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Migueres N, Vandenplas O, Walusiak-Skorupa J, Wiszniewska M, Munoz X, Romero-Mesones C, Suojalehto H, Lindström I, van Kampen V, Merget R, Mason P, Maestrelli P, Sastre J, Quirce S, Rifflart C, Godet J, de Blay F. Sputum Inflammatory Patterns Are Associated With Distinct Clinical Characteristics in Patients with Occupational Asthma Independently of the Causal Agent. J Investig Allergol Clin Immunol 2024; 34:85-96. [PMID: 36377541 DOI: 10.18176/jiaci.0868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Background: Clinical heterogeneity in sensitizer-induced occupational asthma (OA) and its relationship to airway inflammatory profiles remain poorly elucidated. Objectives: To further characterize interactions between induced sputum inflammatory patterns, asthma-related outcomes, and the high- or low-molecular-weight category of causal agents in a large cohort of patients with OA. METHODS We conducted a multicenter, retrospective, cross-sectional study of 296 patients with OA confirmed by a positive specific inhalation challenge who completed induced sputum assessment before and 24 hours after challenge exposure. RESULTS Multivariate logistic regression analysis revealed that sputum eosinophilia ≥3% was significantly associated with a high dose of inhaled corticosteroid (OR [95%CI], 1.31 [1.11 1.55] for each 250-μg increment in daily dose), short-acting ß2-agonist use less than once a day (3.54 [1.82-7.00]), and the level of baseline nonspecific bronchial hyperresponsiveness (mild, 2.48 [1.21-5.08]; moderate/severe, 3.40 [1.44-8.29]). Sputum neutrophilia ≥76% was associated with age (1.06 [1.01-1.11]), male sex (3.34 [1.29-9.99]), absence of corticosteroid use (5.47 [2.09-15.16]), use of short-acting ß2-agonists once or more a day (4.09 [1.71-10.01]), ≥2 severe exacerbations during the previous 12 months at work (4.22 [1.14-14.99]), and isolated early reactions during the specific inhalation challenge (4.45 [1.85-11.59]). CONCLUSIONS The findings indicate that sputum inflammatory patterns in patients with OA are associated with distinct phenotypic characteristics and further highlight the differential effects of neutrophils and eosinophils on asthma-related outcomes. These associations between inflammatory patterns and clinical characteristics share broad similarities with findings reported in nonoccupational asthma and are not related to the type of causal agent.
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Affiliation(s)
- N Migueres
- Division of Pulmonology, Department of Chest Diseases, University Hospital of Strasbourg, Strasbourg University, Strasbourg, France
- UMR 7357 Laboratoire des sciences de l´ingénieur, de l´informatique et de l´imagerie ICUBE, Strasbourg, France
| | - O Vandenplas
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - J Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - M Wiszniewska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - X Munoz
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Romero-Mesones
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - H Suojalehto
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - I Lindström
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - V van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - R Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - P Mason
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - P Maestrelli
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - J Sastre
- Department of Allergy, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - S Quirce
- Department of Allergy, La Paz University Hospital, Madrid, Spain
| | - C Rifflart
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - J Godet
- UMR 7357 Laboratoire des sciences de l´ingénieur, de l´informatique et de l´imagerie ICUBE, Strasbourg, France
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France
| | - F de Blay
- Division of Pulmonology, Department of Chest Diseases, University Hospital of Strasbourg, Strasbourg University, Strasbourg, France
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Mason P, Liviero F, Crivellaro M, Maculan P, Maestrelli P, Guarnieri G. Cutaneous sensitization to aziridine preceding the onset of occupational asthma. Occup Med (Lond) 2021; 70:135-138. [PMID: 32002545 DOI: 10.1093/occmed/kqz154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe a 47-year-old non-atopic woman, working as a spray painter in a tannery for 23 years, with a 16-year history of cutaneous symptoms and a subsequent 2-year history of asthmatic symptoms after exposure to aerosol and vapour of polyfunctional aziridine (PFA) at work. To confirm the occupational origin of the dermatitis and asthma we performed a skin prick test with PFA and a specific inhalation challenge (SIC) with PFA. Prick test with PFA elicited an immediate positive skin reaction. She developed an immediate asthmatic reaction upon SIC with PFA. The onset of occupational dermatitis before asthma is consistent with the hypothesis that the sensitization to PFA was triggered in the skin. The observation that the reactions elicited in skin and airways upon exposure to PFA exhibited the same time course, suggests a similar mechanism at both sites. Thus, the avoidance of both skin and airway exposure to PFA should be recommended in workplace hygiene practice.
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Affiliation(s)
- P Mason
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - F Liviero
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - M Crivellaro
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - P Maculan
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - P Maestrelli
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - G Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
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3
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Mason P, Scarpa MC, Guarnieri G, Giordano G, Baraldi E, Maestrelli P. Exhaled nitric oxide dynamics in asthmatic reactions induced by diisocyanates. Clin Exp Allergy 2016; 46:1531-1539. [PMID: 27533788 DOI: 10.1111/cea.12798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Isocyanate-induced asthmatic reactions are associated with delayed increase in fractional exhaled nitric oxide measured at expiratory flow of 50 mL/s (FeNO50), a biomarker of airway inflammation. The time course of FeNO increase is compatible with the activation of NO synthase, but the origin of NO production in the lung is undetermined. OBJECTIVE The aim of this study was to define the dynamics of airway and alveolar NO during specific inhalation challenge (SIC) with isocyanates and the role of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase. METHODS Spirometry, exhaled NO parameters (FeNO50, bronchial wall NO concentration, NO airway diffusing capacity, NO flux to luminal space, alveolar NO) and ADMA levels in exhaled breath condensate were measured before and at intervals up to 24 h after exposure to isocyanates. The results were compared between 17 SIC-positive and eight SIC-negative subjects. RESULTS A significant FeNO50 increase in SIC-positive subjects was detected 24 h after exposure and was associated with the augmented NO flux from airway wall to the lumen, whereas airway NO diffusion and alveolar NO were not affected. The changes in NO dynamics were specific for the subjects who developed an asthmatic reaction, but were independent from the pattern and magnitude of bronchoconstriction. There was no evidence that exhaled NO is modulated by the changes in ADMA concentration. CONCLUSIONS AND CLINICAL RELEVANCE Because isocyanate-induced increase in FeNO50 was almost exclusively determined by the increase in NO flux, the use of FeNO50 appears adequate to monitor the exhaled NO dynamics during SIC. FeNO50 measurement may provide additional information to spirometry, because bronchoconstriction and airway inflammatory responses are dissociated.
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Affiliation(s)
- P Mason
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - M C Scarpa
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - G Guarnieri
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - G Giordano
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - E Baraldi
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - P Maestrelli
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Scarpa MC, Kulkarni N, Maestrelli P. The role of non-invasive biomarkers in detecting acute respiratory effects of traffic-related air pollution. Clin Exp Allergy 2015; 44:1100-18. [PMID: 25040251 DOI: 10.1111/cea.12373] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of non-invasive methods in the investigation of acute effects of traffic-related air pollution is not clearly established. We evaluated the usefulness of non-invasive biomarkers in detecting acute air pollution effects according to the age of participants, the disease status, their sensitivity compared with lung function tests and their specificity for a type of pollutant. Search terms lead to 535 titles, among them 128 had potentially relevant abstracts. Sixtynine full papers were reviewed, while 59 articles were excluded as they did not meet the selection criteria. Methods used to assess short-term effects of air pollution included analysis of nasal lavage (NAL) for the upper airways, and induced sputum (IS), exhaled breath condensate (EBC) and exhaled nitric oxide (FeNO) for central and lower airways. There is strong evidence that FeNO evaluation is useful independently from subject age, while IS analysis is suitable almost for adults. Biomarker changes are generally observed upon pollutant exposure irrespective of the disease status of the participants. None of the biomarkers identified are specific for a type of pollutant exposure. Based on experimental exposure studies, there is moderate evidence that IS analysis is more sensitive than lung function tests, whereas this is not the case for biomarkers obtained by NAL or EBC. Cells and some cytokines (IL-6, IL-8 and myeloperoxidase) have been measured both in the upper respiratory tract (NAL) and in the lower airways (IS). Overall, the response to traffic exposure seems different in the two compartments. In conclusion, this survey of current literature displays the complexity of this research field, highlights the significance of short-term studies on traffic pollution and gives important tips when planning studies to detect acute respiratory effects of air pollution in a non-invasive way.
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Affiliation(s)
- M C Scarpa
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Maestrelli P. More (on) airway eosinophilia in asthma. Clin Exp Allergy 2014; 44:614-6. [PMID: 24734925 DOI: 10.1111/cea.12282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Maestrelli
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Moscato G, Maestrelli P, Bonifazi F, Troise C, Caminati M, Crivellaro M, Olivieri M, Senna G. OCCUPATION study (OCCUPationl asthma: a naTIONal based study): a survey on occupational asthma awareness among Italian allergists. Eur Ann Allergy Clin Immunol 2014; 46:26-29. [PMID: 24702870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Occupational asthma (OA) is the most common work-related respiratory disease. Case identification still remains underperformed. The present survey aimed at investigating the awareness about OA among Italian allergists. 538 Italian Allergists completed a web anonymous questionnaire concerning: patient profile, occupational history, disease features, diagnostic work-up, causal agents, management after diagnosis. 80 cases were registered by 14 members (2.4%). Patients were mostly between 30 and 62 years old; noteworthy, 19% were between 18 and 30. All the patients had a concomitant rhinitis, usually preceding asthma onset. Bakers, hairdressers and healthcare workers were more frequently involved. Diagnostic process included: skin prick test (85%), stop/resume test (57%), specific IgE dosage for occupational allergens (52.5%), peak expiratory flow monitoring (32.5%). Noteworthy, only 27,5% of patients underwent specific challenge. After the diagnosis 50% of patients did not change job. One third of the subjects were not referred to the national Workers Compensation Authority. Our data show that OA is quite neglected by Italian allergists, despite they have a pivotal role both in early identification and in primary prevention of OA. Thus, it is worth increasing awareness concerning OA and creating an easy-access network involving allergists and referral centers for Occupational respiratory diseases.
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Affiliation(s)
- G Moscato
- Fondazione "Salvatore Maugeri", Institute of Care and Research, Scientific Institute of Pavia, Allergy Unit, Pavia, Italy
| | - P Maestrelli
- University of Padova, Department of Environmental Medicine and Public Health, Padova, Italy
| | - F Bonifazi
- University Hospital, Ospedali Riuniti of Ancona, Department of Immunology, Allergy & Respiratory Diseases, Ancona, Italy
| | - C Troise
- San Martino Hospital, Allergy Unit, Genoa, Italy
| | - M Caminati
- Verona University Hospital, Allergy Unit, Verona, Italy.
| | - M Crivellaro
- University of Padua, Occupational and Environmental Medicine, Padua, Italy
| | - M Olivieri
- Verona University Hospital, Occupational Medicine Unit, Verona, Italy
| | - G Senna
- Verona University Hospital, Allergy Unit, Verona, Italy
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Maestrelli P, Mason P, Costa F, Paggiaro P. Do we need three players in COPD treatment? Respiration 2013; 86:275-6. [PMID: 23988429 DOI: 10.1159/000353553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- P Maestrelli
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Rizzo M, Zanatta E, Guarnieri G, Pigatto E, Favaro M, Cardarelli S, Riato L, Maestrelli P, Punzi L, Cozzi F. AB0818 Nitric oxide diffusion and pulmonary capillary blood volume measurement in scleroderma patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Baur X, Sigsgaard T, Aasen TB, Burge PS, Heederik D, Henneberger P, Maestrelli P, Rooyackers J, Schlünssen V, Vandenplas O, Wilken D. Guidelines for the management of work-related asthma. Eur Respir J 2012; 39:529-45. [PMID: 22379148 DOI: 10.1183/09031936.00096111] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Work-related asthma, which includes occupational asthma and work-aggravated asthma, has become one of the most prevalent occupational lung diseases. These guidelines aim to upgrade occupational health standards, contribute importantly to transnational legal harmonisation and reduce the high socio-economic burden caused by this disorder. A systematic literature search related to five key questions was performed: diagnostics; risk factors; outcome of management options; medical screening and surveillance; controlling exposure for primary prevention. Each of the 1,329 retrieved papers was reviewed by two experts, followed by Scottish Intercollegiate Guidelines Network grading, and formulation of statements graded according to the Royal College of General Practitioners' three-star system. Recommendations were made on the basis of the evidence-based statements, which comprise the following major evidence-based strategic points. 1) A comprehensive diagnostic approach considering the individual specific aspects is recommended. 2) Early recognition and diagnosis is necessary for timely and appropriate preventative measures. 3) A stratified medical screening strategy and surveillance programme should be applied to at-risk workers. 4) Whenever possible, removing exposure to the causative agent should be achieved, as it leads to the best health outcome. If this is not possible, reduction is the second best option, whereas respirators are of limited value. 5) Exposure elimination should be the preferred primary prevention approach.
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Affiliation(s)
- X Baur
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstrasse 10, D-20459 Hamburg, Germany.
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Moscato G, Pala G, Barnig C, Blay F, Del Giacco SR, Folletti I, Heffler E, Maestrelli P, Pauli G, Perfetti L, Quirce S, Sastre J, Siracusa A, Walusiak-Skorupa J, Wjik RG. EAACI consensus statement for investigation of work-related asthma in non-specialized centres. Allergy 2012; 67:491-501. [PMID: 22257175 DOI: 10.1111/j.1398-9995.2011.02784.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2011] [Indexed: 11/28/2022]
Abstract
Work-related asthma (WRA) is a relevant problem in several countries, is cause of disability and socioeconomic consequences for both the patient and the society and is probably still underdiagnosed. A correct diagnosis is extremely important to reduce or limit the consequences of the disease. This consensus document was prepared by a EAACI Task Force consisting of an expert panel of allergologists, pneumologists and occupational physicians from different European countries. This document is not intended to address in detail the full diagnostic work-up of WRA, nor to be a formal evidence-based guideline. It is written to provide an operative protocol to allergologists and physicians dealing with asthma useful for identifying the subjects suspected of having WRA to address them to in-depth investigations in a specialized centre. No evidence-based system could be used because of the low grade of evidence of published studies in this area, and instead, 'key messages' or 'suggestions' are provided based on consensus of the expert panel members.
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Affiliation(s)
- G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - G. Pala
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - C. Barnig
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - F. Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - S. R. Del Giacco
- Department of Medical Sciences ‘M. Aresu’; University of Cagliari; Cagliari; Italy
| | - I. Folletti
- Department of Clinical and Experimental Medicine; Occupational Allergy Unit; Terni Hospital; University of Perugia; Perugia; Italy
| | - E. Heffler
- Allergy and Clinical Immunology; University of Torino; ASO Mauriziano ‘Umberto I’; Torino; Italy
| | - P. Maestrelli
- Department of Environmental Medicine and Public Health; University of Padova; Padova; Italy
| | - G. Pauli
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - L. Perfetti
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz-IdiPAZ and CIBER de Enfermedades Respiratorias CIBERES; Madrid; Spain
| | - J. Sastre
- CIBER de Enfermedades Respiratorias; Ciberes and Department of Allergy; Fundación Jiménez Díaz; Madrid; Spain
| | - A. Siracusa
- Department of Clinical an Experimental Medicine; University of Perugia; Perugia; Italy
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases; Nofer Institute of Occupational Medicine; Lodz; Poland
| | - R. Gerth Wjik
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam; the Netherlands
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Guarnieri G, Cattoni I, Barbetta G, Bordin A, Liviero F, Mason P, Maestrelli P. [Features of occupational asthma in migrant workers living in northern Italy: observational study from 1987 to 2011]. G Ital Med Lav Ergon 2011; 33:152-156. [PMID: 23393825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In the period 1987-2011, 387 cases of occupational asthma (OA) in local workers (LL) and 32 in migrants (LM) were diagnosed in the 36 level Center of Occupational Medicine at University of Padova. Total number of OA decreased from early nineties to 2011. However the proportion of OA in migrants increased from 0.7% to 36.4% along the study period. Severity and causing agents were similar in the two groups. The most frequent cause were isocyanates (68.7% LM vs 52.7% LL). Most of OA in migrants was observed in painters (46.9%), whereas the jobs in asthmatic LL were more widely distributed.
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Affiliation(s)
- G Guarnieri
- Dipartimento di Medicina Ambientale e Sanità Pubblica, Università degli Studi di Padova, via Giustiniani 2-35128 Padova, Italia.
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Vandenplas O, Dressel H, Wilken D, Jamart J, Heederik D, Maestrelli P, Sigsgaard T, Henneberger P, Baur X. Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence. Eur Respir J 2011; 38:804-11. [PMID: 21436354 DOI: 10.1183/09031936.00177510] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Reduction of exposure to sensitising agents causing occupational asthma has been proposed as an alternative to total avoidance in order to minimise the adverse socio-economic impact of the condition. The aim of this systematic review was to compare the effects of these two management options on asthma and socio-economic outcomes. A bibliographic search was conducted to identify studies examining the outcome of workers with occupational asthma after reduction or cessation of exposure to the causal agent. The changes in asthma symptoms and nonspecific bronchial hyperresponsiveness after reduction or cessation of exposure were described in nine and five studies, respectively. The meta-analysis of pooled data showed that a reduction of exposure was associated with a lower likelihood of improvement (OR 0.16, 95% CI 0.03-0.91) and recovery (OR 0.30, 95% CI 0.11-0.84) of asthma symptoms and a higher risk of worsening of the symptoms (OR 10.23, 95% CI 2.97-35.28) and nonspecific bronchial hyperresponsiveness (OR 5.65, 95% CI 1.11-28.82), compared with complete avoidance of exposure. This systematic review indicates that reduction of exposure cannot be routinely recommended as an alternative to cessation of exposure in the management of occupational asthma. However, further investigations are required before drawing evidence-based conclusions on the cost-effectiveness of this approach.
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Affiliation(s)
- O Vandenplas
- Department of Chest Medicine, Mont-Godinne Hospital, Université Catholique de Louvain, Yvoir, Belgium.
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Chu HW, Lloyd CM, Karmaus W, Maestrelli P, Mason P, Salcedo G, Thaikoottathil J, Wardlaw AJ. Developments in the field of allergy in 2009 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2011; 40:1611-31. [PMID: 21039970 DOI: 10.1111/j.1365-2222.2010.03625.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In 2009 the journal published in the region of 200 papers including reviews, editorials, opinion pieces and original papers that ran the full gamut of allergic disease. It is instructive to take stock of this output to determine patterns of interest and where the cutting edge lies. We have surveyed the field of allergic disease as seen through the pages of Clinical and Experimental Allergy (CEA) highlighting trends, emphasizing notable observations and placing discoveries in the context of other key papers published during the year. The review is divided into similar sections as the journal. In the field of Asthma and Rhinitis CEA has contributed significantly to the debate about asthma phenotypes and expressed opinions about the cause of intrinsic asthma. It has also added its halfpennyworth to the hunt for meaningful biomarkers. In Mechanisms the considerable interest in T cell subsets including Th17 and T regulatory cells continues apace and the discipline of Epidemiology continues to invoke a steady stream of papers on risk factors for asthma with investigators still trying to explain the post-second world war epidemic of allergic disease. Experimental Models continue to make important contributions to our understanding of pathogenesis of allergic disease and in the Clinical Allergy section various angles on immunotherapy are explored. New allergens continue to be described in the allergens section to make those allergen chips even more complicated. A rich and vibrant year helpfully summarized by some of our associate editors.
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Affiliation(s)
- H W Chu
- Department of Medicine, National Jewish Health, Denver, CO, USA
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Baraldo S, Turato G, Bazzan E, Ballarin A, Damin M, Balestro E, Lokar Oliani K, Calabrese F, Maestrelli P, Snijders D, Barbato A, Saetta M. Noneosinophilic asthma in children: relation with airway remodelling. Eur Respir J 2011; 38:575-83. [PMID: 21310879 DOI: 10.1183/09031936.00168210] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Noneosinophilic asthma is increasingly recognised as an important clinical-pathological phenotype in adults. However, this entity has scarcely been investigated in children. In particular, it is unknown whether airway remodelling would develop in children with non-eosinophilic asthma to the same degree as in children with eosinophilic disease. We analysed bronchial biopsies from 80 children undergoing bronchoscopy for appropriate clinical indications: 21 with noneosinophilic asthma, 34 with eosinophilic asthma and 25 control children. Features of airway remodelling - basement membrane thickening, epithelial loss and angiogenesis - and immune activation - inflammatory infiltrate, interleukin (IL)-4, IL-5, transforming growth factor (TGF)-β, TGF-β receptor type II - were quantified by histology and immunohistochemistry. The main components of airway remodelling were present in children with noneosinophilic asthma just as in those with eosinophilic disease. Indeed, compared with control children, both noneosinophilic and eosinophilic asthmatic children had thickened basement membrane, increased epithelial loss and higher number of vessels. Moreover, in both groups of asthmatics, expression of IL-4 and IL-5 was increased, while that of TGF-β receptor type II was reduced, compared with controls. This study demonstrates that structural changes typical of asthma develop in asthmatic children even in the absence of a prominent eosinophilic infiltrate, indicating that other mechanisms, besides eosinophilic inflammation, may promote airway remodelling early in life.
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Affiliation(s)
- S Baraldo
- Dept of Cardiac, Thoracic andVascular Sciences, University of Padua, Padua, Italy
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Maestrelli P, Canova C, Scapellato ML, Visentin A, Tessari R, Bartolucci GB, Simonato L, Lotti M. Personal exposure to particulate matter is associated with worse health perception in adult asthma. J Investig Allergol Clin Immunol 2011; 21:120-128. [PMID: 21462802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Epidemiological studies have shown positive associations between particulate matter (PM) air pollution and short-term mortality and morbidity for asthma. The hypothesis that lung inflammation is responsible for these effects has been tested in panel and controlled exposure studies in asthmatic adults, with inconsistent results. OBJECTIVES We investigated whether personal exposure to PM10 and PM2.5 were related to changes in the clinical course of asthma and to lung inflammatory responses in adult asthmatics. METHODS A cohort of 32 asthmatic patients was followed for 2 years. Asthma control test (ACT) and St George's Respiratory Questionnaire (SGRQ) scores, forced expired volume in the first second (FEV1), exhaled nitric oxide (Fe(NO)), and pH of exhaled breath condensate (EBC) were determined on 6 occasions during different seasons. Personal exposure to PM was measured for 24 hours prior to clinical assessments. RESULTS A 10 microg/m3 increase in PM10 personal exposure was associated with an increase in SGRQ scores (regression coefficient beta = 0.22; 95% confidence interval [CI], -0.005 to 4.451; P =.055) and with a decrease in ACT scores (beta = -0.022; 95% CI, -0.045 to 0.001; P = .060), whereas no associations were found between PM10 and FEV1, Fe(NO), or EBC pH. A positive association was detected between Fe(NO) and outdoor O3 (P = .042) and SO2 (P = .042) concentrations in the subgroup of nonsmoking asthmatics. CONCLUSIONS We concluded that increments in personal exposure to PM10 are associated with a decrease in asthma control and health-related quality of life. However, this study does not provide evidence that 24-hour exposures to PM are associated with short-term changes in lung function or inflammatory responses of the lung.
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Affiliation(s)
- P Maestrelli
- Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy.
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Maestrelli P. [New methods for evaluation of the effects of urban pollutants]. G Ital Med Lav Ergon 2010; 32:340-343. [PMID: 21438294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Air pollution represents a health risk for inhabitants of cities and workers operating in urban environment. Short-term effects of pollutants are mainly observed in individuals with preexisting pulmonary and cardiovascular diseases. The present paper reviews the methods for studying short-term effects of pollutants on respiratory tract. The design of such studies is problematic since pollution is present indoor and outdoor making it difficult the examination of non-exposed individuals. Moreover, the causing agent(s) cannot be easily identified due to the multiplicity of pollution components. Whether an inflammatory mechanism plays a role, it is still controversial. Non invasive methods to study pulmonary inflammation have been introduced, that are suitable to study elevated number of subjects, particularly if they are healthy. The methods better standardized are induced sputum, exhaled nitric oxide and exhaled breath condensate.
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Affiliation(s)
- P Maestrelli
- Dipartimento di Medicina Ambientale e Sanità Pubblica, Università di Padova.
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Maestrelli P, Guarnieri G. [Diagnosis of occupational chronic pulmonary diseases]. G Ital Med Lav Ergon 2010; 32:433-436. [PMID: 21438313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Occupational risk factors may induce chronic nonmalignant respiratory diseases such as pneumoconiosis, hypersensitivity pneumonitis, chronic obstructive pulmonary disease (COPD), asthma or bronchiolitis obliterans syndrome. Diagnosis is well codified by international guidelines for most of these occupational diseases except for COPD. The study of occupational COPD is complicated by several issues. In fact, COPD is a multifactorial disease and has a long latency between exposure to causative agents and the occurrence of disease. The main confounding factor is smoking. The quantitative estimation of cigarette smoked is easier and more accurate than that of occupational exposure. The diagnosis of COPD is based on the presence of chronic airflow limitation at spirometry; moreover, an accelerated decline in respiratory function may be observed in the longitudinal evaluation of workers. The retrospective assignment of occupational aetiology of COPD remains difficult in individual cases, especially with a significant history of smoking.
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Affiliation(s)
- P Maestrelli
- Dipartimento di Medicina Ambientale e Sanità Pubblica, Università di Padova, Italy.
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Tura A, Conte B, Caparrotto C, Spinella P, Maestrelli P, Valerio A, Pacini G, Avogaro A. Insulin sensitivity and secretion in young, healthy subjects are not changed by Zone and Mediterranean diets. Mediterranean Journal of Nutrition and Metabolism 2010. [DOI: 10.3233/s12349-010-0026-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrea Tura
- Metabolic Unit, Institute of Biomedical Engineering, CNR (ISIB-CNR), Corso Stati Uniti 4, 35127 Padova, Italy. e-mail:
| | - Barbara Conte
- Department of Clinical and Experimental Medicine, University of Padova, Medical School, Padova, Italy
| | - Carmen Caparrotto
- Department of Clinical and Experimental Medicine, University of Padova, Medical School, Padova, Italy
| | - Paolo Spinella
- Department of Clinical and Experimental Medicine, University of Padova, Medical School, Padova, Italy
| | - Pietro Maestrelli
- Department of Clinical and Experimental Medicine, University of Padova, Medical School, Padova, Italy
| | - Anna Valerio
- Department of Clinical and Experimental Medicine, University of Padova, Medical School, Padova, Italy
| | - Giovanni Pacini
- Metabolic Unit, Institute of Biomedical Engineering, CNR (ISIB-CNR), Corso Stati Uniti 4, 35127 Padova, Italy. e-mail:
| | - Angelo Avogaro
- Department of Clinical and Experimental Medicine, University of Padova, Medical School, Padova, Italy
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Tura A, Conte B, Caparrotto C, Spinella P, Maestrelli P, Valerio A, Pacini G, Avogaro A. Insulin sensitivity and secretion in young, healthy subjects are not changed by Zone and Mediterranean diets. Mediterr J Nutr Metab 2010. [DOI: 10.1007/s12349-010-0026-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Quirce S, Lemière C, de Blay F, del Pozo V, Gerth Van Wijk R, Maestrelli P, Pauli G, Pignatti P, Raulf-Heimsoth M, Sastre J, Storaas T, Moscato G. Noninvasive methods for assessment of airway inflammation in occupational settings. Allergy 2010; 65:445-58. [PMID: 19958319 DOI: 10.1111/j.1398-9995.2009.02274.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present document is a consensus statement reached by a panel of experts on noninvasive methods for assessment of airway inflammation in the investigation of occupational respiratory diseases, such as occupational rhinitis, occupational asthma, and nonasthmatic eosinophilic bronchitis. Both the upper and the lower airway inflammation have been reviewed and appraised reinforcing the concept of 'united airway disease' in the occupational settings. The most widely used noninvasive methods to assess bronchial inflammation are covered: induced sputum, fractional exhaled nitric oxide (FeNO) concentration, and exhaled breath condensate. Nasal inflammation may be assessed by noninvasive approaches such as nasal cytology and nasal lavage, which provide information on different aspects of inflammatory processes (cellular vs mediators). Key messages and suggestions on the use of noninvasive methods for assessment of airway inflammation in the investigation and diagnosis of occupational airway diseases are issued.
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Affiliation(s)
- S Quirce
- Department of Allergy, Hospital La Paz, Madrid, Spain
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Mapp CE, Ferrazzoni S, Rizzo R, Miotto D, Stignani M, Boschetto P, Maestrelli P, Baricordi OR. Soluble human leucocyte antigen-G and interleukin-10 levels in isocyanate-induced asthma. Clin Exp Allergy 2009; 39:812-9. [PMID: 19302248 DOI: 10.1111/j.1365-2222.2009.03215.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We previously reported that in moderate-to-severe asthma there is a deficit of IL-10 secretion that could prevent the production of soluble HLA-G (sHLA-G), a non-classical human leucocyte antigen class I molecule with tissue-protective properties in inflammatory responses. OBJECTIVE Our objective was to investigate the production of sHLA-G and the secretion of IL-10 by peripheral blood mononuclear cells (PBMCs) in asthma induced by isocyanates and to compare the results with those obtained in non-occupational allergic asthma. METHOD sHLA-G and IL-10 were measured by ELISA in the culture supernatants of unstimulated or lipopolysaccharide (LPS)-stimulated PBMCs obtained from 20 subjects with isocyanate asthma, 16 asymptomatic subjects exposed to isocyanates, 18 subjects with non-occupational allergic asthma, and 26 healthy control subjects. RESULTS Occupational exposure to isocyanates was associated with high baseline levels of secretion of IL-10 by PBMCs, whether or not the exposed subjects had asthmatic symptoms. However, spontaneous production of sHLA-G by PBMC was significantly higher in subjects with isocyanate asthma compared with asymptomatic-exposed controls. In contrast, PBMCs from subjects with non-occupational allergic asthma produced sHLA-G only after LPS stimulation. CONCLUSIONS sHLA-G production and IL-10 secretion are influenced by workplace exposure to isocyanates and by development of asthma. The different behaviour of both sHLA-G and IL-10 in asthma induced by isocyanates compared with non-occupational allergic asthma suggests a heterogeneous biological role for HLA-G molecules and for IL-10, a key cytokine of immune and inflammatory responses.
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Affiliation(s)
- C E Mapp
- Department of Clinical and Experimental Medicine, Section of Hygiene and Occupational Medicine, University of Ferrara, Ferrara, Italy
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Canova C, Torresan S, Simonato L, Scapellato ML, Tessari R, Visentin A, Lotti M, Maestrelli P. Carbon monoxide pollution is associated with decreased lung function in asthmatic adults. Eur Respir J 2009; 35:266-72. [PMID: 19679604 DOI: 10.1183/09031936.00043709] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of the present study was to test the effects of exposure to air pollutants on lung function. A panel of 19 adult asthmatics living in Padua (Italy) was followed for five 30-day periods during 2 yrs consecutively (1,492 morning and 1,434 evening measures analysed). Peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV(1)) were measured using a pocket electronic meter. Daily levels of air pollutants and meteorological variables were collected at outdoor city monitoring sites. Significant inverse associations were observed between morning and evening PEF and carbon monoxide level (p = 0.01-0.03), without clear differences between lags (0-3 days). An increment of 1 mg.m(-3) CO was associated with a PEF variation ranging -2.6- -2.8%. All effect estimates on PEF for CO remained significant and even increased after controlling for particles with a 50% cut-off aerodynamic diameter of 10 microm (PM(10)), nitrogen dioxide and sulphur dioxide in single and multi-pollutant models. A similar trend was observed for FEV(1), but the associations were nonsignificant. A nonsignificant inverse relationship between evening PEF and SO(2) was also detected. PEF and FEV(1) were not related to PM(10) and NO(2) concentrations. The present results indicate that, in this panel of adult asthmatics, the worsening of lung function is associated with exposure to gaseous pollutants and occurs at levels of CO and SO(2) lower than current European standards.
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Affiliation(s)
- C Canova
- Dept of Environmental Medicine and Public Health, University of Padova, Via Loredan 18, 35151 Padova, Italy. E-mail:
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Renda T, Baraldo S, Pelaia G, Bazzan E, Turato G, Papi A, Maestrelli P, Maselli R, Vatrella A, Fabbri LM, Zuin R, Marsico SA, Saetta M. Increased activation of p38 MAPK in COPD. Eur Respir J 2007; 31:62-9. [PMID: 17959643 DOI: 10.1183/09031936.00036707] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inflammation, oxidative stress and apoptosis, which are involved in chronic obstructive pulmonary disease (COPD) pathogenesis, may activate the p38 subgroup of mitogen-activated protein kinases (MAPKs). Therefore, the aim of the present study was to evaluate the expression of the phosphorylated, active form of p38 MAPK (phospho-p38) in the lungs of COPD patients. Surgical specimens were obtained from 18 smokers with COPD at different stages of disease severity, plus nine smoking and eight nonsmoking subjects with normal lung function. Phospho-p38+ cells were quantified by immunohistochemistry in both alveolar spaces and alveolar walls. Moreover, a Western blot analysis of phospho-p38 and total p38alpha isoform expressed by alveolar macrophages was performed. Phospho-p38+ alveolar macrophages and phospho-p38+ cells in alveolar walls were increased in patients with severe and mild/moderate COPD, compared with smoking and nonsmoking controls. Moreover, they were inversely correlated to values of forced expiratory volume in one second (FEV(1)) and FEV(1)/forced vital capacity. Western blot analysis showed that phosphorylated p38, but not the total p38alpha isoform, was specifically increased in alveolar macrophages from COPD patients. Activation of the p38 mitogen-activated protein kinase pathway appears to be involved in the pathogenesis of chronic obstructive pulmonary disease. The present findings suggest that this protein may be a suitable pharmacological target for therapeutic intervention.
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Affiliation(s)
- T Renda
- Dept of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Zeni E, Mazzetti L, Miotto D, Lo Cascio N, Maestrelli P, Querzoli P, Pedriali M, De Rosa E, Fabbri LM, Mapp CE, Boschetto P. Macrophage expression of interleukin-10 is a prognostic factor in nonsmall cell lung cancer. Eur Respir J 2007; 30:627-32. [PMID: 17537769 DOI: 10.1183/09031936.00129306] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Interleukin (IL)-10 is expressed in many solid tumours and plays an ambiguous role in controlling cancer growth and metastasis. In order to determine whether IL-10 is involved in tumour progression and prognosis in nonsmall cell lung cancer (NSCLC), IL-10 expression in tumour cells and tumour-associated macrophages (TAMs) and its associations, if any, with clinicopathological features were investigated. Paraffin-embedded sections of surgical specimens obtained from 50 patients who had undergone surgery for NSCLC were immunostained with an antibody directed against IL-10. TAMs and tumour cells positive for IL-10 were subsequently quantified. IL-10-positive TAM percentage was higher in patients with stage II, III and IV NSCLC, and in those with lymph node metastases compared with patients with stage I NSCLC. High IL-10 expression by TAMs was a significant independent predictor of advanced tumour stage, and thus was associated with worse overall survival. Conversely, IL-10 expression by tumour cells did not differ between stages II, III and IV and stage I NSCLC. In conclusion, interleukin-10 expression by tumour-associated macrophages, but not by tumour cells, may play a role in the progression and prognosis of nonsmall cell lung cancer. These results may be useful in the development of novel approaches for anticancer treatments.
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Affiliation(s)
- E Zeni
- Dipartimento di Medicina Clinica e Sperimentale, Sezione di Igiene e Medicina del Lavoro, Via Fossato di Mortara 64/b, 44100, Ferrara, Italy
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Guarnieri G, Lodde V, Ferrazzoni S, Bordini A, Venturini R, Zaninotto M, Clonfero E, Maestrelli P. [Acute effects of environmental pollution on the urban vigilants airways]. G Ital Med Lav Ergon 2007; 29:838-840. [PMID: 18409990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM OF THE STUDY The purpose of this study was to evaluate whether the acute exposure to air pollution, in a group of policemen of Padua, is correlated with increased inflammatory biomarkers (exhaled nitric oxide, feNO) and alterations of bronchiolar cells (assessed by CC16 Clara cell-specific protein). METHODS We studied 44 healthy, non-smokers divided in exposed to traffic and controls (office workers). Before and after the Monday shift serum and urinary concentration of CC16, feNo and spirometry were measured in each subject. Data on air pollutants, PM2.5, PM10, SO2, NO2, CO, O3 were collected from official bulletin online (ARPAV). RESULTS In exposed policemen serum CC16 decreased after shift (before 4.6 +/- 0.2 vs after 6.4 +/- 0.8 ng/ml, = 0.02), while feNO increased significantly (33.2 +/- 4.4 vs 29.7 +/- 3.9 ppb, p = 0.02). feNO cross-shift changes were positively correlated with environmental SO2 levels (rho = 0.48; p = 0.01). CONCLUSIONS Our results suggest that in healthy and nonsmokers subjects the exposure to air pollution is associated with subclinical airway inflammation and decrease of bronchiolar epithelium function.
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Affiliation(s)
- G Guarnieri
- Dipartimento di Medicina Ambientale e Sanità Pubblica, Università degli Studi di Padova, Via Giustiniani, 2, 35128 Padova.
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Beghe B, Bazzan E, Baraldo S, Calabrese F, Rea F, Loy M, Maestrelli P, Zuin R, Fabbri LM, Saetta M. Transforming growth factor-beta type II receptor in pulmonary arteries of patients with very severe COPD. Eur Respir J 2006; 28:556-62. [PMID: 16737987 DOI: 10.1183/09031936.06.00077105] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A mild-to-moderate increase in pulmonary arterial pressure is often associated with severe chronic obstructive pulmonary disease (COPD). Transforming growth factor (TGF)-beta is a cytokine involved in the maintenance of integrity of vasculature. The aim of the study was to investigate whether the TGF-beta pathway might be involved in the development of pulmonary hypertension associated with COPD. Surgical specimens from 14 patients undergoing lung transplantation for very severe COPD (forced expiratory volume in one second 17 +/- 2% of the predicted value) and from seven donors were examined. The expression of TGF-beta1 and TGF-beta type II receptor (TGF-betaRII), cell proliferation index and structural changes in pulmonary arteries were quantified immunohistochemically. In severe COPD patients, increased expression of TGF-betaRII was observed in both the tunica media and intima, which was associated with a normal proliferation index in both layers. Conversely, significant thickening of the tunica intima, which was not present in the tunica media, was observed, suggesting that mechanisms other than cell proliferation may be involved in intimal thickening. In conclusion, in the pulmonary arteries of patients with severe chronic obstructive pulmonary disease, there is upregulation of transforming growth factor-beta type II receptor expression associated with a normal proliferation index. These findings suggest the activation of an antiproliferative pathway, which might explain the relatively low degree of pulmonary hypertension observed in these subjects.
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Affiliation(s)
- B Beghe
- Dept of Cardiological, Thoracic and Vascular Sciences, Section of Respiratory Diseases, University of Padua, Padua, Italy
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Guddo F, Vignola AM, Saetta M, Baraldo S, Siena L, Balestro E, Zuin R, Papi A, Maestrelli P, Fabbri LM, Bonsignore G, Turato G. Upregulation of basic fibroblast growth factor in smokers with chronic bronchitis. Eur Respir J 2006; 27:957-63. [PMID: 16510460 DOI: 10.1183/09031936.06.00057205] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of the study was to investigate the expression of basic fibroblast growth factor (bFGF) and its receptor, fibroblast growth factor receptor (FGFR)-1, in the central airways of smokers with chronic bronchitis. The lobar bronchi from 17 subjects undergoing thoracotomy for solitary nodules were examined. All had a history of cigarette smoking, nine had symptoms of chronic bronchitis and airflow limitation, and eight were asymptomatic with normal lung function. Using immunohistochemical methods, bFGF and FGFR-1 expression in the total airway wall and the different airway compartments, i.e. bronchial glands, submucosal vessels and smooth muscle, was quantified. Moreover, to investigate the role of bFGF in angiogenesis, the number of submucosal vessels was quantified. Smokers with chronic bronchitis had an increased bFGF expression in the total airway wall compared with asymptomatic smokers, which was mainly due to bFGF upregulation in bronchial glands. By contrast, the expression of FGFR-1 and the number of submucosal vessels was similar in the two groups of subjects examined. In conclusion, smokers with chronic bronchitis have an increased expression of basic fibroblast growth factor in the central airways, which is mainly due to an increased expression in bronchial glands, suggesting the involvement of this growth factor in the pathogenesis of chronic bronchitis.
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Affiliation(s)
- F Guddo
- Pathology Unit, V. Cervello Hospital, Palermo, Italy
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Baraldo S, Bazzan E, Turato G, Calabrese F, Beghé B, Papi A, Maestrelli P, Fabbri LM, Zuin R, Saetta M. Decreased expression of TGF-beta type II receptor in bronchial glands of smokers with COPD. Thorax 2005; 60:998-1002. [PMID: 16227324 PMCID: PMC1747268 DOI: 10.1136/thx.2005.046292] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The role of transforming growth factor-beta1 (TGF-beta1) in chronic obstructive pulmonary disease is still controversial, but it has been proposed that it may protect from mucus hypersecretion since it is able to downregulate mucin production. A study was undertaken to investigate the expression of TGF-beta1 and its type II receptor (TGF-beta RII) in the bronchial glands of smokers with COPD. METHODS The expression of TGF-beta(1) and TGF-beta RII were examined immunohistochemically in the bronchial glands of 24 smokers undergoing lung resection for solitary peripheral nodules: 12 with airflow limitation (smokers with COPD) and 12 with normal lung function. RESULTS The expression of TGF-beta1 in bronchial glands was similar in the two groups of subjects while that of TGF-beta RII was lower in smokers with COPD than in smokers with normal lung function (p=0.004). TGF-beta RII expression was inversely correlated with the values of Reid's index, a measure of gland size (p=0.02, r=-0.50). CONCLUSIONS In the bronchial glands of smokers with COPD there is decreased expression of TGF-beta RII which is associated with bronchial gland enlargement. These findings support the view that the absence of TGF-beta signalling may induce structural changes in the bronchial glands which, in turn, may promote mucus hypersecretion.
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Affiliation(s)
- S Baraldo
- Department of Cardio-Thoracic and Vascular Sciences, Section of Respiratory Diseases, University of Padova, Italy
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Siracusa A, Marabini A, Pace ML, Tacconi C, Folletti I, Bussetti A, Maestrelli P. [Occupational asthma: role of airway inflammation and remodelling in persistent respiratory symptoms and bronchial hyper-responsiveness]. Med Lav 2004; 95:275-81. [PMID: 15532960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Until the late 1970's occupational asthma (OA) was considered reversible once patients were removed from exposure. Unfortunately, respiratory symptoms and non-specific bronchial hyper-responsiveness (NSBH) persist in about two-thirds of patients for years after removal from the offending agent. OBJECTIVES AND METHODS This review focuses on the role of airways inflammation and remodelling in persistent respiratory symptoms and NSBH after cessation of occupational exposure. RESULTS Even though cessation of exposure does not always result in remission of OA, symptoms, airways calibre and NSBH do improve in many patients. Although improvements in FEV1 and NSBH tend to reach a plateau 1-2 years after workers leave exposure, reversing NSBH may take much longer and respiratory symptoms and NSBH can persist in subjects removed from exposurefor >10 yrs. Long-term treatment with inhaled corticosteroids (ICS) induces a small but significant improvement in respiratory symptoms and in quality of life and a decrease in NSBH. Prolonged exposure and respiratory symptoms, marked airway obstruction and NSBH, high total cell, eosinophil and neutrophil counts in bronchoalveolar lavage fluid, a strong reaction during specific inhalation challenge, and delayed treatment with ICS have been identified as prognostic factors of unfavourable outcome. If exposure persists, OA tends to deteriorate in many patients but regular long-term treatment with ICS and long-acting beta2-agonists seems to stabilize the outcome. Soon after the last exposure inflammatory cell infiltrates, including eosinophils, and increased thickness of sub-epithelial collagen have been observed. When time since removal from exposure was longer, persistence of respiratory symptoms and NSBH was associated with airway inflammation, remodelling and hypersensitivity to the offending agent. Thickness of sub-epithelial collagen and specific airway sensitivity were reduced after prolonged non-exposure to isocyanates, although NSBH and airway inflammation persisted. CONCLUSIONS Pathologic features are similar in OA and non-occupational asthma. The main factors of favourable outcome are early removal from exposure and a mild airway obstruction and NSBH at diagnosis. Persistence of airway inflammation years after removal from exposure suggests this process may become independent of the offending agent. The role of remodelling on persistence of OA needs to be clarified further.
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Affiliation(s)
- A Siracusa
- Allergologia Professionale e Ambientale, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Perugia.
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Baraldo S, Turato G, Badin C, Bazzan E, Beghé B, Zuin R, Calabrese F, Casoni G, Maestrelli P, Papi A, Fabbri LM, Saetta M. Neutrophilic infiltration within the airway smooth muscle in patients with COPD. Thorax 2004; 59:308-12. [PMID: 15047950 PMCID: PMC1763819 DOI: 10.1136/thx.2003.012146] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND COPD is an inflammatory disorder characterised by chronic airflow limitation, but the extent to which airway inflammation is related to functional abnormalities is still uncertain. The interaction between inflammatory cells and airway smooth muscle may have a crucial role. METHODS To investigate the microlocalisation of inflammatory cells within the airway smooth muscle in COPD, surgical specimens obtained from 26 subjects undergoing thoracotomy (eight smokers with COPD, 10 smokers with normal lung function, and eight non-smoking controls) were examined. Immunohistochemical analysis was used to quantify the number of neutrophils, macrophages, mast cells, CD4+ and CD8+ cells localised within the smooth muscle of peripheral airways. RESULTS Smokers with COPD had an increased number of neutrophils and CD8+ cells in the airway smooth muscle compared with non-smokers. Smokers with normal lung function also had a neutrophilic infiltration in the airway smooth muscle, but to a lesser extent. When all the subjects were analysed as one group, neutrophilic infiltration was inversely related to forced expiratory volume in 1 second (% predicted). CONCLUSIONS Microlocalisation of neutrophils and CD8+ cells in the airway smooth muscle in smokers with COPD suggests a possible role for these cells in the pathogenesis of smoking induced airflow limitation.
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Affiliation(s)
- S Baraldo
- Department of Clinical and Experimental Medicine, Section of Respiratory Diseases, University of Padova, Italy
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Visentin A, Fedeli U, Zanetti C, Marcer G, Bordin A, Zedda L, Dal Borgo D, Maestrelli P. [Follow-up of latex-induced occupational asthma]. G Ital Med Lav Ergon 2003; 25 Suppl:190-1. [PMID: 14979144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We studied 29 subjects with latex-induced occupational asthma in a follow-up of 5 +/- 3 years. Initial and follow-up visits included a questionnaire and measurement of lung volumes, bronchial responsiveness to methacholine (PD20FEV1), and latex-specific serum IgE levels. At follow-up, 17 subjects were no longer exposed to latex, whereas 12 subjects had reduced exposure. Asthma and rhinitis symptoms, use of steroids and bronchial hyperresponsiveness improved significantly at follow-up, whereas mean FEV1% and FVC% decreased (p < 0.05). Multiple regression analysis showed that the main determinant of FEV1 and PD20FEV1 at follow up were the values of these variables at diagnosis. Complete recovery of occupational asthma was observed in 7 subjects (24%), all in the non-exposed group. Latex-specific IgE did not exhibit significant changes. In conclusion latex-induced occupational asthma improves after a follow-up of 5 +/- 3 years, but a complete recovery occurs in a minority of subjects and is associated with cessation of exposure. Lung function measurements at follow up depend from their impairment at the time of diagnosis.
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Affiliation(s)
- A Visentin
- Dipartimento di Medicina Ambientale e Sanità Pubblica, Università degli Studi di Padova
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Maestrelli P, Páska C, Saetta M, Turato G, Nowicki Y, Monti S, Formichi B, Miniati M, Fabbri LM. Decreased haem oxygenase-1 and increased inducible nitric oxide synthase in the lung of severe COPD patients. Eur Respir J 2003; 21:971-6. [PMID: 12797490 DOI: 10.1183/09031936.03.00098203] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Oxidant/antioxidant imbalance is implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD). The current study examined the expression of antioxidant and pro-oxidant enzymes, haem oxygenases (HO) and inducible nitric oxide synthase (iNOS) respectively, in patients with severe COPD and control smokers without lung function impairment. Immunoreactivity for HO-1, HO-2, iNOS and nitric oxide-derived oxidants expressed as nitrotyrosine (N-Tyr) was quantified in peripheral lung. HO-1+ alveolar macrophages were decreased in severe COPD compared to control smokers, whereas no difference was observed in iNOS+ macrophages. In contrast, severe patients had significantly higher numbers of iNOS+ cells in alveolar walls. These iNOS+ cells were identified as type 2 pneumocytes and their number was inversely related to HO-1+ macrophages. There were no significant differences in N-Tyr immunostaining between the two groups. However, the rate of protein nitration in lung tissue was directly related to iNOS expression and associated with lower values of forced expiratory volume in one second/forced vital capacity. HO-2 was constitutively expressed by type 2 pneumocytes and these cells were increased in severe COPD. In conclusion, the results suggest that the enzymes involved in the oxidative stress response may have a different role in the lung defence and that imbalance between haem oxygenase-1 and inducible nitric oxide synthase may be associated with the development of severe impairment in chronic obstructive pulmonary disease patients.
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Affiliation(s)
- P Maestrelli
- Dept of Environmental Medicine and Public Health, Section of Respiratory Diseases, University of Padova, Padua, Italy.
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Padoan M, Pozzato V, Simoni M, Zedda L, Milan G, Bononi I, Piola C, Maestrelli P, Boschetto P, Mapp CE. Long-term follow-up of toluene diisocyanate-induced asthma. Eur Respir J 2003; 21:637-40. [PMID: 12762349 DOI: 10.1183/09031936.03.00060703] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Eighty-seven cases of occupational asthma induced by toluene diisocyanate (TDI) were diagnosed by an inhalation challenge with TDI and methacholine. After an average follow-up interval of 11 yrs, all subjects were re-examined. Of the 87 subjects examined, 13 (15%) had remained in the same job, 44 (50.5%) had been removed from exposure for <10 yrs and 30 (34.5%) had been removed for >10 yrs. The proportion of subjects who experienced symptoms of asthma and those who were hyperresponsive to methacholine was significantly lower. Of the patients, 59% used short-acting bronchodilators, 8% long-acting bronchodilators and 18% were on regular inhaled glucocorticoids. Thus, multiple regression analysis showed a positive correlation between forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) at follow-up and FVC and FEV1 at diagnosis, and a negative correlation with smoking and with therapy with bronchodilators. Stepwise logistic regression showed that the follow-up provocative dose causing a 20% fall in the FEV1 (PD20) could be predicted from baseline PD20. These results indicate that respiratory symptoms and airway hyperresponsiveness to methacholine persist in subjects removed from exposure to TDI for >10 yrs. A more favourable prognosis was associated with a better lung function and a lower degree of airway hyperresponsiveness to methacholine at diagnosis.
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Affiliation(s)
- M Padoan
- Dept of Environmental Medicine and Public Health, University of Padua, Padua, Italy
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Affiliation(s)
- P L Paggiaro
- Cardiothoracic Dept, Cisanello Hospital, Pisa, Italy.
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Maestrelli P. Environmental exposure and occupational asthma. Monaldi Arch Chest Dis 2002; 57:167-8. [PMID: 12619375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Environmental exposure in relation to occupational asthma (OA) concerns the exposure of subjects in the work-place. There are qualitative and quantitative differences in occupational exposures which may influence the development and/or the course of OA. Although more than 300 different agents have been described causing OA, 5-6 groups of substances are sufficient to explain more than 80% of all cases of OA. In addition, a variant of occupational asthma without latency period may occur after an acute inhalation of massive concentrations of irritants, and exacerbations of a pre-existent asthma may be due to products or conditions in the work-place. Despite our increased knowledge of the etiology and pathophysiology of OA, its prevalence in the industrialised world has been relatively steady over the last decade. Therefore, the transfer of knowledge has not been sufficiently effective in the prevention of the disease. The results of studies on the exposure-response relationship for several high molecular weight chemicals (and fewer low molecular weight) indicate that sensitisation may be prevented in large part by reducing work-place concentrations of these agents. These data give support to the attempt to develop Threshold Limit Values (TLV) for sensitisers.
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Affiliation(s)
- P Maestrelli
- Dipartimento di Medicina Ambientale e Sanità Pubblica, Sede di Medicina del Lavoro-Servizio di Fisiopatologia Respiratoria, Università di Padova, Via Giustiniani 2, 35128 Padova, Italy.
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Moscato G, Dellabianca A, Maestrelli P, Paggiaro P, Romano C, De Zotti R, Marabini A, Voltolini S, Crippa M, Previdi M, Bramé B, Benzon R, Siracusa A. Features and severity of occupational asthma upon diagnosis: an Italian multicentric case review. Allergy 2002; 57:236-42. [PMID: 11906338 DOI: 10.1034/j.1398-9995.2002.1o3337.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The severity of occupational asthma (OA) at the time of diagnosis is not known. In this study we aimed to evaluate some features of the disease at the time of diagnosis, particularly looking at severity and treatment before diagnosis. METHODS Medical records of subjects (n = 197) who had received a diagnosis of OA in six specialized centres of Northern and Central Italy in the period 1992-97 were reviewed. The severity of the disease at the time of diagnosis was determined on the basis of symptoms, peak expiratory flow (PEF, percentage predicted), forced expiratory volume in one second (FEV1, percentage predicted), and PEF variability, following the criteria of the National Institutes of Health and World Health Organizaton (NIH/WHO) guidelines on asthma. Medications used in the month before diagnosis were recorded. RESULTS The most common etiological agents were isocyanates (41.6%), flours (19.8%), woods (9.7%) and natural rubber latex (7.6%). The level of asthma severity (AS) was mild intermittent in 23.9% patients, mild persistent in 28.9%, moderate in 41.6%, and severe in 5.6%. Asthma severity was positively associated with current or previous smoking (P < 0.05), and was not related to atopy and current exposure. A relationship with bronchial reactivity to methacholine was shown in subjects at work. Treatment before diagnosis was consistent with the NIH/WHO guidelines in only 13.2% patients, whereas 75.6% were undertreated and 11.2% were overtreated. CONCLUSIONS In this study we found that the majority of patients had mild asthma at the time of diagnosis and that cigarette smoking was associated with a greater severity. Moreover, the majority of patients were undertreated before etiological diagnosis.
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Affiliation(s)
- G Moscato
- Fondazione Salvatore Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Pavia, Servizio Autonomo di Allergologia e Immunologia Clinica, Università degli Studi di Pavia, Italy
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Miotto D, Hollenberg MD, Bunnett NW, Papi A, Braccioni F, Boschetto P, Rea F, Zuin A, Geppetti P, Saetta M, Maestrelli P, Fabbri LM, Mapp CE. Expression of protease activated receptor-2 (PAR-2) in central airways of smokers and non-smokers. Thorax 2002; 57:146-51. [PMID: 11828045 PMCID: PMC1746249 DOI: 10.1136/thorax.57.2.146] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Protease activated receptor-2 (PAR-2) is a transmembrane G protein coupled receptor preferentially activated by trypsin and tryptase. The protease activated receptors play an important role in most components of injury responses including cell proliferation, migration, matrix remodelling, and inflammation. Cigarette smoking causes an inflammatory process in the central airways, peripheral airways, lung parenchyma, and adventitia of pulmonary arteries. METHODS To quantify the expression of PAR-2 in the central airways of smokers and non-smokers, surgical specimens obtained from 30 subjects undergoing lung resection for localised pulmonary lesions (24 with a history of cigarette smoking and six non-smoking control subjects) were examined. Central airways were immunostained with an antiserum specific for PAR-2 and PAR-2 expression was quantified using light microscopy and image analysis. RESULTS PAR-2 expression was found in bronchial smooth muscle, epithelium, glands, and in the endothelium and smooth muscle of bronchial vessels. PAR-2 expression was similar in the central airways of smokers and non-smokers. When smokers were divided according to the presence of symptoms of chronic bronchitis and chronic airflow limitation, PAR-2 expression was increased in smooth muscle (median 3.8 (interquartile range 2.9-5.8) and 1.4 (1.07-3.4) respectively); glands (33.3 (18.2-43.8) and 16.2 (11.5-22.2), respectively); and bronchial vessels (54.2 (48.7-56.8) and 40.0 (36-40.4), respectively) of smokers with symptoms of chronic bronchitis with normal lung function compared with smokers with chronic airflow limitation (COPD), but the increase was statistically significant (p<0.005) only for bronchial vessels. CONCLUSIONS PAR-2 is present in bronchial smooth muscle, glands, and bronchial vessels of both smokers and non-smokers. An increased expression of PAR-2 was found in bronchial vessels of patients with bronchitis compared with those with COPD.
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Affiliation(s)
- D Miotto
- Institute of Respiratory Diseases, University of Ferrara, Italy
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Maestrelli P, Saetta M, Mapp CE, Fabbri LM. Remodeling in response to infection and injury. Airway inflammation and hypersecretion of mucus in smoking subjects with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 164:S76-80. [PMID: 11734472 DOI: 10.1164/ajrccm.164.supplement_2.2106067] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Airway epithelium represents the first line of defense against toxic inhalants. In some subjects, cigarette smoking causes airway inflammation, hypersecretion of mucus, and poorly reversible airflow limitation through mechanisms that are still largely unknown. Likewise, it is unclear why only some smokers develop chronic obstructive pulmonary disease (COPD). Two cell types consistently result in relation to chronic airflow limitation in COPD: neutrophils and CD8(+) cells. Neutrophils are compartmentalized in the mucosal surface of the airways and air spaces, that is, the epithelium and lumen, whereas CD8(+) cells exhibit a more extensive distribution along the subepithelial zone of the airways and lung parenchyma, including alveolar walls and arteries. This pattern of inflammatory cell distribution is observed in mild or moderate COPD, and in patients who have developed COPD, it is not modified by smoking cessation. The number of neutrophils further increases in the submucosa of patients with severe COPD, suggesting a role for these cells in the progression of the disease. Hypersecretion of mucus is a major manifestation in COPD. Mucus is produced by bronchial glands and goblet cells lining the airway epithelium. Unlike mucous gland enlargement, greater mucosal inflammation is associated with sputum production. Whereas neutrophil infiltration of submucosal glands occurs only in smokers with COPD, goblet cell hyperplasia in peripheral airways occurs both in smokers with or without COPD, suggesting that the major determinant of goblet cell hyperplasia is cigarette smoke itself.
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Affiliation(s)
- P Maestrelli
- Department of Environmental Medicine and Public Health, University of Padua, Padua, Italy.
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Maestrelli P, El Messlemani AH, De Fina O, Nowicki Y, Saetta M, Mapp C, Fabbri LM. Increased expression of heme oxygenase (HO)-1 in alveolar spaces and HO-2 in alveolar walls of smokers. Am J Respir Crit Care Med 2001; 164:1508-13. [PMID: 11704604 DOI: 10.1164/ajrccm.164.8.2011083] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
It has been suggested that oxidative stress protein heme oxygenase (HO)-1 plays a role in chronic airway diseases including chronic obstructive pulmonary disease (COPD). The inducible isoform HO-1 and the constitutive HO-2 catalyze the same reaction. Their distribution in situ was studied in lungs of 10 nonsmoking subjects, 6 healthy smokers, and 10 smokers with COPD. Paraffin-embedded sections of surgical lung specimens were immunostained with antibodies against HO-1 and HO-2. HO-1 immunoreactivity was observed mainly in alveolar macrophages. HO-1-positive macrophages were increased in smokers with COPD (median: 36%) as compared with nonsmoking subjects (13%; p < 0.02), whereas no differences were observed between patients with COPD and healthy smokers (34%). HO-2 had a more widespread distribution in cells of the alveolar wall, in adventitia of pulmonary arteries and bronchioles, and in vascular smooth muscle. Lower percentages of alveolar macrophages exhibited positive staining for HO-2 without significant differences between the three groups. HO-2(+) cells in the alveolar wall were increased in smokers with (15/mm) and without COPD (12/mm) as compared with nonsmokers (8/mm, p < 0.01). In conclusion, inducible HO-1 and constitutive HO-2 are detectable in human lung tissue and their expression is increased in smokers, suggesting that oxidative stress due to cigarette smoke may increase lung cells expressing HO-1 and HO-2.
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Affiliation(s)
- P Maestrelli
- Department of Environmental Medicine and Public Health, University of Padua, Padua, Italy.
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Affiliation(s)
- M Saetta
- Department of Clinical and Experimental Medicine, Section of Respiratory Diseases, University of Padova, Via Giustiniani 3, 35128 Padua, Italy.
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Maestrelli P, Zanolla L, Puccinelli P, Pozzan M, Fabbri LM. Low domestic exposure to house dust mite allergens (Der p 1) is associated with a reduced non-specific bronchial hyper-responsiveness in mite-sensitized asthmatic subjects under optimal drug treatment. Clin Exp Allergy 2001; 31:715-21. [PMID: 11422130 DOI: 10.1046/j.1365-2222.2001.01020.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Airway inflammation in asthma causes symptoms, airflow limitation and bronchial hyper-responsiveness. The strategy of asthma management is to reduce airway inflammation by drug treatment and avoidance of triggers, including allergens. OBJECTIVE We determined the effect of exposure to house dust mite (HDM) allergens on bronchial responsiveness in asthmatics sensitive to mites while under optimal drug treatment. METHODS We studied 71 mild to moderate HDM-sensitive asthmatics. Drug treatment sufficient to keep asthma under control was administered to each patient for 1 year. Subjects were divided into two groups, according to the amount of Der p 1 in their bedrooms measured after standard HDM reduction measures: low Der p 1 exposure (0.64 +/- 0.5 microg/g dust) (Group 1, n = 34) and high Der p 1 exposure (12.5 +/- 11.4 microg/g) (Group 2, n = 37). Bronchial responsiveness to methacholine (PD20FEV1) was determined at the beginning and end of the study. RESULTS In Group 1, PD20FEV1 increased 2.15-fold at the end of the study from 57 to 123 microg (P < 0.05), whereas in Group 2 no significant changes were observed. The subjects in Group 2 tended to increase the use of inhaled steroids and bronchodilators in the autumn months compared with subjects in Group 1, but the difference was not significant. CONCLUSION This long-term study shows that exposure to lower levels of mite allergens in the bedroom is associated with a decrease of bronchial hyper-responsiveness in sensitized asthmatic subjects under optimal drug treatment.
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Affiliation(s)
- P Maestrelli
- Institute of Occupational Medicine, University of Padova, Ospedale Giustinianeo, via Giustiniani 3, 35128 Padua, Italy.
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De Marzo N, Jovine L, Rizzotti P, Cassetti P, Boschetto P, Miotto D, Saetta M, Maestrelli P, Mapp CE. Modification of serum proteins in guinea pigs immunized and challenged with toluene diisocyanate. Scand J Work Environ Health 2000; 26:153-60. [PMID: 10817381 DOI: 10.5271/sjweh.525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Guinea pigs were used to determine whether immunization and challenge by toluene diisocyanate (TDI) induce changes in the serum protein concentrations of the "acute-phase response" and whether TDI can form adducts with serum proteins. METHODS Guinea pigs were immunized by weekly intradermal injections of TDI and challenged with TDI 7 days after the 3rd injection. The animals were killed 6 hours after the challenge, and serum was analyzed for protein characterization by gel electrophoresis and for specific antibodies to TDI by enzyme-linked immunosorbent assay (ELISA) and Western blotting. RESULTS The total serum protein concentration of the immunized TDI-challenged guinea pigs increased in comparison with that of nonimmunized animals [75 (SE 0.7) versus 47.4 (SE 2.3) mg/ml; ]. Albumin and alpha, and alpha2 globulins increased significantly [respectively: 65.8 (SE 0.2)%, 2.1 (SE 0.1)% and 7.2 (SE 0.1)% versus 59 (SE 1.3)%, 1.3 (SE 0.1)% and 3.7 (SE 0.1)%], whereas beta1 and beta2 globulins decreased in the immunized TDI-challenged guinea pigs [7.8 (SE 0.2)% and 0.8 (SE 0.2)% versus 15.8 (SE 0.7)% and 4.8 (SE 0.2)%]. The gamma globulin concentrations did not change significantly. In the immunized TDI-challenged animals, albumin was modified by TDI and ran faster on agarose gel electrophoresis than did albumin from nonimmunized guinea pigs. In the ELISA, only immunized animals had high titers of TDI-specific antibodies (IgG and IgG1); by blotting, the antibodies reacted against TDI, the TDI-BSA-conjugate and several TDI-conjugated guinea pig serum proteins, but they did not react against any native or denaturated serum protein when unconjugated with TDI. CONCLUSIONS These findings indicate that, in guinea pigs, immunization and challenge with TDI induces changes in serum proteins of the "acute phase response" and TDI is adducted to serum proteins with different molecular weights (eg, albumin).
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Affiliation(s)
- N De Marzo
- Department of Environmental Medicine and Public Health, University of Padova, Italy
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48
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Saetta M, Turato G, Baraldo S, Zanin A, Braccioni F, Mapp CE, Maestrelli P, Cavallesco G, Papi A, Fabbri LM. Goblet cell hyperplasia and epithelial inflammation in peripheral airways of smokers with both symptoms of chronic bronchitis and chronic airflow limitation. Am J Respir Crit Care Med 2000; 161:1016-21. [PMID: 10712357 DOI: 10.1164/ajrccm.161.3.9907080] [Citation(s) in RCA: 192] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To quantify the number of goblet cells and inflammatory cells in the epithelium of peripheral airways in smokers with both symptoms of chronic bronchitis and chronic airflow limitation, we examined surgical specimens obtained from 25 subjects undergoing lung resection for localized pulmonary lesions: 10 smokers with symptoms of chronic bronchitis and chronic airflow limitation, six asymptomatic smokers with normal lung function, and nine nonsmoking control subjects. Peripheral airways were examined with histochemical methods to identify goblet cells and with immunohistochemical methods to identify total leukocytes (CD45(+) cells), neutrophils, macrophages, CD4(+) and CD8(+) cells in the epithelium. When compared with nonsmokers, smokers with both symptoms of chronic bronchitis and chronic airflow limitation had an increased number of goblet cells (p < 0.01), CD45(+) cells (p < 0. 01), macrophages (p < 0.05), and CD8(+) cells (p < 0.01) in the epithelium of peripheral airways. When all the smokers were grouped together, they showed an increased number of neutrophils (p < 0.05) along with an increased number of goblet cells, CD45(+) cells, macrophages and CD8(+) cells (p < 0.05) compared with nonsmokers. In conclusion, smokers with both symptoms of chronic bronchitis and chronic airflow limitation have an increased number of goblet cells and inflammatory cells in the epithelium of peripheral airways.
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Affiliation(s)
- M Saetta
- Institute of Occupational Medicine, University of Padova, Italy.
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49
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Mapp CE, Miotto D, Braccioni F, Saetta M, Turato G, Maestrelli P, Krause JE, Karpitskiy V, Boyd N, Geppetti P, Fabbri LM. The distribution of neurokinin-1 and neurokinin-2 receptors in human central airways. Am J Respir Crit Care Med 2000; 161:207-15. [PMID: 10619822 DOI: 10.1164/ajrccm.161.1.9903137] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The precise locations of neurokinin (NK)-1 and NK-2 receptors in human airways, and their role in airway inflammatory diseases, have not been carefully examined. To determine the distribution of NK-1 and NK-2 receptors in human central airways, and to determine whether their distribution was different in smokers, we examined surgical specimens from patients undergoing lung resection for limited lung lesions. We mapped NK-1 and NK-2 receptors in four groups of subjects: four asymptomatic nonsmokers, seven asymptomatic smokers, seven symptomatic smokers with normal lung function, and eight symptomatic smokers with chronic airflow limitation. Tissues were immunostained with anti-NK-1- and anti-NK-2-receptor antibodies. Expression of NK-1 and NK-2 receptors was quantified through light microscopy and image analysis. Both NK-1 and NK-2 receptors were found in bronchial glands, bronchial vessels, and bronchial smooth muscle. Although no receptors were observed in the epithelium, receptors were occasionally found in nerves (NK-1) and in inflammatory cells (NK-2) such as T lymphocytes, macrophages, and mast cells. The distribution of both NK-1 and NK-2 receptors was similar in all the tissues examined in the four groups of subjects. These data show that NK-1 and NK-2 receptors are present in human central airways and that their expression is not modified by cigarette smoking.
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Affiliation(s)
- C E Mapp
- Institute of Occupational Medicine, University of Padua, Padua, Italy.
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Maestrelli P, De Fina O, Bertin T, Papiris S, Ruggieri MP, Saetta M, Mapp CE, Fabbri LM. Integrin expression on neutrophils and mononuclear cells in blood and induced sputum in stable asthma. Allergy 1999; 54:1303-8. [PMID: 10688435 DOI: 10.1034/j.1398-9995.1999.00337.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We speculated that the expression of integrins in the airway lumen of asthmatic subjects might be altered compared with normal subjects during cell recruitment from circulation. METHODS To test this hypothesis, we investigated the expression of integrin alpha-chains (CD11a, CD11b, and CD11c) in hypertonic saline-induced sputum and peripheral blood leukocytes in mild to moderate stable asthmatic and control subjects. Immunoreactivity for integrin alpha-chains was assessed by immunocytology on cytospin preparations of sputum and blood. RESULTS In comparison of the percentages of CD11a+, CD11b+ and CD11c+ mononuclear cells in sputum with their blood counterparts, no significant differences were observed in control subjects, whereas CD11a and CD11b in asthmatic subjects were less expressed on sputum cells. In both control and asthmatic subjects, sputum neutrophils tended to decrease their expression of integrin alpha-chains compared with circulating neutrophils. CONCLUSIONS We showed that the sputum of asthmatics, unlike normal subjects, is characterized by decreased expression of integrins on mononuclear cells compared with their blood counterparts. The results suggest that downregulation of integrins occurs in asthmatic airways after cell recruitment from circulation.
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Affiliation(s)
- P Maestrelli
- Institute of Occupational Medicine, University of Padova, Italy
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