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Davidson KR, Ha DM, Schwarz MI, Chan ED. Bronchoalveolar lavage as a diagnostic procedure: a review of known cellular and molecular findings in various lung diseases. J Thorac Dis 2020; 12:4991-5019. [PMID: 33145073 PMCID: PMC7578496 DOI: 10.21037/jtd-20-651] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Bronchoalveolar lavage (BAL) is a commonly used procedure in the evaluation of lung disease as it allows for sampling of the lower respiratory tract. In many circumstances, BAL differential cell counts have been reported to be typical of specific lung disorders. In addition, more specific diagnostic tests including molecular assays such as polymerase chain reaction (PCR) or enzyme-linked immunosorbent assay, special cytopathologic stains, or particular microscopic findings have been described as part of BAL fluid analysis. This review focuses on common cellular and molecular findings of BAL in a wide range of lung diseases. Since the performance of the first lung irrigation in 1927, BAL has become a common and important diagnostic tool. While some pulmonary disorders have a highly characteristic signature of BAL findings, BAL results alone often lack specificity and require interpretation along with other clinical and radiographic details. Development of new diagnostic assays is certain to reinforce the utility of BAL in the future. Our review of the BAL literature is intended to serve as a resource to assist clinicians in the care of patients with lung disorders.
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Affiliation(s)
- Kevin R Davidson
- Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Duc M Ha
- Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Marvin I Schwarz
- Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward D Chan
- Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,National Jewish Health, Denver, Colorado, USA
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Han RT, Kim S, Choi K, Jwa H, Lee J, Kim HY, Kim HJ, Kim HR, Back SK, Na HS. Asthma-like airway inflammation and responses in a rat model of atopic dermatitis induced by neonatal capsaicin treatment. J Asthma Allergy 2017; 10:181-189. [PMID: 28572736 PMCID: PMC5441677 DOI: 10.2147/jaa.s124902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Recent studies have shown that approximately 70% of patients with severe atopic dermatitis (AD) develop asthma. Development of AD in infancy and subsequent other atopic diseases such as asthma in childhood is referred to as atopic march. However, a causal link between the diseases of atopic march has remained largely unaddressed, possibly due to lack of a proper animal model. Recently, we developed an AD rat model showing chronically relapsing dermatitis and scratching behaviors induced by neonatal capsaicin treatment. Here, we investigated whether our model also showed asthmatic changes, with the aim of expanding our AD model into an atopic march model. First, we confirmed that capsaicin treatment (50 mg/kg within 24 h after birth) induced dermatitis and scratching behaviors until 6 weeks of age. After that, the mRNA expression of Th1 and Th2 cytokines, such as IFN-γ and TNF-α, and IL-4, IL-5, and IL-13, respectively, was quantified with quantitative real-time polymerase chain reaction in the skin and the lungs. The number of total cells and eosinophils was counted in bronchoalveolar lavage (BAL) fluid. The levels of IgE in the serum and BAL fluid were determined with enzyme-linked immunosorbent assay. Paraffin-embedded sections (4 μm) were stained with hematoxylin/eosin to analyze the morphology of the lung and the airway. Airway responsiveness was measured in terms of airway resistance and compliance using the flexiVent system. In the capsaicin-treated rats, persistent dermatitis developed, and scratching behaviors increased over several weeks. The levels of IgE in the serum and BAL fluid as well as the mRNA expression of Th2 cytokines, including IL-4, IL-5, and IL-13, in both the skin and the lungs were elevated, and the number of eosinophils in the BAL fluid was also increased in the capsaicin-treated rats compared to control rats. Morphological analysis of the airway revealed smooth muscle hypertrophy and extensive mucus plug in the capsaicin-treated rats. Functional studies demonstrated an increment of the airway resistance and a decrement of lung compliance in the capsaicin-treated rats compared to control rats. Taken together, our findings suggested that neonatal capsaicin treatment induced asthma-like airway inflammation and responses in juvenile rats.
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Affiliation(s)
| | - Sewon Kim
- Department of Microbiology, College of Medicine, Korea University, Seoul
| | - Kyungmin Choi
- Neuroscience Research Institute.,Department of Physiology
| | - Hyeonseok Jwa
- Neuroscience Research Institute.,Department of Physiology
| | - JaeHee Lee
- Neuroscience Research Institute.,Department of Physiology
| | - Hye Young Kim
- Neuroscience Research Institute.,Department of Physiology
| | - Hee Jin Kim
- Division of Biological Science and Technology, Science and Technology College, Yonsei University Wonju Campus, Wonju
| | - Hang-Rae Kim
- Department of Anatomy, College of Medicine, Seoul National University, Seoul
| | - Seung Keun Back
- Department of Pharmaceutics and Biotechnology, College of Medical Engineering, Konyang University, Chungnam, South Korea
| | - Heung Sik Na
- Neuroscience Research Institute.,Department of Physiology
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3
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Keskin O, Keskin M, Kucukosmanoglu E, Ozkars MY, Gogebakan B, Kul S, Bayram H, Coskun Y. Exhaled RANTES and interleukin 4 levels after exercise challenge in children with asthma. Ann Allergy Asthma Immunol 2012; 109:303-8. [PMID: 23062383 DOI: 10.1016/j.anai.2012.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/20/2012] [Accepted: 08/20/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the universality and clinical significance of exercise-induced bronchospasm (EIB), the mechanisms responsible for it are incompletely understood. OBJECTIVE To investigate the role of exhaled RANTES (regulated on activation, normal T-cell expressed and secreted) and interleukin (IL) 4 in EIB in children with asthma. METHODS Fifty-six children with asthma were evaluated with exercise challenge and exhaled RANTES and IL-4 levels. Exhaled breath condensate was collected before and 30 minutes after exercise challenge. RANTES and IL-4 concentrations were determined using a specific immunoassay kit. RESULTS A significant increase was found in RANTES levels after exercise challenge in the asthmatic children (P<.001). A statistically significant increase in RANTES levels was noted after exercise challenge in both the asthmatic children with EIB (n=25, P=.007) and in the non-EIB asthmatic group (n=31, P=.005). Our study revealed that exhaled RANTES level correlates significantly well with percentage of forced expiratory volume in 1 second (FEV1), exacerbation frequency, serum IgE, and body mass index. No statistically significant increase was found in IL-4 levels after exercise challenge. The maximal postexercise decrease in FEV1 strongly correlated with total eosinophil count (P<.001, r = -0.61) and baseline ratio of FEV1 to forced vital capacity (FVC) (P=.002, r=0.40). Results from multivariate regression analysis adjusted for age, sex, and atopy as covariates showed that eosinophil count and FEV1/FVC ratio were significantly associated with EIB. CONCLUSION We found that exercise challenge, leading to hyperosmolar stimulus, may increase exhaled RANTES levels in children with asthma. In addition, exhaled RANTES levels correlate well with serum IgE, severity of asthma, FEV1/FVC ratio, and body mass index. RANTES and IL-4 may not be independent predictors for EIB. Furthermore, eosinophil count and FEV1/FVC ratio may predict the presence and severity of EIB in asthmatic children.
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Affiliation(s)
- Ozlem Keskin
- Department of Pediatric Allergy and Immunology, Medical Faculty, Gaziantep University, Gaziantep, Turkey.
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Cell surface antigen expression by peripheral blood monocytes in allergic asthma: results of 2.5 years therapy with inhaled beclomethasone dipropionate. Mediators Inflamm 2012; 5:362-9. [PMID: 18475731 PMCID: PMC2365803 DOI: 10.1155/s096293519600052x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
At present, inhaled glucocorticoids are widely accepted as the therapy of choice in chronic asthma. Treatment with inhaled glucocorticoids significantly suppresses local airway inflammation in asthmatics, but may also have systemic effects, e.g. a reduction of the number of circulating hypodense eosinophils or a down-modulation of HLA-DR antigen (Ag) expression by T lymphocytes in peripheral blood. However, the effect of long-term therapy with inhaled glucocorticoids on peripheral blood monocytes (PBM), which are the precursors of the most numerous cell type in the lung, the alveolar macrophage, have not yet been evaluated. We therefore investigated the expression of various cell surface Ag on PBM from non-smoking patients with allergic asthma who were treated for 2.5 years with a β2-receptor agonist plus either an inhaled glucocorticoid (beclomethasone dipropionate, BDP) (n = 4) or an anticholinergic or placebo (n = 8). We compared the results with healthy volunteers (n = 7). Long-term treatment of allergic asthmatics with inhaled BDP, but not anticholinergic or placebo therapy, was associated with a significantly lower CDllb Ag expression (p < 0.04) and higher expression of CD13, CD14 and CD18 Ag (p < 0.05, p < 0.02 and p < 0.04, respectively) when compared with the healthy control subjects (n = 7). Most interestingly, PBM of asthmatics treated with inhaled BDP expressed an almost two-fold higher level of CD14 Ag on their cell surface than PBM of patients treated with anticholinergic or placebo (p < 0.03). No significant differences in the expression of CD16, CD23, CD25, CD32 and CD64 Ag or HLA-DR were observed between PBM from the different patient groups or healthy controls. Taken together, this study shows that long-term local therapy with inhaled BDP coincides with an altered expression of at least one cell surface Ag on PBM from allergic asthmatics.
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Saad-El-Din Bessa S, Abo El-Magd GH, Mabrouk MM. Serum chemokines RANTES and monocyte chemoattractant protein-1 in Egyptian patients with atopic asthma: relationship to disease severity. Arch Med Res 2012; 43:36-41. [PMID: 22300682 DOI: 10.1016/j.arcmed.2012.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 01/18/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Asthma is a highly prevalent, complex inflammatory disease of the airways often associated with bronchial hyperreactivity and atopy. The chemokine RANTES (regulated upon activation, normal T -cell expressed and secreted) is an important element for the chemotaxis at the site of allergic inflammation. This study aimed to assess the serum levels of the chemokines RANTES and monocyte chemoattractant protein-1 (MCP-1) in Egyptian patients with atopic asthma and to evaluate their possible relation t the severity of airway obstruction. METHODS The study included 60 Egyptian patients with atopic asthma and 20 healthy volunteers. Serum levels of the chemokines RANTES and MCP-1 were measured. Total serum IgE level and absolute eosinophil counts were determined. The severity of airway obstruction was assessed using spirometric measurement (FEV(1)). RESULTS The serum levels of RANTES were significantly higher in all asthmatic patients than the controls (p <0.001). Moreover, RANTES levels were significantly increased in patients with moderate and severe asthma as compared to those with mild asthma (p <0.001). Serum RANTES correlated positively with absolute eosinophil counts and total serum IgE and negatively with FEV(1), whereas there was no significant correlation with serum MCP-1 in all asthmatic patients. CONCLUSIONS Serum RANTES may be used as a useful noninvasive marker of airway obstruction and a potential diagnostic tool for monitoring asthma severity. In this regard, identification and blocking of this chemokine and/or its receptor may be a promising therapeutic approach to asthmatic patients.
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Abstract
Asthma significantly affects quality of sleep. Asthma physiology follows a diurnal pattern with peak flow at its lowest during early morning hours. The type and timing of release of inflammatory mediators also varies during the day and nighttime. Nocturnal symptoms are common in poorly controlled asthma. Hence, these nighttime symptoms play a significant role in the assessment of asthmatic patients as demonstrated in validated asthma control and quality of life questionnaires. Comorbid conditions may include allergic rhinitis, obesity, obstructive sleep apnea, and gastroesophageal reflux, all of which may worsen asthma symptoms, especially during sleep. In addition, exposure to greater loads of allergens in susceptible individuals during sleep is a significant problem and must be addressed to break the cycle of poor asthma control. Thus, asthma education for better symptom control should address these particular issues surrounding sleep.
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Affiliation(s)
- Catherine Kier
- Stony Brook University Medical Center, Stony Brook, New York
| | - Stephanie Hom
- Stony Brook University Medical Center, Stony Brook, New York
| | - Faiza Qureshi
- Stony Brook University Medical Center, Stony Brook, New York
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Kuo PL, Hsu YL, Tsai MJ, Lien CT, Huang MS, Ko YC. Nonylphenol induces bronchial epithelial apoptosis via Fas-mediated pathway and stimulates bronchial epithelium to secrete IL-6 and IL-8, causing bronchial smooth muscle proliferation and migration. Basic Clin Pharmacol Toxicol 2011; 110:178-86. [PMID: 21917119 DOI: 10.1111/j.1742-7843.2011.00797.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Features of airway remodelling have been described using tissue obtained from fatal cases of asthma and bronchial biopsies from mildly, moderately and severely asthmatic patients. Epithelial detachment and smooth muscle mass enhancement are common features of asthmatic bronchial tissue. This study is the first to investigate the inhibitory effect of nonylphenol (NP) on human bronchial epithelial cell lines BEAS-2B and HBE135-E6E7 (HBE). The results show that NP inhibits bronchial epithelial proliferation via the Fas/Fas ligand apoptotic system. We also treated BEAS-2B and HBE with NP and harvested the condition medium (CM), which was then added to bronchial smooth muscle cells (BSMC). Cultures of BSMC with NP-BEAS-2B-CM and NP-HBE-CM increased BSMC proliferation and migration. Exposure of BEAS-2B and HBE to NP caused epithelial cells to produce inflammatory cytokines IL-6 and IL-8, which subsequently induced BSMC proliferation and migration. Depleting both IL-6 and IL-8 completely reversed the effect of NP-BEAS-2B-CM- and NP-HBE-CM-mediated BSMC proliferation and migration, suggesting that this effect is a synergistic influence of IL-6 and IL-8. This study is the first to demonstrate that NP not only induces bronchial epithelial apoptosis via the Fas-mediated pathway but also stimulates the bronchial epithelium to secrete IL-6 and IL-8, which cause bronchial smooth muscle proliferation and migration - major features in asthma remodelling.
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Affiliation(s)
- Po-Lin Kuo
- Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanCenter of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanGraduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDivision of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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8
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Sharma RM, Dham SK. Ventilatory Strategy in Acute Severe Asthma. Med J Armed Forces India 2011; 60:281-3. [PMID: 27407649 DOI: 10.1016/s0377-1237(04)80063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- R M Sharma
- Associate Prosfessor, Department of Anesthesiology, Armed Forces Medical College, Pune-40
| | - S K Dham
- Ex-Director General Medical Services (Air)
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9
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Wadsworth SJ, Atsuta R, McIntyre JO, Hackett TL, Singhera GK, Dorscheid DR. IL-13 and TH2 cytokine exposure triggers matrix metalloproteinase 7-mediated Fas ligand cleavage from bronchial epithelial cells. J Allergy Clin Immunol 2010; 126:366-74, 374.e1-8. [PMID: 20624652 DOI: 10.1016/j.jaci.2010.05.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 03/30/2010] [Accepted: 05/11/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bronchial epithelial damage and activation likely contribute to the inflammatory and airway-remodeling events characteristic of severe asthma. Interaction of Fas receptor (CD95) with its ligand (FasL; CD95L) is an important mechanism of cell-mediated apoptosis. Bronchial epithelial FasL expression provides immune barrier protection from immune cell-mediated damage. OBJECTIVES Membrane FasL (mFasL) is a cleavage target of matrix metalloproteinases (MMPs). We investigated whether the asthmatic T(H)2 environment might influence disease processes by increasing airway epithelial MMP-mediated cleavage of mFasL into proinflammatory soluble FasL. METHODS We used human airway epithelial cell lines and primary cells to model the human airway epithelium in vitro. Airway tissue from healthy subjects and patients with severe asthma was used to investigate MMP expression patterns in diseased airways. RESULTS We demonstrate that active MMP-7 is present in the ciliated epithelial cells of normal human airways. In patients with severe asthma, MMP-7 levels are increased in basal epithelial cells. Airway epithelial cell lines (1HAEo(-) and 16HBE14o(-)) in vitro express constitutively high levels of MMP-2 and MMP-9 but relatively low levels of MMP-7. T(H)2 cytokine (IL-4, IL-9, and IL-13) treatment of 1HAEo(-) cells increased MMP-7 mRNA and activity, triggered colocalization of intracellular MMP-7 with FasL, and caused mFasL cleavage with soluble FasL release. Small interfering RNA knockdown shows that cytokine-induced mFasL cleavage is dependent on MMP-7 activity. CONCLUSIONS MMPs serve multiple beneficial roles in the lung. However, chronic disordered epithelial expression of MMP-7 in patients with asthma might increase mFasL cleavage and contribute to airway epithelial damage and inflammation.
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Affiliation(s)
- Samuel J Wadsworth
- UBC James Hogg Research Laboratories, Providence Heart and Lung Institute, University of British Columbia, Vancouver, British Columbia, Canada.
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10
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Allen DL, Herman DR, Williams GD, Spaethe SM, Dorato MA, Wolff RK. Effect of an LTB4 Aerosol Exposure on Pulmonary Function, Cell Populations, and Mediators in the Lungs of Rhesus Monkeys. Inhal Toxicol 2008. [DOI: 10.3109/08958379509012809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lauer ME, Erzurum SC, Mukhopadhyay D, Vasanji A, Drazba J, Wang A, Fulop C, Hascall VC. Differentiated murine airway epithelial cells synthesize a leukocyte-adhesive hyaluronan matrix in response to endoplasmic reticulum stress. J Biol Chem 2008; 283:26283-96. [PMID: 18644783 DOI: 10.1074/jbc.m803350200] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In this report, we describe a novel method for culturing murine trachea epithelial cells on a native basement membrane at an air-liquid interface to produce a pseudostratified, differentiated airway epithelium composed of ciliated and nonciliated cells. This model was used to examine hyaluronan synthesis by the airway epithelial cells (AECs) in response to poly(I,C) and tunicamycin. The former induces a response similar to viral infection, and the latter is a bacterial toxin known to induce endoplasmic reticulum (ER) stress. We found significant accumulation of hyaluronan on the apical surface of the AECs in response to ER stress, but, unlike previously reported results with smooth muscle cells, no increase in hyaluronan was observed in response to poly(I,C). Monocytic U937 cells adhered at 4 degrees C to the apical surface of the AECs subjected to ER stress by a mechanism almost entirely mediated by hyaluronan. The U937 cells spontaneously released themselves from the abnormal hyaluronan matrix when their metabolism was restored by shifting the temperature from 4 to 37 degrees C in a custom-made flow chamber. Time lapse confocal microscopy permitted live imaging of this interaction between the U937 cells and the hyaluronan matrix and their subsequent response at 37 degrees C. Within 45 min, we observed dynamic protrusions of the U937 cell plasma membrane into nearby hyaluronan matrix, resulting in the degradation of this matrix. Simultaneously, we observed some reorganization of the hyaluronan matrix, from a generalized, apical distribution to localized regions around the AEC tight junctions. We discuss the implications these results might have for the airway epithelium and its relation to airway inflammation and hyperresponsiveness associated with asthma and other airway diseases.
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Affiliation(s)
- Mark E Lauer
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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12
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RANTES in exhaled breath condensate of stable and unstable asthma patients. Respir Med 2008; 102:1198-202. [PMID: 18603420 DOI: 10.1016/j.rmed.2008.03.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 02/11/2008] [Accepted: 03/10/2008] [Indexed: 11/20/2022]
Abstract
RANTES has been implicated in the allergic inflammation of asthma by promoting the migration and activation of the inflammatory cells, including eosinophils. The study was undertaken to evaluate RANTES levels in the exhaled breath condensate (EBC) of asthmatics with different degrees of asthma severity. EBC was collected from 33 patients with allergic asthma (11 with steroid-naïve mild asthma, 10 with ICS-treated, stable mild-to-moderate asthma, 12 with ICS-treated unstable, severe asthma) and seven healthy volunteers. In the three groups of asthmatics, RANTES concentrations in EBC were significantly higher compared with healthy volunteers. RANTES levels were significantly higher in patients with unstable asthma than in the two groups with stable disease. We observed statistically significant correlations between the concentrations of RANTES in EBC and F(ENO) in the three studied groups of asthmatics; notably, the correlation between the parameters described above was strong positive in the group of unstable and steroid-naïve stable asthmatics. We also discovered a significantly positive correlation between RANTES in EBC and the serum ECP or blood eosinophil count in the groups of asthmatics with severe, unstable asthma and between RANTES and serum ECP in the group of steroid-naïve stable asthmatics. Measurements of RANTES in EBC may provide another useful diagnostic tool for detecting and monitoring inflammation in patients with asthma.
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Ueno T, Kataoka M, Hirano A, Iio K, Tanimoto Y, Kanehiro A, Okada C, Soda R, Takahashi K, Tanimoto M. Inflammatory markers in exhaled breath condensate from patients with asthma. Respirology 2008; 13:654-63. [PMID: 18513240 DOI: 10.1111/j.1440-1843.2008.01315.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Evaluation of airway inflammation is important for the diagnosis and treatment of asthma. Exhaled breath condensate (EBC) is a minimally invasive method for assessing inflammation and may be useful for monitoring airway inflammation in asthma. The aims of this study were to establish an EBC collection method, to assess biomarkers reflecting asthmatic airway inflammation, and to determine the relationship of these biomarkers with asthma severity and lung function. METHODS Fifty-eight non-smoking healthy subjects, seven asymptomatic smokers, nine subjects with common cold and 55 asthmatics with disease severity ranging from mild intermittent to severe persistent were studied. The efficacy of a pipette method was compared with that of a commercial collecting device. pH, CRP, albumin, hydrogen peroxide (H(2)O(2)) and nitrite/nitrate levels were measured in EBC. RESULTS Except for the quantity of EBC collected and albumin levels, there were no differences between the commercial method and the pipette method in levels of biomarkers measured. Levels of CRP, H(2)O(2) and nitrite/nitrate were significantly higher in the asthma group than that in the control group. In terms of asthma severity, pH and levels of CRP, H(2)O(2) and nitrate were significantly higher in the mild persistent group than that in the other groups. In addition, H(2)O(2) levels in EBC correlated significantly with the level of nitrite/nitrate. FEV(1) and PEF showed significant negative correlations with H(2)O(2) and nitrite/nitrate levels. CONCLUSION Measurement of EBC biomarkers is a non-invasive and useful way to evaluate airway inflammation in patients with asthma.
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Affiliation(s)
- Tomoe Ueno
- Field of Medical Technology, Graduate School of Health Sciences, Okayama University, Okayama, Japan
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15
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Pedreira WL, de Souza R, Fiks IN, Salge JM, de Carvalho CRR. Functional implications of BAL in the presence of restrictive or obstructive lung disease. Respir Med 2006; 101:1344-9. [PMID: 17118639 DOI: 10.1016/j.rmed.2006.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 09/17/2006] [Accepted: 10/02/2006] [Indexed: 10/23/2022]
Abstract
Most of the complications associated to bronchoscopy are related to changes of the respiratory function during or after its performance. Prevention of complications should be achieved by understanding the effects of bronchoscopic procedures and their relation to the pulmonary function deterioration. Previous studies regarding the functional impairment caused by bronchoalveolar lavage (BAL) were mostly limited by the presence of interferent factors such as sedative drugs. Furthermore, it is not clear whether or not patients with different ventilatory disturbances present the same functional response to bronchoscopy and BAL. The aim of this study was to determine the additional effects of BAL over the respiratory function deterioration related to bronchoscopy in patients with different respiratory function profiles (normal, restrictive and obstructive). Forty patients submitted to bronchoscopy without premedication were divided into four groups: group I-normal pulmonary function submitted to basic bronchoscopy; group II-bronchoscopy in combination with BAL, subdivided according to pulmonary function: group IIa (normal function), group IIb (restrictive ventilatory disturbances) and group IIc (obstructive ventilatory disturbances). Spirometry was made before and after the bronchoscopic procedure. Baseline hemoglobin saturation was compared to the lowest level during the procedure. Functional worsening caused by the procedure was observed with a decrease in forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)) and Hemoglobin saturation in all groups. Comparison between groups showed no significant difference regarding the changes in FVC (P=0.8324), FEV(1) (P=0.6952) and hemoglobin saturation (P=0.5044). We conclude that standardized BAL, like the one used in our study, does not result in an increased risk for ventilatory impairment compared to bronchoscopy itself, independently of the presence of previous respiratory disease.
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Affiliation(s)
- Wilson Leite Pedreira
- Pulmonary Division, University of São Paulo Medical School, Rua Bagé 163 apto 182, São Paulo 04012-140, Brazil.
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Busse WW, Wanner A, Adams K, Reynolds HY, Castro M, Chowdhury B, Kraft M, Levine RJ, Peters SP, Sullivan EJ. Investigative bronchoprovocation and bronchoscopy in airway diseases. Am J Respir Crit Care Med 2005; 172:807-16. [PMID: 16020805 PMCID: PMC2718402 DOI: 10.1164/rccm.200407-966ws] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Basic and clinical research strategies used for many lung diseases have depended on volunteer subjects undergoing bronchoscopy to establish access to the airways to collect biological specimens and tissue, perhaps with added bronchoprovocation in asthma syndromes. These procedures have yielded a wealth of important scientific information. Since the last critical review more than a decade ago, some of the techniques and applications have changed, and untoward events have occurred, raising safety concerns and increasing institutional review scrutiny. OBJECTIVES AND METHODS To reappraise these investigational methods in the context of current knowledge, the National Heart, Lung, and Blood Institute and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health convened a working group to review these procedures used for airway disease research, emphasizing asthma and chronic obstructive pulmonary disease. MAIN RESULTS The group reaffirmed the scientific importance of investigative bronchoscopy and bronchoprovocation, even as less invasive technologies evolve. The group also considered the safety of bronchoscopy and bronchoprovocation with methacholine and antigen to be acceptable for volunteer subjects and patients, but stressed the need to monitor this closely and to emphasize proper training of participating medical research personnel. Issues were raised about vulnerable volunteers, especially children who need surrogates for informed consent. CONCLUSION This review of investigative bronchoscopy and bronchoprovocation could serve as the basis for future guidelines for the use of these procedures in the United States.
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Mathur R, Bell D. Asthma management in police study. ACTA ACUST UNITED AC 2005; 3:133-40. [PMID: 15335610 DOI: 10.1016/s1353-1131(96)90003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Asthma is a common condition and, therefore, may be seen by the clinical forensic physician and police in widely different circumstances ranging from the autopsy room to roadside breath alcohol testing. This paper concentrates on the assessment and treatment of asthmatics detained in custody and does not refer to the Road Traffic Act provisions. A careful history and objective recording of simple severity markers and peak expiratory flow rate should identify patients who may require hospitalization or urgent treatment. Asthma mortality may be reduced by better understanding of the disease and its treatment and by greater use of prophylactic rather than reliance on relief therapy for bronchospasm.
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Affiliation(s)
- R Mathur
- Department of Thoracic Medicine, Central Middlesex Hospital, London, UK
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18
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Gomes MJM. Avanços e desafios no diagnóstico e tratamento médico da patologia pulmonar**Texto de uma conferência proferida na XI Reunião de Pneumologistas do Hospital de Pulido Valente SA. REVISTA PORTUGUESA DE PNEUMOLOGIA 2005. [DOI: 10.1016/s0873-2159(15)30480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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19
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Clercx C, Peeters D, German AJ, Khelil Y, McEntee K, Vanderplasschen A, Schynts F, Hansen P, Detilleux J, Day MJ. An Immunologic Investigation of Canine Eosinophilic Bronchopneumopathy. J Vet Intern Med 2002. [DOI: 10.1111/j.1939-1676.2002.tb02362.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Silvestri M, Sabatini F, Spallarossa D, Fregonese L, Battistini E, Biraghi MG, Rossi GA. Exhaled nitric oxide levels in non-allergic and allergic mono- or polysensitised children with asthma. Thorax 2001; 56:857-62. [PMID: 11641510 PMCID: PMC1745945 DOI: 10.1136/thorax.56.11.857] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increased fractional exhaled NO concentrations (FENO) and blood/tissue eosinophilia are frequently reported in allergic children with mild asthma and are thought to reflect the intensity of the inflammation characterising the disease. The aim of this study was to investigate possible differences in FENO levels or in the intensity of the blood eosinophilia in allergic and non-allergic asthmatic children. METHODS 112 children with stable, mild, intermittent asthma with a positive bronchial challenge to methacholine were consecutively enrolled in the study; 56 were skin prick test and RAST negative (non-sensitised) while 56 were sensitised to house dust mites (23 only to house dust mites (monosensitised) and 33 were sensitised to mites and at least another class of allergens (pollens, pet danders, or moulds)). Nineteen sex and age matched healthy children formed a control group. RESULTS Compared with non-allergic patients, allergic children had a significantly higher rate of blood eosinophilia (p=0.0001) with no differences between mono- and polysensitised individuals. Forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), forced expiratory flow at 25-75% of vital capacity (FEF(25-75%)), and the degree of bronchial reactivity to methacholine were similar in non-atopic and atopic children, with no differences between mono- and polysensitised individuals. FENO levels measured by chemiluminescence analyser were higher in asthmatic children (15.9 (14.3) ppb) than in the control group (7.6 (1.6) ppb, p=0.04) and higher in allergic patients (23.9 (2.1) ppb) than in non-allergic patients (7.9 (0.8) ppb, p=0.0001), but there were no differences between mono- and polysensitised individuals (p>0.1). Significant correlations between blood eosinophilia and FENO levels were seen only in allergic (r=0.35, p<0.01) and in polysensitised individuals (r=0.45, p<0.05). CONCLUSIONS In children with mild asthma, a similar degree of functional disease severity may be associated with a higher inflammatory component in allergic than in non-allergic subjects.
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Affiliation(s)
- M Silvestri
- Pulmonary Division, G. Gaslini Institute, Largo G Gaslini 5, 16148 Genoa, Italy
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21
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Spallarossa D, Battistini E, Silvestri M, Sabatini F, Biraghi MG, Rossi GA. Time-dependent changes in orally exhaled nitric oxide and pulmonary functions induced by inhaled corticosteroids in childhood asthma. J Asthma 2001; 38:545-53. [PMID: 11714077 DOI: 10.1081/jas-100107119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Exhaled nitric oxide levels are elevated in asthmatic children and decrease after inhaled steroid treatment. We evaluated the time-dependent changes in fractional exhaled nitric oxide concentration (FENO) and pulmonary function parameters following inhaled steroid therapy. Thirty-nine steroid-naive atopic patients (age 11.92+/-0.48 years) with mild intermittent asthma and 22 age-matched healthy controls were enrolled in the study; pulmonary functions and FE(NO) levels were measured. Low doses of inhaled steroids were prescribed to all asthmatic patients who were reevaluated in a second visit (between 10 and 40 days after the beginning of the treatment). At the enrolment, asthmatic patients had similar forced expiratory volume in 1 sec (FEV1) and forced vital capacity (FVC) values (p > 0.05) but reduced forced expiratory flows at 25-75% of the vital capacity (FEF(25-75%)) values, as compared to controls (p < 0.05). In addition, FE(NO) levels were significantly higher in asthmatics with respect to control subjects (30.8+/-3.0 and 4.0+/-0.5 ppb, respectively; p < 0.01). All asthmatics had FE(NO) levels higher than 8.8 ppb (i.e., > 2 standard deviations of the mean in controls). After steroid treatment, patients showed significant improvement of FEV1, FVC, and FEF(25-75%) (p = 0.0001; each comparison) and a reduction of FE(NO) levels (p = 0.0001). A weak significant correlation was found between percent decrease in FE(NO) levels and percent increase in FEV1 (r = 0.33, p = 0.04) or in FEF(25-75%) (r = 0.4, p = 0.01) after treatment. When changes in FE(NO) levels and in pulmonary function parameters were corrected for days of treatment, significant correlations were still present between percent decrease in FE(NO) levels and percent increase in FEV1 (r = 0.57, p = 0.0004) or percent increase in FEF(25-75%) (r = 0.45, p = 0.006). Sixteen of the 39 asthmatic patients were evaluated on two occasions after the beginning of treatment, at days 10 and 40. The significant reduction in FE(NO) levels (p < 0.01) and the significant increase in FEV1 and FEF(25-75%) values observed (p < 0.05) after 10 days did not further improve at day 40. These data show that it is possible to demonstrate early effects of low-dose inhaled steroids in asthmatic children using objective measurements of airway caliber and inflammation.
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Affiliation(s)
- D Spallarossa
- Pulmonary Division, G. Gaslini Institute, Genoa, Italy
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22
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Abstract
Current strategies for the management of asthma focus on suppressing airway inflammation. Other characteristic features of human asthma, such as airway hyperreactivity and the structural changes collectively referred to as airway remodeling, are largely ignored in existing guidelines for monitoring the effectiveness of treatment. Evidence is accumulating that pharmacologic therapy targeting airway wall remodeling may be valuable in treating asthma. However, development of appropriate therapeutic agents will require a better understanding of the pathogenesis of remodeling, which appears to be regulated by a variety of cytokines and growth factors produced by inflammatory, epithelial, and stromal cells. Furthermore, testing the effectiveness of novel agents that specifically target the process of remodeling will require appropriate experimental models, but most currently available animal models of asthma have major limitations. A recently described murine model of chronic human asthma offers considerable potential for dissection of the mechanisms of airway wall remodeling, as well as for investigation of the therapeutic potential of drugs that can modulate chronic inflammation and remodeling.
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Affiliation(s)
- R K Kumar
- Inflammation Research Unit, School of Pathology, The University of New South Wales, Sydney, Australia 2052.
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23
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Affiliation(s)
- M Afzal
- Division of Pulmonary and Critical Care, University of California, Davis, 4150 Stockton Blvd PSSB Suite 3400, Sacramento, CA 95817, USA
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24
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Silvestri M, Spallarossa D, Battistini E, Fregonese B, Rossi GA. e-NO peak versus e-NO plateau values in evaluating e-NO production in steroid-naive and in steroid-treated asthmatic children and in detecting response to inhaled steroid treatment. Pediatr Pulmonol 2001; 31:37-43. [PMID: 11180673 DOI: 10.1002/1099-0496(200101)31:1<37::aid-ppul1005>3.0.co;2-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SUMMARY. Airway nitric oxide (NO) production can be measured by chemiluminescence analyzer in children able to perform a single low exhalation. The aim of the present study was to evaluate whether exhaled NO (e-NO) peaks (first part of the exhalation) were as useful as e-NO plateaus (last part of the exhalation) in evaluating e-NO production in asthmatic children and in detecting responses to inhaled steroid treatment. E-NO peak, plateau, and rate of production values were measured in 100 atopic asthmatic children using a chemiluminescence analyser. Thirty-seven patients (mean age, 11.1 +/- 0.7 years) were receiving inhaled steroids (flunisolide, 0.8-1 mg daily) or beclomethasone (0.2-0.4 mg daily), while the remaining 63 (mean age, 12.0 +/- 0.4 yrs) were-steroid naive and treated only with inhaled beta(2)-agonists on an as-needed basis. Fifteen out of the 63 steroid-naive patients were reevaluated after a short course (3 weeks) of inhaled corticosteroid treatment (flunisolide, 0.8-1 mg daily, or beclomethasone, 0.2-0.4 mg daily). Regardless of the type of data analysis (peak, plateau, or rate of production), the e-NO values of the steroid-naive patients were significantly higher than those of inhaled steroid-treated patients (P < 0.01, each comparison). Similarly, in the subgroup of steroid-naive patients, the three methods were able to detect a decrease in e-NO levels by inhaled steroid therapy (P < 0.001, each comparison). Plotting the difference between e-NO peak and e-NO plateau values against their average, the peak e-NO concentrations were higher than e-NO plateau values. This difference was independent of the absolute e-NO concentration. The results of the two types of data analysis seems to agree more closely in steroid-naive patients than in steroid treated patients, or in the subgroup of steroid-naive patients who received a short course treatment with inhaled steroids. In steroid-treated subjects, the differences were up to five times higher for peak than plateau e-NO values. These data suggest that both e-NO plateau and e-NO peak values are useful in detecting airway NO production in atopic asthmatic children, but they cannot be used interchangeably. Because of possible nasal contamination in e-NO peak measurement, we prefer e-NO plateau levels for evaluating lower airway e-NO production.
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Affiliation(s)
- M Silvestri
- Lung Diseases Unit, G. Gaslini Research Institute, Largo G. Gaslini 5, 16148 Genoa, Italy
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25
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Trakada G, Tsourapis S, Marangos M, Spiropoulos K. Arterial and bronchoalveolar lavage fluid endothelin-1 concentration in asthma. Respir Med 2000; 94:992-6. [PMID: 11059954 DOI: 10.1053/rmed.2000.0890] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endothelins are a family of peptide mediators that have a number of biological properties, including the ability to act as bronchoconstrictors and vasoconstrictors of isolated airways and vessels. Endothelin-1 (ET-1) is the more potent peptide compared with the other two peptides of the family. To examine a possible involvement of ET- 1 in the pathogenesis of asthma, we measured arterial ET-1 levels in 11 patients with atopic asthma during attack and during remission, and in 11 healthy control subjects. We also performed fiberoptic bonchoscopy and bronchoalveolar lavage (BAL) to measure ET-1 levels in the 11 asthmatic patients during remission, and in the 11 healthy control subjects. ET-1 concentrations in arterial blood and in BAL were measured by a radioimmunoassay method. Arterial ET-1 levels were very significantly higher in asthma attack (3.67 +/- 0.51 pg ml(-1)) and in asthma remission (2.65 +/- 10.62 pg ml(-1)) compared with those of the healthy controls (1.37 +/- 0.14 pg ml(-1)) (P < 0.001). Arterial ET-1 levels were also very significantly higher during asthma attack compared with those in asthma remission (P < 0.001). BAL ET-1 levels were significantly higher in asthma remission (0.73 +/- 0.53 pmol g(-1)) compared with those of the healthy controls (0.16 +/- 0.02 pmol g(-1)) (P < 0.05). No correlation was observed between arterial and BAL ET-1 levels, PaO2 and peak expiratory flow rate (PEFR). These data are consistent with the hypothesis that ET-1 contributes to the pathophysiology of asthma. However, it is likely that the true importance of this vasoconstrictor peptide will only be revealed by pharmacological studies with specific receptor antagonists.
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Affiliation(s)
- G Trakada
- Department of Internal Medicine, University of Patras Medical School, Greece
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26
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Silvestri M, Spallarossa D, Battistini E, Brusasco V, Rossi GA. Dissociation between exhaled nitric oxide and hyperresponsiveness in children with mild intermittent asthma. Thorax 2000; 55:484-8. [PMID: 10817797 PMCID: PMC1745786 DOI: 10.1136/thorax.55.6.484] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Bronchial hyperresponsiveness and airway inflammation are distinctive features of asthma. Evaluation of nitric oxide (NO) levels in expired air have been proposed as a reliable method for assessing the airway inflammatory events in asthmatic subjects. A study was undertaken to evaluate whether airway hyperresponsiveness is related to levels of exhaled NO. METHODS Thirty two steroid-naive atopic children with mild intermittent asthma of mean (SD) age 11.8 (2.3) years and 28 age matched healthy controls were studied to investigate whether baseline lung function or airway hyperresponsiveness is related to levels of exhaled NO. Airway responsiveness was assessed as the dose of methacholine causing a 20% decrease in forced expiratory volume in one second (FEV(1)) from control (PD(20) methacholine) and exhaled NO levels were measured by chemiluminescence analysis of exhaled air. RESULTS At baseline asthmatic children had significantly higher NO levels than controls (mean difference 25.87 ppb (95% CI 18.91 to 32.83); p<0.0001) but there were no significant differences in lung function parameters (forced vital capacity (FVC), FEV(1) (% pred), and forced expiratory flows at 25-75% of vital capacity (FEF(25-75%))). In the asthmatic group exhaled NO levels were not significantly correlated with baseline lung function values or PD(20) methacholine. CONCLUSIONS These results suggest that levels of exhaled NO are not accurate predictors of the degree of airway responsiveness to inhaled methacholine in children with mild intermittent asthma.
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Affiliation(s)
- M Silvestri
- Divisione di Pneumologia, Istituto G Gaslini, Largo G Gaslini 5, 16148 Genoa, Italy
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27
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Abstract
An important advance in our understanding of the pathophysiology of asthma has been the discovery that airway inflammation is not confined to severe asthma but also characterizes mild and moderate asthma. Inflammation in asthma may be the result of a peculiar type of lymphocytic inflammation whereby Th2 lymphocytes secrete cytokines that orchestrate cellular inflammation and promote airway hyperresponsiveness. The term "airway remodeling" in asthma refers to structural changes that occur in conjunction with, or because of, chronic airway inflammation. Airway remodeling results in alterations in the airway epithelium, lamina propria, and submucosa, leading to thickening of the airway wall. The consequences of airway remodeling in asthma may include incompletely reversible airway narrowing, bronchial hyperresponsivenesss, airway edema, and mucus hypersecretion. Airway remodeling in asthma thus may predispose persons with asthma to asthma exacerbations and even death from airway obstruction caused by smooth muscle contraction, airway edema, and mucus plugging. Although much has been learned in the past 25 years about the pathophysiology of airway inflammation and airway remodeling in asthma, important questions remain about the relation between airway inflammation and remodeling, the natural history of airway remodeling, and the effects of current asthma treatments on remodeled airways.
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Affiliation(s)
- J V Fahy
- Department of Medicine and the Cardiovascular Research Institute, University of California at San Francisco, 94143-0111, USA
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28
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Dahlen JR, Foster DC, Kisiel W. Inhibition of neutrophil elastase by recombinant human proteinase inhibitor 9. BIOCHIMICA ET BIOPHYSICA ACTA 1999; 1451:233-41. [PMID: 10556578 DOI: 10.1016/s0167-4889(99)00095-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Proteinase inhibitor PI9 (PI9) is an intracellular 42-kDa member of the ovalbumin family of serpins that is found primarily in placenta, lung and lymphocytes. PI9 has been shown to be a fast-acting inhibitor of granzyme B in vitro, presumably through the utilization of Glu(340) as the P(1) inhibitory residue in its reactive site loop. In this report, we describe the inhibition of human neutrophil elastase by recombinant human PI9. Inhibition occurred with an overall K(i)' of 221 pM and a second-order association rate constant of 1.5 x 10(5) M(-1) s(-1), indicating that PI9 is a potent inhibitor of this serine proteinase in vitro. In addition, incubation of recombinant PI9 with native neutrophil elastase resulted in the formation of an SDS-resistant 62-kDa complex. Amino-terminal sequence analyses provided evidence that inhibition of elastase occurred through the use of Cys(342) as the reactive P(1) amino acid residue in the PI9 reactive site loop. Thus, PI9 joins its close relatives PI6 and PI8 as having the ability to utilize multiple reactive site loop residues as the inhibitory P(1) residue to expand its inhibitory spectrum.
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Affiliation(s)
- J R Dahlen
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
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29
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Neuparth N, Araújo Gonçalves P, Bugalho De Almeida A, Bensabat Rendas A. Asma e leucotrienos. REVISTA PORTUGUESA DE PNEUMOLOGIA 1999. [DOI: 10.1016/s0873-2159(15)31004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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30
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Marguet C, Jouen-Boedes F, Dean TP, Warner JO. Bronchoalveolar cell profiles in children with asthma, infantile wheeze, chronic cough, or cystic fibrosis. Am J Respir Crit Care Med 1999; 159:1533-40. [PMID: 10228122 DOI: 10.1164/ajrccm.159.5.9805028] [Citation(s) in RCA: 171] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Differential cell counts of bronchoalveolar lavage (BAL) have been reported in normal children but few data on cellular profiles in bronchial diseases in childhood are available. We determined the BAL cell profiles of 72 children divided into 5 groups: asthma (n = 14), chronic cough (n = 12), infantile wheeze (n = 26), cystic fibrosis (n = 10), and control (n = 10). The highest total cell, eosinophil, and neutrophil counts were found in children with cystic fibrosis. The cell profile of children with chronic cough was similar to that of control children. Asthma and infantile wheeze were characterized by a high median ratio of eosinophils (3%) and neutrophils (12%), respectively. In both diseases, epithelial shedding was suggested by an elevated epithelial cell count, 13.5 and 12%, respectively. Lymphocyte subset analysis showed a higher proportion of CD8 cells (58 versus 40%) and therefore a lower CD4/CD8 ratio (0.266 versus 0. 455) in children with asthma compared with infantile wheezers (p = 0. 02). Irrespective of the presence or absence of radiological abnormalities, a proportion of neutrophils > 10%, was found in one-third of the children with asthma and in half of the infantile wheezers, and was related to symptom severity. We suggest that neutrophil-mediated inflammation, with or without bacterial infection, may contribute to symptoms of asthma in childhood. Chronic cough, however, is not associated with the cell profiles suggestive of asthma and in isolation should not be treated with prophylactic antiasthma drugs.
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Affiliation(s)
- C Marguet
- Paediatric Respiratory Disease Unit, Hopital Ch. Nicolle, Rouen, France
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31
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Abstract
Over the past 15 years, much has been learned about the presence of airway inflammation in asthma through the use of investigative bronchoscopy. It has become quite clear that inflammation is present even in mild asthma. In addition to the eosinophils, T-lymphocytes and a variety of cytokines have been identified to play a prominent role in asthmatic inflammation. The concept of delayed asthmatic response after allergen exposure and its relationship to cellular inflammation and airway hyper-reactivity has become more clearly established. Our understanding of asthmatic airway inflammation, however, is incomplete. As interesting as the database has been so far, investigative FB has not defined a unique profile for patients with asthma. Specifically, lavage or endobronchial biopsy has not identified parameters that help in the diagnosis, assessment of disease severity, prognosis, or likelihood to respond to specific therapies. Also, the exact relationship between parameters in lavage compared with mucosal biopsy and how these are related to airway hyper-reactivity and the clinical syndrome of asthma remains poorly understood. In this regard, it must be confessed that currently FB with lavage and biopsy in asthmatics needs to be considered as a research tool for specimen retrieval to help characterize and express inflammation. Although these techniques have contributed immensely to our understanding of asthma pathogenesis, presently these techniques do not have any practical role or clinical usefulness.
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Affiliation(s)
- M S Kavuru
- Pulmonary Function Laboratory, Cleveland Clinic Foundation, Ohio, USA
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32
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Zaitsu M, Hamasaki Y, Ishii K, Kita M, Hayasaki R, Muro E, Yamamoto S, Kobayashi I, Matsuo M, Ichimaru T, Miyazaki S. Direct evidence that LTC4 and LTB4 but not TXA2 are involved in asthma attacks in children. J Asthma 1998; 35:445-8. [PMID: 9734352 DOI: 10.3109/02770909809048953] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There are substantial numbers of reports showing that leukotrienes (LTs) play important roles in adult asthma. No definite evidence has been demonstrated that LTs are involved in asthma attacks in children, although it is highly expected. In this report, we demonstrated that the levels of LTB4 and LTC4 but not thromboxane B2 (TXB2), a stable metabolite of TXA2, were significantly elevated in the bronchoalveolar lavage fluid, which was obtained from intubated and mechanically ventilated children with severe asthma attacks. This is direct evidence that LTB4 and LTC4 predominantly participate in asthma attacks in pediatric patients.
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Affiliation(s)
- M Zaitsu
- Department of Pediatrics, Saga Medical School, Japan
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Harbeck RJ. Immunophenotyping of bronchoalveolar lavage lymphocytes. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1998; 5:271-7. [PMID: 9605975 PMCID: PMC104508 DOI: 10.1128/cdli.5.3.271-277.1998] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R J Harbeck
- National Jewish Medical and Research Center, Denver, Colorado 80206, USA. harbeck.njc.org
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34
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Jarjour NN, Peters SP, Djukanović R, Calhoun WJ. Investigative use of bronchoscopy in asthma. Am J Respir Crit Care Med 1998; 157:692-7. [PMID: 9517577 DOI: 10.1164/ajrccm.157.3.9705020] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The incorporation of bronchoscopy and bronchoscopic procedures into the investigation of asthma mechanisms, treatment, and in particular, the role of airway inflammation has contributed significantly to the enhanced understanding of this disease. Carefully drafted guidelines have allowed the gradual inclusion of subjects with more severe disease in studies utilizing bronchoscopic investigative tools. Many more questions remained unanswered, including the importance of persistence of airway inflammation in asymptomatic asthma, the specific antiinflammatory effects of new (and old) asthma therapies, the contribution of airway structural changes (subepithelial fibrosis) to nonreversible obstruction, the role of antiinflammatory versus proinflammatory cytokines in the pathogenesis of airway inflammation and the heterogeneity of disease expression in various groups of subjects. We are confident that current and future meticulously designed and executed research studies utilizing bronchoscopic techniques will significantly add to our knowledge of disease mechanisms and lead us to new and improved treatments for asthma.
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Affiliation(s)
- N N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine, Madison, USA
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35
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Lamblin C, Gosset P, Tillie-Leblond I, Saulnier F, Marquette CH, Wallaert B, Tonnel AB. Bronchial neutrophilia in patients with noninfectious status asthmaticus. Am J Respir Crit Care Med 1998; 157:394-402. [PMID: 9476849 DOI: 10.1164/ajrccm.157.2.97-02099] [Citation(s) in RCA: 236] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cellular events that occur in status asthmaticus (SA) remain poorly investigated. Autopsy studies frequently emphasized about the presence of eosinophils in bronchial airway wall, whereas recent studies reported increased number of neutrophils in patients dying of sudden-onset fatal asthma. Mucus plugs occluding the bronchial lumen are almost constant features during SA. Bronchial lavage (BL) may be useful to remove mucus plugs in cases of atelectasis and/or refractory SA. We investigated the contribution of different cell types and cellular mediators (neutrophil elastase, eosinophil cationic protein [ECP], histamine, interleukin-8 [IL-8]) to the pathogenesis of SA. We studied 16 BL from eight patients undergoing mechanical ventilation (MV) for SA (time interval from onset of MV = Day 0 to Day 11), four BL from patients undergoing MV without preexisting respiratory disease (V), 11 BL from patients with stable asthma (A) and eight BL from healthy controls (C). SA exhibited higher number and percentage of neutrophils (81.5 +/- 4.5%) than V (44.3 +/- 12.2) (p < 0.05), A (6.9 +/- 2.7) and C (9.5 +/- 3.8) (p < 0.0001), and higher number of eosinophils than V, A, and C (p < 0.01). Neutrophil elastase, ECP, and IL-8 levels were dramatically increased in SA. Histamine was higher in SA than in C and V (p < 0.05). Bronchial neutrophilia was not related to concomitant bacterial infection as bacteriological cultures were positive in only three BL. Eosinophils, mast cells and histamine were higher in BL performed within the first 48 h of MV (p < 0.05) than in BL performed later on. Our results indicate that bronchial inflammation in SA differs from bronchial inflammation in mild asthma. Persistent bronchial neutrophilia is associated with increased eosinophils and mast cells in the early phase of SA. Neutrophils may result in tissue damage and participate to the shedding of the epithelium in SA.
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Affiliation(s)
- C Lamblin
- Clinique des Maladies Respiratoires, Hôpital A. Calmette, CHRU, Lille, France
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36
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Brinkman L, Aslander MM, Raaijmakers JA, Lammers JW, Koenderman L, Bruijnzeel-Koomen CA. Bronchial and cutaneous responses in atopic dermatitis patients after allergen inhalation challenge. Clin Exp Allergy 1997; 27:1043-51. [PMID: 9678836 DOI: 10.1111/j.1365-2222.1997.tb01256.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is often associated with allergic asthma (AA). Inhalation of allergens influences the activity of AA but the effect on the skin in AD is unclear. OBJECTIVES We evaluated the degree of bronchial hyperresponsiveness to methacholine in eight AD patients with AA (AD+) and eight AD patients without AA (AD-) and studied bronchial and cutaneous responses after allergen inhalation challenge. METHODS All patients were treated in hospital for their eczema with tar ointment (pix liquida) and orally administered antihistamines (mean hospital stay 37 days). After clearing of the skin lesions allergen inhalation challenge was performed. Cutaneous responses were studied by measuring the 'Costa' score before and 24 h after allergen inhalation challenge. RESULTS The median value of the provocative concentration of methacholine causing a 20% fall (PC20 Mch) in forced expiratory volume in 1 second (FEV1) was significantly higher in the AD- group compared to the AD+ group with median values of 10.70 and 0.60 mg/mL, respectively. These values did not change significantly in both groups during hospital stay. After challenge all AD+ patients showed early and late asthmatic responses whereas only four AD patients showed early asthmatic responses (mean values of the maximal fall in FEV1 during the EAR 37%/16% and in PEF during the LAR 27%/4% for AD+ and AD-patients, respectively). The 'Costa' score increased in both groups (mean score before 19.1/24.4 and after challenge 26.8/26.9 for AD+ and AD- patients, respectively). The increase in the AD+ group was significantly higher compared with the AD- group (P=0.016). CONCLUSION We conclude that allergen inhalation challenge causes a flare up of the skin lesions in atopic dermatitis patients. This was more prominent in atopic dermatitis patients who already suffered from an IgE-mediated allergic inflammation in the lung.
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Affiliation(s)
- L Brinkman
- Department of Pulmonary Diseases, University Hospital Utrecht, The Netherlands
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37
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Abstract
Despite improved understanding of the pathophysiology and treatment of asthma, significant morbidity and mortality exist for both the pediatric and adult patient. The critical care practitioner must understand the chronic as well as the acute nature of the condition in order to provide effective intervention. This article reviews the epidemiology and pathophysiology of asthma, clinical assessment, management principles, therapeutic modalities, and future approaches to the management of asthma.
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Affiliation(s)
- N H Cohen
- Department of Anesthesia, University of California, San Francisco, USA
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38
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Oddera S, Silvestri M, Sacco O, Crimi E, Rossi GA. Inflammatory changes in proximal and peripheral airways of asthmatic patients. Respir Med 1997; 91:323-6. [PMID: 9282233 DOI: 10.1016/s0954-6111(97)90057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S Oddera
- Divisione di Pneumologia, Istituto G. Gaslini Genoa, Italy
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39
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Jolliet P, Bulpa P, Thorens JB, Ritz M, Chevrolet JC. Nitric oxide and prostacyclin as test agents of vasoreactivity in severe precapillary pulmonary hypertension: predictive ability and consequences on haemodynamics and gas exchange. Thorax 1997; 52:369-72. [PMID: 9196521 PMCID: PMC1758528 DOI: 10.1136/thx.52.4.369] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In patients with primary pulmonary hypertension who respond to vasodilators acutely, survival can be improved by the long term use of calcium channel blockers. However, testing for such a response with calcium channel blockers or prostacyclin (PGI2) may cause hypotension and adversely affect gas exchange. Nitric oxide (NO), which does not have these effects, could be a better test agent. METHODS NO (10, 20, and 40 ppm for 15 minutes), PGI2 (1-->10 ng/kg/min), and oral nifedipine (10 mg, then 20 mg/h) were administered sequentially to 10 patients after determination of the 24 hour spontaneous variability of their pulmonary and systemic mean arterial pressures. Patients were considered responders if the mean pulmonary artery pressure or pulmonary vascular resistance decreased by 20% or more. RESULTS Six patients (60%) responded to all three agents, and three to none of the agents. One patient responded to PGI2 only. In those who responded to vasodilators, NO had no major effect on gas exchange or systemic haemodynamics, while PGI2 and nifedipine both induced systemic hypotension (mean (SD) systemic arterial pressure 72 (14) versus 89 (19) mm Hg with PGI2 and 72 (15) versus 86 (17) mm Hg with nifedipine, p < 0.05) and hypoxaemia (PaO2 8.7 (1.4) versus 10.8 (1.0) kPa with PGI2 and 8.6 (1.4) versus 10.2 (1.5) kPa with nifedipine, p < 0.05) and increased venous admixture (28 (9) versus 14 (4)% with PGI2 and 22 (9) versus 13 (5)% with nifedipine, p < 0.05). CONCLUSIONS NO inhalation can accurately predict a vasodilator response to nifedipine in patients with severe pulmonary hypertension without adverse effects on systemic haemodynamics and gas exchange. This absence of side effects may make it a more appropriate agent for testing the vasodilator response.
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Affiliation(s)
- P Jolliet
- Medical ICU Division, University Hospital, Geneva, Switzerland
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40
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Keatings VM, Evans DJ, O'Connor BJ, Barnes PJ. Cellular profiles in asthmatic airways: a comparison of induced sputum, bronchial washings, and bronchoalveolar lavage fluid. Thorax 1997; 52:372-4. [PMID: 9196522 PMCID: PMC1758529 DOI: 10.1136/thx.52.4.372] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Analysis of bronchoalveolar lavage fluid has improved our understanding of the pathogenesis of asthma. Safety issues and access to expert resources limit this techniques as a research tool. Induced sputum is a non-invasive method of collecting airway fluid which is applicable to subjects with a range of severity of airflow obstruction. The method of sputum collection and processing differs between groups. A study was undertaken to compare induced sputum with bronchoscopically collected fluid. METHODS Sixteen patients with mild stable asthma underwent both sputum induction and bronchoscopic examination with bronchial washings and bronchoalveolar lavage (BAL) in random order, with each procedure being separated by an interval of 12 days. Airway fluid was processed and stained for differential cell counting. RESULTS Induced sputum was relatively rich in neutrophils and eosinophils compared with bronchial washings and BAL fluid (mean (SE) 1.3 (0.4)%, 5.0 (2.7)%, and 36.4 (3.7)% neutrophils and 0.6 (0.1)%, 1.6 (0.6)%, and 3.3 (1.1)% eosinophils in BAL fluid, bronchial washings, and induced sputum, respectively). The proportions of cells obtained at sputum induction correlated with those in bronchial washings but not BAL fluid (r = 0.6 and 0.7 for neutrophils and eosinophils, respectively, p < 0.05). By contrast, induced sputum had a lower proportion of lymphocytes and macrophages than bronchial washings or BAL fluid, without any correlation. CONCLUSION Induced sputum is rich in neutrophils and eosinophils and poor in lymphocytes, suggesting an origin in the larger airways. Induced sputum adequately reflects the findings in fluid collected by direct bronchoscopy.
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41
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Bromley IM, Donaldson K. Binding of Aspergillus fumigatus spores to lung epithelial cells and basement membrane proteins: relevance to the asthmatic lung. Thorax 1996; 51:1203-9. [PMID: 8994516 PMCID: PMC472764 DOI: 10.1136/thx.51.12.1203] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Aspergillus fumigatus is an opportunistic pathogen to which asthmatic subjects are particularly susceptible. The ability of spores of A fumigatus to bind to pulmonary cells and basement membrane proteins was investigated to determine the mechanisms involved in this susceptibility. METHODS Cells of the A549 pulmonary epithelial cell line or purified basement membrane proteins were immobilised on the wells of microtitre plates. They were then exposed to spores of A fumigatus in suspension, with or without various pretreatments of the spores, cells, and proteins. Adherent spores were counted by light microscopy. RESULTS Spores of A fumigatus bound in a concentration dependent manner to A549 epithelial cells and pretreatment of cells with interferon gamma (2500 units/ml) caused a significant doubling of spore binding. Binding of spores to A549 cells was inhibited by about a third by pre-incubation of the spores with fibrinogen (100 micrograms/ml). Spores bound specifically to extracellular matrix (ECM) components laid down by A549 cells, and pretreatment of the ECM components with hydrogen peroxide (25-80 microM) enhanced spore binding by approximately one third. They also bound specifically and in a saturable manner to purified fibrinogen, fibronectin, laminin, type I collagen, and type IV collagen. Pre-incubation of spores with Arg-Gly-Asp tripeptide (RGD; 50-200 micrograms/ ml) inhibited binding to fibronectin and type I collagen by 50%. CONCLUSIONS This study suggests that the presence of activated epithelial cells and the exposure of basement membrane that occurs in asthma, together with oxidant stress, may facilitate the colonisation of the asthmatic lung by A fumigatus. The RGD sequence may be involved in spore binding to some ECM proteins. Free fibrinogen may protect against binding of A fumigatus spores to the pulmonary epithelium.
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Affiliation(s)
- I M Bromley
- Department of Biological Sciences, Napier University, Edinburgh, UK
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42
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Abstract
A great deal of information about the pathophysiology of asthma and its treatment have been obtained through the use of bronchoalveolar lavage (BAL), especially in combination with airway biopsies. The introduction of highly sophisticated methods for examining BAL aspirate, including fluorocein activated cell scanning (FACS) analysis and molecular biology techniques has emphasized the potential power of this method of airway investigation. For those contemplating the use of BAL in asthma research programmes, we hope that this review will provide a useful insight into the current state of knowledge about the technique and its application, and that it will provide a solid platform for study design.
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Affiliation(s)
- E H Walters
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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43
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Dye JA, McKiernan BC, Rozanski EA, Hoffmann WE, Losonsky JM, Homco LD, Weisiger RM, Kakoma I. Bronchopulmonary disease in the cat: historical, physical, radiographic, clinicopathologic, and pulmonary functional evaluation of 24 affected and 15 healthy cats. J Vet Intern Med 1996; 10:385-400. [PMID: 8947872 DOI: 10.1111/j.1939-1676.1996.tb02086.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The results of clinical and pulmonary functional evaluation of 24 cats with bronchopulmonary disease and 15 healthy cats are presented. Affected cats had historical evidence of excessive reflexes (coughing, sneezing); physical evidence of airway secretions (crackles), obstruction (wheezing), and increased tracheal sensitivity; radiographic evidence of bronchial and interstitial lung disease; and cytological evidence of airway inflammation or mucous secretions. Bacterial isolates from healthy and affected cats were predominantly Gram-negative rods, indicating that bronchi of cats are not always sterile and that normal flora should be considered in interpreting cultures from cats with suspected bronchopulmonary disease. Cats were grouped according to relative disease severity based on scored historical, physical, and radiographic abnormalities. The mean (+/- standard deviation) baseline lung resistance measurement in healthy cats was 28.9 cm H2O/L/s (+/- 6.2 cm H2O/L/s), whereas in mildly, moderately, and severely affected cats it was 38.3 cm H2O/L/s (+/- 21.5 cm H2O/L/s), 44.8 cmH2O/L/s (+/- 7.7 cm H2O/L/s), and 105.2 cm H2O/L/s (+/- 66.9 cm H2O/L/s), respectively. In healthy cats, dynamic lung compliance was 19.8 (+/- 7.4), whereas in mildly, moderately, and severely affected cats it was 14.7 mL/cm H2O (+/- 3.8 mL/cm H2O), 17.7 mL/cm H2O (+/- 6.9 mL/cm H2O), and 13.0 mL/cm H2O (+/- 7.9 mL/cm H2O), respectively. Thus, airway obstruction was present in many of the affected cats. Based on acute response to the bronchodilator, terbutaline, airway obstruction was partially reversible in many affected cats, although the degree of reversibility varied. Furthermore, based on bronchoprovocation testing, 6 (of 7) affected cats evaluated also had increased airway responsiveness to aerosolized methacholine.
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Affiliation(s)
- J A Dye
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana 60801, USA
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44
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Frangova V, Sacco O, Silvestri M, Oddera S, Balbo A, Crimi E, Rossi GA. BAL neutrophilia in asthmatic patients. A by-product of eosinophil recruitment? Chest 1996; 110:1236-42. [PMID: 8915227 DOI: 10.1378/chest.110.5.1236] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Although neutrophil number may be increased in the airways of patients with asthma, its pathogenetic role in this disorder remains unclear. We evaluated BAL of 8 normal control subjects, 30 +/- 2 years of age, and 24 patients with mild asthma: 17 patients with allergic asthma, 24 +/- 1 years of age, and 7 patients with nonallergic asthma, 30 +/- 1 years of age. The BAL of asthmatic patients showed increased numbers of neutrophils (p < 0.01), eosinophils (p < 0.01), and ciliated epithelial cells (p < 0.05) and increased concentrations of myeloperoxidase (MPO) (p < 0.01) compared with control subjects. Positive correlations were observed between the number of BAL neutrophils and eosinophils (Rs = 0.780, p < 0.0001) and between BAL neutrophil numbers and BAL MPO levels (Rs = 0.40, p < 0.05). No correlations were found between the following: (1) BAL eosinophils or neutrophils and BAL epithelial cells (p > 0.05, each comparison); (2) BAL neutrophils or eosinophils and log Pd15 methacholine (MCh) (p > 0.05, each comparison); or (3) BAL epithelial cells or log Pd15 MCh and BAL MPO (p > 0.05, each comparison). Dividing the patient population into two groups, allergic asthmatics and nonallergic asthmatics, similar BAL neutrophil, eosinophil, and epithelial cell numbers and similar MPO levels were found (p > 0.05, each comparison). In addition, the correlations between BAL neutrophils and eosinophils showed similar significance in the two patient subgroups (p > 0.05, each comparison). These results suggest that, both in allergic and nonallergic asthma, airway recruitment and activation of neutrophils occur as does parallel eosinophil migration. However, airway neutrophils do not seem to contribute significantly to epithelial cell injury or to airway hyperresponsiveness in the steady state.
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Affiliation(s)
- V Frangova
- Divisione di Pneumologia, Istituto G. Gaslini, Genoa, Italy
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45
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Kodavanti UP, Jaskot RH, Bonner J, Badgett A, Dreher KL. Eosinophilic lung inflammation in particulate-induced lung injury: technical consideration in isolating RNA for gene expression studies. Exp Lung Res 1996; 22:541-54. [PMID: 8886758 DOI: 10.3109/01902149609046041] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Particulate and other pollutant exposures are associated with lung injury and inflammation. The purpose of this study was to develop an approach by which intact RNA could be obtained from inflamed lung tissue from particulate-exposed animals in order to correlate injury with specific gene expression. Male Sprague Dawley (SD) and Fischer-344 (F-344) rats were intratracheally instilled with saline or residual oil fly ash (ROFA) particles, 8.3 mg/kg body weight in saline. At various time points following ROFA instillation, lungs were either lavaged or used for RNA isolation. ROFA exposure produced an increase in bronchoalveolar lavage fluid (BALF) neutrophils in both SD and F-344 rats. A time-dependent increase in eosinophils occurred only in SD rats but not in F-344 rats. Extraction of inflamed pulmonary tissue having a high influx of eosinophils for RNA using the conventional acid guanidinium thiocyanate phenol-chloroform (AGPC) procedure failed to provide undegraded RNA suitable for RT-PCR and Northern blot analysis of beta-actin mRNA expression. Mixing intact total RNA from saline control rat lungs with degraded RNA samples from inflamed lung yielded a gel profile of degraded RNA, indicating the presence of ribonuclease-like activity in the RNA extracted from lung tissues having eosinophil influx. Evidently, the conventional AGPC procedure failed to completely remove ribonuclease activity associated with ROFA-induced pulmonary eosinophil influx. This study reports a single-step modification to the AGPC extraction method that does not require additional reagents or additional precipitation steps for extracting undegraded RNA from nuclease-rich inflamed lung tissue. The aqueous layer resulting from mixing homogenate and chloroform is extracted a second time using an equal volume of AGPC buffer followed by addition of chloroform and centrifugation. The second aqueous phase is then treated as described in the conventional RNA extraction protocol. This simple and convenient modification does not require multiple precipitations of RNA and yields undegraded RNA from inflamed lung tissue with a slightly higher A260/A280 ratio without affecting overall RNA recovery. The results indicate that undegraded RNA could not be isolated using the routine AGPC-based isolation technique from lung tissue containing eosinophils following ROFA exposure. The degraded RNA preparations were unsuitable for gene expression studies. However, undegraded RNA can be isolated from these tissues by modifying the original AGPC RNA extraction procedure, which is suitable for gene expression analysis using northern blot and RT-PCR techniques.
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Affiliation(s)
- U P Kodavanti
- Pulmonary Toxicology Branch, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
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46
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Humbert M, Robinson DS, Assoufi B, Kay AB, Durham SR. Safety of fibreoptic bronchoscopy in asthmatic and control subjects and effect on asthma control over two weeks. Thorax 1996; 51:664-9. [PMID: 8882070 PMCID: PMC472486 DOI: 10.1136/thx.51.7.664] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Concerns remain about the safety of bronchoscopy in asthma and there are few data on the effect of this procedure on asthma control in the days or weeks following bronchoscopy. METHODS In an initial study of bronchoalveolar lavage and bronchial biopsies in asthmatic and control subjects, data on peak expiratory flow rates (PEFR) collected prospectively before and after the procedure were available from 21 of the 29 asthmatic subjects studied. These showed a median 23% fall in PEFR from baseline after bronchoscopy (range 3-58%). To determine whether this fall in PEFR following bronchoscopy reflected bronchospasm or the effect of sedation, PEFR and spirometric tests were performed during the two hours following bronchoscopy in a further study of 15 symptomatic asthmatic subjects and 20 non-asthmatic controls. To examine the effect on asthma control, asthmatic patients recorded PEFR, symptom scores, and medication use for two weeks before and after bronchoscopy. RESULTS After bronchoscopy with bronchial biopsies there was no difference between the median maximal fall in either PEFR or arterial oxygen saturation between the 15 asthmatic patients (10.4% and 4%, respectively) and 20 controls (12% and 3%). Moreover, there were no significant changes in PEFR, symptom score, or medication use by the asthmatic subjects in the two weeks after bronchoscopy when compared with the two weeks before bronchoscopy. CONCLUSIONS Fibreoptic bronchoscopy is well tolerated in asthmatic subjects. Falls in PEFR in both asthmatic and non-asthmatic subjects after bronchial biopsy may reflect the effects of sedation rather than bronchospasm. Additional bronchoalveolar lavage may cause bronchoconstriction. Careful monitoring is therefore essential. Peak flow monitoring up to two weeks after bronchoscopy with bronchial biopsy revealed no delayed effects on asthma control.
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Affiliation(s)
- M Humbert
- Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, UK
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47
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Affiliation(s)
- H M Jansen
- Department of Pulmonology, Academic Medical Center, Amsterdam, The Netherlands
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48
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Gormand F, Chabannes B, Moliere P, Perrin-Fayolle M, Lagarde M, Pacheco Y. Uptake of 12-HETE by human bronchial epithelial cells (HBEC): effects on HBEC cytokine production. PROSTAGLANDINS 1996; 51:263-73. [PMID: 8935186 DOI: 10.1016/0090-6980(96)00021-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
12-HETE, the major lipoxygenase end-product of platelets and macrophages, may be released in contact of bronchial epithelium in inflammatory diseases of the lung. We have studied the outcome of 12-HETE in presence of human bronchial epithelial cells (HBEC). When HBEC were incubated with [3H]12-HETE for 30 minutes, 27.5% of total radioactivity was found in HBEC and 72.5% in supernatants. Unesterified 12-HETE accounted for 22.4% of total radioactivity, 4.5% being recovered in phospholipids, preferentially in phosphatidylcholine and phosphatidylethanolamine. No incorporation in neutral lipids was detected. 72.9% of the incubated radioactivity was recovered in un identified metabolites. As 12-HETE has been shown to modulate the expression and production of various proteins, the consequence of the 12-HETE uptake on the release of GM-CSF and IL8 by HBEC was assessed. HBEC from control subjects were cultured for 24 hours with 12-HETE (10(-9) to 10(-7)M) in the presence or absence of TNF alpha. Detectable amounts of both cytokines were released in the supernatant in basal conditions at 24hr, and TNF alpha increased significantly the release of GM-CSF. 12-HETE at 10(-7)M weakly but significantly decreased the TNF-induced release of GM-CSF from HBEC. Thus the uptake of 12-HETE could affect the epithelial cell function in some situations.
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Affiliation(s)
- F Gormand
- Laboratoire d'Immunoallergologie Respiratoire and Unite Inserm 352, Centre Hospitalier Lyon-Sud, France
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49
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Abstract
Adolescent pregnancy has increased in the past decade (1-5), often in association with poverty, poor education, and inadequate prenatal care. While it has been suggested that adverse pregnancy outcomes are more common among adolescents in the inner city, recent data show that in a white, middle-class population teenaged mothers are more likely to have adverse pregnancy outcomes (5). Asthma is also becoming more common, with an incidence of at least 6.6% in 15-16 year old girls (6,7). Poverty and living in the inner city are associated with increased morbidity and mortality from asthma (8-11). Adolescents with asthma who become pregnant provide an added challenge to the physician who must consider the impact of the pregnancy on the asthma and vice versa. The physician must understand the effects of both the asthma medication and/or poorly controlled disease on the fetus. The physician must also be able to convey this information to the adolescent in a developmentally appropriate manner to enable the patient to make informed health care decisions (12).
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Affiliation(s)
- V Shulman
- Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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50
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Oddera S, Silvestri M, Balbo A, Jovovich BO, Penna R, Crimi E, Rossi GA. Airway eosinophilic inflammation, epithelial damage, and bronchial hyperresponsiveness in patients with mild?moderate, stable asthma. Allergy 1996. [DOI: 10.1111/j.1398-9995.1996.tb00042.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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