Bronchodilator responsiveness testing with inhaled budesonide/formoterol in asthma

BACKGROUND

The choice of bronchodilators for responsiveness testing (BRT) is a clinical decision according to ATS/ERS. Since January 2019 we use budesonide/formoterol for BRT in asthma at our center in Argentina. The aim was to compare budesonide/formoterol with salbutamol for BRT in stable asthmatic patients that were followed up in a short-acting beta2 agonist (SABA)-free asthma center.

METHODS

From the Hospital database, we found for the same patient at least one BRT using salbutamol 200 µg and another with budesonide/formoterol 320/9 µg.

RESULTS

We found similar BRT between salbutamol and budesonide/formoterol in 101 asthmatic individuals (26 males) aged 38.14 ± 16.1 yrs (mean ± Standard deviation). The absolute response was 0.18 ± 0.21 L in FEV1 after salbutamol and 0.20 ± 0.22 L in FEV1 after budesonide/formoterol. Afterwards, we showed 202 patients tested with budesonide/formoterol; the mean absolute response was 0.21 ± 0.22 L in FEV1. There were no unexpected safety findings.

CONCLUSIONS

In asthmatic patients, we demonstrated similar efficacy between Budesonide/formoterol and salbutamol for BRT.

Asthma-related hospitalizations after implementing SABA-free asthma management with a maintenance and anti-inflammatory reliever regimen

Overreliance on short-acting β₂-agonists (SABA) has been a common feature of asthma management globally for at least 30 years. However, given the evidence against the long-term use of SABA, including potentially increased risk of exacerbations, emergency room visits, overall healthcare resource utilization, and mortality, the latest Global Initiative for Asthma report no longer recommends SABA only therapy. Since 2014, we implemented an ICS-containing reliever strategy at our asthma center at the G Baigorria Hospital in Argentina; we only administered budesonide/formoterol via a single inhaler device across the spectrum of asthma severity and completely eliminated the use of SABA therapy. In this article, we compare hospitalization data from our center, previously reported in the EAGLE study (when inhaled corticosteroids plus as-needed SABA was administered) for the years 1999 and 2004 with data from 2017 to 2018 (when budesonide/formoterol in a single inhaler device was administered as maintenance and/or anti-inflammatory reliever therapy [MART/AIR] without any SABA) from our center, to assess the impact of two distinct asthma management strategies on asthma-related hospitalizations. MART/AIR regimens in our SABA-free center reduced asthma hospitalizations from 9 (1999 and 2004) to 1 (2017 and 2018) (Fisher's exact test, p = 0.031; odds ratio = 0.11; 95% confidence interval [CI] = 0.013-0.98); the hospitalization rate was reduced by 92% (1.47% in 1999 and 2004 to 0.12% in 2017 and 2018). Our data provide preliminary real-world evidence that MART/AIR with budesonide/formoterol simultaneously with SABA elimination across asthma severities is an effective asthma management strategy for reducing asthma-related hospitalizations.

Leptin does not enhance cell-mediated immune responses following mycobacterial antigen stimulation

BACKGROUND

Tuberculosis (TB) is a infectious disease characterised by a profound immune-endocrine metabolic imbalance, including a diminution in leptin plasma levels. Leptin appears to be the link between nutritional status and the development of a protective immune response.

OBJECTIVE

To examine the effects of leptin on the proliferation and production of interferon-gamma (IFN-γ) by peripheral blood mononuclear cells (PBMC) in TB patients and healthy controls stimulated with mycobacterial antigens with or without leptin. As macrophages are key cells in mycobacterial containment, the effect of leptin on the production of interleukin (IL) 1β and IL-1Ra by the monocytic cell line THP-1 was also studied.

RESULTS

Leptin diminished the proliferative capacity of PBMC on mycobacterial stimulation, and had no effect on IFN-γ production in terms of measurements in culture supernatants or intracytoplasmic analysis using flow cytometry. Real-time polymerase chain reaction studies of PBMC from TB patients revealed a preserved expression of leptin receptor. Furthermore, IL-1β and IL-1Ra secretion by THP-1 cells was not modified by leptin treatment.

CONCLUSION

The study results do not support the utility of treatment with leptin to correct immune imbalances due to TB.

Proliferative and maturative behaviour patterns on murine bone marrow and spleen erythropoiesis along hypoxia

The present study was performed to determine quantitative and qualitative effects of hypoxia on murine erythron. CF1 mice were submitted to hypobaric hypoxia (HH) along 18 days. The proliferative response to recombinant human erythropoietin (rHuEPO: 0-250 mU/ml) was analyzed by DNA assays from bone marrow and spleen cells at different times. Bone marrow proliferative response showed a slight increment under stress but remained over control by the end of the experience. Splenic erythroid proliferative response was observed at a maximum rate on day 6 of HH (26 fold) and returned near to control values after day 10. The assessment of erythropoietic maturative pattern was performed by 59Fe uptake assays. Total nuclear cell counts increased in both tissues (1.5 times in marrow and 5 times in spleen) under hypoxia. In addition, percentages of different lineages (erythroid, myeloid and lymphoid) were scored. Total erythroid marrow cell counts increased in a narrowly degree and persisted above basal counts after day 18. Meanwhile, splenic red cells rose to 30 times over control on day 6 and failed sharply near control values from day 12 of HH. Splenic red cells contribution was approximately 60% of total production between 6-8 days. By the end of the assay bone marrow took back erythroid command (90%). These findings indicate correlation between the time course as well as quantitative and qualitative parameters in the patterns of proliferation and maturation. Moreover, the erythron response to hypoxia, seemed to be related to microenvironmental regulations rather than to hormonal variances.

The mechanism of the transient depression of the erythropoietic rate induced in the rat by a single injection of uranyl nitrate

With the purpose of assessing the effect of uranyl nitrate (UN) on the rate of erythropoiesis, 1 mg/kg of the compound was injected iv to adult female Wistar rats. The dosing vehicle was injected into control animals. A single injection of UN induced a transient depression of the rate of red cell volume 59Fe uptake, which reached its lowest value (68% depression) by the seventh postinjection day. By 14 days, 59Fe incorporation had returned to normal. The amount of iron going to erythroid tissue per hour, reticulocyte count, and immunoreactive erythropoietin concentration in both plasma and kidney extracts were also significantly depressed in UN-treated rats in relation to these values in vehicle-injected rats by the seventh postinjection day. Dose-response curves for exogenous erythropoietin (Epo) performed in polycythemic intact and UN-treated rats 7 days after drug injection revealed a significant depression of the response in UN-injected animals. Moreover, bone marrow cells obtained from rats pretreated with UN formed a reduced number of erythroid colonies in vitro in response to Epo. Therefore, possible mechanisms for the observed transient depression in the rate of erythropoiesis associated with acute UN treatment include decreased Epo production and direct or indirect damage of erythroid progenitor cells.