Once-daily inhaled glucocorticosteroid administration in controlled asthma patients

Effect of two administration routes of Shenmai Injection () on pulmonary gas exchange function after tourniquet-induced ischemia-reperfusion

OBJECTIVE

To compare the effect between nebulized and intravenous administration of Shenmai Injection () on pulmonary gas exchange function of patients following tourniquet-induced lower limb ischemia-reperfusion.

METHODS

Thirty-eight patients scheduled for lower extremity surgery were randomized into three groups using the closed envelop method: Shenmai Injection was administered 30 min before tourniquet inflflation by nebulization [0.6 mL/kg in 10 mL normal saline (NS)] in the nebulization group or by intravenous drip (0.6 mL/kg dissolved in 250 mL of 10% glucose) in the intravenous drip group, and equal volume of NS was given intravenously in the NS group; 15 in each group. Arterial blood gases were analyzed, serum levels of malonaldehyde (MDA) and interleukine-6 (IL-6) and interleukine-8 (IL-8) were determined using the method of thiobarbituric acid reaction and enzyme-linked immuno sorbent assay respectively just before tourniquet inflflation (T0), and at 0.5 h (T1), 2 h (T2), 6 h (T3) after tourniquet deflflation.

RESULTS

Compared with baselines at T0, MDA levels signifificantly increased at T2, T3 in the NS group and at T3 in the nebulization group, and IL-6 and IL-8 levels were signifificantly increased at T2, T3 in NS, the intravenous drip and the nebulization groups (P <0.05). Arterial pressure of oxygen (PaO₂) at T3 was decreased, while alveolararterial oxygen tension showed difference (PA-aDO₂) at T3 in the NS group; RI at T3 in both intravenous drip and the nebulization groups were enhanced (P <0.05). Compared with the NS group, MDA and IL-8 levels at T2, T3, IL-6 at T3 in the intravenous drip group, and IL-8 at T3 in the nebulization group were all remarkably increased (P <0.05). Additionally, MDA level at T3 in the nebulization group was higher than that in the intravenous drip group (P <0.05).

CONCLUSIONS

Intravenous administration of Shenmai Injection provided a better protective effect than nebulization in mitigating pulmonary gas exchange dysfunction in patients following tourniquet-induced limb ischemia-reperfusion.

Alveolar nitric oxide concentration reflects peripheral airway obstruction in stable asthma

BACKGROUND AND OBJECTIVE

Increased fraction of exhaled nitric oxide (FeNO) has been shown to reflect airway inflammation in asthma. Central airway NO flux (J'awNO; nL/s) and peripheral airway/alveolar NO concentration (CANO; ppb) can be calculated separately. CANO has been reported to reflect small airway inflammation. The aim of the present study is to correlate CANO levels with clinical and physiological parameters in patients with stable asthma.

METHODS

Seventy-three well-controlled asthmatics (mean age 61) were enrolled. Measurement of FeNO (at 50, 100, 150 and 200 mL/s) and pulmonary function test were performed. J'awNO(TMAD) and CANO(TMAD) were calculated and corrected by the trumpet shape of the airway tree and axial back-diffusion (TMAD).

RESULTS

CANO(TMAD) was significantly correlated with forced expiratory flow between 25-75% of the forced vital capacity (FVC) (FEF(25 -75)), FEF(25 -75) percentage of the predicted value (%pred), forced expiratory flow at 50% of the FVC (FEF(50)) and FEF(50) %pred (R = -0.39 P = 0.002, R = -0.29 P = 0.02, R = -0.39 P = 0.001, R = -0.29 P = 0.02, respectively). CANO(TMAD) was positively correlated with age (R = -0.45 P = 0.0002) and weakly correlated with duration of asthma (R = -0.27 P = 0.03). Forced expiratory volume in 1 s/FVC was negatively correlated with CANO(TMAD), J'awNO(TMAD) and FeNO 50 mL/s. Among these, correlation between forced expiratory volume in 1 s/FVC and FeNO 50 mL/s was the strongest (R = -0.34 P = 0.004).

CONCLUSIONS

CANO(TMAD) may be a more specific marker of peripheral airway obstruction than FeNO and J'awNO(TMAD) in stable asthma.

Impact of add-on pranlukast in stable asthma; the additive effect on peripheral airway inflammation

BACKGROUND

The importance of airway inflammation has been highlighted in the pathophysiology of asthma. Even in controlled asthmatics treated with inhaled corticosteroid (ICS), residual airway inflammation is reported. Systemic therapy with oral leukotriene receptor antagonist, pranlukast, may have additive effects to improve asthma control.

METHODS

Twenty-five controlled asthmatics treated with ICS or ICS plus long-acting β2-agonist (LABA) were enrolled for a randomized crossover trial evaluating the effect of additional oral pranlukast. The patients were assigned to two groups receiving ICS (+LABA) or ICS (+LABA) + pranlukast for 8 weeks. After washout period, two groups were switched over for another 8 weeks. Fraction of exhaled nitric oxide (FeNO), lung function tests, peak expiratory flow (PEF) and asthma control test (ACT) were evaluated at the beginning and end of each period. Central airway NO flux (J'(awNO)) and peripheral airway/alveolar NO concentration (C(ANO)) were measured and adjusted for axial NO back-diffusion.

RESULTS

FEV1, % predicted, forced expired flow (FEF) (25-75), % predicted, morning PEF and ACT were significantly increased after the addition of pranlukast. Oral pranlukast administration significantly decreased both C(ANO) and corrected C(ANO).

CONCLUSIONS

The addition of oral pranlukast to ICS or ICS + LABA therapy may improve asthma control with reducing distal airway inflammation.

TRIAL REGISTRATION

UMIN 000003781.

Compound CVT-E002 attenuates allergen-induced airway inflammation and airway hyperresponsiveness, in vivo

Immune modulation has been a sought after means of therapy for atopic diseases. CVT-E002 is an extract derived from North American Ginseng shown to promote T-helper-1-like responses. We determined what effect CVT-E002 could have in a mouse model of atopic asthma. We report that oral CVT-E002 inhibited the development of allergic airway inflammation and airway hyperresponsiveness. This correlated with an increased presence of interferon-γ in the lung, and also increased regulatory T cells and IL-10. The ability of CVT-E002 to induce regulatory T-cell development was also seen in human in vitro co-cultures.