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Razi CH, Cörüt N, Andıran N. Budesonide reduces hospital admission rates in preschool children with acute wheezing. Pediatr Pulmonol 2017; 52:720-728. [PMID: 28085236 DOI: 10.1002/ppul.23667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 11/28/2016] [Accepted: 12/18/2016] [Indexed: 11/05/2022]
Abstract
The object of this study was to determine whether high doses of inhaled budesonide provide additional benefits to a standardized treatment regimen that includes systemic steroids and salbutamol in preschool patients presented to the emergency department (ED) with acute wheezing attacks. Methods This randomized, double-blind, placebo-controlled, parallel group trial was conducted in children, 6 months-6 years with moderate or severe acute wheezing epizode, as determined based on a pulmonary index score (PIS) of 7-13 points. We compared the addition of budesonide 3 mg versus placebo to standard acute asthma treatment, which included salbutamol and a single 1 mg/kg dose of methylprednisolone given at the beginning of therapy. The primary outcome was differences in hospitalization rates within 4 hr. Secondary outcome was difference in median PIS between treatment groups at 2 hr. Results One hundred patients were enrolled. Cumulative hospitalization rate at 120, 180, and 240 min were 0.72, 0.62, and 0.58 in placebo group; and 0.44, 0.30, and 0.24 in budesonide group. Discharged rate in budesonide group was significantly higher than the placebo group (log-rank = 12.407 ve P < 0.001). Expected mean discharged times were 200.4 (95%CI = 185.3-215.5) min in placebo group and 164.4 (95%CI = 149.4-179.4) min in budesonide group. Median (25-75%) PIS at the 120th min was significantly lower in budesonide group than the placebo group (5 [4-8] vs. 8 [5-9] respectively, P = 0.006). Conclusions The addition of budesonide nebulization may decrease the admission rate of preschool children who have moderate to severe acute wheezing epizodes. Pediatr Pulmonol. 2017;52:720-728. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Cem Hasan Razi
- Division of Pediatric Allergy, Acıbadem, Ankara Private Hospital, Ankara, Turkey
| | - Nazlı Cörüt
- Division of Pediatric Allergy, Department of Pediatrics, Sami Ulus Pediatrics and Gynecology Education and Research Hospital, Ankara, Turkey
| | - Nesibe Andıran
- Department of Pediatrics, Kecioren Education and Research Hospital, Ankara, Turkey
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2
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Green CE, Turner AM. The role of the endothelium in asthma and chronic obstructive pulmonary disease (COPD). Respir Res 2017; 18:20. [PMID: 28100233 PMCID: PMC5241996 DOI: 10.1186/s12931-017-0505-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/13/2017] [Indexed: 01/05/2023] Open
Abstract
COPD and asthma are important chronic inflammatory disorders with a high associated morbidity. Much research has concentrated on the role of inflammatory cells, such as the neutrophil, in these diseases, but relatively little focus has been given to the endothelial tissue, through which inflammatory cells must transmigrate to reach the lung parenchyma and cause damage. There is evidence that there is an abnormal amount of endothelial tissue in COPD and asthma and that this tissue and its’ progenitor cells behave in a dysfunctional manner. This article reviews the evidence of the involvement of pulmonary endothelium in COPD and asthma and potential treatment options for this.
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Affiliation(s)
- Clara E Green
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK.
| | - Alice M Turner
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
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3
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Tikhonova IV, Kosyakova NI, Tankanag AV, Chemeris NK. Oscillations of Skin Microvascular Blood Flow in Patients with Asthma. Microcirculation 2016; 23:33-43. [PMID: 26494289 DOI: 10.1111/micc.12252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 10/19/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This research is aimed at studying the features of skin blood flow oscillations in patients with severe persistent atopic BA during a period of fine control over symptoms. METHODS The study of microcirculation was carried out by LDF at rest and in response to a transient ischemia in 20 patients. The time-amplitude adaptive wavelet analysis of the blood flow oscillations was conducted to elucidate the peculiarities of microcirculatory regulation system functioning. RESULTS No significant changes were revealed for SBP and the oscillation amplitudes in the cardiac (0.6-2 Hz) and respiratory (0.145-0.6 Hz) intervals, both at rest and in response to transient ischemia, in patients compared to the control group. A consistent twofold decrease in the oscillation amplitudes was found in the neurogenic (0.021-0.052 Hz) interval at rest, as well as in the myogenic (0.052-0.145 Hz) and NO-dependent endothelial (0.0095-0.021 Hz) intervals both at rest and during the postocclusive reactive hyperemia in patients with lung obstruction (FEV1 < 80%) in comparison with a control group. CONCLUSIONS The amplitudes of skin blood flow oscillations in the myogenic, neurogenic and NO-dependent endothelial intervals in patients with obstruction are different from those in patients without obstruction.
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Affiliation(s)
- Irina V Tikhonova
- Institute of Cell Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - Ninel I Kosyakova
- Hospital of Pushchino Scientific Center, Russian Academy of Sciences, Pushchino, Russia
| | - Arina V Tankanag
- Institute of Cell Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - Nikolai K Chemeris
- Institute of Cell Biophysics, Russian Academy of Sciences, Pushchino, Russia
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4
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Jang EJ, Lee CH, Yoon HI, Kim YJ, Kim JM, Choi SM, Yim JJ, Kim DK. Association between inhaler use and risk of haemoptysis in patients with non-cystic fibrosis bronchiectasis. Respirology 2015; 20:1213-21. [PMID: 26293490 DOI: 10.1111/resp.12618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/30/2014] [Accepted: 04/05/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Inhaled medications have been widely applied to patients with airflow limiting non-cystic fibrosis (non-CF) bronchiectasis. However, the association between the use of inhalers and the development of haemoptysis has rarely been explored. The objective of this study was to assess the association between the risk of haemoptysis and the use of inhalers in patients with non-CF bronchiectasis. METHODS A nested case-control study was performed using a national claims database from 1 January 2009 to 31 December 2011. Inhalers including inhaled corticosteroids (ICS), long-acting β2 agonists (LABA), long-acting muscarinic antagonists (LAMA), short-acting β2 agonists (SABA), short-acting muscarinic antagonists (SAMA) and their combinations were tested for the risk of clinically significant haemoptysis events. RESULTS Among the 62 530 eligible new users of inhalers with non-CF bronchiectasis, 6180 patients with haemoptysis and 27 486 strictly matched controls were selected. In the unadjusted analyses, SAMA, LAMA, SABA and ICS/LABA significantly increased the risk of haemoptysis. After adjustment for other inhaled respiratory medications, comorbidities, health-care utilization and concomitant medications, SAMA, SABA and LAMA consistently increased the risk of haemoptysis (SAMA: odds ratio (OR), 1.6; 95% confidence interval (CI), 1.1-1.4; LAMA: OR, 1.2; 95% CI: 1.1-1.2; SABA: OR, 1.2; 95% CI: 1.1-1.2). The association between anticholinergics (SAMA and LAMA) and risk of haemoptysis showed a dose-dependent trend (P for trend, <0.001). CONCLUSIONS The use of SABA and inhaled anticholinergics in patients with non-CF bronchiectasis increased the risk of haemoptysis. The risk-benefit ratio of inhaled bronchodilators should be considered in the haemoptysis-susceptible population.
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Affiliation(s)
- Eun Jin Jang
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.,Department of Information Statistics, Andong National University, Andong, Korea
| | - Chang-Hoon Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Korea
| | - Yun Jung Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ji Min Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seong Mi Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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5
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Mendes ES, Cadet L, Arana J, Wanner A. Acute effect of an inhaled glucocorticosteroid on albuterol-induced bronchodilation in patients with moderately severe asthma. Chest 2015; 147:1037-1042. [PMID: 25611803 DOI: 10.1378/chest.14-1742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We have previously shown that in patients with asthma a single dose of an inhaled glucocorticosteroid (ICS) acutely potentiates inhaled albuterol-induced airway vascular smooth muscle relaxation through a nongenomic action. An effect on airway smooth muscle was not seen, presumably because the patients had normal lung function. The purpose of the present study was to conduct a similar study in patients with asthma with airflow obstruction to determine if an ICS could acutely also potentiate albuterol-induced airway smooth muscle relaxation in them. METHODS In 15 adult patients with asthma (mean ± SE baseline FEV1, 62% ± 3%), the response to inhaled albuterol (180 μg) was assessed by determining the change in FEV1 (ΔFEV1) for airway smooth muscle and in airway blood flow (ΔQaw) for airway vascular smooth muscle measured 15 min after drug inhalation. Using a double-blind design, the patients inhaled a single dose of the ICS mometasone (400 μg) or placebo simultaneously with or 30 min before albuterol inhalation. RESULTS After simultaneous drug administration, mean ΔFEV1 was 0.20 ± 0.05 L (10%) after placebo and 0.32 ± 0.04 L (19%) after mometasone (P < .05); mean ΔQaw was -2% after placebo and 30% after mometasone (P < .005). When mometasone or placebo was administered 30 min before albuterol, there was a lesser and insignificant difference in ΔFEV1 between the two treatments, whereas the difference in ΔQaw remained significant. CONCLUSIONS This pilot study showed that in adult patients with asthma with airflow obstruction, a single standard dose of an ICS can acutely increase the FEV1 response to a standard dose of inhaled albuterol administered simultaneously. The associated potentiation of albuterol-induced vasodilation in the airway was of greater magnitude and retained when the ICS was administered 30 min before albuterol. The clinical significance of this observation will have to be established by a study involving a larger patient cohort. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01210170; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Eliana S Mendes
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL.
| | - Lilian Cadet
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Johana Arana
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Adam Wanner
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL
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6
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Cancado JE, Mendes ES, Arana J, Horvath G, Monzon ME, Salathe M, Wanner A. Effect of airway acidosis and alkalosis on airway vascular smooth muscle responsiveness to albuterol. BMC Pharmacol Toxicol 2015; 16:9. [PMID: 25889594 PMCID: PMC4384333 DOI: 10.1186/s40360-015-0008-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/16/2015] [Indexed: 11/10/2022] Open
Abstract
Background In vitro and animal experiments have shown that the transport and signaling of β2-adrenergic agonists are pH-sensitive. Inhaled albuterol, a hydrophilic β2-adrenergic agonist, is widely used for the treatment of obstructive airway diseases. Acute exacerbations of obstructive airway diseases can be associated with changes in ventilation leading to either respiratory acidosis or alkalosis thereby affecting albuterol responsiveness in the airway. The purpose of this study was to determine if airway pH has an effect on albuterol-induced vasodilation in the airway. Methods Ten healthy volunteers performed the following respiratory maneuvers: quiet breathing, hypocapnic hyperventilation, hypercapnic hyperventilation, and eucapnic hyperventilation (to dissociate the effect of pH from the effect of ventilation). During these breathing maneuvers, exhaled breath condensate (EBC) pH and airway blood flow response to inhaled albuterol (ΔQ̇aw) were assessed. Results Mean ± SE EBC pH (units) and ΔQ̇aw (μl.min-1.mL-1) were 6.4 ± 0.1 and 16.8 ± 1.9 during quiet breathing, 6.3 ± 0.1 and 14.5 ± 2.4 during eucapnic hyperventilation, 6.6 ± 0.2 and -0.2 ± 1.8 during hypocapnic hyperventilation (p = 0.02 and <0.01 vs. quiet breathing), and 5.9 ± 0.1 and 2.0 ± 1.5 during hypercapnic hyperventilation (p = 0.02 and <0.02 vs quiet breathing). Conclusions Albuterol responsiveness in the airway as assessed by ΔQ̇aw is pH sensitive. The breathing maneuver associated with decreased and increased EBC pH both resulted in a decreased responsiveness independent of the level of ventilation. These findings suggest an attenuated response to hydrophilic β2-adrenergic agonists during airway disease exacerbations associated with changes in pH. Trial registration Registered at clinicaltrials.gov: NCT01216748.
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Affiliation(s)
- Jose E Cancado
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Eliana S Mendes
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Johana Arana
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Gabor Horvath
- Department of Pulmonology, Semmelweis University School of Medicine, Budapest, Hungary.
| | - Maria E Monzon
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Matthias Salathe
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Adam Wanner
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
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7
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Rydell-Törmänen K, Risse PA, Kanabar V, Bagchi R, Czubryt MP, Johnson JR. Smooth muscle in tissue remodeling and hyper-reactivity: airways and arteries. Pulm Pharmacol Ther 2012; 26:13-23. [PMID: 22561160 DOI: 10.1016/j.pupt.2012.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 01/17/2023]
Abstract
Smooth muscle comprises a key functional component of both the airways and their supporting vasculature. Dysfunction of smooth muscle contributes to and exacerbates a host of breathing-associated pathologies such as asthma, chronic obstructive pulmonary disease and pulmonary hypertension. These diseases may be marked by airway and/or vascular smooth muscle hypertrophy, proliferation and hyper-reactivity, and related conditions such as fibrosis and extracellular matrix remodeling. This review will focus on the contribution of airway or vascular smooth dysfunction to common airway diseases.
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8
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Mendes ES, Rebolledo P, Wanner A. Acute effects of salmeterol and fluticasone propionate alone and in combination on airway blood flow in patients with asthma. Chest 2011; 141:1184-1189. [PMID: 21980058 DOI: 10.1378/chest.11-0685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The airway contains airway smooth muscle and airway vascular smooth muscle. The acute effects of inhaled long-acting β(2)-adrenergic agonists (LABAs) alone, or in combination with an inhaled glucocorticoid (ICS), on airway smooth muscle tone in asthma are known; however, to the best of our knowledge, their effect on airway vascular smooth muscle tone has not been investigated previously. The objective of this study was to investigate the immediate effects of a LABA and an ICS alone and in combination on airway blood flow (Qaw) as an index of airway vascular smooth muscle tone in patients with stable asthma. METHODS Fourteen subjects with moderate asthma inhaled single doses of salmeterol (50 μg), fluticasone propionate (250 μg), salmeterol/fluticasone propionate (50/250 μg), or placebo; Qaw was measured before and serially for 240 min after drug administration. RESULTS Mean Qaw increased after salmeterol and salmeterol/fluticasone propionate, with peaks at 60 min of 34% and 40%, respectively, and returned to baseline by 240 min after inhalation. Fluticasone propionate alone caused a transient decrease in mean Qaw. The maximal changes in Qaw, which occurred at different times, were 60% for salmeterol, 67% for salmeterol/fluticasone propionate, and -19% for fluticasone propionate (P < .05 vs placebo for all). CONCLUSIONS The LABA salmeterol has an acute vasodilator action on the airway of subjects with stable asthma. The addition of fluticasone propionate, which by itself causes vasoconstriction, does not attenuate the salmeterol-induced vasodilation, suggesting that fluticasone propionate potentiates the vasodilator effect of salmeterol. The vasodilation could be of clinical benefit by promoting the vascular clearance of inflammatory mediators including spasmogens from the airway. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01231230; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Eliana S Mendes
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
| | - Patricia Rebolledo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Adam Wanner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
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9
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Alangari AA. Genomic and non-genomic actions of glucocorticoids in asthma. Ann Thorac Med 2011; 5:133-9. [PMID: 20835306 PMCID: PMC2930650 DOI: 10.4103/1817-1737.65040] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 02/05/2010] [Accepted: 04/15/2010] [Indexed: 12/01/2022] Open
Abstract
Glucocorticoids are the mainstay of asthma therapy. They are primarily used to suppress airway inflammation, which is the central pathological change in asthmatic patients’ airways. This is achieved by many different mechanisms. The classical mechanism is by suppression of the genetic transcription of many inflammatory cytokines that are key in asthma pathophysiology (transrepression). On the other hand, the transcription of certain inhibitory cytokines is activated by glucocorticoids (transactivation), a mechanism that also mediates many of the adverse effects of glucocorticoids. The onset of action through these mechanisms is often delayed (4-24 hours). Other mechanisms mediated through non-genomic pathways are increasingly appreciated. These are delivered in part by binding of glucocorticoids to nonclassical membrane-bound glucocorticoid receptors or by potentiating the α1-adrenergic action on the bronchial arterial smooth muscles, in addition to other mechanisms. These effects are characterized by their rapid onset and short duration of action. Understanding these different mechanisms will help in the development of new and better drugs to treat this common disease and to develop new improved strategies in our approach to its management. Here, the genomic and non-genomic mechanisms of actions of glucocorticoids in asthma are briefly reviewed, with special emphasis on the current updates of the non-genomic mechanisms.
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Affiliation(s)
- Abdullah A Alangari
- Department of Pediatrics, College of Medicine, King Saud University and King Khalid University Hospital, Riyadh, Saudi Arabia.
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10
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Mazzone SB, Lim LHK, Wagner EM, Mori N, Canning BJ. Sympathetic nerve-dependent regulation of mucosal vascular tone modifies airway smooth muscle reactivity. J Appl Physiol (1985) 2010; 109:1292-300. [PMID: 20724568 DOI: 10.1152/japplphysiol.00632.2010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The airways contain a dense subepithelial microvascular plexus that is involved in the supply and clearance of substances to and from the airway wall. We set out to test the hypothesis that airway smooth muscle reactivity to bronchoconstricting agents may be dependent on airway mucosal blood flow. Immunohistochemical staining identified vasoconstrictor and vasodilator nerve fibers associated with subepithelial blood vessels in the guinea pig airways. Intravital microscopy of the tracheal mucosal microvasculature in anesthetized guinea pigs revealed that blockade of α-adrenergic receptors increased baseline arteriole diameter by ~40%, whereas the α-adrenergic receptor agonist phenylephrine produced a modest (5%) vasoconstriction in excess of the baseline tone. In subsequent in vivo experiments, tracheal contractions evoked by topically applied histamine were significantly reduced (P < 0.05) and enhanced by α-adrenergic receptor blockade and activation, respectively. α-Adrenergic ligands produced similar significant (P < 0.05) effects on airway smooth muscle contractions evoked by topically administered capsaicin, intravenously administered neurokinin A, inhaled histamine, and topically administered antigen in sensitized animals. These responses were independent of any direct effect of α-adrenergic ligands on the airway smooth muscle tone. The data suggest that changes in blood flow in the vessels supplying the airways regulate the reactivity of the underlying airway smooth muscle to locally released and exogenously administered agents by regulating their clearance. We speculate that changes in mucosal vascular function or changes in neuronal regulation of the airway vasculature may contribute to airways responsiveness in disease.
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Affiliation(s)
- Stuart B Mazzone
- The University of Queensland, School of Biomedical Sciences, St. Lucia, Queensland, Australia.
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11
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Wanner A, Mendes ES. Airway endothelial dysfunction in asthma and chronic obstructive pulmonary disease: a challenge for future research. Am J Respir Crit Care Med 2010; 182:1344-51. [PMID: 20709816 DOI: 10.1164/rccm.201001-0038pp] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Endothelial dysfunction in the extrapulmonary circulation has been linked to cardiovascular disease. Recent investigations have revealed that in the airway circulation, cigarette smoking, chronic obstructive pulmonary disease (COPD), and asthma are also accompanied by endothelial dysfunction. Inhaled glucocorticosteroids can partially or fully restore normal endothelium-dependent vasodilation in these conditions, thereby identifying the airway endothelium as a novel therapeutic target in the treatment of airway disease. The role of the defective endothelium-dependent vasodilation in the pathophysiology in asthma and COPD is still subject to speculation. However, there appears to be an association between COPD and extrapulmonary vascular dysfunction, and the possibility exists that the use of inhaled glucocorticosteroids has a beneficial effect on cardiovascular disease in COPD as suggested by database studies showing that inhaled glucocorticosteroids reduce the incidence of nonfatal and fatal cardiovascular events in COPD.
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Affiliation(s)
- Adam Wanner
- University of Miami Miller School of Medicine, Florida 33136, USA.
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12
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Vasoconstriction after inhalation of budesonide: A study in the isolated and perfused rat lung. Pulm Pharmacol Ther 2010; 23:9-14. [DOI: 10.1016/j.pupt.2009.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 08/14/2009] [Accepted: 09/23/2009] [Indexed: 11/18/2022]
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13
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McCullagh A, Rosenthal M, Wanner A, Hurtado A, Padley S, Bush A. The bronchial circulation--worth a closer look: a review of the relationship between the bronchial vasculature and airway inflammation. Pediatr Pulmonol 2010; 45:1-13. [PMID: 20025051 DOI: 10.1002/ppul.21135] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Until recently, the bronchial circulation has been relatively ignored in the research and clinical arenas, perhaps because of its small volume and seeming dispensability relative to the pulmonary circulation. Although the bronchial circulation only receives around 1% of the cardiac output in health, it serves functions that are critical to maintaining airway and lung function. The bronchial circulation also plays an important role in many lung and airway diseases; through its ability to increase in size, the bronchial circulation is able to provide lung parenchymal perfusion when the pulmonary circulation is compromised, and more recently the role of the bronchial circulation in the pathogenesis of inflammatory airway disease has been explored. Due to the anatomic variability and small volume of the bronchial circulation, much of the research to date has necessitated the use of animal models and invasive procedures. More recently, non-invasive techniques for measuring bronchial blood flow in the mucosal microvascular network have been developed and offer a new avenue for the study of this circulation in humans. In conjunction with molecular research, measurement of airway blood flow (Q(aw)) may help elucidate the role of the bronchial circulation in inflammatory airway disease and become a useful tool for monitoring therapy.
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Affiliation(s)
- Angela McCullagh
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
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14
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Carchietti E, Cecchi A. The Asthmatic Patient and CM-Induced Adverse Reactions. Neuroradiol J 2009; 22:305-12. [DOI: 10.1177/197140090902200304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 05/25/2009] [Indexed: 11/16/2022] Open
Affiliation(s)
- E. Carchietti
- Neuroradiology Unit, University of Bologna, Bellaria Hospital; Bologna, Italy
| | - A. Cecchi
- Neuroradiology Unit, University of Bologna, Bellaria Hospital; Bologna, Italy
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15
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Bailey SR, Boustany S, Burgess JK, Hirst SJ, Sharma HS, Simcock DE, Suravaram PR, Weckmann M. Airway vascular reactivity and vascularisation in human chronic airway disease. Pulm Pharmacol Ther 2009; 22:417-25. [PMID: 19409504 DOI: 10.1016/j.pupt.2009.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 04/01/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
Abstract
Altered bronchial vascular reactivity and remodelling including angiogenesis are documented features of asthma and other chronic inflammatory airway diseases. Expansion of the bronchial vasculature under these conditions involves both functional (vasodilation, hyperperfusion, increased microvascular permeability, oedema formation, and inflammatory cell recruitment) and structural changes (tissue and vascular remodelling) in the airways. These changes in airway vascular reactivity and vascularisation have significant pathophysiological consequences, which are manifest in the clinical symptoms of airway disease. Airway vascular reactivity is regulated by a wide variety of neurotransmitters and inflammatory mediators. Similarly, multiple growth factors are implicated in airway angiogenesis, with vascular endothelial growth factor amongst the most important. Increasing attention is focused on the complex interplay between angiogenic growth factors, airway smooth muscle and the various collagen-derived fragments that exhibit anti-angiogenic properties. The balance of these dynamic influences in airway neovascularisation processes and their therapeutic implications is just beginning to be elucidated. In this review article, we provide an account of recent developments in the areas of vascular reactivity and airway angiogenesis in chronic airway diseases.
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Affiliation(s)
- Simon R Bailey
- Faculty of Veterinary Science, University of Melbourne, Victoria, Australia.
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Morris NR, Ceridon ML, Beck KC, Strom NA, Schneider DA, Mendes ES, Wanner A, Johnson BD. Exercise-related change in airway blood flow in humans: relationship to changes in cardiac output and ventilation. Respir Physiol Neurobiol 2008; 162:204-9. [PMID: 18647664 DOI: 10.1016/j.resp.2008.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Revised: 06/25/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
Abstract
This study examined the relationship between airway blood flow (Q(aw)), ventilation (V(E)) and cardiac output (Q(tot)) during exercise in healthy humans (n=12, mean age 34+/-11 yr). Q(aw) was estimated from the uptake of the soluble gas dimethyl ether while V(E) and Q(tot) were measured using open circuit spirometry. Measurements were made prior to and during exercise at 34+/-5 W (Load 1) and 68+/-10 W (Load 2) and following the cessation of exercise (recovery). Q(aw) increased in a stepwise fashion (P<0.05) from rest (52.8+/-19.5 microl min(-1) ml(-1)) to exercise at Load 1 (67.0+/-20.3 microl min(-1) ml(-1)) and Load 2 (84.0+/-22.9 microl min(-1) ml(-1)) before returning to pre-exercise levels in recovery (51.7+/-13.2 microl min(-1) ml(-1)). Q(aw) was positively correlated with both Q(tot) (r=0.58, P<0.01) and V(E) (r=0.50, P<0.01). These results demonstrate that the increase in Q(aw) is linked to an exercise related increase in both Q(tot) and V(E) and may be necessary to prevent excessive airway cooling and drying.
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Affiliation(s)
- Norman R Morris
- School of Physiotherapy and Exercise Science, Griffith University, Gold Coast Campus, Qld 4222, Australia.
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Walters EH, Reid D, Soltani A, Ward C. Angiogenesis: a potentially critical part of remodelling in chronic airway diseases? Pharmacol Ther 2008; 118:128-37. [PMID: 18358536 DOI: 10.1016/j.pharmthera.2008.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 01/25/2008] [Indexed: 01/28/2023]
Abstract
Angiogenesis is a prominent feature of the structural tissue remodelling that occurs in the chronic airway diseases of asthma, Bronchiolitis Obliterans Syndrome (BOS, post-lung transplantation), and in smoking-related Chronic Obstructive Pulmonary Disease (COPD). For each, we have explored the relationship between angiogenesis and underlying chronic inflammatory processes--are the hypervascular changes secondary to inflammation, or do they occur in parallel? What are the likely growth factors which stimulate the angiogenic process? We discuss the relationships that have been studied between angiogenesis and the physiological impairment of airflow obstruction. The pattern that emerges is complex and variable. In asthma, there is strong evidence to suggest that Vascular Endothelial Growth Factor (VEGF) and its receptor system is upregulated in the airway. Local production of VEGF has also been implicated as a major driver of angiogenesis in the airway component of COPD, though paradoxically emphysema seems to be due to lack of VEGF in the lung parenchyma. In BOS, the evidence suggests that VEGF is lacking in the airway: other mediators and especially C-X-C chemokines such as Interleukin (IL)-8, are likely to be more important in angiogenesis. The physiological consequences of angiogenesis are likely to be important in asthma (especially during acute episodes of deterioration), and probably also in COPD, although data is equivocal. In BOS, increased airway vascularity appears to occur early, but is not progressive. In terms of therapy, evidence for anti-angiogenic effectiveness is strongest for Inhaled Corticosteroid (ICS) and Long Acting Beta-Agonists (LABA) in asthma.
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Affiliation(s)
- Eugene Haydn Walters
- Respiratory Research Group, Menzies Research Institute, University of Tasmania, Australia.
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Mendes ES, Horvath G, Campos M, Wanner A. Rapid corticosteroid effect on beta(2)-adrenergic airway and airway vascular reactivity in patients with mild asthma. J Allergy Clin Immunol 2007; 121:700-4. [PMID: 18086493 DOI: 10.1016/j.jaci.2007.10.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 10/05/2007] [Accepted: 10/25/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Long-term glucocorticoid therapy has been suggested to improve airway and airway vascular smooth muscle responsiveness to inhaled beta(2)-agonists in patients with asthma. OBJECTIVE We sought to assess whether a single dose of an inhaled glucocorticoid acutely potentiates beta(2)-adrenergic airway and airway vascular smooth muscle reactivity in asthma. METHODS In 10 asthmatic and 10 healthy subjects, airway blood flow and FEV(1) were measured before and 30 minutes after fluticasone or placebo inhalation and 15 minutes after the subsequent inhalation of racemic albuterol (0.6 mg or 1.25 mg) or (R)-albuterol (0.3 mg or 0.6 mg). RESULTS In healthy subjects all albuterol formulations increased airway blood flow equally after placebo or fluticasone pretreatment. In asthmatic subjects airway blood flow response was blunted after placebo and acutely restored after fluticasone pretreatment. Fluticasone pretreatment did not increase FEV(1) responses to any albuterol formulation, except 0.6 mg racemic albuterol. CONCLUSION A single dose of an inhaled glucocorticoid restores beta(2)-adrenergic airway vasodilator responses in patients with mild asthma. The mechanism of this rapid glucocorticoid effect remains to be clarified.
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Affiliation(s)
- Eliana S Mendes
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
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19
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Wanner A, Mendes ES, Atkins ND. A simplified noninvasive method to measure airway blood flow in humans. J Appl Physiol (1985) 2006; 100:1674-8. [PMID: 16614365 DOI: 10.1152/japplphysiol.01349.2005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Our laboratory has previously developed and validated a noninvasive soluble gas uptake method to measure airway blood flow (Qaw) in humans (Onorato DJ, Demirozu MC, Breitenbücher A, Atkins ND, Chediak AD, and Wanner A. Am J Respir Crit Care Med 149: 1132-1137, 1994; Scuri M, McCaskill V, Chediak AD, Abraham WM, and Wanner A. J Appl Physiol 79: 1386-1390, 1995). The method has the disadvantage of requiring eight breath-hold maneuvers for a single Qaw measurement, a complicated data analysis, and the inhalation of a potentially explosive gas mixture containing dimethylether (DME) and O2. Because of these shortcomings, the method thus far has not been used in other laboratories. We now simplified the method by having the subjects inhale 500 ml of a 10% DME-90% N2 gas mixture to fill the anatomical dead space, followed by a 5- or 15-s breath hold, and measuring the instantaneous DME and N2 concentrations and volume at the airway opening during the subsequent exhalation. From the difference in DME concentration in phase 1 of the expired N2 wash-in curve multiplied by the phase 1 dead space volume and divided by the mean DME concentration and the solubility coefficient for DME in tissue, Qaw can be calculated by using Fick's equation. We compared the new method to the validated old method in 10 healthy subjects and found mean +/- SE Qaw values of 34.6 +/- 2.3 and 34.6 +/- 2.8 microl.min(-1).ml(-1), respectively (r = 0.93; upper and lower 95% confidence limit +2.48 and -2.47). Using the new method, the mean coefficient of variation for two consecutive measurements was 4.4% (range 0-10.4%); inhalation of 1.2 mg albuterol caused a 53 +/- 14% increase in Qaw (P = 0.02) and inhalation of 2.4 mg methoxamine caused a 32 +/- 7% decrease in Qaw (P = 0.07). We conclude that the new method provides reliable values of and detects the expected changes in Qaw with vasoactive drugs. The simplicity and improved safety of the method should improve its acceptability for the noninvasive assessment of Qaw in clinical research.
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Affiliation(s)
- Adam Wanner
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
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20
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Yun AJ, Lee PY, Gerber AN. Integrating systems biology and medical imaging: understanding disease distribution in the lung model. AJR Am J Roentgenol 2006; 186:925-30. [PMID: 16554557 DOI: 10.2214/ajr.05.0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Many chronic diseases exhibit characteristic pulmonary distribution patterns, but the underlying biologic explanations remain elusive. On the basis of emerging evidence from systems biology, we propose that gradients of T helper immune function exist as an epiphenomenon of the hypoxic pulmonary vasoconstriction response. Regional variation of immune function may contribute to preferential distribution patterning of lung diseases. CONCLUSION The lungs represent but one example in which the distribution of immune function throughout the body may explain disease location. This hypothetic framework can apply to diseases outside the realm of pulmonary biology and illustrates the potential benefit of integrating advances in systems biology and medical imaging.
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Affiliation(s)
- Anthony J Yun
- Department of Radiology, Stanford University, 470 University Ave., Palo Alto, CA 94301, USA.
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21
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Mendes ES, Campos MA, Wanner A. Airway blood flow reactivity in healthy smokers and in ex-smokers with or without COPD. Chest 2006; 129:893-8. [PMID: 16608935 DOI: 10.1378/chest.129.4.893] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Cigarette smoking has been associated with impaired endothelium-dependent relaxation responses in the brachial and coronary arteries (endothelial dysfunction). The aim of the present study was to determine whether the airway circulation is also affected and whether pharmacologic treatment has an effect on endothelial function in patients with COPD. METHODS AND PATIENTS Airway blood flow (Qaw) responses to therapy with inhaled albuterol, which causes endothelium-dependent vasodilation, were measured with a noninvasive soluble-gas-uptake technique in age-matched healthy current smokers (n = 10), healthy ex-smokers (n = 10), ex-smokers with COPD (n = 10), and healthy lifetime nonsmokers. In the ex-smokers with COPD, the albuterol responsiveness measurement was repeated after 4 weeks of treatment with fluticasone/salmeterol and after a drug washout period of 4 or 8 weeks. RESULTS The mean (+/- SE) baseline Qaw values ranged between 40.7 +/- 3.9 and 50.9 +/- 2.8 microL/min/mL anatomic dead space in the four groups (differences were not significant). The mean FEV(1) was 53.4 +/- 2.3% predicted in the ex-smokers with COPD. Albuterol inhalation increased mean Qaw significantly in lifetime nonsmokers (50.1 +/- 8.3% predicted; p < 0.05) and healthy ex-smokers (37.2 +/- 3.4% predicted; p < 0.05), but not in healthy current smokers (13.9 +/- 3.2% predicted; difference was not significant) and ex-smokers with COPD (9.7 +/- 4.5% predicted; difference was not significant). While fluticasone/salmeterol did not change Qaw significantly, it restored albuterol responsiveness (67.6 +/- 11.1% predicted; p < 0.05) in the ex-smokers with COPD; this effect was no longer seen after the drug washout period. CONCLUSIONS Cigarette smoking is associated with a blunted vasodilator response to inhaled albuterol in the airway as an expression of endothelial dysfunction, with a partial recovery of albuterol responsiveness after smoking cessation in healthy ex-smokers but not in ex-smokers with COPD. In the latter group, combined glucocorticoid/long-acting beta(2)-adrenergic agonist treatment restores albuterol responsiveness. The role of endothelial dysfunction in the physiopathology of COPD remains to be examined.
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Affiliation(s)
- Eliana S Mendes
- Division of Pulmonary and Critical Care Medicine, University of Miami School of Medicine, 1600 NW 10th Ave, 7064-A, Miami, FL 33136.
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22
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Horvath G, Vasas S, Wanner A. Inhaled corticosteroids reduce asthma-associated airway hyperperfusion through genomic and nongenomic mechanisms. Pulm Pharmacol Ther 2006; 20:157-62. [PMID: 16765074 DOI: 10.1016/j.pupt.2006.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 03/17/2006] [Indexed: 11/28/2022]
Abstract
Inhaled corticosteroids have both genomic and nongenomic actions on the tracheobronchial (airway) vasculature in patients with bronchial asthma. Genomic actions involve the activation or repression of target genes associated with inflammation, and reduce inflammatory hyperperfusion in the airway. In contrast, nongenomic actions are mediated by rapid cellular mechanisms, and induce transient vasoconstriction. This article reviews recent progress on the mechanisms by which inhaled corticosteroids reverse inflammatory blood flow changes in the airway in asthma.
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Affiliation(s)
- Gabor Horvath
- Department of Respiratory Medicine, Semmelweis University School of Medicine, Diosarok 1/C, Budapest 1125, Hungary.
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23
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Affiliation(s)
- Turk Rhen
- Department of Biology, University of North Dakota, Grand Forks, USA
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Rodrigo GJ. Comparison of inhaled fluticasone with intravenous hydrocortisone in the treatment of adult acute asthma. Am J Respir Crit Care Med 2005; 171:1231-6. [PMID: 15764724 DOI: 10.1164/rccm.200410-1415oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Several studies published in the second half of the 1990s have shown a therapeutic early effect of inhaled corticosteroids in acute asthma. However, systemic corticosteroids are considered the standard of care. OBJECTIVES To compare the effect of repeated doses of inhaled fluticasone with the standard treatment of systemic corticosteroids in adult patients with severe acute asthma. METHODS One hundred six patients (mean age, 33.5 +/- 8.8 years) were randomly assigned to receive fluticasone (3,000 microg/hour) administered through a metered-dose inhaler and spacer at 10-minute intervals for 3 hours, or 500 mg of intravenous hydrocortisone. In addition, all patients received inhaled albuterol and ipratropium bromide. MAIN RESULTS Subjects treated with fluticasone showed 30.5 and 46.4% greater improvements in PEF and FEV1, respectively, compared with the hydrocortisone group. The fluticasone group had better PEF and FEV1 at 120, 150, and 180 minutes (p < 0.05). Also, the fluticasone group showed higher rates of patients who obtained the discharge threshold at 90, 120, and 150 minutes. This therapeutic benefit was particularly evident in those patients with the most severe obstruction. Subjects with a baseline FEV1 of less than 1 L treated with fluticasone showed a significant increase in pulmonary function (p = 0.001) and a significant decrease in hospitalization rate (p = 0.05). CONCLUSIONS The use of repeated doses of inhaled fluticasone was more effective than intravenous hydrocortisone and was associated with an early improvement. This therapeutic benefit was particularly evident in those patients with the most severe obstruction.
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Affiliation(s)
- Gustavo J Rodrigo
- Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Av. 8 de Octubre 3020, Montevideo 11600, Uruguay.
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25
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Paredi P, Kharitonov SA, Barnes PJ. Correlation of exhaled breath temperature with bronchial blood flow in asthma. Respir Res 2005; 6:15. [PMID: 15705206 PMCID: PMC553993 DOI: 10.1186/1465-9921-6-15] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 02/10/2005] [Indexed: 12/02/2022] Open
Abstract
In asthma elevated rates of exhaled breath temperature changes (Δe°T) and bronchial blood flow (Qaw) may be due to increased vascularity of the airway mucosa as a result of inflammation. We investigated the relationship of Δe°T with Qaw and airway inflammation as assessed by exhaled nitric oxide (NO). We also studied the anti-inflammatory and vasoactive effects of inhaled corticosteroid and β2-agonist. Δe°T was confirmed to be elevated (7.27 ± 0.6 Δ°C/s) in 19 asthmatic subjects (mean age ± SEM, 40 ± 6 yr; 6 male, FEV1 74 ± 6 % predicted) compared to 16 normal volunteers (4.23 ± 0.41 Δ°C/s, p < 0.01) (30 ± 2 yr) and was significantly increased after salbutamol inhalation in normal subjects (7.8 ± 0.6 Δ°C/ s, p < 0.05) but not in asthmatic patients. Qaw, measured using an acetylene dilution method was also elevated in patients with asthma compared to normal subjects (49.47 ± 2.06 and 31.56 ± 1.6 μl/ml/min p < 0.01) and correlated with exhaled NO (r = 0.57, p < 0.05) and Δe°T (r = 0.525, p < 0.05). In asthma patients, Qaw was reduced 30 minutes after the inhalation of budesonide 400 μg (21.0 ± 2.3 μl/ml/min, p < 0.05) but was not affected by salbutamol. Δe°T correlates with Qaw and exhaled NO in asthmatic patients and therefore may reflect airway inflammation, as confirmed by the rapid response to steroids.
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Affiliation(s)
- Paolo Paredi
- Department of Thoracic Medicine, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK
| | - Sergei A Kharitonov
- Department of Thoracic Medicine, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK
| | - Peter J Barnes
- Department of Thoracic Medicine, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK
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Abstract
A 54-year-old man of Asian origin with major depression developed an asthma-like reaction during venlafaxine treatment. Two weeks after therapy was initiated, he experienced gradually worsening dry cough at night and periodically dyspnea during the daytime. After 5 weeks, clinical examination revealed marked signs of pulmonary obstruction and the forced expiratory volume (FEV1) was assessed to only 32% of the expected value. The venlafaxine medication was gradually decreased and eventually discontinued 9 weeks after its initiation, resulting in a successive improvement of the patient's respiratory complaints.
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Affiliation(s)
- Øyvind Melien
- Section of Clinical Pharmacology, Rikshospitalet University Hospital, NO-0407, Oslo, Norway.
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Busse W, Banks-Schlegel S, Noel P, Ortega H, Taggart V, Elias J. Future research directions in asthma: an NHLBI Working Group report. Am J Respir Crit Care Med 2004; 170:683-90. [PMID: 15215155 DOI: 10.1164/rccm.200311-1539ws] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Over the last 20 years, the prevalence of asthma has nearly doubled and now affects 8-10% of the population in the United States. Asthma also remains a major illness in terms of morbidity and suffering, and is the leading cause of hospitalizations in children under 15 years of age. Because asthma poses a lifelong burden to patients and society, efforts to increase the understanding of its pathogenesis are a key factor leading to its control and cure. Consequently, the National Heart, Lung, and Blood Institute (NHLBI) convened a Working Group of extramural experts, entitled "Future Research Directions in Asthma," on April 9-10, 2003, to identify research areas of greatest promise and opportunity in the field of asthma. The priority areas identified for research in asthma include: (1) innate immunity, adaptive immunity, and tolerance; (2) mechanisms and consequences of persistent asthma and asthma exacerbations; (3) airway remodeling: clinical consequences and reversibility (clinical relevance and resolution); (4) genetics/gene-environment interactions, pharmacogenetics; (5) intervention/prevention/therapeutics; and (6) vascular basis of asthma.
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Affiliation(s)
- William Busse
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, USA
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28
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Pereira A, Mendes E, Ferreira T, Wanner A. Effect of inhaled racemic and (R)-albuterol on airway vascular smooth muscle tone in healthy and asthmatic subjects. Lung 2004; 181:201-11. [PMID: 14692560 DOI: 10.1007/s00408-003-1022-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although the relative effect of racemic and (R)-albuterol on airway smooth muscle tone have been investigated in patients with airflow obstruction, the comparative effectiveness of these drugs in relaxing airway vascular smooth muscle is unknown. Therefore, we determined the actions of inhaled racemic and (R)-albuterol on airway mucosal blood flow (Qaw) normalized for anatomic dead space as an index of airway vascular smooth muscle tone in 11 healthy subjects and 10 subjects with mild asthma. We also monitored the forced expiratory volume in 1 second (FEV1) as an index of airway smooth muscle tone. Mean +/- SE baseline Qaw was 43.1 +/- 1.5 microl x min(-1) x ml(-1) in healthy subjects and 53.4 +/- 2.1 microl x min(-1) x ml(-1) in asthmatic subjects (p < 0.01). The corresponding values for FEV1 were 95.6 +/- 1.4 and 86.8 +/- 2.5% respectively, of predicted (p = 0.01). Racemic and (R)-albuterol caused a transient, dose-dependent increase of Qaw in healthy, but not in asthmatic subjects; the responses were not different between the two drugs. The FEV1 tended to increase more in asthmatics than in healthy subjects, again without a difference between the two drugs. These results show that racemic and (R)-albuterol have comparable effects on airway vascular smooth muscle and suggest that the blunted airway vascular smooth muscle response to albuterol in asthmatics is not related to (S)-albuterol.
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Affiliation(s)
- A Pereira
- Division of Pulmonary and Critical Care Medicine (R-47), University of Miami at Mount Sinai Medical Center, PO Box 016960, Miami Beach, Florida 33101, USA
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29
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Wanner A, Kumar SD, Brieva JL, Mendes ES. Adrenergic-glucocorticoid interactions in the regulation of airway blood flow. Arch Physiol Biochem 2003; 111:319-21. [PMID: 15764064 DOI: 10.3109/13813450312331337496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Wanner
- Division of Pulmonary and Critical Care Medicine, University of Miami, Miami, Florida 33101, USA.
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30
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Abstract
The actions of norepinephrine (NE) released from airway sympathetic nerves are partially terminated by the extraneuronal catecholamine uptake. Because various steroid hormones inhibit extraneuronal uptake, it could be responsible for the airway vasoconstriction caused by inhaled glucocorticosteroids (GSs) in vivo. Using bronchial arteries obtained from donor lungs rejected for transplantation, we showed that a plasma membrane-associated transporter is responsible for NE uptake by airway vascular smooth muscle. We identified this transporter, namely the extraneuronal monoamine transporter (EMT), by demonstrating its function and mRNA expression. Furthermore, we showed that the rapid, nongenomic inhibitory GS effect on EMT is likely mediated through the activation of specific K+ channels in the plasma membrane. We believe that our studies identified new molecular targets for GSs in modulating noradrenergic control of airway vascular tone.
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Affiliation(s)
- G Horvath
- Department of Respiratory Medicine, Semmelweis University, Budapest, Hungary.
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31
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Horvath G, Sutto Z, Torbati A, Conner GE, Salathe M, Wanner A. Norepinephrine transport by the extraneuronal monoamine transporter in human bronchial arterial smooth muscle cells. Am J Physiol Lung Cell Mol Physiol 2003; 285:L829-37. [PMID: 12807698 DOI: 10.1152/ajplung.00054.2003] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Inhaled glucocorticosteroids (GSs) cause acute, alpha1-adrenoreceptor (AR)-mediated bronchial vasoconstriction. After release from sympathetic nerves, norepinephrine (NE) must be taken up into cells for deactivation by intracellular enzymes. Because postsynaptic cellular NE uptake is steroid sensitive, GSs could increase NE concentrations at alpha1-AR, causing vasoconstriction. We therefore evaluated mRNA expression of different NE transporters in human bronchial arterial smooth muscle and pharmacologically characterized NE uptake into these cells. RT-PCR demonstrated mRNA expression of the extraneuronal monoamine transporter (EMT) and organic cation transporter 1 (OCT-1). Fluorometric uptake assay showed time (within minutes)- and concentration-dependent NE uptake by freshly isolated bronchial arterial smooth muscle cells (SMC) with an estimated Km of 240 microM. Corticosterone and O-methylisoprenaline (1 microM each), but not desipramine, inhibited NE uptake, a profile indicative of NE uptake by EMT, but not OCT-1. Budesonide and methylprednisolone inhibited uptake with IC50 values of 0.9 and 5.6 microM, respectively. Corticosterone's action was reversible and not sensitive to RU-486 (GS receptor antagonist), actinomycin D (transcription inhibitor), or cycloheximide (protein synthesis inhibitor). Corticosterone made membrane impermeant by coupling to BSA also blocked NE uptake. Immunocytochemistry indicated a specific membrane binding site for corticosterone on bronchial arterial SMC. These data demonstrate that although human bronchial arterial SMC express OCT-1 and EMT, EMT is the predominant plasma membrane transporter for NE uptake. This process can be inhibited by GSs, likely via a specific membrane binding site. This nongenomic GS action (increasing NE concentrations at alpha1-AR) could explain acute bronchial vasoconstriction caused by inhaled GSs.
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Affiliation(s)
- Gabor Horvath
- Div. of Pulmonary and Critical Care Medicine, University of Miami School of Medicine, PO Box 016960 R-47 Miami, FL 33101, USA
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32
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Horvath G, Torbati A, Conner GE, Salathe M, Wanner A. Systemic ovalbumin sensitization downregulates norepinephrine uptake by rabbit aortic smooth muscle cells. Am J Respir Cell Mol Biol 2002; 27:746-51. [PMID: 12444035 DOI: 10.1165/rcmb.2002-0030oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Norepinephrine (NE) concentration at alpha-adrenergic receptors is partially regulated by steroid-sensitive, extraneuronal catecholamine uptake (uptake-2). Because alpha(1)-adrenergic agonist- and glucocorticosteroid (GS)-induced bronchial vasoconstriction is enhanced in individuals with asthma, atopy could be associated with decreased uptake-2 by vascular smooth muscle cells (SMCs). We therefore evaluated whether NE uptake and its specific transporter messenger RNA (mRNA) were reduced in aortic SMCs of rabbits systemically sensitized with ovalbumin (OVA). NE uptake was measured using a semiquantitative fluorescence microscopic method. Corticosterone and O-methyl-isoprenaline, but not desipramine, co-incubation (1 micro M each) for 20 min decreased NE uptake into SMCs, an inhibitor profile indicative of extraneuronal monoamine transporter (EMT). In OVA-sensitized rabbits, NE uptake was 25.9 +/- 4.5% (mean +/- SEM) lower than in control animals (P < 0.05). Sensitized serum had no effect on NE uptake into naive SMCs. EMT mRNA expression was measured in aortic smooth muscle, using multiplex reverse transcriptase-polymerase chain reaction. In OVA-sensitized rabbits, expression was 61.1 +/- 16.4% lower than in control animals (P < 0.05). These data demonstrate that NE uptake by aortic SMCs is impaired in atopic rabbits, and associated with a decreased transporter mRNA expression. The same mechanism may operate in bronchial arteries in individuals with asthma.
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Affiliation(s)
- Gabor Horvath
- Division of Pulmonary and Critical Care Medicine, and Department of Cell Biology and Anatomy, University of Miami School of Medicine, Miami, Florida 33101, USA
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