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Shim JS, Kim SS, Lee SH, Kim MH, Cho YJ, Park HW. Fat mass index and airway hyperresponsiveness in Korean adults. Postgrad Med 2023:1-6. [PMID: 36879538 DOI: 10.1080/00325481.2023.2188000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Airway hyperresponsiveness (AHR) is associated with asthma and obesity, which is defined as a high body mass index. Body mass mainly comprises fat mass (FM) and muscle mass (MM), which are independent of each other. We investigated the effect of changes in FM over time on the development of asymptomatic AHR in adults. METHODS This long-term longitudinal study included adults who were underwent health checkups at the Seoul National University Hospital Gangnam Center. The participants underwent two methacholine bronchial provocation tests with a follow-up period (between the first and second tests) of more than 3 years and bioelectrical impedance analysis (BIA) at all visits. FM index (FMI; FM normalized for height) and MM index (MMI; MM normalized for height) were calculated using BIA. RESULTS The study included 328 adult participants (61 women and 267 men). The mean number of BIA measurements was 6.96 and the follow-up duration was 6.69 years. In total, 13 participants showed a positive conversion of AHR. Multivariate analysis indicated that a high rate of change in FMI ([g/m2]/year), not MMI, was significantly associated with the risk of AHR development (P = 0.037) after adjustment for age, sex, smoking status, and FEV1 predicted. CONCLUSION A rapid gain of FM over time may be a risk factor for developing AHR in adults. Prospective studies are needed to confirm our results and evaluate the role of FM reduction in preventing AHR development in obese adults.
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Affiliation(s)
- Ji-Su Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sun-Sin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - So-Hee Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Young-Joo Cho
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Xiong D(JP, Martin JG, Lauzon AM. Airway smooth muscle function in asthma. Front Physiol 2022; 13:993406. [PMID: 36277199 PMCID: PMC9581182 DOI: 10.3389/fphys.2022.993406] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022] Open
Abstract
Known to have affected around 340 million people across the world in 2018, asthma is a prevalent chronic inflammatory disease of the airways. The symptoms such as wheezing, dyspnea, chest tightness, and cough reflect episodes of reversible airway obstruction. Asthma is a heterogeneous disease that varies in clinical presentation, severity, and pathobiology, but consistently features airway hyperresponsiveness (AHR)—excessive airway narrowing due to an exaggerated response of the airways to various stimuli. Airway smooth muscle (ASM) is the major effector of exaggerated airway narrowing and AHR and many factors may contribute to its altered function in asthma. These include genetic predispositions, early life exposure to viruses, pollutants and allergens that lead to chronic exposure to inflammatory cells and mediators, altered innervation, airway structural cell remodeling, and airway mechanical stress. Early studies aiming to address the dysfunctional nature of ASM in the etiology and pathogenesis of asthma have been inconclusive due to the methodological limitations in assessing the intrapulmonary airways, the site of asthma. The study of the trachealis, although convenient, has been misleading as it has shown no alterations in asthma and it is not as exposed to inflammatory cells as intrapulmonary ASM. Furthermore, the cartilage rings offer protection against stress and strain of repeated contractions. More recent strategies that allow for the isolation of viable intrapulmonary ASM tissue reveal significant mechanical differences between asthmatic and non-asthmatic tissues. This review will thus summarize the latest techniques used to study ASM mechanics within its environment and in isolation, identify the potential causes of the discrepancy between the ASM of the extra- and intrapulmonary airways, and address future directions that may lead to an improved understanding of ASM hypercontractility in asthma.
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Affiliation(s)
- Dora (Jun Ping) Xiong
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - James G. Martin
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Anne-Marie Lauzon
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- *Correspondence: Anne-Marie Lauzon,
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Kim CK, Callaway Z, Park JS, Kwon E. Efficacy of subcutaneous immunotherapy for patients with asthma and allergic rhinitis in Korea: effect on eosinophilic inflammation. Asia Pac Allergy 2021; 11:e43. [PMID: 34786373 PMCID: PMC8563102 DOI: 10.5415/apallergy.2021.11.e43] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/23/2021] [Indexed: 11/04/2022] Open
Abstract
Background Atopic asthma (AA) and allergic rhinitis (AR) are often seen as comorbidities and specific immunotherapy (SIT) is considered evidence-based treatment for them both. Objective The purpose of this study was to evaluate the efficacy of multiallergen subcutaneous SIT (SCIT) in reducing nasal and sputum eosinophilia, symptom scores, and impaired lung function in Korean pediatric patients with AR and AA. Methods Children aged 6-15 years with a documented history of bronchial asthma and seasonal/perennial AR were recruited then randomly selected to 1 of 2 groups: "immunotherapy group" (inhaled corticosteroids [ICS] and short-acting beta2-agonist [SABA] + subcutaneous injection of standardized extracts of up to 4 allergens [n = 53]) or "drug only group" (ICS and SABA only [n = 19]). All data were collected retrospectively. Results Comparing the 2 treatment groups, the immunotherapy group showed a significantly (p = 0.006) greater reduction in nasal eosinophilia over the 3-year treatment period. Only the immunotherapy group exhibited a significant reduction in sputum eosinophilia over the 3-year treatment period (p = 0.003). Fifty-one point one percent of patients in the immunotherapy group showed significant improvement in the methacholine challenge test negative conversion rate compared to only 17.65% in the drug only group (p = 0.0168). There were significantly greater improvements in symptom scores in the immunotherapy group compared to the drug only group. For all allergens tested, only house dust mite reactivity changed significantly over the treatment period and only in the immunotherapy group (Dermatophagoides pteronyssinus [p < 0.0001] and Dermatophagoides farina [p = 0.035]). Conclusion SCIT was associated with greater improvements in lung function and bronchial hyperresponsiveness and reductions in nasal and sputum eosinophilia and allergen reactivity. Changes in symptom scores were also much greater in patients receiving SCIT when compared to those who did not receive it. Korean children with AA and AR respond well to long-term multiallergen SCIT.
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Affiliation(s)
- Chang Keun Kim
- Asthma & Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Zak Callaway
- School of Biological Sciences, University of Ulsan, Ulsan, Korea
| | - Jin-Sung Park
- Asthma & Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea.,Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Eunmi Kwon
- Asthma & Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
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Park KH, Kim BG, Lee PH, Hong J, Lee J, Park SW, Kim DJ, Jang AS. Impact of capsaicin concentration evoking coughs on clinical variables in patients with asthma. Exp Lung Res 2020; 47:1-8. [PMID: 33076710 DOI: 10.1080/01902148.2020.1834016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Inhaled capsaicin (8-methyl-N-vanillyl-6-nonenamide) has been used to induce cough in a safe and dose-dependent manner. Chronic cough is associated with an increased sensitivity to inhaled capsaicin in patients with asthma. The aim of this study was to evaluate clinical impact of capsaicin provocation test for chronic cough, and to find relationship between capsaicin concentration producing coughs and clinical variables in patients with asthma. Methods: 385 patients with chronic cough [capsaicin provocation test (+, n = 152)] vs. [capsaicin provocation test (-, n = 233)] who has done with capsaicin provocation test recruited and evaluated by asthma diagnosis and clinical variables. Asthma diagnoses were based on the Global Initiative for Asthma guidelines. Results: Capsaicin positivity was more prevalent in patient with asthma diagnosis than in patients without asthma diagnosis (129/304 vs. 24/81, p = 0.037). Capsaicin positivity was more prevalent in female patients than in male patients (123/271 = 45.4% vs. 30/114 = 26.3%, p = 0.001). Capsaicin concentration producing coughs correlated with smoke amount (r = 0.126, p = 0.014). Capsaicin positivity was more prevalent in nonsmoker patients than in smoker patients (133/295 = 45.1% vs. 20/90 = 22.2%, p = 0.001). Capsaicin concentration producing coughs negatively correlated with methacholine PC20 (4 mg mL-1, p = 0.037), (16 mg mL-1, p = 0.069) and (20 mg mL-1, p = 0.045). Capsaicin concentration producing coughs correlated with BMI (r = 0.120, p = 0.019). Capsaicin concentration producing coughs negatively correlated with FEV1/FVC % pred. (r = -0.137, p = 0.007). There was no relationship between capsaicin concentration producing coughs and age, IgE, and atopy. Conclusions: Capsaicin test for asthma diagnosis should be considered for variable clinical factors. Key message Cough in asthmatic patients is not only common and troublesome but also predicts disease severity and poor prognosis. The capsaicin cough challenge test is a simple and reproducible provocation method for assessing cough susceptibility in patients with cough. Capsaicin test for asthma diagnosis should be considered for variable clinical factors.
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Affiliation(s)
- Kyung-Hun Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Byeong-Gon Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Preun-Haneul Lee
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Jisu Hong
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Junehyuck Lee
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Sung-Woo Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Do-Jin Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - An-Soo Jang
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
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Kang SY, Song WJ, Won HK, Chung SJ, Kim JY, Park HW, Morice AH, Cho SH. Cough persistence in adults with chronic cough: A 4-year retrospective cohort study. Allergol Int 2020; 69:588-593. [PMID: 32327301 DOI: 10.1016/j.alit.2020.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is very limited evidence regarding long-term prognosis of chronic cough. We examined longitudinal outcomes among patients with chronic cough, and explored predictors of cough persistence. METHODS A retrospective cohort was constructed of adults who had newly visited a specialist cough clinic in 2012-2013. All had undergone systematic investigation for chronic cough. The Hull Airway Reflux Questionnaire (HARQ) was administered to assess reflux cough symptoms. A follow-up survey was conducted in 2016-2017 to assess cough persistence. RESULTS From 418 candidates, 323 participated in the follow-up study; main analyses focused on patients with chronic persistent cough (n = 64; 19.8%) and remitted cough (n = 193; 59.8%). Compared with remitted cough group, chronic persistent cough group had more family history of chronic cough (17.2% vs. 4.7%, p = 0.001) and cold air-sensitive cough (62.5% vs. 44.6%, p = 0.013). The total HARQ score did not differ; however, two items (cough with eating and cough with certain foods) scored significantly higher in chronic persistent cough. In multivariate analyses, a family history of chronic cough (adjusted odds ratio 4.27 [95% confidence interval 1.35-9.89]), cold air-sensitive cough (2.01 [1.09-3.73]), and cough with eating (1.22 [1.02-1.45]) were associated with chronic persistent cough at 4 years. CONCLUSIONS Cough persists in about 20% of patients after 4 years following systematic assessment and treatments. Several cough characteristics, such as family history, cold air-sensitivity, or reflux cough, may be associated with cough persistence. Larger cohort studies are warranted to further understand long-term prognosis and confirm predictors of persistence in patients with chronic cough.
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Affiliation(s)
- Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
| | - Woo-Jung Song
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea; Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Soo Jie Chung
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea; Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Ju-Young Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Heung-Woo Park
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Alyn H Morice
- Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Castle Hill Hospital, University of Hull, Cottingham, United Kingdom
| | - Sang-Heon Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Hong JY, Kim JH, Park S, Hwang YI, Jung KS, Jang SH. Efficacy and predictors of response to inhaled corticosteroid treatment for chronic cough. Korean J Intern Med 2019; 34:559-568. [PMID: 30540903 PMCID: PMC6506730 DOI: 10.3904/kjim.2017.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 05/04/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/AIMS Inhaled corticosteroids (ICS) are a treatment of choice for eosinophilic airway diseases, but their efficacy for other causes of chronic cough is controversial. METHODS We conducted a prospective observational study to determine the ICS efficacy and clinical predictors of response to ICS in patients with upper airway cough syndrome (UACS) or unexplained chronic cough (UCC). Sixty-eight patients with UACS and 33 patients with UCC (duration of cough ≥ 8 weeks) were treated with ICS: 250 µg of fluticasone propionate or 400 µg of budesonide twice a day at physician's discretion. They were followed after 2 weeks to assess persistent cough which was measured as 0% to 100% compared with baseline cough frequency. RESULTS The median grade of persistent cough after 2-week ICS treatment was 40% (interquartile range [IQR], 10 to 70) in UACS and was 50% (IQR, 20 to 70) in UCC. The only adverse event was infrequent, mild hoarse voice (five UACS and one UCC). Long duration of cough (≥ 52 weeks) and cough not aggravated by cold air exposure were predictors of a poorer response to short course ICS treatment (logistic regression analysis, p = 0.018 and p = 0.031, respectively). However, prolonged treatment with ICS more than 2 weeks was more effective in patients with long cough duration (≥ 52 weeks). CONCLUSION Short course ICS treatment has modest efficacy on UACS and UCC without significant adverse events. Duration of cough and cough triggered by cold air exposure were the clinical factors associated with ICS response. Extended treatment with ICS may be beneficial in patients with long duration of cough.
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Affiliation(s)
- Ji Young Hong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
| | - Joo-Hee Kim
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sunghoon Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong Il Hwang
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ki-Suck Jung
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seung Hun Jang
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Correspondence to Seung Hun Jang, M.D. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea Tel: +82-31-380-3718 Fax: +82 -31-380 -3973 E-mail:
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Zhai J, Insel M, Addison KJ, Stern DA, Pederson W, Dy A, Rojas-Quintero J, Owen CA, Sherrill DL, Morgan W, Wright AL, Halonen M, Martinez FD, Kraft M, Guerra S, Ledford JG. Club Cell Secretory Protein Deficiency Leads to Altered Lung Function. Am J Respir Crit Care Med 2019; 199:302-312. [PMID: 30543455 PMCID: PMC6363971 DOI: 10.1164/rccm.201807-1345oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/07/2018] [Indexed: 01/27/2023] Open
Abstract
RATIONALE CC16 (club cell secretory protein-16), a member of the secretoglobin family, is one of the most abundant proteins in normal airway secretions and has been described as a serum biomarker for obstructive lung diseases. OBJECTIVES To determine whether low CC16 is a marker for airway pathology or is implicated in the pathophysiology of progressive airway damage in these conditions. METHODS Using human data from the birth cohort of the Tucson Children's Respiratory Study, we examined the relation of circulating CC16 levels with pulmonary function and responses to bronchial methacholine challenge from childhood up to age 32 years. In wild-type and CC16-/- mice, we set out to comprehensively examine pulmonary physiology, inflammation, and remodeling in the naive airway. MEASUREMENTS AND MAIN RESULTS We observed that Tucson Children's Respiratory Study participants in the lowest tertile of serum CC16 had significant deficits in their lung function and enhanced airway hyperresponsiveness to methacholine challenge from 11 years throughout young adult life. Similarly, CC16-/- mice had significant deficits in lung function and enhanced airway hyperresponsiveness to methacholine as compared with wild-type mice, which were independent of inflammation and mucin production. As compared with wild-type mice, CC16-/- mice had significantly elevated gene expression of procollagen type I, procollagen type III, and α-smooth muscle actin, areas of pronounced collagen deposition and significantly enhanced smooth muscle thickness. CONCLUSIONS Our findings support clinical observations by providing evidence that lack of CC16 in the lung results in dramatically altered pulmonary function and structural alterations consistent with enhanced remodeling.
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Affiliation(s)
- Jing Zhai
- Asthma and Airway Disease Research Center
| | | | | | | | | | | | | | - Caroline A. Owen
- Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Monica Kraft
- Asthma and Airway Disease Research Center
- Department of Medicine, and
| | - Stefano Guerra
- Asthma and Airway Disease Research Center
- Department of Medicine, and
- ISGlobal, Barcelona, Spain
| | - Julie G. Ledford
- Asthma and Airway Disease Research Center
- Department of Medicine, and
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
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Cockcroft DW, Davis BE, Blais CM. Direct bronchoprovocation test methods: history 1945-2018. Expert Rev Respir Med 2019; 13:279-289. [PMID: 30632426 DOI: 10.1080/17476348.2019.1568245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Bronchoprovocation inhalation challenge tests with direct acting stimuli (e.g. methacholine) are widely used clinically to aid in the diagnosis of asthma. Areas covered: The history of direct challenges with histamine and muscarinic agonists is reviewed. This began with parenteral administration of stimuli with responses monitored clinically and by VC, progressing to inhalation dose-response challenges monitored by FEV1 and FEV1/VC ratio, both (the challenge method and the technology to measure FEV1) developed by Robert Tiffeneau in the mid-1940s. Careful standardization of methods has become appreciated albeit after-the-fact. Recent guidelines recommend standardizing the methacholine PD20 at 400 μg above which a methacholine challenge is considered negative. CONCLUSIONS The methacholine inhalation test is highly sensitive for a diagnosis of current asthma when symptoms under evaluation are clinically current and when methacholine is inhaled without deep inhalations. Under these circumstances, a methacholine PD20 > 400 μg excludes current asthma with reasonable certainty. PD20 values >25 μg and ≤400 μg will have a variable specificity and positive predictive value for asthma which increases the lower the PD20 and the higher the pre-test probability for a diagnosis of asthma. A PD20 ≤25 μg has high specificity and low sensitivity for asthma.
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Affiliation(s)
- Donald W Cockcroft
- a Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine , University of Saskatchewan
| | - Beth E Davis
- a Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine , University of Saskatchewan
| | - Christianne M Blais
- a Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine , University of Saskatchewan
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Shimoda T, Obase Y, Nagasaka Y, Kishikawa R, Iwanaga T. Lung Sound Analysis and the Respiratory Cycle Dependence of Impulse Oscillometry in Asthma Patients. Intern Med 2019; 58:47-52. [PMID: 30146613 PMCID: PMC6367089 DOI: 10.2169/internalmedicine.8226-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective A lung sound analysis (LSA) is useful for detecting airway inflammation and obstruction in patients with asthma. To elucidate the mechanism of LSA, we investigated the relationship between the exhalation-to-inhalation sound pressure ratio in the low frequency range between 100 and 195 Hz (E/I LF) and the respiratory cycle dependence of impulse oscillometry (IOS) parameters. Methods Asthma patients underwent IOS [resistance of the respiratory system at 5 Hz (R5) and 20 Hz (R20), the reactance area (AX), resonant frequency of reactance (Fres), and reactance of the respiratory system at 5 Hz (X5) ], spirography, and an LSA. The correlation between the LSA-derived E/I LF values and the respiratory cycle dependence of the IOS parameters was analyzed. Patients Thirty-four patients with mild to moderate bronchial asthma, who had not received oral or inhaled corticosteroids and who had no episodes of rumbling or wheezing were examined. Results The E/I LF value was significantly correlated with the differences of the R5 and R5-R20 values between exhalation and inhalation (p=0.035 and p=0.050) in a multivariate analysis. Conclusion E/I LF appears to be an index that expresses the respiratory cycle dependence of asthma as well as IOS.
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Affiliation(s)
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Lévesque V, Poirier C, Dubé BP. Dose omission to shorten methacholine challenge testing: clinical consequences of the use of a 10% fall in FEV 1 threshold. Allergy Asthma Clin Immunol 2018; 14:88. [PMID: 30574169 PMCID: PMC6299950 DOI: 10.1186/s13223-018-0309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction In methacholine challenge testing (MCT), skipping a methacholine dose is suggested if FEV1 falls by < 5%. Using a larger threshold may further shorten test duration, but data supporting this hypothesis is lacking. We evaluated the safety and consequences of using a 10% FEV1 fall as threshold to skip the next dose of methacholine in patients undergoing MCT. Methods We reviewed MCTs performed in our center in 2017–2018. A ≤ 10% FEV1 fall allowed the omission of the next methacholine dose. Patients of interest were those in which a dose was skipped after a previous FEV1 fall outside the usual range (5–10%, termed “skip5–10%”). Adverse events [AE; mild: > 1 nebulized salbutamol dose (2.5 mg) to reach basal FEV1, palpitations; severe: hypoxemia and/or need for medical attention or intervention] were compared in the skip5–10% group and others. Regression analysis was used to identify predictors of AE. Results 208 MCTs were analysed (135 males, age 52 ± 15 years). Skip5–10% occurred 111 times in 90 tests. Prevalence of AE was 5% and all were mild. Patients who developed AEs had lower FEV1, FVC and FEV1/FVC ratio, and higher lung volume values (all p < 0.05), but similar prevalence of skip5–10% (36 vs. 44%, p = 0.64). Overall, MCTs in which at least one skip5–10% occurred had a lower mean number of doses (3.1 ± 0.6 vs. 3.5 ± 1.3 doses, p = 0.007). Baseline residual volume was independently related to the development of AEs (OR 1.05, 95% CI 1.01–1.10, p = 0.01), but not the presence of a skip5–10%, even when the skipped dose directly led to the reaching of PC20 (OR 5.40, 95% CI 0.73–39.22, p = 0.10). Conclusion Omitting a methacholine dose based on a ≤ 10% fall in FEV1 occurs frequently and has the potential to shorten test duration. AE are rare, but patients with worse baseline lung function and gas trapping are at increased risk of mild side effects.
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Affiliation(s)
- Valérie Lévesque
- 1Département de médecine, Service de pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet, Montreal, QC Canada
| | - Claude Poirier
- 1Département de médecine, Service de pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet, Montreal, QC Canada
| | - Bruno-Pierre Dubé
- 1Département de médecine, Service de pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet, Montreal, QC Canada.,2Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) - Carrefour de l'Innovation et de l'Évaluation en Santé, Montreal, QC Canada
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Levy J, Neukirch C, Larfi I, Demoly P, Thabut G. Tolerance to exposure to essential oils exposure in patients with allergic asthma. J Asthma 2018; 56:853-860. [PMID: 29985684 DOI: 10.1080/02770903.2018.1493601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Essential oils are volatile compounds of plant origin increasingly used by allergic and/or asthmatic subjects to purify indoor air. The active compounds of essential oils belong to terpenes, the most widespread biogenic volatile organic compounds (VOC). Although there is substantial literature showing associations between exposure to chemical VOCs and asthmatic symptoms and impaired respiratory function, the impact of essential oils in patients with asthma has never been studied. Objectives: To evaluate the safety of a purifying air spray containing 41 essential oils (PPAS) in patients with mild or moderate allergic asthma. Methods: This was a prospective open study in which 25 mild (19) and moderate (6) asthmatics were exposed to PPAS, one spray twice a day at 8 am and 8 pm in two different corners of a given subjects bedroom for 4 weeks. Before and after 4 weeks of exposure, fractional exhaled nitric oxide (FeNO), lung function and methacholine challenge (PD20) were performed and asthma control was assessed by the 5 questions of the Asthma Control Test (ACT). The spray was weighed after the 4-week exposure to assess compliance. Results: FeNO was the primary endpoint and was thus analyzed in all (N = 25) subjects irrespective of the level of airflow obstruction. The results apply to all (N = 25) subjects in which FeNO could be measured at D1 and D30 (17 subjects). Mean (SD) FeNO amounted to 37.4 (16.6) and to 33.1 (18.7) ppm before and after PPAS exposure, respectively (p = 0.09). No significant change in lung function and methacholine responsiveness was noted after PPAS exposure, the mean PD20 amounting to 1179 (1124.42) μg (range 100-3200) before and to 1226 (1189.8) μg (p = 0.06) after. The mean ACT before and after PPAS exposure amounted to 20.9 (4.2) and 21 (5.15), respectively (p = 0.80). The mean weight of the PPAS bottles was 211.4 g (DS:0) before the first use and 171.41 g (DS: 29.8) at the end of the study. The average amount of PPAS used was 40.0 g (29.8). In the subgroup of subjects who used the highest quantities of essential oils (>40 g), as assessed by the mean weight of the bottle at the end of the study, FeNO after 30 days of exposure decreased more than in the entire group: 7.9 ppm vs 4.2 ppm (p = 0.07). Conclusion: No difference was noted on airway inflammation, lung function or asthma control in mild and moderate allergic asthmatics after exposure twice a day for one month, to a spray containing a mixture of 41 essential oils.
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Affiliation(s)
- Jean Levy
- a Department of Pneumology A, Bichat-Claude Bernard University Hospital , Paris , France.,b Department of Pneumology B, Bichat-Claude Bernard University Hospital , Paris , France
| | - Catherine Neukirch
- a Department of Pneumology A, Bichat-Claude Bernard University Hospital , Paris , France.,b Department of Pneumology B, Bichat-Claude Bernard University Hospital , Paris , France
| | - Isabelle Larfi
- a Department of Pneumology A, Bichat-Claude Bernard University Hospital , Paris , France.,b Department of Pneumology B, Bichat-Claude Bernard University Hospital , Paris , France
| | - Pascal Demoly
- c Department of Pneumology and Allergology, Arnaud de Villeneuve Hospital, University Montpellier, and Sorbonne University, INSERM, IPLESP , Paris , France
| | - Gabriel Thabut
- a Department of Pneumology A, Bichat-Claude Bernard University Hospital , Paris , France.,b Department of Pneumology B, Bichat-Claude Bernard University Hospital , Paris , France.,d Faculty of Medicine, Bichat Campus, Paris Diderot University , Paris , France
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12
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Kirkpatrick CH. Richard Studley Farr, MD. Ann Allergy Asthma Immunol 2018; 121:649-652. [PMID: 30266337 DOI: 10.1016/j.anai.2018.09.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Charles H Kirkpatrick
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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13
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Kim K, Cho HJ, Yoon JW, Choi SH, Sheen YH, Han MY, Baek H. Exhaled nitric oxide and mannitol test to predict exercise-induced bronchoconstriction. Pediatr Int 2018; 60:691-696. [PMID: 29786927 DOI: 10.1111/ped.13599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 04/03/2018] [Accepted: 05/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exercise-induced bronchoconstriction (EIB) is diagnosed via exercise challenge on a treadmill, but such testing requires complex equipment and sufficient health-care resources. The fraction of exhaled nitric oxide (FeNO) test and mannitol bronchial provocation test (BPT) may serve as a surrogate for exercise testing. METHODS We compared the diagnostic utilities of the FeNO test and mannitol BPT in predicting EIB in asthmatic children. We retrospectively analyzed data from 60 asthmatic children aged 6-16 years. We compared the exercise BPT results, FeNO levels, and mannitol BPT data. RESULTS All subjects were divided into exercise-positive (n = 41) or -negative (n = 19) BPT groups. Of the 41 exercise-positive patients, 32 were mannitol BPT positive and nine were mannitol BPT negative. Of the 19 exercise-negative patients, nine and 10, respectively, were mannitol BPT positive and BPT negative. The maximum % forced expiratory volume in 1 s (FEV1 ) decrease after exercise was positively correlated with FeNO (r = 0.556, P < 0.001), and with mannitol response-dose ratio (RDR; r = 0.416, P = 0.001). The receiver operating characteristic (ROC) curve for FeNO to discriminate between asthmatic subjects with and without EIB had an area under the curve (AUC) of 0.771 (95%CI: 0.643-0.870). The discriminatory ROC curve for mannitol RDR had an AUC of 0.763 (95%CI: 0.633-0.864). The AUC of FeNO and mannitol RDR did not differ significantly. CONCLUSIONS EIB significantly correlated with both FeNO and mannitol BPT data. Given that both methods similarly predicted EIB in asthmatic children, the simpler and safer FeNO test alone may be a clinically useful diagnostic tool.
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Affiliation(s)
- Kyubo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Hong Je Cho
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Won Yoon
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Heysung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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14
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Seo HJ, Lee PH, Kim BG, Lee SH, Park JS, Lee J, Park SW, Kim DJ, Park CS, Jang AS. Methacholine bronchial provocation test in patients with asthma: serial measurements and clinical significance. Korean J Intern Med 2018; 33:807-814. [PMID: 29334723 PMCID: PMC6030423 DOI: 10.3904/kjim.2017.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 06/24/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The methacholine bronchial provocation test (MBPT) is used to detect and quantify airway hyper-responsiveness (AHR). Since improvements in the severity of asthma are associated with improvements in AHR, clinical studies of asthma therapies routinely use the change of airway responsiveness as an objective outcome. The aim of this study was to assess the relationship between serial MBPT and clinical profiles in patients with asthma. METHODS A total of 323 asthma patients were included in this study. The MBPT was performed on all patients beginning at their initial diagnosis until asthma was considered controlled based on the Global Initiative for Asthma guidelines. A responder was defined by a decrease in AHR while all other patients were considered non-responders. RESULTS A total of 213 patients (66%) were responders, while 110 patients (34%) were non-responders. The responder group had a lower initial PC20 (provocative concentration of methacholine required to decrease the forced expiratory volume in 1 second by 20%) and longer duration compared to the non-responder group. Members of the responder group also had superior qualities of life, compared to members of the non-responder group. Whole blood cell counts were not related to differences in PC20; however, eosinophil concentration was. No differences in sex, age, body mass index, smoking history, serum immunoglobulin E, or frequency of acute exacerbation were observed between responders and non-responders. CONCLUSIONS The initial PC20, the duration of asthma, eosinophil concentrations, and quality-of-life may be useful variables to identify improvements in AHR in asthma patients.
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Affiliation(s)
- Hyun-Jung Seo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Pureun-Haneul Lee
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Byeong-Gon Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun-Hye Lee
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jong-Sook Park
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Junehyuck Lee
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sung-Woo Park
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Do-Jin Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Choon-Sik Park
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - An-Soo Jang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- Correspondence to An-Soo Jang, M.D. Division of Respiratory and Allergy, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: +82-32-621-5143 Fax: +82-32-621-6950 E-mail:
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15
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Koenig JQ, Covert DS, Larson TV, Pierson WE. The Effect of Duration of Exposure on Sulfuric Acid-Induced Pulmonary Function Changes in Asthmatic Adolescent Subjects: A Dose-Response Study. Toxicol Ind Health 2018. [DOI: 10.1177/074823379200800506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the pulmonary effects of varying doses of sulfuric acid, adolescent subjects with asthma were exposed to 35 or 70 μg/m3 sulfuric acid for 45 or 90 min. Exposure was carried out during intermittent moderate exercise. The pulmonary functions measured before and after exposure were FEV1, FVC, and total respiratory resistance. The 45 min exposures were associated with larger decreases in FEV1 (-6% or -3%) than the 90 min exposures (-1% or +2%). Analysis of variance of the change in FEV1 among the exposures revealed that the 45 min exposure to 35 μg/m3 was significant (p = 0.03). The p value for 45 min exposure to 70 μg/m3 was not significant (p = 0.08). Using analysis of variance, neither of the 90 min exposures was associated with a significant decrease in FEV1 compared to air exposure. Also, none of the changes in FVC or RT was significant. When baseline to post-exposure changes were compared for each of the five test atmospheres using paired t tests, both of the 45 min exposures were associated with statistical significance (p < 0.001 for 35 μg/m3 and p < 0.005 for 70 μg/m3). This baseline to post exposure change was not statistically significant for the 90 min exposures. The reason for the lesser effect on pulmonary function at increased exposure duration is not known; it may be due to changes in either varying deposition patterns or changes in buffering capacity of the cells lining the airways. With respect to individual sensitivities to H2SO4, the data showed a significant consistency across test atmospheres.
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Affiliation(s)
- Jane Q. Koenig
- Departments of Environmental Health, Civil Engineering, Atmospheric Sciences and Pediatrics University of Washington Seattle, Washington
| | - David S. Covert
- Departments of Environmental Health, Civil Engineering, Atmospheric Sciences and Pediatrics University of Washington Seattle, Washington
| | - Timothy V. Larson
- Departments of Environmental Health, Civil Engineering, Atmospheric Sciences and Pediatrics University of Washington Seattle, Washington
| | - William E. Pierson
- Departments of Environmental Health, Civil Engineering, Atmospheric Sciences and Pediatrics University of Washington Seattle, Washington
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16
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Hiranrattana A, Stern DA, Guerra S, Halonen M, Wright AL, Daines M, Martinez FD, Morgan WJ. Alternaria sensitisation at age 6 years is associated with subsequent airway hyper-responsiveness in non-asthmatics. Thorax 2018; 73:1170-1173. [PMID: 29563159 DOI: 10.1136/thoraxjnl-2017-210325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 11/04/2022]
Abstract
In the non-selected birth cohort Tucson Children's Respiratory Study, early sensitisation to Alternaria was associated with increased airway hyper-responsiveness (AHR) into adult life among non-asthmatics. The increase in AHR was of a similar magnitude to that seen for Alternaria sensitised asthmatics and was primarily evident among those who were overweight or obese. In contrast, there was no significant association between early sensitisation to aeroallergens other than Alternaria and AHR among non-asthmatics. Why this group of Alternaria sensitised individuals without asthma demonstrated increased AHR of a magnitude similar to asthmatics is unknown and requires further investigation.
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Affiliation(s)
- Anunya Hiranrattana
- Pediatric Pulmonary Allergy Division, Department of Pediatrics, University of Arizona, Tucson, Arizona, USA
| | - Debra A Stern
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Marilyn Halonen
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Anne L Wright
- Pediatric Pulmonary Allergy Division, Department of Pediatrics, University of Arizona, Tucson, Arizona, USA.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Michael Daines
- Pediatric Pulmonary Allergy Division, Department of Pediatrics, University of Arizona, Tucson, Arizona, USA.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
| | - Wayne J Morgan
- Pediatric Pulmonary Allergy Division, Department of Pediatrics, University of Arizona, Tucson, Arizona, USA.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
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17
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Influence of rosuvastatin treatment on airway inflammatory markers and health related quality of life domains in asthmatic patients. MARMARA MEDICAL JOURNAL 2017. [DOI: 10.5472/marumj.344816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Contrasting effects of ATP and adenosine on capsaicin challenge in asthmatic patients. Pulm Pharmacol Ther 2017; 45:13-18. [PMID: 28392320 DOI: 10.1016/j.pupt.2017.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/28/2017] [Accepted: 04/05/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adenosine 5'-triphosphate (ATP) stimulates pulmonary vagal slow conducting C-fibres and fast conducting Aδ-fibres with rapidly adapting receptors (RARs). Pulmonary C-fibres but not RARs are also sensitive to capsaicin, a potent tussigenic agent in humans. Thus, the aim of this study was to determine the effects of ATP and its metabolite adenosine (given as adenosine 5'-monophosphate, AMP) on capsaicin challenge in asthmatic patients. METHODS Cough (quantified as visual analogue scale, VAS), dyspnoea (quantified as Borg score), and FEV1 were quantified following bronchoprovocation using capsaicin, adenosine and ATP in healthy non-smokers (age 40±4y, 6 males), smokers (45±4y, 5 males) and asthmatic patients (37±3y, 5 males); n = 10 in each group. RESULTS None of the healthy non-smokers responded to either AMP or ATP. AMP induced bronchoconstriction in one smoker and eight asthmatics, and ATP in two smokers and all ten asthmatics. The geometric mean of capsaicin causing ≥5 coughs (C5) increased from 134 to 203 μM in non-smokers and from 117 to 287 μM in asthmatics after AMP, whereas it decreased from 203 to 165 μM and 125 to 88 μM, respectively after ATP. AMP decreased C5 from 58 to 29 μM and ATP increased from 33 to 47 μM in smokers. However, due to intergroup variability, these effects of ATP and AMP were not statistically significant (0.125 ≤ p ≤ 0.998). That notwithstanding, in healthy and asthmatic subjects the effects of the ATP showed a tendency to be greater than those of AMP (p < 0.053). Dyspnea, assessed by Borg score, increased after ATP (p < 0.001) and AMP (p < 0.001) only in asthmatic patients. Intensity of cough assessed by VAS increased (p < 0.05) after second capsaicin challenges performed after AMP in all groups, but not after ATP. CONCLUSIONS Asthmatic patients exhibit hypersensitivity to aerosolized AMP and ATP, but aerosolized AMP does not mimic the effects of ATP and the effects of ATP are not mediated by adenosine.
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19
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Nair P, Martin JG, Cockcroft DC, Dolovich M, Lemiere C, Boulet LP, O'Byrne PM. Airway Hyperresponsiveness in Asthma: Measurement and Clinical Relevance. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:649-659.e2. [PMID: 28163029 DOI: 10.1016/j.jaip.2016.11.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
Airway hyperresponsiveness is a characteristic feature of asthma, and its measurement is an important tool in its diagnosis. With a few caveats, methacholine bronchial provocation by a 2-minute tidal breathing method is highly sensitive; a negative test result (PC20 > 16 mg/mL, PD20 > 400 μg) rules out current asthma with reasonable certainty. A PC20 value of less than 1 mg/mL/PD20 value of less than 25 μg is highly specific (ie, diagnostic) but quite insensitive for asthma. For accurate interpretation of the test results, it is important to control and standardize technical factors that have an impact on nebulizer performance. In addition to its utility to relate symptoms such as cough, wheeze, and shortness of breath to variable airflow obstruction (ie, to diagnose current asthma), the test is useful to make a number of other clinical assessments. These include (1) evaluation of patients with occupational asthma, (2) evaluation of patients with exercise-induced respiratory symptoms, (3) evaluation of novel asthma medications, (4) evaluation of relative potency of inhaled bronchodilators, (5) as a biomarker to adjust anti-inflammatory therapy to improve clinical outcomes, and (6) in the evaluation of patients with severe asthma to rule out masqueraders such as laryngeal dysfunction. The actual mechanism of altered smooth muscle behavior in asthma that is assessed by direct (eg, methacholine) or indirect (eg, allergen) bronchial provocation remains one of the most fundamental questions related to asthma that needs to be determined. The test is underutilized in clinical practice.
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Affiliation(s)
- Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada.
| | - James G Martin
- Meakins Christie Laboratories and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Donald C Cockcroft
- Division of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Myrna Dolovich
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Catherine Lemiere
- Department of Medicine, Sacre Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Louis-Philippe Boulet
- Division of Respirology, Department of Medicine, University of Laval, Laval, Quebec, Canada
| | - Paul M O'Byrne
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
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20
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Park TY, Yi MJ, Choi WH, Kim SY, Yu R, Ban JE, Yang S, Hwang IT, Baek HS. Relationship between atopy and bronchial hyperresponsiveness to indirect stimuli in asthmatic children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.2.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Tae-Young Park
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Min-Ju Yi
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Woo-Hyeok Choi
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Su-Yeong Kim
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Rita Yu
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Ji-Eun Ban
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seong Yang
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Il-Tae Hwang
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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21
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Byeon JH, Ri S, Amarsaikhan O, Kim E, Ahn SH, Choi IS, Kim HJ, Seo S, Yoon W, Yoo Y. Association Between Sensitization to Mold and Impaired Pulmonary Function in Children With Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:509-516. [PMID: 28913990 PMCID: PMC5603479 DOI: 10.4168/aair.2017.9.6.509] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/16/2017] [Accepted: 03/31/2017] [Indexed: 12/27/2022]
Abstract
Purpose Recent data indicate that sensitization to mold contributes to the severity and persistence of asthma. In this study, we investigated the relationships between sensitization to mold and lung function parameters in children with asthma. Methods We retrospectively reviewed clinical data from 551 asthmatic subjects. We selected subjects who met clinical diagnostic criteria of asthma. Their spirometry, methacholine challenge tests, and measurements of blood eosinophils, serum IgE, eosinophil cationic protein (ECP) and fractional exhaled nitric oxide (FeNO) results were included. Skin prick testing (SPT) results with 13 common aeroallergens in Korea including house dust mites, animal dander, pollen, cockroach and mold were reviewed. Subjects were divided into 3 groups according to their SPT results. Subjects who showed no positive result to any aeroallergen were designated as group 1 (non-sensitized). Group 2 represented subjects who were sensitized to aeroallergens other than mold (other allergen-sensitized) and group 3 included subjects who were sensitized to mold allergens (mold-sensitized). Results Among the 551 asthmatic subjects, 67 (12.2%) were sensitized to mold and 366 (66.4%) were sensitized to other aeroallergens. The log mean IgE levels were higher in groups 2 (5.96±1.14 IU/mL) and 3 (5.81±0.97 IU/mL) compared to group 1 (3.88±1.68 IU/mL). Blood eosinophils, ECP and FeNO concentrations were significantly higher in groups 2 and 3, but no significant difference was found between the 2 groups. The mean FEV1 value was significantly lower in group 3 (86.9±12.1%pred) than in groups 2 (92.0±14.8%pred) and 1 (93.4±15.4%pred). The log mean methacholine PC20 was significantly lower in group 3 (0.08±1.91 mg/mL) than in groups 2 (1.31±1.69 mg/mL) and 1 (2.29±1.66 mg/mL). Conclusions We observed a differential association between mold and other aeroallergen sensitization, and severity of asthma. Sensitization to mold is associated with lower lung function and increased airway hyper-responsiveness in children with asthma. Mold sensitization could be an important factor determining asthma severity particularly airflow limitation in children.
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Affiliation(s)
- Jung Hye Byeon
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Soohyun Ri
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Oyuntulga Amarsaikhan
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Eunji Kim
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - So Hyun Ahn
- Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Ic Sun Choi
- Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Hyung Jin Kim
- Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - SungChul Seo
- Environmental Health Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Wonsuck Yoon
- Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea.
| | - Young Yoo
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea.,Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea.,Environmental Health Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea.
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22
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Lung sound analysis can be an index of the control of bronchial asthma. Allergol Int 2017; 66:64-69. [PMID: 27312512 DOI: 10.1016/j.alit.2016.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/10/2016] [Accepted: 05/01/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We assessed whether lung sound analysis (LSA) is a valid measure of airway obstruction and inflammation in patients with bronchial asthma during treatment with inhaled corticosteroids (ICSs). METHODS 63 good adherence patients with bronchial asthma and 18 poor adherence patients were examined by LSA, spirometry, fractional exhaled nitric oxide (FeNO), and induced sputum. The expiration-to-inspiration lung sound power ratio at low frequencies between 100 and 200 Hz (E/I LF) obtained by LSA was compared between healthy volunteers and bronchial asthma patients. Next, post-ICS treatment changes were compared in bronchial asthma patients between the good adherence patients and the poor adherence patients. RESULTS E/I LF was significantly higher in bronchial asthma patients (0.62 ± 0.21) than in healthy volunteers (0.44 ± 0.12, p < 0.001). The good adherence patients demonstrated a significant reduction in E/I LF from pre-treatment to post-treatment (0.55 ± 0.21 to 0.46 ± 0.16, p = 0.002), whereas the poor adherence patients did not show a significant change. The decrease of E/I LF correlated with the improvement of FEV1/FVC ratio during the ICS treatment (r = -0.26, p = 0.04). The subjects with higher pre-treatment E/I LF values had significantly lower FEV1/FVC and V50,%pred (p < 0.001), and significantly higher FeNO and sputum eosinophil percentages (p = 0.008 and p < 0.001, respectively). CONCLUSIONS The E/I LF measurement obtained by LSA is useful as an indicator of changes in airway obstruction and inflammation and can be used for monitoring the therapeutic course of bronchial asthma patients.
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Shimoda T, Obase Y, Nagasaka Y, Kishikawa R, Mukae H, Iwanaga T. Peripheral bronchial obstruction evaluation in patients with asthma by lung sound analysis and impulse oscillometry. Allergol Int 2017; 66:132-138. [PMID: 27516132 DOI: 10.1016/j.alit.2016.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/23/2016] [Accepted: 06/20/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Computer-aided lung sound analysis (LSA) has been reported to be useful for evaluating airway inflammation and obstruction in asthma patients. We investigated the relation between LSA and impulse oscillometry with the evaluation of peripheral airway obstruction. METHODS A total of 49 inhaled corticosteroid-naive bronchial asthma patients underwent LSA, spirometry, impulse oscillometry, and airway hyperresponsiveness testing. The data were analyzed to assess correlations between the expiration: inspiration lung sound power ratio (dB) at low frequencies between 100 and 195 Hz (E/I LF) and various parameters. RESULTS E/I LF and X5 were identified as independent factors that affect V˙50,%predicted. E/I LF showed a positive correlation with R5 (r = 0.34, p = 0.017), R20 (r = 0.34, p = 0.018), reactance area (AX, r = 0.40, p = 0.005), and resonant frequency of reactance (Fres, r = 0.32, p = 0.024). A negative correlation was found between E/I LF and X5 (r = -0.47, p = 0.0006). E/I LF showed a negative correlation with FEV1/FVC(%), FEV1,%predicted, V˙50,%predicted, and V˙25,%predicted (r = -0.41, p = 0.003; r = -0.44, p = 0.002; r = -0.49, p = 0.0004; and r = -0.30, p = 0.024, respectively). E/I LF was negatively correlated with log PC20 (r = -0.30, p = 0.024). Log PC20, X5, and past smoking were identified as independent factors that affected E/I LF level. CONCLUSIONS E/I LF as with X5 can be an indicator of central and peripheral airway obstruction in bronchial asthma patients.
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Affiliation(s)
- Terufumi Shimoda
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan.
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Reiko Kishikawa
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoaki Iwanaga
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan
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Affiliation(s)
- Stephen John Senn
- Inflammation, Bone, Allergy/Epidemiology, Biometrics, Medical Department, CIBA-GEIGY Ltd., Basle, Switzerland
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Park HW, Song WJ, Chang YS, Cho SH, Datta S, Weiss ST, Tantisira KG. Bronchodilator response following methacholine-induced bronchoconstriction predicts acute asthma exacerbations. Eur Respir J 2016; 48:104-14. [PMID: 27076579 DOI: 10.1183/13993003.00182-2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/01/2016] [Indexed: 11/05/2022]
Abstract
Methacholine bronchial provocation test provides the concentration of methacholine causing a 20% decrease in forced expiratory volume in 1 s (FEV1) from baseline (PC20). The dose-response slope (DRS), and other continuous indices of responsiveness (CIR; the percentage decline from the post-diluent baseline FEV1 after the last dose of methacholine), and per cent recovery index (PRI; the percentage increase from the maximally reduced FEV1 after bronchodilator inhalation) are alternative measures. The clinical relevance of these indices in predicting acute asthma exacerbations has not been fully evaluated.In two prospective cohorts of childhood and elderly asthmatics, baseline PC20, DRS, CIR and PRI were measured and evaluated as predictors of acute asthma exacerbations.We found that PRI was significantly related to the presence of asthma exacerbations during the first year of follow-up in both cohorts of childhood (p=0.025) and elderly asthmatics (p=0.003). In addition, PRI showed a significant association with the total number of steroid bursts during 4.3 years of follow-up in the cohort of childhood asthmatics (p=0.04).We demonstrated that PRI, an index of reversibility following methacholine-induced bronchoconstriction, was a good clinical predictor of acute exacerbations of asthma in both childhood and elderly asthmatics.
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Affiliation(s)
- Heung-Woo Park
- The Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo-Jung Song
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon-Suk Chang
- Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Heon Cho
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soma Datta
- The Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott T Weiss
- The Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Partners Center for Personalized Medicine, Partners Health Care, Boston, MA, USA
| | - Kelan G Tantisira
- The Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Shimoda T, Obase Y, Nagasaka Y, Nakano H, Kishikawa R, Iwanaga T. Lung Sound Analysis and Airway Inflammation in Bronchial Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:505-11. [PMID: 27021633 DOI: 10.1016/j.jaip.2016.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/22/2016] [Accepted: 02/03/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our previous study on lung sound analysis (LSA) revealed that the expiration-to-inspiration sound power ratio in a low-frequency range (E/I LF) was increased in patients with bronchial asthma, even when they have no wheezes. OBJECTIVE We also monitored the expiration-to-inspiration sound power ratio in a mid-frequency range (E/I MF) and the mid- to low-frequency sound power ratio for inspiration and expiration (ie, I MF/LF and E MF/LF, respectively) using a new software program to examine which parameter is most suitable as an index of airway inflammation in patients with asthma. METHODS A study was conducted in 31 patients with mild-to-moderate bronchial asthma to examine potential correlations of LSA parameters (E/I LF, E/I MF, I MF/LF, and E MF/LF) with spirogram parameters, airway hyperresponsiveness (PC20), fractional exhaled nitric oxide (NO), and sputum eosinophils. RESULTS E/I LF was significantly correlated with airway narrowing (forced expiratory volume in 1 second [FEV1.0]/forced vital capacity [FVC]%: r = -0.50, maximal expiratory flow at 50% [V50],%pred: r = -0.50) and peripheral airway inflammation (alveolar NO: r = 0.36, eosinophils in peripheral sputum: r = 0.41). E/I MF was significantly correlated with airway narrowing (FEV1.0/FVC%: r = -0.46, V50,%pred: r = -0.49), airway inflammation (bronchial NO: r = 0.43, alveolar NO: r = 0.47, eosinophils in peripheral sputum: r = 0.50), and airway hyperresponsiveness (logPC20: r = -0.49). E MF/LF was significantly correlated with airway inflammation (NO: r = 0.36, eosinophils in sputum: r = 0.40) and airway hyperresponsiveness (logPC20: r = -0.40). I MF/LF was not significantly correlated with any parameters. CONCLUSIONS Among the 4 LSA parameters investigated, E/I MF demonstrated the highest correlation with airway inflammation, and also with bronchial hyperresponsiveness.
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Affiliation(s)
- Terufumi Shimoda
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan.
| | - Yasushi Obase
- Second Department of Internal Medicine, School of Medicine, Nagasaki University, Nagasaki, Japan
| | | | - Hiroshi Nakano
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan
| | - Reiko Kishikawa
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan
| | - Tomoaki Iwanaga
- Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan
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Perzanowski MS, Yoo Y. Exhaled Nitric Oxide and Airway Hyperresponsiveness to Adenosine 5'-monophosphate and Methacholine in Children with Asthma. Int Arch Allergy Immunol 2015; 166:107-13. [PMID: 25792296 DOI: 10.1159/000375237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is increasing interest in the role of indirect bronchial challenges because clinical studies have shown that indirect airway hyperresponsiveness (AHR) reflects underlying airway inflammation better than direct AHR. Fractional exhaled nitric oxide (FeNO) appears to be a useful clinical tool for assessing airway inflammation noninvasively. We examined whether FeNO is more closely related to AHR to indirect stimuli than AHR to direct stimuli in children with mild to moderate asthma. METHODS Fifty-nine asthmatic children aged 6-16 years without rhinitis, underwent spirometry, FeNO measurement and blood tests for serum total IgE, blood eosinophil count and serum eosinophil cationic protein (ECP). All subjects underwent methacholine and adenosine 5-monophosphate (AMP) challenge tests at intervals of 3 days. RESULTS In a univariate linear regression analysis, FeNO was significantly associated with both PC20 AMP (R(2) = 0.341, p < 0.001) and PC20 methacholine (R(2) = 0.188, p = 0.001). After adjustment for age, sex, serum total IgE and blood eosinophil count, the association between FeNO and PC20 AMP (β = -1.98, p = 0.001) was more robust than that between FeNO and PC20 methacholine (β = -0.87, p = 0.081). The significant correlation between FeNO and PC20 AMP was observed in the steroid-naïve group (β = -2.48, p = 0.001), but not in the steroid-treated group (β = 0.88, p = 0.463). CONCLUSIONS FeNO levels were more closely associated with PC20 AMP than with PC20 methacholine. This relationship could only be seen in the steroid-naïve subjects. These results suggest that FeNO levels in children with asthma may be more closely related to indirect AHR than to direct AHR.
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Affiliation(s)
- Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, N.Y., USA
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Myung JH, Seo HJ, Park SJ, Kim BY, Shin IS, Jang JH, Kim YK, Jang AS. Association of nasal inflammation and lower airway responsiveness in schoolchildren based on an epidemiological survey. Korean J Intern Med 2015; 30:226-31. [PMID: 25750565 PMCID: PMC4351330 DOI: 10.3904/kjim.2015.30.2.226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/12/2013] [Accepted: 10/28/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND/AIMS We sought to increase our understanding of the rhinitis-asthma relationship and improve strategies for the treatment of patients with these diseases. The aim of this study was to identify a connection between upper airway inflammation and lower airway responsiveness. METHODS We counted eosinophils on nasal smears, and performed spirometry, allergic skin tests, and methacholine challenge tests in 308 schoolchildren plus a questionnaire on respiratory symptoms. The methacholine concentration causing a 20% fall in forced expiratory volume in 1 second (PC20 < 25 mg/mL) was used as the threshold of bronchial hyperresponsiveness (BHR). RESULTS In total, 26% of subjects had positive nasal eosinophils on a smear, and 46.2% of subjects had BHR at < 25 mg/mL methacholine PC20. Nasal symptoms were higher in subjects with than without nasal eosinophils (p = 0.012). Asthma symptoms did not differ between subjects with and without nasal eosinophils. Nasal eosinophils were higher in subjects with atopy than those without (p = 0.006), and there was no difference in PC20 methacholine according to atopy (15.5 ± 1.07 vs. 17.5 ± 0.62; p > 0.05). No difference in BHR was detected when comparing subjects with and without nasal eosinophils. There were significant differences in the PC20 between subjects with greater than 50% nasal eosinophils and without nasal eosinophils (11.01 ± 2.92 mg/mL vs. 17.38 ± 0.61 mg/mL; p < 0.001). CONCLUSIONS These findings demonstrated that nasal eosinophilic inflammation might contribute to lower airway responsiveness in schoolchildren, based on an epidemiological survey.
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Affiliation(s)
- Jun-Ho Myung
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyun-Jeong Seo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Soo-Jeong Park
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Bo-Young Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Il-Sang Shin
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jun-Hak Jang
- Department of Nursing, Montana State University, Bozeman, MT, USA
| | - Yun-Kyung Kim
- Department of Nursing, Gwangju Workers' Health Center, Gwangju, Korea
| | - An-Soo Jang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Song WJ, Lee SH, Kang MG, Kim JY, Kim MY, Jo EJ, Lee SY, Lee SE, Kim MH, Yang MS, Kim SH, Kang HR, Park HK, Park HW, Chang YS, Kim SS, Lee JM, Min KU, Cho SH. Validation of the Korean version of the European Community Respiratory Health Survey screening questionnaire for use in epidemiologic studies for adult asthma. Asia Pac Allergy 2015; 5:25-31. [PMID: 25653917 PMCID: PMC4313752 DOI: 10.5415/apallergy.2015.5.1.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/25/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Standardized questionnaire is one of key instruments for general population surveys. OBJECTIVE The present study aimed to develop and validate the Korean version of the European Community Respiratory Health Survey (ECRHS) screening questionnaire for adult asthma surveys. METHODS The ECRHS screening questionnaire was translated into Korean language according to the international criteria. Study participants were prospectively recruited from six referral hospitals and one health check-up center. Comprehensibility of the translation was tested in a pilot study of 10 patients. The reliability was evaluated by internal consistency and test-retest repeatability. Validity was assess with regard to physician-diagnosed asthma. RESULTS A total of 100 adult asthma patients and 134 volunteers were recruited. Reliability was examined for 10 items in 100 asthmatics; Cronbach α coefficients were 0.84, and test-retest repeatability was good (Cohen κ coefficient, 0.71-1.00). Validity was assessed for 8 items in 234 participants; in particular, 'recent wheeze' showed a high sensitivity (0.89) for physician-diagnosed asthma. 'Recent asthma attack' and 'current asthma medication' showed high specificity (0.96-0.98). CONCLUSION The present study demonstrated that the Korean version of the ECRHS screening questionnaire was comprehensible, reliable and valid. We suggest the questionnaire to be utilized in further epidemiological studies for asthma in Korean adult populations.
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Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - So-Hee Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
- Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, Korea
| | - Min-Gyu Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Ju-Young Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Mi-Young Kim
- Department of Internal Medicine, Inje University Pusan Paik Hospital, Busan 614-735, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 626-870, Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 626-870, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Kyungpook National University Medical School, Daegu 700-842, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 626-870, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Sun-Sin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
- Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, Korea
| | - Jong-Myung Lee
- Department of Internal Medicine, Kyungpook National University Medical School, Daegu 700-842, Korea
| | - Kyung-Up Min
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
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You JS, Choi WB, Yi YY, Jeong SI, Song JS, Yang S, Hwang IT, Lee HB, Baek HS. Plasma secreted phospholipase A2 in asthmatic children: correlation with leptin levels and exercise induced bronchoconstriction. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jueng-Sup You
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Won-Bok Choi
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Yoon-Young Yi
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Soo-In Jeong
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Joon-Sup Song
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seong Yang
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Il-Tae Hwang
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Ha-Baik Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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Munoz X, Viladrich M, Manso L, del Pozo V, Quirce S, Cruz MJ, Carmona F, Sánchez-Pla A, Sastre J. Evolution of occupational asthma: does cessation of exposure really improve prognosis? Respir Med 2014; 108:1363-70. [PMID: 25160572 DOI: 10.1016/j.rmed.2014.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/28/2014] [Accepted: 08/01/2014] [Indexed: 01/02/2023]
Abstract
AIM To assess the evolution of occupational asthma (OA) depending on whether the patient avoids or continues with exposure to the offending agent. METHODS Study in patients diagnosed with OA using a specific inhalation challenge. Patients underwent the following examinations on the same day: clinical interview, physical examination, forced spirometry, methacholine test and determination of total IgE. Clinical improvement, deterioration or no change were defined according to the changes seen on the GINA severity scale at the time of diagnosis. RESULTS Of the 73 patients finally included, 55 had totally ended exposure and 18 continued to be exposed at work. Clinical improvement was observed in 47% of those who had terminated exposure and in 22% of those who remained exposed; clinical deterioration was observed in 14% and 17% respectively (p = 0.805). Logistical regression analysis, including the type of agent and the persistence or avoidance of exposure among the variables, did not show any predictive factors of clinical evolution. Similarly, the changes in FEV1 and in bronchial hyperresponsiveness were not associated with the avoidance or continuation of exposure to the causative agent. CONCLUSIONS Avoiding exposure to the causative agent in patients with OA does not seem to improve prognosis in this disease. Despite these findings, there is insufficient evidence to recommend a change in current management guidelines.
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Affiliation(s)
- X Munoz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, Spain; Ciber Enfermedades Respiratorias (CibeRes), Spain.
| | - M Viladrich
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, Spain
| | - L Manso
- Ciber Enfermedades Respiratorias (CibeRes), Spain; Servicio de Alergia, Fundación Jiménez Díaz, Madrid, Spain
| | - V del Pozo
- Ciber Enfermedades Respiratorias (CibeRes), Spain; Servicio de Inmunología, IIS Fundación Jiménez Díaz, Madrid, Spain
| | - S Quirce
- Ciber Enfermedades Respiratorias (CibeRes), Spain; Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - M J Cruz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, Spain; Ciber Enfermedades Respiratorias (CibeRes), Spain
| | - F Carmona
- Departamento de Estadística, Universidad de Barcelona, Spain
| | - A Sánchez-Pla
- Departamento de Estadística, Universidad de Barcelona, Spain
| | - J Sastre
- Ciber Enfermedades Respiratorias (CibeRes), Spain; Servicio de Alergia, Fundación Jiménez Díaz, Madrid, Spain
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Leuppi JD. Bronchoprovocation tests in asthma: direct versus indirect challenges. Curr Opin Pulm Med 2014; 20:31-6. [PMID: 24275928 DOI: 10.1097/mcp.0000000000000009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review describes different bronchoprovocation tests and their merits in diagnosing asthma. RECENT FINDINGS A new indirect challenge test using dry powder mannitol has been made available and has been systematically validated and tested in different populations. SUMMARY Airway hyperresponsiveness (AHR) is a characteristic feature of asthma, and its measurement using direct inhalation challenges, particularly with inhaled methacholine or histamine, or indirect challenges using stimuli such as exercise, dry air hyperpnea, distilled water, hypertonic saline and mannitol, and the pharmacological agent adenosine monophosphate is important in establishing a correct diagnosis. Direct challenge tests are sensitive and have a high negative predictive value to exclude asthma. This is particularly true in excluding asthma as a diagnosis in patients with symptoms that suggest asthma, but are caused by another condition. Indirect AHR correlates better with eosinophilic airway inflammation. Therefore, indirect challenge tests are seen as more specific. A newer indirect challenge test that uses a kit containing prepacked capsules of dry powder mannitol in different doses is safe and efficient to use. Indirect challenge tests are superior to direct challenge tests to confirm the presence of asthma.
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Affiliation(s)
- Jörg D Leuppi
- Medical University Clinic, Canton Hospital Baselland, Liestal, Switzerland
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Sturm R. Aerosol bolus dispersion in healthy and asthmatic children-theoretical and experimental results. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:47. [PMID: 25333022 PMCID: PMC4200686 DOI: 10.3978/j.issn.2305-5839.2014.04.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/22/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In the past decades, aerosol bolus inhalation increasingly came into the focus of medical interest due to its potential as a non-invasive technique for the diagnosis of lung diseases. The experimental studies were accompanied by the development of theoretical contributions dealing with aerosol bolus behaviour in healthy and diseased lungs. In this study, bolus dispersion in healthy and asthmatic children is subject to a theoretical approach. Model predictions are validated with related experimental findings. METHODS Aerosol bolus transport was simulated by using (I) a stochastic model of the human respiratory tract; (II) appropriate scaling procedures for the generation of healthy and asthmatic lungs of children; and (III) the concept of effective diffusivities (Deff) for the prediction of convective mixing processes in the conducting airways and alveoli. The aerosol injected into the inhalative air stream consisted of monodisperse particles with a diameter of 0.4 µm (ρ =1 g∙cm(-3)). Volumetric lung depth, being a measure for the position of the aerosol bolus within the inspired air stream, was varied from 95 mL (shallow bolus) to 540 mL (deep bolus). Half-width of the inhaled bolus was set to 50 mL. RESULTS According to the predictions provided by the model, dispersion of the exhaled aerosol bolus increases exponentially with volumetric lung depth in both asthmatic children and healthy controls. Asthmatics tend to develop higher bolus dispersion than healthy subjects, with significant differences between the two groups being noticeable at low volumetric lung depths (<300 mL). Skewness decreases with increasing volumetric lung depth, whereby respective values calculated for asthmatics exceed those values computed for healthy subjects. Theoretical results correspond very well with experimental findings. DISCUSSION AND CONCLUSIONS Results of experimental bolus studies may be approximated by theoretical models with high accuracy. Model predictions confirm the assumption that inhalation of aerosol boluses and dispersion measurements have only a limited diagnostic potential.
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Affiliation(s)
- Robert Sturm
- Brunnleitenweg 41, A-5061 Elsbethen, Salzburg, Austria
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Song WJ, Kim JY, Jo EJ, Lee SE, Kim MH, Yang MS, Kang HR, Park HW, Chang YS, Min KU, Cho SH. Capsaicin cough sensitivity is related to the older female predominant feature in chronic cough patients. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:401-8. [PMID: 25228996 PMCID: PMC4161680 DOI: 10.4168/aair.2014.6.5.401] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/24/2013] [Accepted: 09/17/2013] [Indexed: 12/21/2022]
Abstract
Purpose The present study aimed to examine the age and gender distributions among chronic cough patients referred to a tertiary cough clinic in Korea, and to investigate clinical factors related to the demographic findings. Methods Study participants were unselectively recruited from adult chronic cough patients who attended the cough clinic for the first time during one year. To validate their representativeness, their age and gender distributions were compared to the entire chronic cough population, or with those presenting with other chronic disease. Data from the baseline investigations were analyzed to identify clinical factors related to the demographic findings. Results A total of 272 chronic cough patients were included. They had a middle-aged female predominant feature (mean age: 52.8±15.7 years and female 69.1%). Their age and gender distributions were almost identical to the entire chronic cough population, but were distinct from patients with hypertension. Among clinical factors, the older female predominance was associated with enhanced capsaicin cough sensitivity, and also with the presence of 'cough by cold air' symptom. Allotussia and laryngeal paresthesia were highly common in chronic cough patients, affecting 94.8% and 86.8% of them, respectively. Conclusions The present study demonstrated older female predominance among adult chronic cough patients attending a referral cough clinic in Korea. The demographic features were significantly associated with the capsaicin cough responses and also potentially with allotussia (particularly cold air as the trigger). These findings suggest a role of cough reflex sensitization in the pathophysiology of chronic cough in adults.
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Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Ju-Young Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Up Min
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
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Sood A, Seagrave J, Herbert G, Harkins M, Alam Y, Chiavaroli A, Shohreh R, Montuschi P, Campen M, Harmon M, Qualls C, Berwick M, Schuyler M. High sputum total adiponectin is associated with low odds for asthma. J Asthma 2014; 51:459-66. [PMID: 24447284 DOI: 10.3109/02770903.2014.882934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Adipose tissue produces adiponectin, an anti-inflammatory protein. High systemic total adiponectin is associated with a low risk for incident asthma but the association with lung adiponectin is not known. Our objective was to evaluate the association between sputum total adiponectin and asthma. METHODS This case-control study included 44 cases with objectively-confirmed asthma and an equal number of body mass index (BMI) and sex-matched controls. Serum and sputum adiponectin were estimated by ELISA and Western Blot technique, respectively. While Fisher's exact test, t-test and Spearman's correlations were used for univariate analyses, Spearman and regression analyses were performed for multivariable analyses. RESULTS While high-molecular-weight adiponectin was the dominant isoform in serum, medium-molecular-weight isoform was dominant in sputum. Sputum total adiponectin was not correlated with serum adiponectin or BMI. Sputum total adiponectin was lower among asthmatics than controls (p = 0.03), although individual sputum isoforms were not similarly associated. High sputum total adiponectin was associated with lower odds for asthma (OR 0.33, 95% C.I. 0.12, 0.91), even after adjustment for systemic adiposity measures including serum adiponectin. CONCLUSIONS High sputum total adiponectin predicted lower odds for asthma, even after adjustment for serum adiponectin. Although not studied, it is possible that pharmacological modulation of sputum adiponectin may suggest new ways to prevent and/or treat asthma.
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Affiliation(s)
- Akshay Sood
- School of Medicine, University of New Mexico , Albuquerque, NM , USA
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Kim YS, Jang YH, Jeon JH, Seo JH, Kang SH, Jee YK. The safety and efficacy of recombinant fibroblast growth factor 2 in human asthmatics: A pilot study. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.3.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Youn Seup Kim
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Yong Ho Jang
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ji Hyun Jeon
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ji Hee Seo
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | | | - Young-Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
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38
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Yoo JK, Shin JY, You JS, Jeong SI, Song JS, Yang S, Hwang IT, Lee HB, Baek HS. Serum leptin levels correlate with bronchial hyper-responsiveness to mannitol in asthmatic children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jung-Kyung Yoo
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jae Young Shin
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jueng-Sup You
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Soo-In Jeong
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Joon-Sup Song
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seong Yang
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Il-Tae Hwang
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Ha-Baik Lee
- Department of Pediatrics, Hanyang University Medical Center, Seoul, Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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Shim E, Yu J. Relationship between duration of disease and bronchial responsiveness in 6-8 years old children with asthma. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.1.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Eunhee Shim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Takami S, Mochizuki H, Muramatsu R, Hagiwara S, Arakawa H. Relationship between bronchial hyperresponsiveness and lung function in children age 5 and 6 with and without asthma. Respirology 2013; 18:682-7. [PMID: 23356445 DOI: 10.1111/resp.12061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/09/2012] [Accepted: 11/21/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE It is unknown whether wheezy children have bronchial hyperresponsiveness (BHR) or which lung function parameters are correlated with BHR in children. We evaluated the relationship between BHR parameters and the lung functions by minimizing the effects of age and height in asthmatic, non-asthmatic wheezers and healthy children. METHODS The subjects comprised of 154 children aged 5 and 6 years (78 males, 76 females), who were divided into three groups: asthmatics, non-asthmatic wheezers and healthy controls. Spirometry and a methacholine inhalation challenge by the oscillation method were performed. RESULTS The age of the study cohort was 5.9 ± 0.2 years (mean ± standard deviation), and the height was 114.4 ± 5.3 cm. No significant differences in height, weight, body mass index or lung function were observed in the three groups. The minimal dose of methacholine to start bronchoconstriction, a parameter of bronchial sensitivity, was lower in asthmatics and non-asthmatic wheezers than that in controls. The speed of bronchoconstriction in response to methacholine, a parameter of bronchial reactivity, was strongly correlated with baseline respiratory resistance (Rrs cont) in all three groups. CONCLUSIONS Our data suggest that it not possible to distinguish preschool children with asthma from non-asthmatic wheezers based on their bronchial sensitivity and that the baseline Rrs has a strong effect on the bronchial reactivity in children.
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Affiliation(s)
- Satoru Takami
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan.
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Perpiñá Tordera M, García Río F, Álvarez Gutierrez FJ, Cisneros Serrano C, Compte Torrero L, Entrenas Costa LM, Melero Moreno C, Rodríguez Nieto MJ, Torrego Fernández A. Guidelines for the Study of Nonspecific Bronchial Hyperresponsiveness in Asthma. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Kim YH, Park HB, Kim MJ, Kim HS, Lee HS, Han YK, Kim KW, Sohn MH, Kim KE. Fractional exhaled nitric oxide and impulse oscillometry in children with allergic rhinitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 6:27-32. [PMID: 24404390 PMCID: PMC3881396 DOI: 10.4168/aair.2014.6.1.27] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 03/21/2013] [Accepted: 04/03/2013] [Indexed: 12/23/2022]
Abstract
Purpose Airway inflammation, bronchial hyper-responsiveness (BHR), and bronchodilator response
(BDR) are representative characteristics of asthma. Because allergic rhinitis (AR) is a
risk factor for asthma development, we evaluated these 3 characteristics in AR using
measurement of fractional exhaled nitric oxide (FeNO), a methacholine challenge test
(MCT), and impulse oscillometry (IOS). Methods This study included 112 children with asthma (asthma group), 196 children with AR (AR
group), and 32 control subjects (control group). We compared pulmonary function
parameters and FeNO levels among the 3 groups. The AR group was subdivided into 2
categories: the AR group with BHR and the AR group without, and again pulmonary function
and FeNO levels were compared between the 2 subgroups. Results FeNO levels were more increased in the AR and asthma groups than in the control group;
within the AR group, FeNO was higher in the AR group with BHR than in the AR group
without. The BDR was more increased in the AR group than in the control group when
percent changes in reactance at 5 Hz (Δ X5) and reactance area (Δ AX) were
compared. In the AR group, however, there was no difference in Δ X5 and Δ
AX between the AR group with BHR and the AR group without. Conclusions Reversible airway obstruction on IOS and elevated FeNO levels were observed in children
with AR. Because elevated FeNO levels can indicate airway inflammation and because
chronic inflammation may lead to BHR, FeNO levels may be associated with BHR in AR. IOS
can be a useful tool for detecting lower airway involvement of AR independent of BHR
assessed in the MCT.
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Affiliation(s)
- Yoon Hee Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Bin Park
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Soo Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Seon Lee
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ki Han
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Perpiñá Tordera M, García Río F, Álvarez Gutierrez FJ, Cisneros Serrano C, Compte Torrero L, Entrenas Costa LM, Melero Moreno C, Rodríguez Nieto MJ, Torrego Fernández A. Guidelines for the study of nonspecific bronchial hyperresponsiveness in asthma. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Arch Bronconeumol 2013; 49:432-46. [PMID: 23896599 DOI: 10.1016/j.arbres.2013.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/10/2013] [Accepted: 05/13/2013] [Indexed: 11/20/2022]
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Sood A, Qualls C, Seagrave J, McDonald J, Shohreh R, Chiavaroli A, Schuyler M. Effect of allergen inhalation on airway oxidant stress, using exhaled breath condensate 8-isoprostane, in mild asthma. J Asthma 2013; 50:449-56. [PMID: 23461590 DOI: 10.3109/02770903.2013.780609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Exhaled breath condensate (EBC) 8-isoprostane concentrations are increased in asthma, but it is not known if they acutely change following bronchoprovocation. The objective of this study was to evaluate EBC 8-isoprostane concentrations following allergen-induced bronchoprovocation in asthma. METHODS This comparison study included eight mild atopic asthmatics and six controls. Asthmatics were challenged with inhaled specific allergen, methacholine, and irrelevant allergen in random order. Controls were challenged with irrelevant allergen. EBCs collected at 0, 3, 6, 9, and 23 hours by the R-tube method were measured for 8-isoprostanes by ELISA technique. Repeated measures ANOVA technique was used for analysis. RESULTS EBC 8-isoprostane concentrations did not change following any inhalational challenge, as compared to baseline, in either asthmatics or controls. CONCLUSIONS EBC 8-isoprostane concentrations do not acutely change following bronchoprovocation in subjects with mild asthma.
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Affiliation(s)
- Akshay Sood
- Department of Medicine, University of New Mexico Health Sciences Center School of Medicine, Albuquerque, NM, USA.
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46
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Neumonitis por hipersensibilidad a isocianatos. Características clínico-radiológicas y de función pulmonar. Arch Bronconeumol 2013; 49:169-72. [DOI: 10.1016/j.arbres.2012.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/27/2012] [Accepted: 08/30/2012] [Indexed: 11/19/2022]
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Uranga A, Sánchez-Ortiz M, Morell F, Cruz MJ, Muñoz X. Hypersensitivity Pneumonitis Due to Isocyanates: Lung Function, Clinical and Radiological Characteristics. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2012.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jang WN, Park IS, Choi CH, Bauer S, Harmin S, Seo SC, Choi IS, Choung JT, Yoo Y. Relationships between exhaled nitric oxide and atopy profiles in children with asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 5:155-61. [PMID: 23638314 PMCID: PMC3636450 DOI: 10.4168/aair.2013.5.3.155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/05/2012] [Accepted: 10/17/2012] [Indexed: 01/10/2023]
Abstract
Purpose We examined whether fractional exhaled nitric oxide (FeNO) levels are associated with atopy profiles in terms of mono-sensitization and poly-sensitization in asthmatic children. Methods A total of 119 children underwent an assessment that included FeNO measurements, spirometry, methacholine challenge, and measurement of blood eosinophil count, serum total IgE, and serum eosinophil cationic protein (ECP). We also examined sensitization to five classes of aeroallergens (house dust mites, animal danders, pollens, molds, and cockroach) using skin prick testing. The children were divided into three groups according to their sensitization profiles to these aeroallergens (non-sensitized, mono-sensitized, and poly-sensitized). Results The geometric means (range of 1 SD) of FeNO were significantly different between the three groups (non-sensitized, 18.6 ppb [10.0-34.7 ppb]; mono-sensitized, 28.8 ppb [16.6-50.1 ppb]; and poly-sensitized, 44.7 ppb [24.5-81.3 ppb], P=0.001). FeNO levels were correlated with serum total IgE concentrations, peripheral blood eosinophilia, and serum ECP levels to different degrees. Conclusions FeNO levels vary according to the profile of atopy, as determined by positive skin prick test results to various classes of aeroallergens. FeNO is also moderately correlated with serum total IgE, blood eosinophilia, and serum ECP. These results suggest that poly-sensitized asthmatic children may have the highest risk of airway inflammation.
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Affiliation(s)
- Won-Nyung Jang
- Department of Pediatrics, Hanil General Hospital, Seoul, Korea
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Muñoz X, Sanchez-Vidaurre S, Roca O, Torres F, Morell F, Cruz MJ. Bronchial inflammation and hyperresponsiveness in well controlled asthma. Clin Exp Allergy 2013; 42:1321-8. [PMID: 22925318 DOI: 10.1111/j.1365-2222.2012.04004.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little research has been devoted to the characteristics of bronchial inflammation in patients with stable, well controlled asthma. OBJECTIVE The aim of this study was to assess the degree and type of airway inflammation and to investigate the relationship between inflammation and bronchial hyperresponsiveness in patients with well controlled asthma. METHODS A cross-sectional study was conducted in 84 adult patients (43 men, mean age 43 years) with documented well controlled asthma. Induced sputum samples were obtained and cell types determined by differential cell count. Spirometry and methacholine challenge testing were performed. Asthma Control Questionnaire (ACQ) was used to assess symptoms. Patients were included if their ACQ score was < 0.75. RESULTS A total of 59 patients had persistent bronchial inflammation: 28 cases were considered eosinophilic, 28 neutrophilic, and 3 mixed. Median (range) percentage of eosinophils was 4% (0-64) in patients testing positive to methacholine challenge (n = 66) and 1% (0-3) in those testing negative (n = 18) (P = 0.003). A positive correlation was found between eosinophil percentage and the methacholine dose/response ratio (r = 0.477, P = 0.0001). The geometric mean (95% CI) of the methacholine PC20 was 1.74 mg/mL (1.04-2.93) in patients with eosinophilic inflammation and 4.14 mg/mL (2.5-6.84) in those with neutrophilic inflammation (P = 0.03). CONCLUSIONS Inflammation and bronchial hyperresponsiveness persist in most patients with well controlled asthma. CLINICAL RELEVANCE The study demonstrates that eosinophilic or neutrophilic inflammation persisted in most well controlled asthma patients despite the fact that their condition was controlled and therefore, measurement of bronchial inflammation seems essential to achieve proper asthma control.
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Affiliation(s)
- X Muñoz
- Pulmonology Service, Medicine Department, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Sposato B, Scalese M, Scichilone N, Pammolli A, Balducci MT, Migliorini MG, Scala R. BMI can influence adult males' and females' airway hyperresponsiveness differently. Multidiscip Respir Med 2012; 7:45. [PMID: 23157852 PMCID: PMC3529699 DOI: 10.1186/2049-6958-7-45] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/30/2012] [Indexed: 11/16/2022] Open
Abstract
Background Epidemiological data indicate that obesity is a risk factor for asthma, but scientific literature is still debating the association between changes in body mass index (BMI) and airway hyperresponsiveness (AHR). Methods This study aimed at evaluating the influence of BMI on AHR, in outpatients with symptoms suggestive of asthma. 4,217 consecutive adult subjects (2,439 M; mean age: 38.2±14.9 yrs; median FEV1 % predicted: 100 [IQR:91.88-107.97] and FEV1/FVC % predicted: 85.77% [IQR:81.1-90.05]), performed a methacholine challenge test for suspected asthma. Subjects with PD20 < 200 or 200 < PD20 < 800 or PD20 > 800 were considered affected by severe, moderate or mild AHR, respectively. Results A total of 2,520 subjects (60% of all cases) had a PD20 < 3,200 μg, with a median PD20 of 366 μg [IQR:168–1010.5]; 759, 997 and 764 patients were affected by mild, moderate and severe AHR, respectively. BMI was not associated with increasing AHR in males. On the contrary, obese females were at risk for AHR only when those with moderate AHR were considered (OR: 1.772 [1.250-2.512], p = 0.001). A significant reduction of FEV1/FVC for unit of BMI increase was found in moderate AHR, both in males (β = −0.255; p =0.023) and in females (β = −0.451; p =0.017). Conclusions Our findings indicate that obesity influences AHR only in females with a moderate AHR level. This influence may be mediated by obesity-associated changes in baseline lung function.
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Affiliation(s)
- Bruno Sposato
- Unit of Pneumology, "Misericordia" Hospital, Via Senese 161, 58100, Grosseto, Italy.
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