Effects of skin cooling on airway reactivity in asthma

Exercise-induced bronchoconstriction, temperature regulation and the role of heat shock proteins in non-asthmatic recreational marathon and half-marathon runners

Exercise is the most common trigger of bronchospasm. Heat shock protein (HSP) expression was linked to asthmatic patients. The prevalence and pathophysiology of exercise-induced bronchoconstriction (EIB) in non-professional non-asthmatic runners is unknown. We sought to investigate the frequency of EIB and cytokine changes in non-professional non-asthmatic marathon and half marathoners with and without EIB. Testing was performed before the marathon (baseline), immediately post-marathon at the finish area (peak), and 2–7 days after the marathon (recovery): immunosorbent assays for measurement of HSP70, blood count analysis, spirometry and temperature measurements. We experienced a decline in FEV1 of ≥10% in 35.29% of marathon and 22.22% of half marathon runners. Runners with EIB had significantly higher HSP70 serum concentrations at baseline than those without EIB (987.4 ± 1486.7 vs. 655.6 ± 1073.9; p = 0.014). Marathoners with EIB had significantly increased WBC before participating in the competition (7.4 ± 1.7 vs. 6.0 ± 1.5; p = 0.021). After recovery we found increased HSP70 serum concentrations in marathoners with EIB compared to those without (2539.2 ± 1692.5 vs. 1237.2 ± 835.2; p = 0.032), WBC (7.6 ± 1.8 vs. 6.4 ± 1.6; p = 0.048) and PLT (273.0 ± 43.0 vs 237.2 ± 48.3; p = 0.040). At all measured skin sites skin temperatures in runners were significantly lower immediately after participating in the competition when compared to temperature before the race (skin temperature baseline vs. peak: abdominal: 33.1 ± 0.2 vs. 30.0 ± 0.4; p < 0.001; upper arm: 31.6 ± 0.2 vs. 29.4 ± 0.3; p < 0.001; upper leg: 30.7 ± 0.3 vs. 29.4 ± 0.2; p = 0.014; lower leg: 30.6 ± 1.0 vs. 30.2 ± 1.5; p = 0.007). We found a higher than expected number of non-professional athletes with EIB. HSP70 serum concentrations and elevated WBC could indicate a predisposition to EIB.

The effects of daily bathing on symptoms of patients with bronchial asthma

Background

The influence of bathing in asthma patients is not yet fully known.

Objective

We conducted an observational study to investigate changes in symptoms and their degree by bathing in asthmatic patients.

Methods

A questionnaire focusing on ever experienced bathing-induced symptom changes and their degree, as well as contributing factors, was designed and administered to asthmatic patients in the outpatient department of our institute between January 2012 and November 2013.

Results

Two hundred fifteen cases were recruited. In 60 cases (27.9%), asthmatic symptoms appeared, including 20 cases of chest discomfort (33.3%), 19 cases of cough (31.7%), and 21 cases of wheezing (35.0%). The triggering factors included vapor inhalation (32 cases, 53.3%), hydrostatic pressure on the thorax due to body immersion in the bathtub (26 cases, 43.3%), and sudden change of air temperature (16 cases, 26.7%). Thirty-eight cases (17.7%) experienced improvement in active asthmatic symptoms by bathing. Vapor inhalation was the most common contributing factor (34 cases, 89.5%), followed by warming of the whole body (13 cases, 34.2%). There was no relationship between asthma severity and the appearance of bathing-induced symptoms or improvement of active asthmatic symptoms by bathing.

Conclusion

The effects of bathing in asthmatic patients widely differed from patient to patient and their etiology includes several factors. For those who suffer from bathing-induced asthma symptoms, preventive methods, such as premedication with bronchodilators before bathing, should be established. This study is registered in the University Hospital Medical Information Network (UMIN) clinical trials registry in Japan with the registration number UMIN000015641.

Asthma control and cold weather-related respiratory symptoms

BACKGROUND

In the northern hemisphere people are exposed recurrently to cold air and asthmatics experience more respiratory symptoms. We hypothesized that subjects with poor asthma control are more prone to experience cold weather-related respiratory symptoms than those with good asthma control.

METHODS

A population-based cross-sectional study of 1995 adult asthmatics (response rate 40.4%) living in the Northern Finland was conducted using a questionnaire where cold weather-related respiratory symptoms as well as questions related to asthma control were inquired. The Asthma Control Test (ACT) was defined based on five questions (disadvantage and occurrence of asthma symptoms, waking up because of asthma symptoms, use of rescue medication and self-assessment of asthma control during the past 4 weeks), and was divided into quartiles.

RESULTS

Cold weather-related respiratory symptoms were more frequent among asthmatics with poorly controlled asthma (ACT Q1 vs. ACT Q4); adjusted prevalence ratio (PR) for shortness of breath (men 1.47, 95% confidence interval 1.22-1.77; women 1.18, 1.07-1.30), cough (men 1.10, 0.91-1.34; women 1.18, 1.08-1.30), wheezing (men 1.91, 1.31-2.78; women 1.48, 1.17-1.87), phlegm production (men 1.51, 1.06-2.14; women 1.62, 1.27-2.08) and chest pain (men 4.47, 1.89-10.56; women 2.60, 1.64-4.12). The relations between asthma control and symptom occurrence seemed stronger among smokers than never smokers and subjects with body mass index (BMI) below and above 25-30.

CONCLUSIONS

Our study provides new evidence that subjects whose asthma is poorly controlled are more prone to experience cold weather-related respiratory symptoms and even a slight worsening of asthma control increases symptom prevalences.

Deletion of secretory group V phospholipase A2 attenuates cell migration and airway hyperresponsiveness in immunosensitized mice

We investigated the role of group V phospholipase A2 (gVPLA2) in OVA-induced inflammatory cell migration and airway hyperresponsiveness (AHR) in C57BL/6 mice. Repeated allergen challenge induced biosynthesis of gVPLA2 in airways. By aerosol, gVPLA2 caused dose-related increase in airway resistance in saline-treated mice; in allergic mice, gVPLA2 caused persistent airway narrowing. Neither group IIa phospholipase A2, a close homolog of gVPLA2, nor W31A, an inactive gVPLA2 mutant with reduced activity, caused airway narrowing in immune-sensitized mice. Pretreatment with MCL-3G1, a blocking Ab against gVPLA2, before OVA challenge blocked fully gVPLA2-induced cell migration and airway narrowing as marked by reduction of migrating leukocytes in bronchoalveolar lavage fluid and decreased airway resistance. We also assessed whether nonspecific AHR caused by methacholine challenge was elicited by gVPLA2 secreted from resident airway cells of immune-sensitized mice. MCL-3G1 also blocked methacholine-induced airway bronchoconstriction in allergic mice. Blockade of bronchoconstriction by MCL-3G1 was replicated in allergic pla2g5-/- mice, which lack the gene encoding gVPLA2. Bronchoconstriction caused by gVPLA2 in pla2g4-/- mice was comparable to that in pla2g4+/+ mice. Our data demonstrate that gVPLA2 is a critical messenger enzyme in the development of AHR and regulation of cell migration during immunosensitization by a pathway that is independent of group IVa phospholipase A2.

Facial cooling enhances exercise-induced bronchoconstriction in asthmatic children

PURPOSE

Exercising in cold air enhances bronchial responsiveness (BR) as compared with exercising in warm air. This may be due to intrathoracic cooling or to increased vagal activity caused by facial cooling. The purpose of this study was to compare the effects on BR of cold air inhalation and of facial exposure to cold air, as well as the combined effect of both.

METHODS

Fourteen children with asthma (eight girls) performed four exercise challenge tests in a climatic chamber, under one of the following conditions: 1) inhaling warm air while the face was exposed to warm air (WW, 21 degrees C, 25% relative humidity (RH)); 2) inhaling warm air while the face was exposed to cold air (WC, 0 degrees C, 80% RH); 3) inhaling cold air while the face was exposed to cold air (CC); and 4) inhaling cold air while the face was exposed to warm air (CW). The study was analyzed, using a one- and two-way ANOVA.

RESULTS

Postexercise forced expiratory volume in the first second (FEV1) and maximal mid-expiratory flow (MMEF) values as percent predicted (% pred) showed significant reductions over time (P < 0.001), significant differences among the four experimental conditions (P < 0.001) and a significant condition x time interaction (FEV1:P < 0.001, MMEF:P < 0.01). FEV1 was significantly lower for CC and WC, as compared with WW and CW at 5 and 10 min postexercise. The lowest postexercise values for FEV1 occurred in the CC and WC sessions (76% predicted in both). A similar pattern was obtained for MMEF.

CONCLUSION

Facial cooling combined with either cold or warm air inhalation causes the greatest EIB, as compared with the isolated challenge with cold air inhalation. We suggest that vagal mechanisms play a major role in exercise and cold-induced bronchoconstriction.

Effect of three resuscitation procedures on respiratory and metabolic adaptation to extra uterine life in newborn calves

The purpose of this study was to evaluate the effects of three resuscitation procedures on respiratory and metabolic adaptation to extra-uterine life during the first 24 h after birth in healthy newborn calves. Twenty-four newborn calves were randomly grouped into four categories: six calves did not receive any specific resuscitation procedure and were considered as controls (C); six received pharyngeal and nasal suctioning immediately after birth by use of a hand-powered vacuum pump (SUC); six received five litres of cold water poured over their heads immediately after birth (CW) and six were housed in a calf pen with an infrared radiant heater for 24 h after birth (IR). Calves were examined at birth, 5, 15, 30, 45 and 60 min, 2, 3, 6, 12 and 24 h after birth and the following measurements were recorded: physical and clinical examination, arterial blood gas analysis, pulmonary function tests using the oesophageal balloon catheter technique, arterial and venous blood acid-base balance analysis, jugular venous blood sampling for determination of metabolic, haematological and passive immune transfer variables. SUC was accompanied by improved pulmonary function efficiency and by a less pronounced decrease in body temperature. The "head shaking movement" and the subsequent temporary increase in total pulmonary resistance as well as the greater lactic acidosis due to CW were accompanied by more efficient, but statistically non-significant, pulmonary gas exchanges. IR allowed maintenance of higher body temperature without requiring increased catabolism of energetic stores. IR also caused a change in breathing pattern which contributed to better distribution of the ventilation and to slightly improved gas exchange. The results indicate that use of SUC, CW and IR modified respiratory and metabolic adaptation during the first 24 h after birth without side-effects. These resuscitation procedures should be recommended for their specific indication, i.e. cleansing of fetal fluid from upper airways, hypothermal stimulation of breathing and prevention of heat losses.

Effects of immersion in cool water on lung-exhaled nitric oxide at rest and during exercise

Lung nitric oxide (NO) has been postulated to relax airway and vascular smooth muscle at rest and during exercise. As a cold environment is a common cause of respiratory distress, lung exhaled NO was measured during skin and core body cooling at rest and during a progressive cycle exercise. Ten healthy male subjects were immersed in water at a water temperature (Tw) which was thermal neutral (35 degrees C) at 30 degrees C Tw, at which only skin temperature is decreased; and at 20 degrees C Tw, at which the core temperature is decreased (0.05 degrees C). At rest, V(O), and V(E) increased while exhaled NO concentration [NO] and the rate of expiration of NO (V(NO)) decreased with decreased Tw. V(O2) and ventilation (V(E)) increased with workload (W) and the values at all Tw were not different, whereas, [NO] decreased with W and the values during exercise were progressively less at all Ws as Tw declined. These results indicate that lung NO output is reduced in a graded fashion during body cooling at rest and during exercise. This suggests that lower lung NO may contribute to airway obstruction in cold environments and NO may contribute to regulation of lung heat and water exchange.