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Praca E, Jalou H, Krupp N, Delecaris A, Hatch J, Slaven J, Gunst SJ, Tepper RS. Effect of CPAP on airway reactivity and airway inflammation in children with moderate-severe asthma. Respirology 2019; 24:338-344. [PMID: 30444283 PMCID: PMC6743322 DOI: 10.1111/resp.13441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/05/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Asthma is characterized by airway hyperreactivity and airway inflammation. We previously demonstrated that adults with mild well-controlled asthma exhibited a marked decrease in airway reactivity (PC20 increased >2-fold) after using nocturnal continuous positive airway pressure (CPAP) for 1 week. If CPAP produces a similar suppression of airway reactivity in children with moderate-severe asthma, who require chronic use of corticosteroids, then this non-pharmacological therapy might provide a beneficial alternative or supplemental therapy in these subjects. METHODS Children aged 8-17 years with moderate-severe asthma were treated with 4 weeks of nocturnal CPAP (8-10 cm H2 O) or sham CPAP (<2 cm H2 O). Adherence was monitored with a modem installed in the equipment or by memory cards. Airway reactivity, assessed by methacholine bronchial challenge, was measured prior to and following treatment. RESULTS The percentage of subjects adherent to treatment was similar in both groups (19/27 CPAP vs 19/28 sham, ~70%). There was a tendency for PC20 to increase with treatment in both groups (3.0-5.3 mg/mL CPAP vs 3.2 to 4.3 mg/mL sham, P = 0.083); however, the change did not differ significantly between groups (P = 0.569). CONCLUSION We found that the 4-week treatment with nocturnal CPAP did not produce a twofold suppression of airway reactivity in children with moderate-severe asthma.
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Affiliation(s)
- Eduardo Praca
- Department of Pediatrics, Division of Pulmonology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hasnaa Jalou
- Department of Pediatrics, Division of Pulmonology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nadia Krupp
- Department of Pediatrics, Division of Pulmonology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Angela Delecaris
- Department of Pediatrics, Division of Pulmonology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph Hatch
- Department of Pediatrics, Division of Pulmonology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James Slaven
- Department of Biostatistics, Indiana University Schools of Medicine and Public Health, Indianapolis, IN, USA
| | - Susan J Gunst
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert S Tepper
- Department of Pediatrics, Division of Pulmonology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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Karrasch S, Radtke T, Simon M, Kronseder A, Dressel H, Jörres RA, Ochmann U. Acute effects of hypertonic saline inhalation on nitric oxide pulmonary diffusing capacity in healthy adults. Respir Physiol Neurobiol 2018; 258:40-46. [PMID: 30261306 DOI: 10.1016/j.resp.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/13/2018] [Accepted: 09/21/2018] [Indexed: 11/26/2022]
Abstract
We investigated acute effects of inhalation of hypertonic saline solution (HSS) and oxygen (O2, control exposure) on pulmonary diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO). In a randomized crossover study, 20 healthy, non-smoking subjects were allocated to short-term inhalation of HSS or O2. Spirometry [(forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)] and combined single-breath DLNO-DLCO measurements were performed before and immediately after inhalation of either HSS or O2. Percent changes were presented as median values (interquartile range). After HSS inhalation, DLNO, FEV1 and FVC were decreased by -3.0% (-7.3, 0.5), -3.1% (-4.2, -1.6) and -1.2% (-3.3, 0.6), respectively (all P < 0.05), without significant effect on DLCO. No changes in spirometry and diffusing capacity were observed following O2 inhalation. Acute inhalation of HSS causes a slight decrease in membrane conductance, probably as a result of fluid imbalance at the alveolar surface and interstitial fluid accumulation, both of which could impair gas exchange.
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Affiliation(s)
- S Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Neuherberg, Germany
| | - T Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Division of Occupational and Environmental Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
| | - M Simon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - A Kronseder
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - H Dressel
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Division of Occupational and Environmental Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - R A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Neuherberg, Germany
| | - U Ochmann
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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Gagliardo R, Gras D, La Grutta S, Chanez P, Di Sano C, Albano GD, Vachier I, Montalbano AM, Anzalone G, Bonanno A, Riccobono L, Gjomarkaj M, Profita M. Airway lipoxin A4/formyl peptide receptor 2-lipoxin receptor levels in pediatric patients with severe asthma. J Allergy Clin Immunol 2016; 137:1796-1806. [PMID: 26971688 DOI: 10.1016/j.jaci.2015.11.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 11/10/2015] [Accepted: 11/20/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Lipoxins are biologically active eicosanoids with anti-inflammatory properties. Lipoxin A4 (LXA4) signaling blocks asthmatic responses in human and experimental model systems. There is evidence that patients with respiratory diseases, including severe asthma (SA), display defective generation of lipoxin signals despite glucocorticoid therapy. OBJECTIVE We investigated airway levels of formyl peptide receptor 2-lipoxin receptor (FPR2/ALXR), LXA4, and its counterregulatory compound, leukotriene B4 (LTB4), in patients with childhood asthma. We addressed the potential interplay of the LXA4-FPR2/ALXR axis and glucocorticoids in the resolution of inflammation. METHODS We examined LXA4 and LTB4 concentrations in induced sputum supernatants from children with intermittent asthma (IA), children with SA, and healthy control (HC) children. In addition, we investigated FPR2/ALXR expression in induced sputum cells obtained from the study groups. Finally, we evaluated in vitro the molecular interaction between LXA4 and glucocorticoid receptor-based mechanisms. RESULTS We found that children with SA have decreased LXA4 concentrations in induced sputum supernatants in comparison with children with IA. In contrast to decreases in LXA4 concentrations, LTB4 concentrations were increased in children with asthma independent of severity. LXA4 concentrations negatively correlated with LTB4 concentrations and with exacerbation numbers in children with SA. FPR2/ALXR expression was reduced in induced sputum cells of children with SA compared with that seen in HC subjects and children with IA. Finally, we describe in vitro the existence of crosstalk between LXA4 and glucocorticoid receptor at the cytosolic level mediated by G protein-coupled FPR2/ALXR in peripheral blood granulocytes isolated from HC subjects, children with IA, and children with SA. CONCLUSION Our findings provide evidence for defective LXA4 generation and FPR2/ALXR expression that, associated with increased LTB4, might be involved in a reduction in the ability of inhaled corticosteroids to impair control of airway inflammation in children with SA.
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Affiliation(s)
- Rosalia Gagliardo
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy.
| | - Delphine Gras
- Département des Maladies Respiratoires, AP-HM, Aix Marseille Université, Marseille, France
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy
| | - Pascal Chanez
- Département des Maladies Respiratoires, AP-HM, Aix Marseille Université, Marseille, France
| | - Caterina Di Sano
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy
| | - Giusy D Albano
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy
| | | | - Angela M Montalbano
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy
| | - Giulia Anzalone
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy
| | - Anna Bonanno
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy
| | - Loredana Riccobono
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy
| | - Mark Gjomarkaj
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy
| | - Mirella Profita
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, Palermo, Italy
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Keeratichananont W, Nilmoje T, Keeratichananont S, Rittatorn J. Diagnostic yield and safety of sputum induction with nebulized racemic salbutamol versus hypertonic saline in smear-negative pulmonary tuberculosis. Ther Adv Respir Dis 2015. [PMID: 26206666 DOI: 10.1177/1753465815594529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of the study was to compare the diagnostic yield and safety profile of sputum induction (SI) with nebulized racemic salbutamol solution versus hypertonic saline in smear-negative pulmonary tuberculosis (TB). METHODS The prospective study was conducted at Songklanagarind Hospital, Thailand. Suspected smear-negative pulmonary TB cases were recruited and randomized to receive SI with either nebulized racemic salbutamol solution or 3% sodium chloride (NaCl) solution. Induced sputum was examined with the acid-fast bacilli (AFB) smear test and cultured for Mycobacterium tuberculosis. The efficacy and adverse events of SI were analyzed. RESULTS A total of 59 patients received SI with nebulized racemic salbutamol solution and 53 received 3% NaCl solution. There was no significant difference between the two groups in the average quantity of induced sputum (1.3 ± 0.1 versus 1.2 ± 0.2 ml, p = 0.5). The percentages of positive AFB smear and TB cultures in the salbutamol group were 15% and 22%, and 13% and 17% in the 3% NaCl group (p = 0.5), respectively. Racemic salbutamol solution could increase the TB diagnostic yield similarly to 3% NaCl, but incurred less chest tightness (5% versus 15%) and bronchospasm (0% versus 11.3%, p = 0.02) compared with 3% NaCl. CONCLUSIONS SI by nebulized racemic salbutamol solution offers equal benefits to 3% NaCl solution in increasing both sputum quantity and diagnostic yield in smear-negative patients suspected of having pulmonary TB. Nebulized racemic salbutamol does not produce bronchospasm and chest tightness occurs less frequently than with 3% NaCl. Therefore, SI with nebulized racemic salbutamol solution should be considered as a good alternative noninvasive diagnostic tool for the diagnosis of pulmonary TB when hypertonic saline is unavailable or contraindicated.
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Affiliation(s)
- Warangkana Keeratichananont
- Assistant Professor, Division of Respiratory and Respiratory Critical Care Medicine, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Thanapon Nilmoje
- Department of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | | | - Jedsada Rittatorn
- Department of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
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Gagliardo R, Chanez P, Gjomarkaj M, La Grutta S, Bonanno A, Montalbano AM, Di Sano C, Albano GD, Gras D, Anzalone G, Riccobono L, Profita M. The role of transforming growth factor-β1 in airway inflammation of childhood asthma. Int J Immunopathol Pharmacol 2014; 26:725-38. [PMID: 24067469 DOI: 10.1177/039463201302600316] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
TGF-beta-targeting structural and inflammatory cells has been implicated in the mechanisms leading to the inflammatory and restructuring processes in asthma, suggesting an impact of TGF-beta1 signaling on the development and persistency of this disease. We investigated the potential early involvement of TGF-beta1 activity in the immunological and molecular mechanisms underlying progression of inflammation in childhood asthma. We evaluated the levels of TGF-beta1 in induced sputum supernatants (ISSs) and the expression of small mother cell against decapentaplegic (Smad) 2 and Smad7 proteins in induced sputum cells (ISCs) from children with intermittent asthma (IA), moderate asthma (MA) and control subjects (C). Furthermore, we investigated the regulatory role of TGF-beta1 activity on eosinophil and neutrophil adhesion to epithelial cells using adhesion assay, and on the granulocyte expression of adhesion molecule CD11b/CD18 Macrophage-1 antigen (MAC-1), by flow cytometry. We found that the levels of TGF-beta1 are increased in ISSs of IA and MA in comparison to C, concomitantly to the activation of intracellular signaling TGFbeta/Smads pathway in ISCs. In MA, TGF-beta1 levels correlated with the number of sputum eosinophils and neutrophils. Furthermore, we showed the ability of sputum TGF-beta1 to promote eosinophil and neutrophil adhesion to epithelial cells, and to increase the expression of MAC-1 on the granulocyte surface. This study shows the activation of TGFbeta/Smad signaling pathway in the airways of children with IA and, despite the regular ICS treatment, in children with MA, and provides evidence for the contribution of TGF-beta1 in the regulation of granulocyte activation and trafficking.
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Affiliation(s)
- R Gagliardo
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, A. Maurizio Vignola Laboratories, Italian National Research Council, Palermo, Italy
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Brooks CR, Gibson PG, Douwes J, Van Dalen CJ, Simpson JL. Relationship between airway neutrophilia and ageing in asthmatics and non-asthmatics. Respirology 2014; 18:857-65. [PMID: 23490307 DOI: 10.1111/resp.12079] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 11/11/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Increased sputum neutrophilia has been observed in asthma, but also during normal ageing in asthmatics and non-asthmatics. It remains unclear what constitutes 'normal' neutrophil levels in different age groups. METHODS We assessed the relationship between age and airway neutrophils of 194 asthmatics and 243 non-asthmatics (age range: 6-80 years). Regression analyses were used to assess this relationship adjusted for confounders including asthma status, atopy, gender, smoking and current use of inhaled corticosteroids (ICS). Age-corrected reference values for different age groups were determined using the 95th percentile of non-asthmatic participants. RESULTS Age was positively associated with sputum neutrophils in both asthmatic and non-asthmatic adults (0.46% neutrophil increase/year (95% confidence interval (CI) 0.18, 0.73) and 0.44%/year (0.25, 0.64, respectively), but no association was found in the <20-year age category. Individuals with high sputum neutrophil counts (>95th percentile of non-asthmatic counts for any given age group) were significantly more likely to be asthmatic (odds ratio = 2.5; 95% CI: 1.3, 5.0), with the greatest effect observed in the older age group. Other factors that independently associated with increased sputum neutrophil levels included atopy in non-asthmatic adults, male gender and current use of ICS in asthmatic adults. Age-specific reference values for neutrophil percentage were under 20 years-76%, 20-40 years-62%, 40-60 years-63% and over 60 years-67%. CONCLUSIONS Airway neutrophilia is related to age in adults, with a neutrophilic asthma phenotype present in older adults. The use of appropriate age-specific reference values is recommended for future studies aimed at elucidating the role of neutrophils in asthma.
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Affiliation(s)
- Collin R Brooks
- Centre for Public Health Research, Massey University Wellington Campus, Wellington, New Zealand.
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Cabana MD, Kunselman SJ, Nyenhuis SM, Wechsler ME. Researching asthma across the ages: insights from the National Heart, Lung, and Blood Institute's Asthma Network. J Allergy Clin Immunol 2014; 133:27-33. [PMID: 24369796 PMCID: PMC3901784 DOI: 10.1016/j.jaci.2013.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/24/2022]
Abstract
Clinical asthma studies across different age groups (ie, cross-age studies) can potentially offer insight into the similarities, differences, and relationships between childhood and adult asthma. The National Institutes of Health's Asthma Research Network (AsthmaNet) is unique and innovative in that it has merged pediatric and adult asthma research into a single clinical research network. This combination enhances scientific exchange between pediatric and adult asthma investigators and encourages the application of cross-age studies that involve participants from multiple age groups who are generally not studied together. The experience from AsthmaNet in the development of cross-age protocols highlights some of the issues in the evaluation of cross-age research in asthma. The aim of this review is to summarize these challenges, including the selection of parallel cross-age clinical interventions, identification of appropriate controls, measurement of meaningful clinical outcomes, and various ethical and logistic issues.
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Affiliation(s)
- Michael D Cabana
- Departments of Pediatrics, Epidemiology, and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, Calif.
| | | | - Sharmilee M Nyenhuis
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Hospital and Health Sciences System, Chicago, Ill
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Vizmanos-Lamotte G, Moreno-Galdó A, Muñoz X, Gómez-Ollés S, Gartner S, Cruz MJ. Induced sputum cell count and cytokine profile in atopic and non-atopic children with asthma. Pediatr Pulmonol 2013; 48:1062-9. [PMID: 23401467 DOI: 10.1002/ppul.22769] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 11/02/2012] [Accepted: 11/02/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIM Sputum induction is a semi-invasive technique used to detect and monitor airway inflammation. In this study, the cell profile, and Th1 and Th2 cytokine levels in induced sputum of asthmatic and healthy children (HC) are compared. METHODS Sputum induction was performed in healthy and asthmatic children by inhalation of hypertonic saline solution. Differential cell count in the specimen obtained was carried out using optic microscopy. IFN-γ, IL-2, IL-10, IL-8, IL-6, IL-4, IL-5, IL-1β, TNF-α, and IL-12p70 levels were determined in sputum sample supernatants by flow cytometry. RESULTS Sputum induction was performed in 31 HC and 77 asthmatic children (60 atopic and 17 non-atopic asthma, NAA). Twenty-four samples were obtained in HC and 64 in patients. Median eosinophil count in atopic asthma (AA; 2%) was higher than in NAA (P = 0.02) or HC (P = 0.01). IL-4, IL-5, IFNγ, IL-2, and IL-12p70 concentrations were higher in AA than in NAA or HC. IL-8 was higher in asthmatic children (atopic and non-atopic) than in healthy ones. IL-10 was higher in the healthy group than in the AA group (P = 0.02). CONCLUSIONS As compared to HC, the inflammatory profile in induced sputum of children with asthma showed an increase in proinflammatory cytokines. Concentrations of IL-10, an anti-inflammatory cytokine, were lower in children with AA than in HC.
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Affiliation(s)
- G Vizmanos-Lamotte
- Servicio de Pediatría, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Principat d'Andorra Andorra
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Tillie-Leblond I, Deschildre A, Gosset P, de Blic J. Difficult childhood asthma: management and future. Clin Chest Med 2013; 33:485-503. [PMID: 22929097 DOI: 10.1016/j.ccm.2012.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diagnosis and management of severe asthma implies the definition of different entities, that is, difficult asthma and refractory severe asthma, but also the different phenotypes included in the term refractory severe asthma. A complete evaluation by a physician expert in asthma is necessary, adapted for each child. Identification of mechanisms involved in different phenotypes in refractory severe asthma may improve the therapeutic approach. The quality of care and monitoring of children with severe asthma is as important as the prescription drug, and is also crucial for differentiating between severe asthma and difficult asthma, whereby expertise is required.
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Affiliation(s)
- Isabelle Tillie-Leblond
- Pulmonary Department, University Hospital, Medical University of Lille, Hôpital Calmette, 1 Boulevard Leclercq, Lille Cedex 59037, France.
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Chen DH, Zhong GY, Luo W, Chen QL, Sun BQ, Chen RC, Lin YN, Pan XA, Li JY, Wu SZ, Lai KF, Zeng GQ. Reference values of induced sputum cytology in healthy children in guangzhou, southern china. Pediatrics 2013; 131:e518-24. [PMID: 23296442 DOI: 10.1542/peds.2012-0946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To establish normal reference values of induced sputum cytology in healthy children in southern China. METHODS During a period from January 2010 to December 2011, a total of 580 healthy children (5-16 years of age) were approached. A total of 266 children (137 boys and 129 girls) participated in the study. Sputum induction was carried out by using 5% hypertonic saline. Cell types in the sputum were examined by using routine methods. RESULTS Sputum induction was completed in 175 of the 266 subjects (65.79%), but 16 sputum samples were disqualified. The overall success rate was 59.77% (159/266). Macrophages and neutrophils were the predominant cell types: macrophages: median, 76.14%; interquartile range (IQR), 32.68%; and 2.5% to 97.5% percentile, 1.00% to 94.50%; neutrophils: median, 20.67%; IQR, 33.0%; and 2.5% to 97.5% percentile, 4.00% to 92.75%; eosinophils: median, 0.39%; IQR, 1.93%; and 2.5% to 97.5% percentile, 0.00% to 6.50%; and lymphocytes: median, 1.22%; IQR, 2.04%; and 2.5% to 97.5% percentile, 0.00% to 5.00%. The cell types did not differ among different age, gender, and passive smoking groups. Adverse events occurred in 4.4% (7/159) of the participants who completed the procedures but required no specific treatment to dissipate. Peak expiratory flow did not differ between those who completed the procedures compared with those who did not, suggesting that the procedure is safe and feasible in children. CONCLUSIONS The current study represents the first attempt to develop normal reference values of induced sputum cytology in Chinese children, and could be used as a control for future studies.
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Affiliation(s)
- De-Hui Chen
- State Key Laboratory of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical College, 151 Yanjiang Rd, Guangzhou, China 510120.
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Abstract
Three pools of exhaled breath condensate (EBC) from non-smokers plus healthy smokers (NS + HS, n = 45); chronic obstructive pulmonary disease (COPD) without emphysema (COPD, n = 15) and subjects with pulmonary emphysema associated with α1-antitrypsin deficiency (AATD, n = 23) were used for an exploratory proteomic study aimed at generating fingerprints of these groups that can be used in future pathophysiological and perhaps even clinical research. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was the platform applied for this hypothesis-free investigation. Analysis of pooled specimens resulted in the production of a “fingerprint” made of 44 proteins for NS/HS; 17 for COPD and 15 for the group of AATD subjects. Several inflammatory cytokines (IL-1α, IL-1β, IL-2; IL-12, α and β subunits, IL-15, interferon α and γ, tumor necrosis factor α); Type I and II cytokeratins; two SP-A isoforms; Calgranulin A and B and α1-antitrypsin were detected and validated through the use of surface enhanced laser-desorption ionization mass spectrometry (SELDI-MS) and/or by Western blot (WB) analysis. These results are the prelude of quantitative studies aimed at identifying which of these proteins hold promise as identifiers of differences that could distinguish healthy subjects from patients.
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Grant LR, Hammitt LL, Murdoch DR, O'Brien KL, Scott JA. Procedures for collection of induced sputum specimens from children. Clin Infect Dis 2012; 54 Suppl 2:S140-5. [PMID: 22403228 PMCID: PMC3297553 DOI: 10.1093/cid/cir1069] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/22/2011] [Indexed: 12/17/2022] Open
Abstract
In most settings, sputum is not routinely collected for microbiological diagnosis from children with lower respiratory disease. To evaluate whether it is feasible and diagnostically useful to collect sputum in the Pneumonia Etiology Research for Child Health (PERCH) study, we reviewed the literature on induced sputum procedures. Protocols for induced sputum in children were collated from published reports and experts on respiratory disease and reviewed by an external advisory group for recommendation in the PERCH study. The advisory group compared 6 protocols: 4 followed a nebulization technique using hypertonic saline, and 2 followed a chest or abdomen massage technique. Grading systems for specimen quality were evaluated. Collecting sputum from children with lower respiratory tract illness is feasible and is performed around the world. An external advisory group recommended that sputum be collected from children hospitalized with severe and very severe pneumonia who participate in the PERCH study provided no contraindications exist. PERCH selected the nebulization technique using hypertonic saline.
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Affiliation(s)
- Lindsay R Grant
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Brannan JD, Koskela H, Anderson SD. Monitoring asthma therapy using indirect bronchial provocation tests. CLINICAL RESPIRATORY JOURNAL 2010; 1:3-15. [PMID: 20298272 DOI: 10.1111/j.1752-699x.2007.00004.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Bronchial provocation tests that assess airway hyperresponsiveness (AHR) are known to be useful in assisting the diagnosis of asthma and in monitoring inhaled corticosteroid therapy. We reviewed the use of bronchial provocation tests that use stimuli that act indirectly for monitoring the benefits of inhaled corticosteroids. DATA SOURCE Published clinical trials investigating the effect of inhaled corticosteroids on bronchial hyperresponsiveness in persons with asthma were used for this review. STUDY SELECTION Studies using indirect stimuli to provoke airway narrowing such as exercise, eucapnic voluntary hyperventilation, cold air hyperventilation, hypertonic saline, mannitol, or adenosine monophosphate (AMP) to assess the effect of inhaled corticosteroids were selected. RESULTS Stimuli acting indirectly result in the release of a variety of bronchoconstricting mediators such as leukotrienes, prostaglandins, and histamine, from cells such as mast cells and eosinophils. A positive response to indirect stimuli is suggestive of active inflammation and AHR that is consistent with a diagnosis of asthma. Persons with a positive response to indirect stimuli benefit from daily treatment with inhaled corticosteroids. Symptoms and lung function are not useful to predict the long-term success of inhaled corticosteroid dose as they usually resolve rapidly, and well before inflammation and AHR has resolved. Following treatment, AHR to indirect stimuli is attenuated. Further, during long-term treatment, asthmatics can become as non-responsive as non-asthmatic healthy persons, suggesting that asthma is not active. CONCLUSIONS Non-responsiveness to indirect bronchial provocation tests following inhaled corticosteroids occurs weeks to months following the resolution of symptoms and lung function. Non-responsiveness to indirect stimuli may provide a goal for adequate therapy with inhaled corticosteroids.
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Affiliation(s)
- John D Brannan
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada L8N 4A6.
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Vizmanos Lamotte G, Moreno Galdó A, Cruz Carmona MJ, Muñoz Gall X, Gómez Olles S, de Mir Messa I, Gartner S, Martín de Vicente C. [Sputum induction in children: Technical development]. An Pediatr (Barc) 2010; 72:199-204. [PMID: 20138598 DOI: 10.1016/j.anpedi.2009.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 10/13/2009] [Accepted: 10/16/2009] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To compare low and high flow nebulizers performance (total of samples) and its side effects on sputum induction in asthmatic children. PATIENTS AND METHODS Sputum induction was performed by inhalation of a hypertonic saline solution at increasing concentrations (3%, 4% and 5%) using low flow (OMRON NE-U07; flow rate 1ml/min), or high flow (OMRON NE-U12; flow rate 3ml/min, and DeVilbiss Ultraneb 3000; flow rate 2.5ml/min) ultrasonic nebulizers. RESULTS We performed 49 inductions in 49 patients from 7 to 15 years old (in 15 children we used a low flow nebulizer (Omron NE-U07) and in 34 children a high flow nebulizer (OMRON NEU12, 6 patients, and DeVilbiss Ultraneb 3000, 28 patients). We obtained 37 samples of which 36 had less than 20% of squamous cells, and 26 had a viability > or =60%. The test performance was higher with high-flow nebulizers, obtaining 85.3% of samples compared to 53% (p=0.04). A total of 69% of samples obtained with the high flow nebulizer were valid, compared to 62.5% (p=0.7) with the low flow nebulizers. With high flow rate nebulizers the incidence of cough (17.6%, p=0.08) and itchy eyes (0%, p=0.02) decreased with the low flow nebulizer (47% and 20% respectively), but bad taste (82.3%, p <0.001) and salivation (14.7%, p=0.3) increased. CONCLUSIONS With high flow rate ultrasonic nebulizers we obtain a higher performance of the technique without an increase in significant side effects.
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Ratnawati, Morton J, Henry RL, Thomas PS. Mediators in exhaled breath condensate after hypertonic saline challenge. J Asthma 2010; 46:1045-51. [PMID: 19995145 DOI: 10.3109/02770900903301252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Airway narrowing after hypertonic saline challenge (HSC) is postulated to be mediated by bronchoconstrictors and inflammatory mediators. OBJECTIVE To study the mechanism of this challenge by using exhaled breath condensate (EBC). METHODS Fifty-six subjects (9 to 72 years of age) performed an HSC, with EBC collection and exhaled nitric oxide (FENO) measurements before and after the challenge. Bronchial hyper-reactivity (BHR) was defined if forced expiratory volume in 1 second (FEV1) decreased by 10% compared with baseline (PD10). EBC volume was recorded and was analyzed for mucin, histamine, nitrite/nitrate, and pH. RESULTS Those with BHR had a significant rise in EBC volume/5-minute collection period after challenge (286.3 +/- 25.6 microl vs 402.2 +/- 31.3 microl, p = 0.0002), while BHR(-) subjects did not show this change (387.6 +/- 29.7 microl vs 364.1 +/- 30.1 microl, p = 0.55). FENO showed a significant decrease in both BHR(+) and BHR(-) groups after challenge (p = < 0.0001). In BHR(+) subjects histamine increased significantly (1.3 +/- 0.1 microM vs 1.5 +/- 0.1 microM, p = 0.006) compared with baseline, while EBC pH and mucin increased significantly after HSC in both groups. EBC nitrite did not change in either group. CONCLUSION EBC analysis suggests that HSC causes an increase in pH and mucin in both groups, but EBC volume and histamine only increased in the BHR(+) group. This suggests that mast cells are activated and fluid flux is associated with the positive response, while mucin release is independent of BHR in HSC.
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Affiliation(s)
- Ratnawati
- Centre for Infection and Inflammation Research, School of Medical Sciences, University of New South Wales, New South Wales, Australia
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Gagliardo R, La Grutta S, Chanez P, Profita M, Paternò A, Cibella F, Bousquet J, Viegi G, Gjomarkaj M. Non-invasive markers of airway inflammation and remodeling in childhood asthma. Pediatr Allergy Immunol 2009; 20:780-90. [PMID: 19788537 DOI: 10.1111/j.1399-3038.2009.00945.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To evaluate the relationship between pro-inflammatory and pro-remodeling mediators and severity and control of asthma in children, the levels of IL-8, MMP-9, TIMP-1 in induced sputum supernatants, the number of sputum eosinophils, as well as FeNO, were investigated in 35 asthmatic children, 12 with intermittent (IA) and 23 with moderate asthma (MA), and 9 controls (C). The patients with asthma were followed for 1 yr and sputum was obtained twice during the follow-up. Biomarker levels were correlated with the number of exacerbations. We found that IL-8, MMP-9, TIMP-1 and the numbers of eosinophils in induced sputum, as well as FeNO, were increased in children with IA and MA in comparison to C. The ongoing inflammation was confirmed by increased nuclear p65 NF-kappaB subunit localization in sputum cells. In MA, FeNO measurements, sputum eosinophils and IL-8 levels, positively correlated with the occurrence of disease exacerbations during a 1-yr follow-up. According to FeNO, sputum eosinophils and IL-8 sputum concentrations, and the number of exacerbations, two distinct phenotypes of MA were identified. This study shows that the presence of bronchial inflammation is detectable in the airways of some IA, as well as in the airways of MA, despite the regular ICS treatment. This study also proposes the need to perform large prospective studies to confirm the importance of measuring specific biomarkers in induced sputum, concomitantly to FeNO analyses, to assess sub-clinical airway inflammation and disease control in children with asthma.
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Affiliation(s)
- Rosalia Gagliardo
- Institute of Biomedicine and Molecular Immunology, Unit of Immunopathology and Pharmacology of the Respiratory System, Italian National Research Council, 90146 Palermo, Italy.
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18
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Hirsch J, Ware LB, Matthay MA. Pulmonary Proteomics. Clin Proteomics 2008. [DOI: 10.1002/9783527622153.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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19
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Baumann U, Göcke K, Gewecke B, Freihorst J, von Specht BU. Assessment of pulmonary antibodies with induced sputum and bronchoalveolar lavage induced by nasal vaccination against Pseudomonas aeruginosa: a clinical phase I/II study. Respir Res 2007; 8:57. [PMID: 17683588 PMCID: PMC1973076 DOI: 10.1186/1465-9921-8-57] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 08/05/2007] [Indexed: 02/06/2023] Open
Abstract
Background Vaccination against Pseudomonas aeruginosa is a desirable albeit challenging strategy for prevention of airway infection in patients with cystic fibrosis. We assessed the immunogenicity of a nasal vaccine based on the outer membrane proteins F and I from Pseudomonas aeruginosa in the lower airways in a phase I/II clinical trial. Methods N = 12 healthy volunteers received 2 nasal vaccinations with an OprF-OprI gel as a primary and a systemic (n = 6) or a nasal booster vaccination (n = 6). Antibodies were assessed in induced sputum (IS), bronchoalveolar lavage (BAL), and in serum. Results OprF-OprI-specific IgG and IgA antibodies were found in both BAL and IS at comparable rates, but differed in the predominant isotype. IgA antibodies in IS did not correlate to the respective serum levels. Pulmonary antibodies were detectable in all vaccinees even 1 year after the vaccination. The systemic booster group had higher IgG levels in serum. However, the nasal booster group had the better long-term response with bronchial antibodies of both isotypes. Conclusion The nasal OprF-OprI-vaccine induces a lasting antibody response at both, systemic and airway mucosal site. IS is a feasible method to non-invasively assess bronchial antibodies. A further optimization of the vaccination schedule is warranted.
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Affiliation(s)
- Ulrich Baumann
- Department of Paediatric Pulmonology and Neonatalogy, Hanover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Kerstin Göcke
- Department of Paediatric Pulmonology and Neonatalogy, Hanover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Britta Gewecke
- Department of Paediatric Pulmonology and Neonatalogy, Hanover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Joachim Freihorst
- Department of Paediatric Pulmonology and Neonatalogy, Hanover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
- Pediatric Hospital, Ostalb-Klinikum, 73430 Aalen, Germany
| | - Bernd Ulrich von Specht
- Centre for Clinical Research, Freiburg University, Breisacherstr.66, 79106 Freiburg, Germany
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Abstract
Conventional asthma management aimed at controlling the underlying airway inflammation is classically based on symptoms and lung function. More recently, various non invasive markers of airway inflammation have become available. The ideal measurement method should be safe, non-invasive, easy to perform, reproducible and accurate. Fractional exhaled nitric oxide (FeNO) measurements fulfil these criteria, however some issues concerning cut off values and clinical variability as well as the interpretation of high values in the absence of symptoms still need to be solved. Induced sputum measurements are more labour intensive, however have the advantage of providing direct, additional information on the current inflammatory status of the airways. The most frequently analysed marker is sputum eosinophil percentage, although other markers of inflammation have also been under investigation. Both methods, FeNO and induced sputum should be seen as complementary to the conventional tools such as spirometry and bronchial hyperresponsiveness (BHR) testing.
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Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB. Evaluation and outcome of young children with chronic cough. Chest 2006; 129:1132-41. [PMID: 16685002 DOI: 10.1378/chest.129.5.1132] [Citation(s) in RCA: 226] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To evaluate the use of an adult-based algorithmic approach to chronic cough in a cohort of children with a history of > 3 weeks of cough and to describe the etiology of chronic cough in this cohort. METHODS A prospective cohort study of children referred to a tertiary hospital with a history of > 3 weeks of cough between June 2002 and June 2004. All included children followed a pathway of investigation (including flexible bronchoscopy and evaluation of airway cytology via BAL) until diagnosis was made and/or their cough resolved. RESULTS In our cohort of 108 young children (median age 2.6 years), the majority had wet cough (n = 96; 89%), and BAL fluid samples obtained during bronchoscopy led to a diagnosis in 45.4% (n = 49). The most common final diagnosis was protracted bacterial bronchitis (n = 43; 39.8%). These patients had neutrophil levels on BAL samples that were significantly higher than those in other diagnostic groups (p < 0.0001). Asthma, gastroesophageal reflux disease (GERD), and upper airway cough syndrome (UACS), which are common causes of chronic cough in adults, were found in < 10% of the cohort (n = 10). CONCLUSIONS The adult-based anatomic pathway, which involves the investigation and treatment of patients with asthma, GERD, and UACS first is largely unsuitable for use in the management of chronic cough in young children as the common etiologies of chronic cough in children are different from those in adults.
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Affiliation(s)
- Julie M Marchant
- Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, QLD, Australia.
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Simpson JL, Wood LG, Gibson PG. Inflammatory mediators in exhaled breath, induced sputum and saliva. Clin Exp Allergy 2006; 35:1180-5. [PMID: 16164445 DOI: 10.1111/j.1365-2222.2005.02327.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Airway inflammation is assessed to monitor progression, control and treatment of asthma. The collection of exhaled breath condensate (EBC) provides a non-invasive alternative to induced sputum samples for the monitoring of airway inflammation. Both samples can be confounded by salivary contamination. The aim of this study was to compare the levels of inflammatory mediators in samples of EBC, induced sputum and saliva samples from subjects with asthma. METHOD EBC, saliva and induced sputum samples were collected from subjects with asthma (n=10). Total protein, IL-8, 8-isoprostane and surfactant protein A (SPA) were assessed in each sample. RESULTS Total protein, IL-8, 8-isoprostane and SPA were detected in all sputum samples. Only total protein and SPA were consistently measured in EBC, with levels at least 100-fold lower than those measured in induced sputum. In saliva, total protein, SPA and 8-isoprostane were detected in all samples, with IL-8 detected in 60% of samples. CONCLUSIONS Induced sputum is a reliable technique that can be used to assess markers of airway inflammation. While EBC is a simple and inexpensive technique to collect lower airway secretions, the detection of inflammatory mediators is variable, and further work is required to validate this technique to assess inflammatory mediators.
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Affiliation(s)
- J L Simpson
- School of Medical Practice and Population Health, The University of Newcastle, Callaghan NSW, Australia
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Abstract
Assessment of airway function is difficult in young children with asthma, and in addition, only reflects the status of the disease at the time of the measurement. Thus, there is increasing interest in monitoring airway inflammation in asthma, which may provide a longer term assessment of disease activity. Most methods of assessing asthmatic inflammation are invasive, and are not feasible in the paediatric population. This review discusses exhaled nitric oxide as a marker of asthmatic inflammation, and compares it with other recognized markers. Exhaled nitric oxide has the potential to become a noninvasive method of assessing asthma control in the paediatric population.
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Leuppi JD, Anderson SD, Brannan JD, Belousova E, Reddel HK, Rodwell LT. Questionnaire responses that predict airway response to hypertonic saline. Respiration 2005; 72:52-60. [PMID: 15753635 DOI: 10.1159/000083401] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Accepted: 05/26/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Airway hyperresponsiveness to hypertonic saline (HS) is associated with airway inflammation. We investigated if responsiveness to HS was predicted by asthma symptoms in the last 3 months. OBJECTIVES To investigate if responsiveness to HS can be estimated by questionnaire items investigating asthma symptoms of the last 3 months. METHODS Six hundred and four patients with physician-diagnosed asthma being assessed for asthma severity were studied. Bronchial provocation with 4.5% saline was performed, and a questionnaire was administered. The response to 4.5% saline was reported as the provoking dose to cause a 15% fall in the forced expiratory volume in 1 s FEV(1) (PD(15)) and the response-dose ratio (RDR). RESULTS Based on the GINA guidelines, asthma severity was intermittent in 497 patients, mild in 107 patients, moderate in 3 patients and severe in 1 patient. A PD(15) to 4.5% saline was recorded in 234 of the 604. Questions on self-recognition of asthma, dust as a trigger, food as a trigger, and frequency of bronchodilator use were significant predictors for a PD(15), and currently taking steroids decreased the likelihood of a positive response to 4.5% saline. Using a multiple-linear regression model, a difference in the RDR could be calculated between those who answered positively compared with the reference group, who answered negatively. This difference could be used as a guide for predicting abnormal reactivity. An increase in RDR in response to 4.5% saline, compared with the reference group, was demonstrated in the presence of self-recognition of asthma severity, dust and cats as a trigger or use of bronchodilator during sleep hours. CONCLUSIONS Because of the high positive predictive value of HS for identifying patients with asthma it might be that the need for bronchodilator use at night not only predicts airway hyperresponsiveness to HS, it also could reflect the severity of asthma.
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Affiliation(s)
- Jorg D Leuppi
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
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Lex C, Payne DNR, Zacharasiewicz A, Li AM, Wilson NM, Hansel TT, Bush A. Sputum induction in children with difficult asthma: safety, feasibility, and inflammatory cell pattern. Pediatr Pulmonol 2005; 39:318-24. [PMID: 15678506 DOI: 10.1002/ppul.20159] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Difficult childhood asthma is defined by persistent symptoms despite maximal conventional therapy. We aimed to establish a safe method of sputum induction for these children and to study cytology and the relationship to exhaled nitric oxide (eNO). Sputum induction was performed in 38/40 children (aged 6-16 years) with difficult asthma, using 3.5% saline for four 5-min periods after bronchodilator pretreatment. Two children were excluded from sputum induction because postbronchodilator forced expired volume in 1 sec (FEV(1)) was <65% predicted. Seven of 38 children had symptoms (dyspnea and wheezing) during induction; of these, 3 experienced a fall in FEV(1) of >20% from postbronchodilator FEV(1), readily reversed with salbutamol. Sputum induction was successful in 28/38 children, with a higher success rate in children >/= 12 years than in younger children (87% vs. 50%, P = 0.02). Only 9/28 had abnormal sputum cytology; of these, 6 had predominant sputum eosinophilia (>2.5% eosinophils, </=54% neutrophils), while 3 had sputum neutrophilia (</=2.5% eosinophils, >54% neutrophils). Of 23 children with elevated eNO values, only 6 had sputum eosinophilia. In conclusion, sputum induction can be used to assess airway inflammation in children with difficult asthma, but abnormal sputum cytology is only present in a minority. Raised nitric oxide is only poorly predictive of sputum eosinophilia in these children.
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Affiliation(s)
- Christiane Lex
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
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Pradal M, Retornaz K, Poisson A. [Chronic cough in childhood]. Rev Mal Respir 2005; 21:743-62. [PMID: 15536376 PMCID: PMC7135783 DOI: 10.1016/s0761-8425(04)71416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction La toux chronique de l’enfant bien que moins fréquente que les toux répétées liées aux infections virales reste un problème diagnostique parfois difficile à résoudre. États des connaissances La majorité des auteurs estiment que sa durée doit être supérieure à trois semaines. Peu d’études ont été consacrées au diagnostic étiologique de la toux chronique chez l’enfant mais celles-ci retrouvent les mêmes causes principales que chez l’adulte : l’asthme, les pathologies ORL (dont la sinusite), le reflux gastro-œsophagien. Chaque tranche d’âge connaît des étiologies plus spécifiques ; notamment malformatives entre 0 et 1 an, et toux psychogène chez l’adolescent. Perspectives Des techniques « nouvelles » comme l’étude de l’expectoration induite permettent d’affiner le diagnostic d’une toux chronique de l’enfant en tout cas après 7 ans. La découverte d’une bronchite à éosinophiles quelle soit associée ou pas à une hyperréactivité bronchique a des conséquences thérapeutiques indiscutables compte tenu de sa corticosensibilité. Conclusions L’exploration d’une toux chronique de l’enfant doit reposer sur un raisonnement anatomique et sur des arguments de fréquence. Le contrôle et la disparition de la toux ne seront possibles qu’avec un diagnostic précis et un traitement adapté.
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Affiliation(s)
- M Pradal
- Service de Pneumologie, Hôpital Paul Desbief, Marseille, France.
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Zacharasiewicz A, Wilson N, Lex C, Erin EM, Li AM, Hansel T, Khan M, Bush A. Clinical use of noninvasive measurements of airway inflammation in steroid reduction in children. Am J Respir Crit Care Med 2005; 171:1077-82. [PMID: 15709050 DOI: 10.1164/rccm.200409-1242oc] [Citation(s) in RCA: 219] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The use of noninvasive methods of monitoring airway inflammation, such as exhaled nitric oxide (eNO) and induced sputum, has been shown to improve asthma monitoring and optimize treatment in adult patients with asthma. There is a lack of comparable data in children. Forty children with stable asthma eligible for inhaled steroid reduction were reviewed every 8 weeks, and their inhaled steroid dose halved if clinically indicated. eNO, sputum induction combined with bronchial hyperreactivity testing, and exhaled breath condensate collection were performed at each visit to predict success or failure of reduction of inhaled steroids. Thirty of 40 (75%) children tolerated at least one dose reduction, 12 of 40 (30%) were successfully weaned off, and in total, 15 of 40 (38%) children experienced loss of asthma control. Treatment reduction was successful in all children who had no eosinophils in induced sputum before the attempted reduction. Using multiple logistic regression, increased eNO (odds ratio, 6.3; confidence interval, 3.75-10.58) and percentage of sputum eosinophils (odds ratio, 1.38; confidence interval, 1.06-1.81) were significant predictors of failed reduction. These findings suggest that monitoring airway inflammation may be useful in optimizing treatment in children with asthma.
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Affiliation(s)
- Angela Zacharasiewicz
- Department of Respiratory Pediatrics, Clinical Trials and Evaluation Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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Abstract
The most important aspect of dealing with a pre-school child suspected of having difficult asthma, is to ensure that the diagnosis is correct, in order to avoid the inappropriate use of therapies such as inhaled corticosteroids. After exclusion of other diagnoses, if a pre-school child is thought to have asthma, difficult or otherwise, the corollary is, what sort of asthma? Is it a syndrome with airway inflammation susceptible to treatment, or one in which there is no inflammation and time alone will result in resolution of symptoms? Probably the most common mistake in this age group is to fail to recognise the latter and institute ever more aggressive and useless therapies. An approach to excluding other diagnoses, appropriate investigations to elicit the presence of airway inflammation and suggestions for subsequent management have been detailed in this review.
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Affiliation(s)
- Sejal Saglani
- Department of Respiratory Paediatrics, Royal Brompton Hospital, Sydney Street, London, UK
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Hirsch J, Hansen KC, Burlingame AL, Matthay MA. Proteomics: current techniques and potential applications to lung disease. Am J Physiol Lung Cell Mol Physiol 2004; 287:L1-23. [PMID: 15187006 DOI: 10.1152/ajplung.00301.2003] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Proteomics aims to study the whole protein content of a biological sample in one set of experiments. Such an approach has the potential value to acquire an understanding of the complex responses of an organism to a stimulus. The large vascular and air space surface area of the lung expose it to a multitude of stimuli that can trigger a variety of responses by many different cell types. This complexity makes the lung a promising, but also challenging, target for proteomics. Important steps made in the last decade have increased the potential value of the results of proteomics studies for the clinical scientist. Advances in protein separation and staining techniques have improved protein identification to include the least abundant proteins. The evolution in mass spectrometry has led to the identification of a large part of the proteins of interest rather than just describing changes in patterns of protein spots. Protein profiling techniques allow the rapid comparison of complex samples and the direct investigation of tissue specimens. In addition, proteomics has been complemented by the analysis of posttranslational modifications and techniques for the quantitative comparison of different proteomes. These methodologies have made the application of proteomics on the study of specific diseases or biological processes under clinically relevant conditions possible. The quantity of data that is acquired with these new techniques places new challenges on data processing and analysis. This article provides a brief review of the most promising proteomics methods and some of their applications to pulmonary research.
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Affiliation(s)
- Jan Hirsch
- Cardiovascular Research Institute, University of California, San Francisco, 505 Parnassus Ave. HSW 825, San Francisco, CA 94143-0130, USA.
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Choi IS, Hong SN, Lee YK, Koh YI, Jang AS, Lee HC. Asthmatic airway inflammation is more closely related to airway hyperresponsiveness to hypertonic saline than to methacholine. Korean J Intern Med 2003; 18:83-8. [PMID: 12872444 PMCID: PMC4531613 DOI: 10.3904/kjim.2003.18.2.83] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Airway hyperresponsiveness (AHR) to direct stimuli, such as methacholine (MCh), is observed not only in asthma but other diseases. AHR to indirect stimuli is suggested to be more specific for asthma. The purpose of this study was to determine whether asthmatic airway inflammation is more closely related to AHR to hypertonic saline (HS), an indirect stimulus, than to MCh. METHODS Sixty-four consecutive adult patients with suspected asthma (45 asthma and 19 non-asthma) performed a combined bronchial challenge and sputum induction with 4.5% saline, and MCh challenge on the next day. RESULTS Both HS-PD15 and MCh-PC20 were significantly lower in asthma patients than in non-asthma patients. However, the sensitivity/specificity for asthma was 48.9%/100%, respectively, in the HS test and 82.2%/84.2%, respectively, in the MCh test. There was a significant relationship between HS-PD15 and MCh-PC20 and only 52.9% of patients with MCh-PC20 < or = 4 mg/mL showed HS-AHR, but 4 patients with HS-AHR showed MCh-PC20 > 4 mg/mL. There were significant correlations between both HS-PD15 and MCh-PC20 and FEV1, or sputum eosinophils, but FEV1 was more closely related to MCh-PC20 (r = 0.478, p < 0.01) than to HS-PD15 (r = 0.278, p < 0.05), and sputum eosinophils were more closely related to HS-PD15 (r = -0.324, p < 0.01) than to MCh-PC20 (r = -0.317, p < 0.05). Moreover, the IL-5 level (r = 0.285, p < 0.05) and IFN-gamma/IL-5 ratio (r = 0.293, p < 0.05) in sputum were significantly related to HS-PD15, but not to MCh-PC20. CONCLUSION HS-AHR may reflect allergic asthmatic airway inflammation more closely than MCh-AHR.
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Affiliation(s)
- Inseon S Choi
- Departments of Internal Medicine and Microbiology, Chonnam National University Medical School, Gwangju, Korea.
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Noël-Georis I, Bernard A, Falmagne P, Wattiez R. Database of bronchoalveolar lavage fluid proteins. J Chromatogr B Analyt Technol Biomed Life Sci 2002; 771:221-36. [PMID: 12016001 DOI: 10.1016/s1570-0232(02)00114-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Bronchoalveolar lavage during fiberoptic bronchoscopy is extensively used for investigating cellular and biochemical alterations of the epithelial lining fluid in various lung disorders. Two-dimensional electrophoresis (2-DE) offers the possibility to simultaneously display and analyze proteins contained in bronchoalveolar lavage fluid (BALF). We present the current status of 2-DE of BALF samples with an updated listing of the proteins already identified and of their level and/or posttranslational alterations in lung disorders. Alternatives to 2-DE of BALF samples and future prospects of proteomics to unravel lung functions and pathologies are discussed.
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Affiliation(s)
- Isabelle Noël-Georis
- Department of Biological Chemistry, University of Mons-Hainaut, Avenue du Champs de Mars 6, B-7000 Mons, Belgium.
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Affiliation(s)
- Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Route 11N, Hines, Illinois 60141, USA.
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