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Teodorescu M, Song R, Brinkman JA, Sorkness RL. Chronic intermittent hypoxia increases airway hyperresponsiveness during house dust mites exposures in rats. Respir Res 2023; 24:189. [PMID: 37468919 DOI: 10.1186/s12931-023-02493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Accumulating clinical evidence links Obstructive Sleep Apnea (OSA) with worse outcomes of asthma, but impact on airway function remains sparsely studied. We tested effects of Chronic Intermittent Hypoxia (CIH) - a hallmark of OSA - on airway hyperresponsiveness (AHR), in a rat model of chronic allergen-induced inflammation. METHODS Brown Norway rats were exposed to six weeks of CIH or normoxia (NORM) concurrent with weekly house dust mites (HDM) or saline (SAL) challenges. At endpoint, we assessed responses to seven Methacholine (Mch) doses (0, 4, 8, 16, 32, 64, 128 mg/mL) on a FlexiVent system (Scireq). Maximal (or plateau) responses (reactivity) for total respiratory system Resistance (Rrs) and Elastance (Ers), Newtonian airway resistance (RN, a measure of central airways function) and tissue damping (G, a measure of distal airways function) were plotted. RESULTS HDM/CIH-treated animals demonstrated the highest reactivity to Mch in Rrs and Ers compared to all other groups (HDM/NORM, SAL/CIH and SAL/NORM p < 0.05 for all comparisons, for doses 5-7 for Rrs, and for doses 4-7 for Ers). The enhanced Rrs response was due to an increase in G (doses 4-7, p < 0.05 for comparisons to all other groups), whereas RN was not affected by CIH. CONCLUSIONS In rats chronically challenged with HDM, concurrent CIH exposure induces AHR primarily in the distal airways, which affects the respiratory system frequency-dependent elastic properties.
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Affiliation(s)
- Mihaela Teodorescu
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin- Madison, Madison, WI, USA.
- William S. Middleton Memorial VA Medical Center, Madison, WI, USA.
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, William S. Middleton Memorial Veterans' Hospital, 2500 Overlook Terrace, D2212, Madison, WI, 53705, USA.
| | - Ruolin Song
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin- Madison, Madison, WI, USA
| | - Jacqueline A Brinkman
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin- Madison, Madison, WI, USA
| | - Ronald L Sorkness
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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van Boven FE, de Jong NW, Braunstahl GJ, Gerth van Wijk R, Arends LR. A meta-analysis of baseline characteristics in trials on mite allergen avoidance in asthmatics: room for improvement. Clin Transl Allergy 2020; 10:2. [PMID: 31921410 PMCID: PMC6943957 DOI: 10.1186/s13601-019-0306-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence regarding the clinical effectiveness of mite allergen avoidance for the treatment of asthma is lacking. In previous meta-analyses on mite allergen control, the baseline data were not discussed in detail. This study updates and extends the existing Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187), with a focus on baseline asthma outcomes and allergen exposures. METHODS We used the existing trials in the original Cochrane review and included newly published studies. The baseline data for the mite allergen load from the mattress, the standardized asthma symptom score (ASS), the forced expiratory volume in 1 s percentage of predicted (FEV1 %pred.), and the histamine provocative concentration causing a 20% drop in FEV1 (PC20) were extracted. First, the mean values of the outcomes were calculated. The influence of the mite allergen load was examined with a random-effect meta-regression using the Metafor package in R. RESULTS Forty-five trials were included; 39 trials reported strategies for concurrent bedroom interventions, and 6 trails reported strategies for air purification. The mite allergen load ranged from 0.44 to 24.83 μg/g dust, with a mean of 9.86 μg/g dust (95% CI 5.66 to 14.05 μg/g dust, I2 = 99.8%). All health outcomes showed considerable heterogeneity (standardized ASS mean: 0.13, 95% CI 0.08 to 0.18, I2 = 99.9%; FEV1 %pred. mean: 85.3%, 95% CI 80.5 to 90.1%, I2 = 95.8%; PC20 mean: 1.69 mg/mL, 95% CI 0.86 to 2.52 mg/mL, I2 = 95.6%). The covariate mite allergen load did not significantly influence health outcomes. DISCUSSION This meta-analysis shows that mite avoidance studies are characterized by the inclusion of patients with rather mild to moderate asthma and with varying and sometimes negligible levels of allergen exposure. Future studies should focus on patients with severe asthma and increased levels of allergen exposure.
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Affiliation(s)
- Frank E. van Boven
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Nicolette W. de Jong
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Sint Franciscus Vlietland Groep, P.O. Box 10900, 3004 BA Rotterdam, The Netherlands
- Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Lidia R. Arends
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Rodriguez E, Barthold JS, Kreiger PA, Armani MH, Wang J, Michelini KA, Wolfson MR, Boyce R, Barone CA, Zhu Y, Waldman SA, Shaffer TH. The orl rat is more responsive to methacholine challenge than wild type. Pulm Pharmacol Ther 2014; 29:199-208. [PMID: 25218882 DOI: 10.1016/j.pupt.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/29/2014] [Accepted: 09/01/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study presents an animal model of native airway hyperresponsiveness (AHR). AHR is a fundamental aspect of asthma and reflects an abnormal response characterized by airway narrowing following exposure to a wide variety of non-immunological stimuli. Undescended testis (UDT) is one of the most common male congenital anomalies. The orl rat is a Long Evans substrain with inherited UDT. Since boys born with congenital UDT are more likely to manifest asthma symptoms, the main aim of this study was to investigate the alternative hypothesis that orl rats have greater AHR to a methacholine aerosol challenge than wild type rats. METHODS Long Evans wild type (n = 9) and orl (n = 13) rats were anesthetized, tracheostomized, and mechanically ventilated at 4 weeks of age. Escalating concentrations of inhaled methacholine were delivered. The methacholine potency and efficacy in the strains were measured. Respiratory resistance was the primary endpoint. After the final methacholine aerosol challenge, the short-acting β2-adrenoceptor agonist albuterol was administered as an aerosol and lung/diaphragm tissues were assayed for interleukin (IL)-4, IL-6, and tumor necrosis factor (TNF)-α. Histological and histomorphometrical analyses were performed. RESULTS The methacholine concentration-response curve in the orl group indicated increased sensitivity, hyperreactivity, and exaggerated maximal response in comparison with the wild type group, indicating that orl rats had abnormally greater AHR responses to methacholine. Histological findings in orl rats showed the presence of eosinophils, unlike wild type rats. β2-Adrenoceptor agonist intervention resulted in up-regulation of IL-4 diaphragmatic levels and down-regulation of IL-4 and IL-6 in the lungs of orl rats. CONCLUSION orl rats had greater AHR than wild type rats during methacholine challenge, with higher IL-4 levels in diaphragmatic tissue homogenates. Positive immunostaining for IL-4 was detected in lung and diaphragmatic tissue in both strains. This model offers advantages over other pre-clinical murine models for studying potential mechanistic links between cryptorchidism and asthma. This animal model may be useful for further testing of compounds/therapeutics options for treating AHR.
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Affiliation(s)
- Elena Rodriguez
- Alfred I. duPont Hospital for Children, Nemours Lung Center, Wilmington, DE 19803, United States; Alfred I. duPont Hospital for Children, Nemours Biomedical Research, Wilmington, DE 19803, United States; Thomas Jefferson University, Division of Clinical Pharmacology, Dept. of Pharmacology and Experimental Therapeutics, Philadelphia, PA 19107, United States.
| | - Julia S Barthold
- Alfred I. duPont Hospital for Children, Nemours Biomedical Research, Wilmington, DE 19803, United States; Nemours Alfred I. duPont Hospital for Children, Division of Urology, Wilmington, DE 19803, United States
| | - Portia A Kreiger
- Nemours Alfred I. duPont Hospital for Children, Department of Pathology, Wilmington, DE 19803, United States
| | - Milena Hirata Armani
- Alfred I. duPont Hospital for Children, Nemours Lung Center, Wilmington, DE 19803, United States; Alfred I. duPont Hospital for Children, Nemours Biomedical Research, Wilmington, DE 19803, United States
| | - Jordan Wang
- Alfred I. duPont Hospital for Children, Nemours Lung Center, Wilmington, DE 19803, United States
| | - Katherine A Michelini
- Alfred I. duPont Hospital for Children, Nemours Lung Center, Wilmington, DE 19803, United States; Alfred I. duPont Hospital for Children, Nemours Biomedical Research, Wilmington, DE 19803, United States
| | - Marla R Wolfson
- Temple University School of Medicine, Department of Physiology, Philadelphia, PA 19140, United States; Temple University School of Medicine, Department of Pediatrics, Philadelphia, PA 19140, United States
| | - Roberta Boyce
- Alfred I. duPont Hospital for Children, Histotechnology Core Laboratory, Wilmington, DE 19803, United States
| | - Carol A Barone
- Alfred I. duPont Hospital for Children, Histotechnology Core Laboratory, Wilmington, DE 19803, United States
| | - Yan Zhu
- Alfred I. duPont Hospital for Children, Nemours Lung Center, Wilmington, DE 19803, United States; Alfred I. duPont Hospital for Children, Nemours Biomedical Research, Wilmington, DE 19803, United States
| | - Scott A Waldman
- Thomas Jefferson University, Division of Clinical Pharmacology, Dept. of Pharmacology and Experimental Therapeutics, Philadelphia, PA 19107, United States
| | - Thomas H Shaffer
- Alfred I. duPont Hospital for Children, Nemours Lung Center, Wilmington, DE 19803, United States; Temple University School of Medicine, Department of Physiology, Philadelphia, PA 19140, United States; Temple University School of Medicine, Department of Pediatrics, Philadelphia, PA 19140, United States
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Cardarelli WJ. Asthma: are we monitoring the correct measures? Popul Health Manag 2010; 12:87-94. [PMID: 19320609 DOI: 10.1089/pop.2008.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The prevalence of asthma, a common chronic inflammatory disease of the airways, has risen sharply over the past 25-30 years, with the biggest increase found in children. Currently, more than 22 million Americans have asthma. Asthma also is associated with significant morbidity and mortality worldwide. Each year, asthma is responsible for $16 billion in direct and indirect costs due to health care utilization and loss of productivity, with over 14 million missed workdays. Asthma also accounts for almost 1.8 million emergency room visits and almost 500,000 hospitalizations annually. Therefore, assessment and monitoring of disease activity is critical to improve clinical and economic outcomes for patients with asthma. To help in this endeavor, practitioners and payers rely on evidence-based guidelines to classify disease severity, to guide treatment decisions, and to assess the degree of asthma control. In August 2007, the National Asthma Education and Prevention Program (NAEPP) updated its guidelines based on greater knowledge of disease pathophysiology and the development of newer therapeutic agents. This includes an increased emphasis on the need to establish disease severity, including the components of impairment and risk, as well as on the level of asthma control. Despite the availability of the NAEPP and other guidelines, asthma control often remains suboptimal. While numerous clinical and patient-reported measures are available, it is clear that the optimal monitoring schema for patients with asthma remains undefined. To clearly establish whether asthma control is attained, multiple measures are required and should include clinical and patient-reported assessments.
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Affiliation(s)
- William J Cardarelli
- Atrius Health/Harvard Vanguard Medical Associates, Watertown, Massachusetts 02472, USA.
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Van Schoor J, Pauwels R, Joos G. Indirect bronchial hyper-responsiveness: the coming of age of a specific group of bronchial challenges. Clin Exp Allergy 2005; 35:250-61. [PMID: 15784100 DOI: 10.1111/j.1365-2222.2005.02177.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- J Van Schoor
- Department of Respiratory Diseases, Ghent University Hospital, B-9000 Ghent, Belgium
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Perng DW, Huang HY, Lee YC, Perng RP. Leukotriene modifier vs inhaled corticosteroid in mild-to-moderate asthma: clinical and anti-inflammatory effects. Chest 2004; 125:1693-9. [PMID: 15136378 DOI: 10.1378/chest.125.5.1693] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE Evidence for the anti-inflammatory activity of leukotriene receptor antagonists in humans is somewhat limited. There are also no data comparing the anti-inflammatory effects of leukotriene receptor antagonists with those of inhaled corticosteroids. This study was designed to assess the clinical efficacy and anti-inflammatory effects of leukotriene receptor antagonist plus low-dose inhaled corticosteroids compared to those of a high-dose inhaled corticosteroid in patients with mild-to-moderate asthma. METHODS Forty-nine patients with newly diagnosed asthma were recruited. They were randomly assigned to groups that received, for a 6-week period, either (1) budesonide, 600 microg bid (1,200 microg/d) or (2) budesonide, 200 microg (400 microg/d), and zafirlukast, 20 mg bid. The variables of asthma control were recorded daily. Sputum induction and methacholine provocation tests were performed. RESULTS The results indicated that the administration of a low-dose inhaled corticosteroid plus zafirlukast was as effective as that of a high-dose inhaled corticosteroid regarding clinical improvement and anti-inflammatory effects (ie, eosinophil percentage, and eosinophilic cationic protein [ECP] and cysteinyl leukotriene C4 levels in induced sputum). Nineteen (group 1, 8 patients; group 2, 11 patients) of 49 patients (38.8%) had returned to normal airway responsiveness after treatment. Among these patients, 16 patients (84.2%) had normal ECP levels and 10 patients (52.6%) had normal percentages of eosinophils. ECP level, but not the eosinophil percentage, was significantly associated with symptom scores. The peak expiratory flow rate (PEFR) showed a significant correlation with the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) instead of with symptom scores. CONCLUSIONS The addition of a leukotriene modifier to treatment with low-dose inhaled corticosteroids is equivalent to treatment with high-dose inhaled corticosteroids in patients with newly diagnosed mild-to-moderate asthma. In addition to symptoms and PEFR, the monitoring of ECP and PC20 may be of great value in achieving optimal control of asthma.
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Affiliation(s)
- Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Groneberg DA, Witt H, Adcock IM, Hansen G, Springer J. Smads as intracellular mediators of airway inflammation. Exp Lung Res 2004; 30:223-50. [PMID: 15195555 DOI: 10.1080/01902140490276320] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transforming growth factor-beta (TGF-beta) plays an important role in the pathogenesis of allergic asthma and other airway diseases. Signals from the activated TGF-beta receptor complex are transduced to the nucleus of airway cells by Smad proteins, which represent a family of transcription factors that have recently been implicated to play a major role as intracellular mediators of inflammation. The Smad family consists of the receptor-regulated Smads, a common pathway Smad, and inhibitory Smads. Receptor-regulated Smads (R-Smads) are phosphorylated by the TGF-beta type Ireceptor. They include Smad2 and Smad3, which are recognized by TGF-beta and activin receptors, and Smads 1, 5, 8, and 9, which are recognized by bone morphogenetic protein (BMP) receptors. Smad4 is a common pathway Smad, which is also defined as cooperating Smad (co-Smad) and is not phosphorylated by the TGF-beta type I receptor. Inhibitory Smads(anti-Smads) include Smad6 and Smad7, which down-regulate TGF-beta signaling. To date, the Smads are the only TGF-beta receptor substrates with a demonstrated ability to propagate signals and with regard to the growing number of investigations of Smad-mediated effects in the airways, Smads may prove to be an important target for future development of new therapeutic strategies for asthma and chronic obstructive pulmonary disease.
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Affiliation(s)
- David A Groneberg
- Division of Allergy Research, Department of Pediatric Pneumology and Immunology, Charité Campus-Virchow, Humboldt-University, Berlin, Germany.
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Tovar JM, Gums JG. Monitoring pulmonary function in asthma and COPD: point-of-care testing. Ann Pharmacother 2004; 38:126-33. [PMID: 14742806 DOI: 10.1345/aph.1d230] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To provide pharmacists and other healthcare providers with a better understanding of new monitoring technologies for asthma and chronic obstructive pulmonary disease (COPD) available to clinics and pharmacies. DATA SOURCES Forty scientific articles were identified through a MEDLINE search (1990-June 2003), additional references listed in articles, and abstracts from scientific meetings. STUDY SELECTION AND DATA EXTRACTION English-language literature of controlled human clinical studies was reviewed to evaluate the accuracy, reliability, validity, and response of the new monitoring technologies. DATA SYNTHESIS The In-Check DIAL is a pulmonary airflow meter that identifies the most appropriate inhaler for a patient and is useful in determining how efficiently patients use their inhalers. Electronic peak flow meters such as the AirWatch, VMX Wright Mini-Log, PiKo-1, and electronic asthma monitor store and download multiple pulmonary function test (PFT) readings to a personal computer, allowing easy identification of patients who are fabricating results. The AirWatch also has the ability to measure forced expiratory volume in 1 second. The Spirophone AG-SP, VM Plus, and Micro DiaryCard spirometer are portable spirometers that can be used at home without the need for supervision. Bronchial challenge tests have been recently standardized and may prove to be beneficial in modifying drug therapy in patients with asthma and COPD. CONCLUSIONS Despite recent advances in medical technology, monitoring of asthma and COPD has not changed significantly. PFTs continue to be the gold standard for evaluating airway obstruction and/or restriction. Clinical trials that will evaluate outcomes such as decreased number of hospitalizations, emergency department visits, unscheduled visits to physicians, and days absent from school or work are needed to determine the utility of new monitoring technologies.
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Affiliation(s)
- John M Tovar
- Department of Pharmacy Practice, University of Florida, Gainesville, FL 32601, USA.
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Haggerty CL, Ness RB, Kelsey S, Waterer GW. The impact of estrogen and progesterone on asthma. Ann Allergy Asthma Immunol 2003; 90:284-91; quiz 291-3, 347. [PMID: 12669890 DOI: 10.1016/s1081-1206(10)61794-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This paper describes evidence of a positive effect of both endogenous and exogenous estrogen and progesterone on lung function across the life span in women. DATA SOURCES Articles were identified using the keywords asthma, pulmonary function, menarche, menopause, estrogen, progesterone, hormone replacement therapy, oral contraceptives, and menstrual cycle from years 1966 to 2001 in MEDLINE. Additional studies were identified from article reference lists. STUDY SELECTION Relevant, peer-reviewed original research articles in the English language were selected. RESULTS Estrogen and/or progesterone may alter pulmonary function and asthma. Premenopausal women experience decreases in pulmonary function and increases in asthma exacerbations and hospitalizations during the premenstrual and menstrual phases. Oral contraceptives and hormone replacement therapy are associated with improved pulmonary function and decrease in asthma exacerbation. Some asthmatic patients experience improved pulmonary function and reduced asthma medication requirement during pregnancy. CONCLUSIONS Estrogen and progesterone modify airway responsiveness. Further research is needed to elucidate the clinical relevance of estrogen and progesterone in the pathophysiology and therapy of asthma.
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Affiliation(s)
- Catherine L Haggerty
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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