser Physics, Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands.
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Yoo Y, Seo SC, Kim YI, Chung BH, Song DJ, Choung JT. Bronchodilator responses after methacholine and adenosine 5'-monophosphate (AMP) challenges in children with asthma: their relationships with eosinophil markers. J Asthma 2012; 49:717-23. [PMID: 22747180 DOI: 10.3109/02770903.2012.692845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bronchodilator responsiveness (BDR) and eosinophilic inflammation are characteristic features of asthma. Objective. The aim of this study was to compare the relationships of BDR after methacholine challenge or adenosine 5'-monophosphate (AMP) challenge to blood eosinophil markers in children with asthma. METHODS Methacholine and AMP challenges were performed on 69 children with mild intermittent to moderate persistent asthma. BDR was calculated as the change in forced expiratory volume in 1 second, expressed as percentage change of the value immediately after the each challenge and the value after inhalation of salbutamol. Serum total IgE levels, blood eosinophil counts, and serum eosinophil cationic protein (ECP) levels were determined for each subject. RESULTS A positive relationship between serum total IgE levels and BDR was found only after the AMP challenge (R(2) = 0.345, p = .001) rather than after the methacholine challenge (R(2) = 0.007, p = .495). Peripheral blood eosinophil counts correlated more significantly with BDR after AMP challenge (R(2) = 0.212, p = .001) than BDR after methacholine challenge (R(2) = 0.002, p = .724). Both BDR after methacholine challenge (R(2) = 0.063, p = .038) and BDR after AMP challenge (R(2) = 0.192, p = .001) were significantly correlated with serum ECP levels. CONCLUSION BDR after AMP challenge may be more closely related to eosinophilic inflammation, compared with that after methacholine challenge.
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Affiliation(s)
- Young Yoo
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea.
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15
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Bak JP, Son JH, Kim YM, Jung JH, Leem KH, Lee EY, Kim EH. Suppression Effect of the Inflammatory Response in Macrophages by Paeoniae Radix Rubra Extracts. ACTA ACUST UNITED AC 2011. [DOI: 10.7783/kjmcs.2011.19.5.373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Mahut B, Bokov P, Delclaux C. [Physiological characteristics associated with previous control in asthmatic children]. Rev Mal Respir 2011; 28:1131-7. [PMID: 22123139 DOI: 10.1016/j.rmr.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 04/28/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To analyze MEF(50%) (central airways), RV/TLC (distal airways), reversibility of FEV(1) (bronchial tone, REV(FEV1)) and FE(NO) (inflammation) in relation to clinical events in asthmatic children on the assumption that mild symptoms and severe exacerbations in the previous 3 months could be associated with distinct functional characteristics. PATIENTS AND METHODS A retrospective, single center, out-patient hospital study including all asthmatic children who had complete lung function testing (without and with bronchodilation) during a period of clinical stability, without treatment on the day of the test. RESULTS Two hundred and forty-five children (11.4±2.4 years) were included: 114 (46%) were asymptomatic, 87 (36%) had minor symptoms and 44 (18%) had had a severe exacerbation in the past 3 months. FEV(1), FEV(1)/FVC and MEF(50%) were not different in these three groups. REV(FEV1) was higher in the symptomatic than in the asymptomatic group (P=0.019), RV/TLC was greater in the exacerbation group than in the asymptomatic group (P=0.019), and FE(NO) was higher in the symptomatic group than in the asymptomatic and exacerbation groups (P=0.006). CONCLUSIONS In asthmatic children, minor symptoms and severe exacerbation in the previous 3 months are associated with distinct functional characteristics that are not detected by single baseline spirometry without treatment on the day of testing.
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Affiliation(s)
- B Mahut
- Cabinet La-Berma, 4, avenue de la Providence, 92160 Antony, France
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17
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Suh DI, Koh YY. Assessment of bronchodilator responsiveness after methacholine-induced bronchoconstriction. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:215-6. [PMID: 21966600 PMCID: PMC3178818 DOI: 10.4168/aair.2011.3.4.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 08/01/2011] [Indexed: 11/20/2022]
Affiliation(s)
- Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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García-Río F, Casitas R, Romero D. Utility of two-compartment models of exhaled nitric oxide in patients with asthma. J Asthma 2011; 48:329-34. [PMID: 21504346 DOI: 10.3109/02770903.2011.565847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Two-compartment models provide more precise information about the contribution of the different portions of the airways to exhaled nitric oxide (NO). Airway wall concentration of NO (Caw,NO) and maximum flux of NO in the airways (J'aw,NO) reflect the tissue production rate of NO and they can be modified by corticosteroids. The airway wall diffusing capacity of NO (Daw,NO) depends on diverse physical and anatomical determinants of the airways, such as gas exchange surface area. Daw,NO can be modified by structural and physiological changes that are characteristic of airway remodeling, which take place over the long term. The alveolar concentration of NO (Calv,NO) represents the degree of small airway inflammation. The persistence of high Calv,NO in patients treated with inhaled corticosteroids could reflect the incapacity of these drugs to reach distal locations due to the heterogeneity of the acinar ventilation. In this review, we evaluate the parameters provided by the compartmentalized analysis of exhaled NO that could be useful in characterizing asthma patients.
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Shorter JH, Nelson DD, McManus JB, Zahniser MS, Sama SR, Milton DK. Clinical study of multiple breath biomarkers of asthma and COPD (NO, CO(2), CO and N(2)O) by infrared laser spectroscopy. J Breath Res 2011; 5:037108. [PMID: 21757803 DOI: 10.1088/1752-7155/5/3/037108] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breath analysis is a powerful non-invasive technique for the diagnosis and monitoring of respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD). Exhaled nitric oxide (NO) and carbon monoxide (CO) are markers of airway inflammation and can indicate the extent of respiratory diseases. We have developed a compact fast response quantum cascade laser system for analysis of multiple gases by tunable infrared absorption spectroscopy. The ARI breath analysis instrument has been deployed in a study of exhaled breath from patients with asthma or COPD. A total of 173 subjects participated, including both adult and pediatric patients. Patients in asthma or COPD exacerbations were evaluated twice-during the exacerbation and at a follow-up visit-to compare variations in breath biomarkers during these events. The change in exhaled NO levels between exacerbation and 'well' visits is consistent with spirometry data collected. Respiratory models are important for understanding the exchange dynamics of nitric oxide and other species in the lungs and airways. At each patient's visit, tests were conducted at four expiratory flow rates. We have applied a trumpet model with axial diffusion to the multi-flow exhaled nitric oxide data, obtaining NO alveolar concentrations and airway fluxes. We found higher airway fluxes for those with more severe asthma and during exacerbation events. The alveolar concentrations from the model were higher in adults with asthma and COPD, but this trend was less clear among the pediatric subjects.
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Affiliation(s)
- Joanne H Shorter
- Center for Atmospheric and Environmental Chemistry, Aerodyne Research, Inc., Billerica, MA, USA.
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20
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Galant SP, Morphew T, Newcomb RL, Hioe K, Guijon O, Liao O. The relationship of the bronchodilator response phenotype to poor asthma control in children with normal spirometry. J Pediatr 2011; 158:953-959.e1. [PMID: 21232757 PMCID: PMC3160763 DOI: 10.1016/j.jpeds.2010.11.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/31/2010] [Accepted: 11/10/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the relationship of poor asthma control to bronchodilator response (BDR) phenotypes in children with normal spirometry. STUDY DESIGN Children with asthma were assessed for clinical indexes of poorly controlled asthma. Pre- and post-bronchodilator spirometry were performed, and the percent BDR was determined. Multivariate logistic regression assessed the relationship of the clinical indices to BDR at ≥ 8%, ≥ 10%, and ≥ 12% BDR thresholds. RESULTS There were 510 controller naïve children and 169 on controller medication. In the controller naïve population the mean age (± 1 SD) was 9.5 (3.4); 57.1% were male, 85.7% Hispanic. Demographics were similar in both populations. In the adjusted profile, significant clinical relationships were found particularly to positive BDR phenotypes ≥ 10% and ≥ 12% versus negative responses including younger age, (OR 2.0, 2.5; P < .05), atopy (OR 1.9, 2.6; P < .01), nocturnal symptoms in females (OR 3.4, 3.8; P < .01); β₂ agonist use (OR 1.7, 2.8; P < .01); and exercise limitation (OR 2.2, 2.5; P < .01) only in the controller naïve population. CONCLUSIONS The BDR phenotype ≥ 10% is significantly related to poor asthma control, providing a potentially useful objective tool in controller naïve children even when the pre-bronchodilator spirometry result is normal.
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Mahut B, Peyrard S, Delclaux C. Exhaled nitric oxide and clinical phenotypes of childhood asthma. Respir Res 2011; 12:65. [PMID: 21599913 PMCID: PMC3126727 DOI: 10.1186/1465-9921-12-65] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 05/20/2011] [Indexed: 11/16/2022] Open
Abstract
Whether exhaled NO helps to identify a specific phenotype of asthmatic patients remains debated. Our aims were to evaluate whether exhaled NO (FENO(0.05)) is independently associated (1) with underlying pathophysiological characteristics of asthma such as airway tone (bronchodilator response) and airway inflammation (inhaled corticosteroid [ICS]-dependant inflammation), and (2) with clinical phenotypes of asthma.We performed multivariate (exhaled NO as dependent variable) and k-means cluster analyses in a population of 169 asthmatic children (age ± SD: 10.5 ± 2.6 years) recruited in a monocenter cohort that was characterized in a cross-sectional design using 28 parameters describing potentially different asthma domains: atopy, environment (tobacco), control, exacerbations, treatment (inhaled corticosteroid and long-acting bronchodilator agonist), and lung function (airway architecture and tone). Two subject-related characteristics (height and atopy) and two disease-related characteristics (bronchodilator response and ICS dose > 200 μg/d) explained 36% of exhaled NO variance. Nine domains were isolated using principal component analysis. Four clusters were further identified: cluster 1 (47%): boys, unexposed to tobacco, with well-controlled asthma; cluster 2 (26%): girls, unexposed to tobacco, with well-controlled asthma; cluster 3 (6%): girls or boys, unexposed to tobacco, with uncontrolled asthma associated with increased airway tone, and cluster 4 (21%): girls or boys, exposed to parental smoking, with small airway to lung size ratio and uncontrolled asthma. FENO(0.05) was not different in these four clusters.In conclusion, FENO(0.05) is independently linked to two pathophysiological characteristics of asthma (ICS-dependant inflammation and bronchomotor tone) but does not help to identify a clinically relevant phenotype of asthmatic children.
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Affiliation(s)
- Bruno Mahut
- Cabinet La Berma, 4 avenue de la Providence; 92 160 Antony, France
- Assistance Publique-Hôpitaux de Paris; Hôpital Européen Georges Pompidou; Service de Physiologie - Clinique de la Dyspnée, Paris, France
- Mosquito respiratory research group, Paris, France
| | - Séverine Peyrard
- CIC 9201 Plurithématique, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Delclaux
- Assistance Publique-Hôpitaux de Paris; Hôpital Européen Georges Pompidou; Service de Physiologie - Clinique de la Dyspnée, Paris, France
- Mosquito respiratory research group, Paris, France
- University Paris Descartes, Paris, France
- CIC 9201 Plurithématique, Hôpital Européen Georges Pompidou, Paris, France
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Allergen exposure modifies the relation of sensitization to fraction of exhaled nitric oxide levels in children at risk for allergy and asthma. J Allergy Clin Immunol 2011; 127:1165-72.e5. [PMID: 21463890 DOI: 10.1016/j.jaci.2011.01.066] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 12/23/2010] [Accepted: 01/31/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies on airway inflammation, measured as fraction of exhaled nitric oxide (FENO), have focused on its relation to control of asthma, but the contribution of allergen exposure to the increase in FENO levels is unknown. OBJECTIVE We evaluated (1) whether FENO levels were increased in children with allergic sensitization or asthma; (2) whether specific allergen exposure increased FENO levels in sensitized, but not unsensitized, children; and (3) whether sedentary behavior increased FENO levels independent of allergen exposures. METHODS At age 12 years, in a birth cohort of children with a parental history of allergy or asthma, we measured bed dust allergen (dust mite, cat, and cockroach) by means of ELISA, specific allergic sensitization primarily based on specific IgE levels, and respiratory disease (current asthma, rhinitis, and wheeze) and hours of television viewing/video game playing by means of questionnaire. Children performed spirometric maneuvers before and after bronchodilator responses and had FENO levels measured by using electrochemical detection methods (NIOX MINO). RESULTS FENO levels were increased in children with current asthma (32.2 ppb), wheeze (27.0 ppb), or rhinitis (23.2 ppb) compared with subjects without these respective symptoms/diagnoses (16.4-16.6 ppb, P < .005 for all comparisons). Allergic sensitization to indoor allergens (cat, dog, and dust mite) predicted higher FENO levels and explained one third of the variability in FENO levels. FENO levels were highest in children both sensitized and exposed to dust mite. Greater than 10 hours of weekday television viewing was associated with a 0.64-log increase in FENO levels after controlling for indoor allergen exposure, body mass index, and allergic sensitization. CONCLUSION Allergen exposures and sedentary behavior (television viewing/video game playing) might increase airway inflammation, which was measured as the FENO.
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Lee JK, Suh DI, Koh YY. The role of inhaled and/or nasal corticosteroids on the bronchodilator response. KOREAN JOURNAL OF PEDIATRICS 2010; 53:951-6. [PMID: 21218017 PMCID: PMC3012275 DOI: 10.3345/kjp.2010.53.11.951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 09/17/2010] [Accepted: 10/16/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the profiles of the bronchodilator response (BDR) among children with asthma and/or allergic rhinitis (AR) and to determine whether BDR in these children is reduced by treatment with inhaled and/or nasal corticosteroid. METHODS Sixty-eight children with asthma (mean age, 10.9 years), 45 children with comorbid asthma and AR (mean age, 10.5 years), and 44 children with AR alone (mean age, 10.2 years) were investigated. After a 2-week baseline period, all children were treated with inhaled fluticasone propionate (either 100 or 250 µg b.i.d., tailored to asthma severity) or nasal fluticasone propionate (one spray b.i.d. in each nostril) or both, according to the condition. Before and 2 weeks after starting treatment, all children were evaluated with spirometry and bronchodilator testing. BDR was calculated as a percent change from the forced expiratory volume in 1 second (FEV(1)) at baseline. RESULTS The mean BDR was 10.3% [95% confidence interval (CI) 8.3-12.4%] in children with asthma, 9.0% (95% CI 7.3-10.9%) in subjects with asthma and AR, and 5.0% (95% CI 4.1-5.9%) in children with AR alone (P<0.001). After treatment, the mean BDR was reduced to 5.2% (95% CI 4.2-6.3%) (P<0.001) in children with asthma and to 4.5% (95% CI 3.5-5.5%) (P<0.001) in children with asthma and AR. However, children with rhinitis showed no significant change in BDR after treatment, with the mean value being 4.7% (95% CI 3.7-5.8%) (P=0.597). CONCLUSION The findings of this study imply that an elevated BDR in children with AR cannot be attributed to nasal inflammation alone and highlights the close relationship between the upper and lower airways.
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Affiliation(s)
- Ju Kyung Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Matsumoto H, Niimi A, Jinnai M, Nakaji H, Takeda T, Oguma T, Otsuka K, Inoue H, Yamaguchi M, Matsuoka H, Ito I, Hirai T, Chin K, Mishima M. Association of alveolar nitric oxide levels with pulmonary function and its reversibility in stable asthma. ACTA ACUST UNITED AC 2010; 81:311-7. [PMID: 20938160 DOI: 10.1159/000319566] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 07/09/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inflammation of peripheral airways is implicated in the pathophysiology of severe asthma. However, contributions of peripheral airway inflammation to airway caliber/function in patients with stable asthma, including those with mild to moderate disease, remain to be confirmed. OBJECTIVES To determine whether peripheral airway inflammation affects airway function in patients with asthma. METHODS In 70 patients with mild to severe asthma, alveolar nitric oxide [CANO(TMAD)] levels were examined as a noninvasive biomarker of peripheral airway/alveolar inflammation. CANO(TMAD) and maximal nitric oxide (NO) flux in the airway compartment, J'awNO, were estimated with a model that incorporated trumpet-shaped airways and axial diffusion using exhaled NO output at different flow rates. Measures of pulmonary function were then assessed by spirometry and an impulse oscillometry system, and their bronchodilator reversibility was examined. RESULTS CANO(TMAD) levels were not correlated with pre- or postbronchodilator spirometric values, but were significantly associated with prebronchodilator reactance at low frequency (Xrs5) (rho = -0.31, p = 0.011), integrated area of low-frequency Xrs (AX) (rho = 0.35, p = 0.003) and negative frequency dependence of resistance (Rrs5-Rrs20) (rho = 0.35, p = 0.004). Furthermore, CANO(TMAD) levels were associated with bronchodilator reversibility of FEV(1), FEF(25-75%), Xrs5 and AX (rho = 0.35, 0.31, -0.24 and -0.31, respectively; p ≤ 0.05 for all). No variables were related to J'awNO. CONCLUSIONS Elevated CANO(TMAD), but not J'awNO, partly reflects reversible airway obstruction originating in the peripheral airway. These findings indicate the involvement of peripheral airway inflammation in physiological abnormalities in asthma.
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Affiliation(s)
- Hisako Matsumoto
- Department of Respiratory Medicine, Kyoto University, Kyoto, Japan. hmatsumo @ kuhp.kyoto-u.ac.jp
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Gelb AF, George SC, Camacho F, Fraser C, Flynn Taylor C, Shakkottai S. Increased nitric oxide concentrations in the small airway of older normal subjects. Chest 2010; 139:368-375. [PMID: 20705799 DOI: 10.1378/chest.10-1157] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is a paucity of normal-age stratified data for fraction of exhaled nitric oxide (Feno). Our goal was to obtain normal data for large-airway nitric oxide flux (J'awno) and small-airway and/or alveolar nitric oxide concentration (Cano) in nonsmoking, healthy, adult subjects of various ages. METHODS In 106 normal volunteer subjects (60 women) aged 55 ± 20 years (mean ± SD), Feno (parts per billion [ppb]) was measured at 50, 100, 150, and 200 mL/s and J'awno (nL/s) and Cano (ppb) were calculated using a two-compartment model with correction for axial nitric oxide (NO) back diffusion. Fourteen older normal subjects were also treated with inhaled corticosteroid (540 μg budesonide bid) for 14 days. RESULTS We studied 34 younger normal subjects (17 women) aged 18 to 39 years (younger), 26 middle-aged normal subjects (22 women) aged 40 to 59 years (middle-aged), and 46 older normal subjects (21 women) aged 60 to 86 years (older). Feno at 50 mL/s in the younger group was 21 (14-28) ppb (median, 1-3 interquartile); in the middle-aged group it was 22 (18-30) ppb, and in the older group it was 27 (21-33) ppb, (analysis of variance [ANOVA]) P = .02. For Feno, the younger vs older groups was (Mann-Whitney) P = .03, and Feno in the combined younger and middle-aged groups was 21 (15-29) ppb vs 27 (21-33) ppb, P = .006 for the older group. Corrected J'awno in the younger group was 1.5 (1.0-2.1) nL/s; in the middle-aged group it was 1.4 (1.0-2.0) nL/s, and in the older group it was 1.8 (1.2-2.4) nL/s, (ANOVA) P = .3. Corrected Cano in the younger group was 1.9 (0.8-3.0) ppb; in the middle-aged group it was 2.8 (0.8-5.1) ppb, and in the older group it was 3.9 (1.4-6.6) ppb, (ANOVA) P = .02. Cano in the younger vs older groups was P = .003, and the combined younger and middle-aged group result was 2.0 (0.8-3.8) vs 3.9 (1.4-6.6), P = .01 in the older group. There was no change in NO gas exchange with inhaled corticosteroids. CONCLUSIONS In nonsmoking healthy subjects with normal spirometry, Feno at 50 mL/s and Cano increased significantly with age ≥ 60 years, whereas J'awno did not. We suspect the increase in Cano was due to a decrease in capillary blood volume with reduced NO diffusion, which is also reflected in increased Feno. Inhaled budesonide had no anti-NO-mediated inflammatory effect. Age-matched control subjects will be needed in NO comparative studies. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00576069 and NCT00568347; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Arthur F Gelb
- Pulmonary Division, the Department of Medicine, Lakewood Regional Medical Center, Lakewood, CA; Geffen School of Medicine at University of California at Los Angeles Medical Center, Los Angeles, CA.
| | - Steven C George
- Department of Biomedical Engineering and Chemical Engineering and Materials Science, University of California, Irvine, CA
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