PAF antagonism as an approach to the treatment of airway hyperreactivity

Neutrophilic Dermatoses and Their Implication in Pathophysiology of Asthma and Other Respiratory Comorbidities: A Narrative Review

Neutrophilic dermatoses (ND) are a polymorphous group of noncontagious dermatological disorders that share the common histological feature of a sterile cutaneous infiltration of mature neutrophils. Clinical manifestations can vary from nodules, pustules, and bulla to erosions and ulcerations. The etiopathogenesis of neutrophilic dermatoses has continuously evolved. Accumulating genetic, clinical, and histological evidence point to NDs being classified in the spectrum of autoinflammatory conditions. However, unlike the monogenic autoinflammatory syndromes where a clear multiple change in the inflammasome structure/function is demonstrated, NDs display several proinflammatory abnormalities, mainly driven by IL-1, IL-17, and tumor necrosis factor-alpha (TNF-a). Additionally, because of the frequent association with extracutaneous manifestations where neutrophils seem to play a crucial role, it was plausible also to consider NDs as a cutaneous presentation of a systemic neutrophilic condition. Neutrophilic dermatoses are more frequently recognized in association with respiratory disorders than by chance alone. The combination of the two, particularly in the context of their overlapping immune responses mediated primarily by neutrophils, raises the likelihood of a common neutrophilic systemic disease or an aberrant innate immunity disorder. Associated respiratory conditions can serve as a trigger or may develop or be exacerbated secondary to the uncontrolled skin disorder. Physicians should be aware of the possible pulmonary comorbidities and apply this knowledge in the three steps of patients' management, work-up, diagnosis, and treatment. In this review, we attempt to unravel the pathophysiological mechanisms of this association and also present some evidence for the role of targeted therapy in the treatment of both conditions.

Pressure support ventilation via face mask in acute respiratory failure in hypercapnic COPD patients

OBJECTIVE

To test whether non-invasive ventilation via facial mask could reduce the need for tracheal intubation when mechanical ventilation must be initiated in COPD patients.

DESIGN

Open prospective interventional study.

SETTING

General Intensive Care Service of a County Hospital.

PATIENTS

We have studied 12 COPD patients during 14 episodes of acute exacerbation of chronic respiratory failure who failed to improve with intensive medical therapy and showed impairments in severe respiratory acidosis and/or hypercapnic encephalopathy leading their attending physicians to order mechanical ventilation.

INTERVENTIONS

In these circumstances, a trial of pressure-support (PS) ventilation (Servo Ventilator 900C) via facial mask Vital Signs Inc.) was performed. The level of pressure support was adjusted to obtain a tidal volume > 400 ml. If the patient deteriorated, tracheal intubation and standard mechanical ventilation were performed.

MEASUREMENTS AND RESULTS

Measurements are presented as means +/- SEM. A pressure-support level of 14 +/- 3 cmH2O was used during a period of 8 +/- 4 h. Low levels of external PEEP were used in 4 patients, while it generated excessive leaks in the others. Significant differences (p < 0.05 ANOVA for repeated measures) in data obtained on admission, when patients deteriorated and after pressure support was administered were only observed in PaCO2 (68 +/- 3 versus 92 +/- 3 versus 67 +/- 3 mmHg), arterial pH (7.27 +/- 0.03 versus 7.19 +/- 0.02 versus 7.31 +/- 0.01). SaO2 (60 +/- 4 versus 86 +/- 3 versus 92 +/- 1%) and respiratory rate (35 +/- 2 versus 32 +/- 2 versus 23 +/- 1 breaths.min-1). Three patients needed intubation and one of them died in the ICU.

CONCLUSION

Non-invasive ventilation (pressure-support) via face mask may reduce the need for tracheal intubation in the severe hypercapnic failure of COPD patients.

Platelet-activating factor-induced human eosinophil transendothelial migration: evidence for a dynamic role of the endothelium

Stimulated migration of eosinophils out of the bloodstream and into the lung is key in the development of tissue eosinophilia and inflammation in asthma. Platelet-activating factor (PAF) has been implicated as an important inflammatory mediator in asthma pathogenesis in part because of its chemotactic capacity. We therefore studied the ability of PAF to induce human peripheral blood eosinophil migration through naked filters and human umbilical vein endothelial cells (HUVECs) cultured on these filters. PAF induced eosinophil migration through both barriers in a time-dependent fashion, with maximal eosinophil migration occurring at 180 min. Significant eosinophil migration was observed at PAF concentration > or = 0.1 microM and was dose dependent up to 10.0 microM. No significant differences in eosinophil chemotactic responses were noted between naked filter and HUVEC barriers. The PAF receptor antagonist, WEB 2086, inhibited (> 85%) eosinophil transendothelial migration when co-incubated with PAF or when used as a pretreatment of either the eosinophils or HUVECs. However, WEB 2086 pretreatment of HUVECs did not inhibit PAF-induced neutrophil transendothelial migration, nor did it affect leukotriene B4-induced neutrophil or eosinophil transendothelial migration. Thus, the data indicate that the endothelial cell plays an important role in PAF-induced eosinophil inflammatory processes. Moreover, these data suggest that PAF's pathogenic role in asthma may in part be due to its ability to stimulate eosinophil migration across endothelial barriers and into the airways.