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Fernando Y, Wickramasinghe P, De Silva U, Alahakoon M, Anuradha KWDA, Handunnetti S. Differences in serum markers of oxidative stress in well controlled and poorly controlled asthma in Sri Lankan children: a pilot study. Allergy Asthma Clin Immunol 2020; 16:66. [PMID: 32944026 PMCID: PMC7491346 DOI: 10.1186/s13223-020-00463-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022] Open
Abstract
Background Asthma is a disease characterised by hyper responsiveness and bronchoconstriction of airways, and is a major health burden globally. A dysfunction of the oxidant-antioxidant balance, termed oxidative stress, has been implicated in the pathophysiology of asthma. The present study aims to assess the changes in oxidative stress markers, namely nitric oxide metabolites and antioxidant capacity, in children with poorly controlled and well controlled asthma, in comparison to healthy controls. Methods The present study enrolled 72 children (ages 5-15 years) classified into three groups: (1) poorly controlled asthma (n = 20), (2) well controlled asthma (n = 24) and (3) healthy controls (n = 27). An interviewer-administered questionnaire was used to record socio-demographic data of the participants. The serum concentrations of the oxidant markers (nitrite, nitrate and total nitric oxide metabolites [NOx]) were determined using the Griess test, and the total antioxidant capacity (TAOC) was determined using the ABTS decolorisation method. The concentrations of these markers were compared across the three groups. Results The three study groups were similar in terms of socio-demographic data. The differences across the three groups were statistically significant for serum concentrations of nitrate and NOx (but not nitrite) and serum TAOC. Further analyses showed that the disparity for nitrate and NOx concentrations was greatest between poorly controlled asthma and healthy controls (p = 0.001 and p < 0.001) compared to the well-controlled asthmatics and healthy controls (p = 0.036 and p = 0.049). A significant difference in serum nitrate and NOx concentrations was not observed between the two asthma groups (p = 0.311 and 0.203). The TAOC were significantly lower in poorly controlled asthmatics as compared to well-controlled asthmatics (p = 0.003) and healthy controls (p < 0.001). However, there was no significant difference in the serum TAOC between healthy controls and well-controlled asthmatics (p = 0.496). These findings may indicate that it is perhaps the higher TAOC that contributes to the well controlled state of asthma. Conclusions The present study indicated that an imbalance of oxidants and antioxidants in the serum may have an underlying role in asthma pathophysiology, and how these markers may be effective in asthma management.
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Affiliation(s)
- Yenuli Fernando
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka.,Colombo International School, Colombo, 7 Sri Lanka
| | - Pujitha Wickramasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Udani De Silva
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | | | - K W D A Anuradha
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Shiroma Handunnetti
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
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Abstract
OBJECTIVE Summarize developed evidence-based diagnostic and treatment guidelines for work-related asthma (WRA). METHODS Comprehensive literature reviews conducted with article critiquing and grading. Guidelines developed by a multidisciplinary expert panel and peer-reviewed. RESULTS Evidence supports spirometric testing as an essential early test. Serial peak expiratory flow rates measurement is moderately recommended for employees diagnosed with asthma to establish work-relatedness. Bronchial provocation testing is moderately recommended. IgE and skin prick testing for specific high-molecular weight (HMW) antigens are highly recommended. IgG testing for HMW antigens, IgE testing for low-molecular weight antigens, and nitric oxide testing for diagnosis are not recommended. Removal from exposure is associated with the highest probability of improvement, but may not lead to complete recovery. CONCLUSION Quality evidence supports these clinical practice recommendations. The guidelines may be useful to providers who diagnose and/or treat WRA.
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Ben Anes A, Ben Nasr H, Fetoui H, Bchir S, Chahdoura H, Yacoub S, Garrouch A, Benzarti M, Tabka Z, Chahed K. Alteration in systemic markers of oxidative and antioxidative status in Tunisian patients with asthma: relationships with clinical severity and airflow limitation. J Asthma 2015; 53:227-37. [PMID: 26516659 DOI: 10.3109/02770903.2015.1087559] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aims to determine the systemic oxidant-antioxidant status in Tunisian patients with asthma. METHODS We evaluated the levels of malondialdehyde (MDA) as thiobarbituric acid complexes, total protein carbonyls (PCs) and advanced oxidation protein products (AOPP). The levels of total thiols, protein sulfhydryls, glutathione (GSH), together with hydrogen peroxide, ascorbic acid, iron and total antioxidant status (TAS) were colorimetrically estimated. Glutathione peroxidase (GSH-Px), catalase (CAT) and superoxide dismutase (SOD) activities were assessed in plasma and erythrocytes by spectrophotometry. We also determined the levels of nitric oxide (NO) and peroxynitrite in plasma from asthmatic patients and healthy controls. The volume of fractionated exhaled NO (FeNO) was evaluated by the Medisoft HypAir method. Estimation of DNA damage was determined using the comet assay. RESULTS Asthmatic patients showed increased levels of MDA in comparison to healthy controls (p < 0.001), while no significant difference was found in protein carbonyls (p = 0.79) and AOPP (p = 0.98). Patients with asthma also had significantly lower levels of total thiols (355.9 ± 15.72 versus 667.9 ± 22.65, p < 0.001), protein sulfhydryls (333.99 ± 16.41 versus 591.95 ± 24.28, p < 0.001) and glutathione (p < 0.001). They also showed decreased GSH-Px activity (p < 0.001), whereas no significant differences in measurements of catalase and SOD enzyme activities were observed between the two groups (respectively, p = 0.06 and p = 0.55). In addition, ascorbic acid and nitric oxide levels were decreased in asthmatics in comparison to controls (p < 0.01). CONCLUSIONS Our findings highlight that oxidative stress and defective anti-oxidative status are major alterations in Tunisian patients with asthma.
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Affiliation(s)
- Amel Ben Anes
- a Unité de Recherche UR12ES06, Physiologie de l'Exercice et Physiopathologie, de l'Intégré au Moléculaire, Biologie, Médecine et Santé, Université de Sousse , Sousse, Tunisia .,b Faculté des Sciences de Bizerte , Université de Carthage , Bizerte, Tunisia
| | - Hela Ben Nasr
- a Unité de Recherche UR12ES06, Physiologie de l'Exercice et Physiopathologie, de l'Intégré au Moléculaire, Biologie, Médecine et Santé, Université de Sousse , Sousse, Tunisia
| | - Hamadi Fetoui
- c Faculté des Sciences de Sfax , Unité de Recherche de Toxicologie-Microbiologie Environnementale et Santé (UR/11 ES70) , Sfax, Tunisia
| | - Sarra Bchir
- a Unité de Recherche UR12ES06, Physiologie de l'Exercice et Physiopathologie, de l'Intégré au Moléculaire, Biologie, Médecine et Santé, Université de Sousse , Sousse, Tunisia
| | - Hassiba Chahdoura
- d Génome, Diagnostic Immunitaire et valorisation, Unité de Recherche 03/UR/09-01, Institut Supérieur de Biotechnologie de Monastir, Université de Monastir , Monastir, Tunisia
| | - Saloua Yacoub
- e Unité de Recherche, UR06SP05, Centre Régional de Transfusion Sanguine, CHU Farhat Hached , Sousse-Tunisia
| | | | - Mohamed Benzarti
- f Service de Pneumo-Allergologie, CHU Farhat Hached , Sousse-Tunisia , and
| | - Zouhair Tabka
- a Unité de Recherche UR12ES06, Physiologie de l'Exercice et Physiopathologie, de l'Intégré au Moléculaire, Biologie, Médecine et Santé, Université de Sousse , Sousse, Tunisia
| | - Karim Chahed
- a Unité de Recherche UR12ES06, Physiologie de l'Exercice et Physiopathologie, de l'Intégré au Moléculaire, Biologie, Médecine et Santé, Université de Sousse , Sousse, Tunisia .,g Faculté des Sciences de Sfax , Université de Sfax , Sfax, Tunisia
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Lee MH, Choi JW, Jang WR, Kim JM, Kim JH. Activation of eosinophils is more closely linked with interleukin-5 and nitric oxide production than tumor necrosis factor-α and immunoglobulin E levels. Acta Haematol 2013; 130:238-41. [PMID: 23860462 DOI: 10.1159/000350474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/17/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Moon Hee Lee
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
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Radwan ZM, Nasser Yamamah GA, Shaaban HH, Omar Abdel-Rahman AM, Abdel-Ghany Ismaeil A, Mohamed Mostafa E. Effect of different monotherapies on serum nitric oxide and pulmonary functions in children with mild persistent asthma. Arch Med Sci 2010; 6:919-25. [PMID: 22427767 PMCID: PMC3302705 DOI: 10.5114/aoms.2010.19302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 04/28/2010] [Accepted: 05/05/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Common medications used to treat mild persistent asthma are glucocorticoids, leukotriene receptor antagonists and theophylline. The aim of the study was to evaluate monotherapy with either inhaled steroids, oral leukotriene receptor antagonist or theophylline in Egyptian children with mild persistent asthma by determining their clinical, laboratory and spirometric responses to treatment. MATERIAL AND METHODS Thirty-nine mild asthmatic children between 8 and 13 years of age were included in the study. Patients were classified according to therapy received into four groups: oral leukotriene receptor antagonist (montelukast), inhaled corticosteroid (fluticasone propionate), sustained-release (SR) theophylline, and no treatment. Pulmonary function testing was performed at the start of therapy and 8 weeks later using spirometry. Eosinophil count and serum nitric oxide were estimated in the blood. Minitab statistical package was used for analysis of data. RESULTS Follow-up after 8 weeks revealed significant improvement in FEV1% in groups 1 (p < 0.01) and 3 (p < 0.05), significant improvement in PEFR in groups 1 (p < 0.05) and 2 (p < 0.01), significant decline in serum NO levels in groups 1 (p < 0.05) and 2 (p < 0.05), as well as significant improvement in eosinophil count in groups 1, 2 and 3 (p < 0.01, < 0.001, < 0.01 respectively). There was a statistically significant positive correlation between the decline in serum NO and the decline in blood eosinophil % in group 2 (p < 0.05). CONCLUSIONS Inhaled corticosteroids and montelukast have a significant role in controlling the pulmonary functions and the inflammatory process in children with mild persistent asthma, although inhaled corticosteroids seem to yield a better response. Children with mild persistent asthma should receive a controller medication, and SR theophylline may be a good cost-benefit alternative for low socio-economic groups of patients.
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Al Obaidi AHA, Al Samarai AGM, Al-Janabi J, Yahia A. The predictive value of eosinophil cationic protein and lactate dehydrogenase in asthma: a comparative study of serum versus sputum. World Allergy Organ J 2009; 2:144-9. [PMID: 23283064 PMCID: PMC3651008 DOI: 10.1097/wox.0b013e3181b2fe64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND : Serum and sputum eosinophil cationic protein (ECP) levels are correlated with asthma disease severity. OBJECTIVE : To establish a diagnostic accuracy of ECP and lactate dehydrogenase (LDH) in serum (indirectly) and sputum (directly) as inflammatory markers in asthma. PATIENTS AND METHODS : In a cross sectional study, 76 asthmatic patients with exacerbation were enrolled in the study. ECP was determined using enzyme linked immuno-assay. RESULTS : Asthmatic patients compared with control subjects, had a significant higher levels of ECP and LDH in sputum. Both sputum and serum ECP and LDH were reduced significantly with prednisolone treatment. FEV1 was inversely correlated with sputum ECP, serum ECP, and sputum LDH. A significant positive correlation was noted between sputum ECP and sputum LDH. Serum LDH does not demonstrate any significant correlations with other variables. The area under receiver operating characteristic curve showed that sputum ECP (0.92) was a significantly an accurate marker more than serum ECP (0.81), sputum (0.80) LDH, and serum (0.65) LDH. Furthermore, the area under curve was lower for serum ECP (0.81) than that for sputum ECP (0.92). However, serum ECP (0.81) was more accurate marker than serum LDH (0.65). CONCLUSION : Serum and sputum ECP as eosinophilic inflammatory markers are associated with poor asthma control. Sputum ECP and LDH were significantly an accurate markers more than serum ECP and LDH.
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Recabarren A, Apaza C, Castro-Rodríguez JA. Nitrites in induced sputum as a simple and cheap non-invasive marker of airway inflammation for asthmatic schoolchildren. Pediatr Allergy Immunol 2008; 19:433-7. [PMID: 18167157 DOI: 10.1111/j.1399-3038.2007.00671.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To determine if there are differences in the nitric oxide metabolites (nitrites) in sputum of patients with persistent asthma and healthy schoolchildren, we performed a case-control study in a tertiary care hospital in Arequipa, Perú. Nitrites in induced sputum samples were measured using the Griess assay in 30 persistent asthmatics (mean age of 10.1 yr) and 30 controls (mean age of 11.9 yr). The mean +/- s.d. of nitrites among asthmatics was significantly higher than the controls (16.30 +/- 8.6 vs. 10.25 +/- 4.68 nmol/ml, respectively, p = 0.001). Moreover, the nitrite level in the sputum in children with severe persistent asthma was higher than in the level found in the moderate and mild asthmatics (32.83 +/- 9.48 vs. 18.10 +/- 1.96 vs. 11.84 +/- 4.73 nmol/ml, respectively, p < 0.01 for linear trend). This study showed for the first time in children that asthmatics have significantly higher levels of nitrites in induced sputum than healthy controls and that the level of nitrite correlates with the severity of the asthma. Nitrite levels in sputum, a simple and cheap, non-invasive method, may be a good alternative to measure the severity of inflammation in asthmatic children.
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Affiliation(s)
- Arturo Recabarren
- Hospital III Yanahuara EsSalud and Universidad Nacional San Agustín, Arequipa, Perú
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Song HM, Jang AS, Ahn MH, Takizawa H, Lee SH, Kwon JH, Lee YM, Rhim TY, Park CS. Ym1 and Ym2 expression in a mouse model exposed to diesel exhaust particles. ENVIRONMENTAL TOXICOLOGY 2008; 23:110-116. [PMID: 18214922 DOI: 10.1002/tox.20319] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Chitinase may play a role in regulating allergic diseases. OBJECTIVE We studied the role of chitinase in a mouse model exposed to diesel exhaust particles (DEP). Mice were exposed to intranasal DEP (0.6 mg/mL) for 5 days and challenged with aerosolized DEP (6 mg/m(3)) on days 6-8. Enhanced pause (Penh), as an airway obstruction marker, was measured on day 9, and bronchoalveolar lavage (BAL) fluid and lung tissues were collected on day 10. The expression of Ym1 and Ym2 mRNA was assessed in lung tissue extracts by reverse transcription-polymerase chain reaction. RESULTS DEP induced significant increases in methacholine-induced Penh and IL-4 levels in BAL fluid relative to the control group. Peribronchial and perivascular inflammatory cell infiltrates were prominent in the DEP group. DEP induced Ym1 and Ym2 mRNA expression in lung tissue extracts relative to the control group. CONCLUSION These results demonstrate that DEP induced airway hyperresponsiveness and Ym mRNA expression via a Th2 cell-biased response, suggesting that chitinase may play an important role in airway inflammation and responsiveness upon exposure to DEP in a mouse model, and may therefore be involved in regulating allergic diseases.
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Affiliation(s)
- Hyun-Mi Song
- Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Korea
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Jang AS, Park CS, Choi IS. Particulate Air Pollutants and Airway Inflammation. Chonnam Med J 2008. [DOI: 10.4068/cmj.2008.44.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- An Soo Jang
- Asthma and Allergy Research Group, Division of Allergy and Respiratory Diseases, Soonchunhyang University Hospital, Bucheon, Korea
| | - Choon-Sik Park
- Asthma and Allergy Research Group, Division of Allergy and Respiratory Diseases, Soonchunhyang University Hospital, Bucheon, Korea
| | - In Seon Choi
- Department of Allergy, Chonnam National University Medical School and the Research Institute of Medical Sciences, Gwangju, Korea
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Chladkova J, Krcmova I, Chladek J, Cap P, Micuda S, Hanzalkova Y. Validation of nitrite and nitrate measurements in exhaled breath condensate. Respiration 2005; 73:173-9. [PMID: 16549945 DOI: 10.1159/000088050] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Accepted: 02/17/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inflammatory markers in exhaled breath condensate (EBC) are investigated as a non-invasive approach to monitoring of inflammation in the respiratory tract. EBC concentrations of nitrite and nitrate, the stable end products of oxidative metabolism of nitric oxide, are increased in patients with asthma, especially during acute exacerbations. OBJECTIVES To examine methodological aspects of nitrite and nitrate measurements in EBC such as sample collection, storage and analysis. METHODS In a randomized study, EBC was collected twice within 1 h (with and without a nose clip) in 20 healthy adults and 20 patients with well-controlled asthma and no symptoms of allergic rhinitis. Nitrite and nitrate were assayed by ionex chromatography and fluorimetrically after derivatization with diaminonaphthalene. RESULTS The geometric mean [exp (mean +/- SD)] EBC levels of nitrite and nitrate in healthy subjects [4.3 (3.0-6.1) and 11.0 (5.3-22.7) micromol/l] and patients [4.6 (2.6-7.3) and 8.7 (3.2-23.8) micromol/l] did not differ (p = 0.13). Wearing a nose clip (p = 0.3) did not influence nitrite and nitrate concentrations. The mean intra-subject %CVs of EBC concentrations of nitrite were 26 and 21% in healthy subjects and patients, while those of nitrate achieved 49 and 88%, respectively. CONCLUSIONS Ionex chromatography of nitrite and nitrate requires no sample pretreatment and provides comparable results as a more laborious diaminonaphthalene method. EBC samples should be kept cold (8 degrees C) and analyzed for nitrite and nitrate within 24 h of collection or stored in the freezer and thawed preferably only once. Wearing a nose clip during EBC collection has no influence on nitrite and nitrate concentrations. Short-term repeatability of nitrite and nitrate measurements was worse compared to published data on exhaled nitric oxide.
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Affiliation(s)
- Jirina Chladkova
- Department of Pediatrics, Charles University in Prague, Faculty of Medicine in Hradec Králové, Prague, Czech Republic
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Jang AS, Choi IS, Lee JU, Park SW, Lee JH, Park CS. Changes in the expression of NO synthase isoforms after ozone: the effects of allergen exposure. Respir Res 2004; 5:5. [PMID: 15251042 PMCID: PMC451659 DOI: 10.1186/1465-9921-5-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Accepted: 06/05/2004] [Indexed: 01/25/2023] Open
Abstract
Background The functional role of nitric oxide (NO) and various nitric oxide synthase (NOS) isoforms in asthma remains unclear. Objective This study investigated the effects of ozone and ovalbumin (OVA) exposure on NOS isoforms. Methods The expression of inducible NOS (iNOS), neuronal NOS (nNOS), and endothelial NOS (eNOS) in lung tissue was measured. Enhanced pause (Penh) was measured as a marker of airway obstruction. Nitrate and nitrite in bronchoalveolar lavage (BAL) fluid were measured using a modified Griess reaction. Results The nitrate concentration in BAL fluid from the OVA-sensitized/ozone-exposed/OVA-challenged group was greater than that of the OVA-sensitized/saline-challenged group. Methacholine-induced Penh was increased in the OVA-sensitized/ozone-exposed/OVA-challenged group, with a shift in the dose-response curve to the left, compared with the OVA-sensitized/saline-challenged group. The levels of nNOS and eNOS were increased significantly in the OVA-sensitized/ozone-exposed/OVA-challenged group and the iNOS levels were reduced compared with the OVA-sensitized/saline-challenged group. Conclusion In mice, ozone is associated with increases in lung eNOS and nNOS, and decreases in iNOS. None of these enzymes are further affected by allergens, suggesting that the NOS isoforms play different roles in airway inflammation after ozone exposure.
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Affiliation(s)
- An-Soo Jang
- Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, 1174, Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767 Republic of Korea
| | - Inseon-S Choi
- Research Institute of Medical Sciences, Department of Internal Medicine, Chonnam National University, 8, Hak-1-dong, Gwangju, 501-757, Republic of Korea
| | - Jong-Un Lee
- Physiology, Chonnam National University Medical School, Chonnam National University, 5, Hak-1-dong, Gwangju, 501-757, Republic of Korea
| | - Sung-Woo Park
- Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, 1174, Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767 Republic of Korea
| | - June-Hyuk Lee
- Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, 1174, Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767 Republic of Korea
| | - Choon-Sik Park
- Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, 1174, Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767 Republic of Korea
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Schulz R, Schmidt D, Blum A, Lopes-Ribeiro X, Lücke C, Mayer K, Olschewski H, Seeger W, Grimminger F. Decreased plasma levels of nitric oxide derivatives in obstructive sleep apnoea: response to CPAP therapy. Thorax 2000; 55:1046-51. [PMID: 11083891 PMCID: PMC1745665 DOI: 10.1136/thorax.55.12.1046] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reduced endothelium dependent vasodilation has been reported in patients with obstructive sleep apnoea (OSA) but direct measurements of the most potent naturally occurring vasodilator, nitric oxide (NO) or its derivatives (nitrate and nitrite, NO(x)), have not yet been performed in these patients. METHODS In 21 patients with OSA of mean (SE) age 54 (2) years, body mass index (BMI) 30.9 (1.1) kg/m(2), and apnoea-hypopnoea index (AHI) 37 (4)/h, NO(x) levels were measured in peripheral venous blood samples by chemiluminescence. Blood samples were obtained before and after two nights of continuous positive airway pressure (CPAP) and after 5.5 (1.5) months of follow up. Thirteen age matched, healthy volunteers and 18 patients without OSA but with a similar spectrum of comorbidity served as controls (control groups 1 and 2). RESULTS Before CPAP NO(x) levels were 21.7 (1.5) microM in patients with OSA compared with 42.6 (2.2) microM and 36.7 (1.7) microM in control groups 1 and 2, respectively (p<0.01 for each comparison). NO(x) concentrations increased to 32.1 (2.7) microM after two nights of CPAP and remained constant at 32.9 (2.3) microM at follow up (p<0.01 compared with levels before CPAP). CONCLUSIONS Plasma NO(x) levels are reduced in OSA and can be increased by short and long term CPAP therapy. Although the precise mechanism underlying this observation remains to be clarified, it may have important implications for the development of cardiovascular disease in patients with OSA and for the life saving effect of CPAP.
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Affiliation(s)
- R Schulz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Justus-Liebig University, 35392 Giebetaen, Germany
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