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Côté MÈ, Boulay MÈ, Plante S, Côté A, Chakir J, Boulet LP. Comparison of circulating fibrocytes from non-asthmatic patients with seasonal allergic rhinitis between in and out of pollen season samples. Allergy Asthma Clin Immunol 2022; 18:24. [PMID: 35296352 PMCID: PMC8925232 DOI: 10.1186/s13223-022-00663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Allergic rhinitis is a risk factor for asthma development. In asthma, fibroblast progenitors, fibrocytes, are increased in the blood and bronchial mucosa following allergen exposure. These cells may play a role in lower airways remodeling as observed in non-asthmatic subjects with allergic rhinitis. Objective To determine the influence of seasonal allergen exposure on blood circulating fibrocytes in allergic rhinitic subjects without asthma. Methods Non-asthmatic subjects with seasonal allergic rhinitis had blood sampling at baseline and at the peak of rhinitis symptoms. Cells were stained for fibrocyte markers (CD34, CD45, CXCR4, collagen I) and analyzed by flow cytometry. Results Data from 26 subjects (11M:15F) aged 29 ± 8 years were analysed. Compared to baseline, there was a significant decrease in blood fibrocytes during the pollen season in subjects sensitized to trees [median (25–75 percentile), 9.3 (6.4–20.7)% vs 7.0 (4.2–10.1)%, P = 0.007] and a significant increase in subjects sensitized to grass [12.7 (9.9–23.1)% vs 64.0 (57.6–73.6)%, P < 0.001] and ragweed [8.0 (7.4–10.8)% vs 48.2 (43.5–52.6)%, P < 0.001]. A significant decrease in CXCR4 mean fluorescence was also observed between the two visits [1814 (1261–2235) vs 1352 (814–1796) (arbitrary units), P = 0.02]. Conclusions and clinical relevance These results contribute to document dynamic variations in blood fibrocytes’ activation and migration into the airways following natural exposure to allergens. These findings may help identify one of the potential factors involved in the development of asthma in allergic rhinitic subjects.
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Affiliation(s)
- Marie-Ève Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada
| | - Marie-Ève Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada
| | - Sophie Plante
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada
| | - Andréanne Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada
| | - Jamila Chakir
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada
| | - Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada.
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Jantrapirom S, Hirunsatitpron P, Potikanond S, Nimlamool W, Hanprasertpong N. Pharmacological Benefits of Triphala: A Perspective for Allergic Rhinitis. Front Pharmacol 2021; 12:628198. [PMID: 33995026 PMCID: PMC8120106 DOI: 10.3389/fphar.2021.628198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/16/2021] [Indexed: 12/24/2022] Open
Abstract
Allergic rhinitis (AR) is considered a major nasal condition impacting a large number of people around the world, and it is now becoming a global health problem. Because the underlying mechanisms of AR are complex, the development of single-drug treatment might not be enough to treat a wide spectrum of the disease. Although the standard guidelines classify and provide suitable diagnosis and treatment, the vast majority of people with AR are still without any means of controlling it. Moreover, the benefits of AR drugs are sometimes accompanied by undesirable side effects. Thus, it is becoming a significant challenge to find effective therapies with limited undesirable side effects for a majority of patients suffering from uncontrolled AR. Aller-7/NR-A2, a polyherbal formulation, has revealed promising results in patients by reducing nasal symptoms and eosinophil counts without serious adverse effects. Interestingly, three out of seven of the herbals in the Aller-7/NR-A2 formulation are also found in an Ayurvedic polyherbal formulation known as “Triphala,” which is a potential candidate for the treatment of AR. However, there are no current studies that have examined the effects of Triphala on the disease. This review aims to describe the complexity of AR pathophysiology, currently available treatments, and the effects of Triphala on AR in order to help develop it as a promising alternative treatment in the future.
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Affiliation(s)
- Salinee Jantrapirom
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Drosophila Center for Human Diseases and Drug Discovery (DHD), Faculty of Medicine, Chiang Mai, University, Chiang Mai, Thailand
| | - Pannaphak Hirunsatitpron
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Graduate School, Chiang Mai University, Chiang Mai, Thailand
| | - Saranyapin Potikanond
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wutigri Nimlamool
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nutthiya Hanprasertpong
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Antosova M, Bencova A, Mokra D, Plevkova J, Pepucha L, Buday T. Exhaled and Nasal Nitric Oxide - Impact for Allergic Rhinitis. Physiol Res 2021; 69:S123-S130. [PMID: 32228017 DOI: 10.33549/physiolres.934393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
FeNO measurement is a validated non-invasive technique, which is used for diagnosis and monitoring of asthma. It would be desirable to find a reliable method to monitor allergic rhinitis (AR) via measurement of FeNO, and/or nasal nitric oxide (nNO). The aim of our study was the assessment of the efficacy of FeNO and nNO as markers in AR treatment. FeNO and nNO were measured with the portable NO analyser (NIOX MINO®) in healthy participants and in patients with AR. The patients were examined during the pollen season and out of it. The effect of local corticosteroids and antihistamine therapy was observed in patients with AR during pollen season after three weeks of therapy. There are significant differences between FeNO and nNO in patients with AR compared to healthy controls at all set points of measurements. While FeNO responded well to the treatment with both antihistamines and combined therapy, nNO decreased only after combined therapy with antihistamines and nasal corticosteroids. nNO monitoring alone is not a suitable method to monitor inflammation of the upper airways in AR and its suppression by anti-allergic treatment and should be correlated with other markers as FeNO or symptom scores.
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Affiliation(s)
- M Antosova
- BioMed Martin, Division of Respirology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovak
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Carpagnano GE, Ruggieri C, Scioscia G, Storto MML, Zoppo L, Foschino-Barbaro MP. Is the Exhaled Breath Temperature Sensitive to Cigarette Smoking? COPD 2016; 13:642-6. [PMID: 26934668 DOI: 10.3109/15412555.2016.1143458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The smoking habit is accompanied by an acute inflammatory response which follows tissue injury. It would be desirable to find a non-invasive inflammatory marker that would simplify the task of studying and monitoring smokers more simply and allow us to identify populations at risk of contracting Chronic Obstructive Pulmonary Disease (COPD). Today's expectations regarding research focus on issues ranging from inflammatory markers to those of exhaled breath temperature (EBT) are considerable. That said, although the EBT has been largely studied in asthma and COPD, there have not been any studies thus far that have analysed the effect of cigarette smoking on the EBT. Bearing this in mind, in this longitudinal study we aim to analyse the EBT in current smokers, monitor the effects both of cigarette smoking on EBT and of what happens after smoking cessation. Twenty-five (25) smokers (59.5 ± 3.1 yrs, 12 M) who participated in a multi-disciplinary smoking cessation programme and 25 healthy never-smokers (58.7 ± 2.9, 13 M) underwent EBT measurement. EBT values were higher in smokers before smoking (T0) than in never-smokers [34.6 (34.2-35) vs 33.2 (32.4-33.7)°C, p < 0.001. The smokers repeated measurement 5 minutes after smoking a cigarette (T1) and 2 hours after (T2). They repeated EBC measurement after 1 week (T3) and then after 3 months (T4) from smoking cessation. EBT is higher in smokers compared to controls. EBT increases after cigarette smoking and progressively decreases with the increase of time from when the last cigarette was smoked. Thus, we can conclude that EBT is increased in smokers and also sensitive to the acute effect of cigarette smoke.
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Affiliation(s)
- Giovanna E Carpagnano
- a Institute of Respiratory Disease, Department of Medical and Surgical Sciences, University of Foggia , Italy
| | - Cinzia Ruggieri
- a Institute of Respiratory Disease, Department of Medical and Surgical Sciences, University of Foggia , Italy
| | - Giulia Scioscia
- a Institute of Respiratory Disease, Department of Medical and Surgical Sciences, University of Foggia , Italy
| | - Maria Maddalena Lo Storto
- a Institute of Respiratory Disease, Department of Medical and Surgical Sciences, University of Foggia , Italy
| | - Luigi Zoppo
- a Institute of Respiratory Disease, Department of Medical and Surgical Sciences, University of Foggia , Italy
| | - Maria P Foschino-Barbaro
- a Institute of Respiratory Disease, Department of Medical and Surgical Sciences, University of Foggia , Italy
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Abstract
BACKGROUND Bronchial hyperresponsiveness (BHR) is often regarded as a 'hallmark' of asthma and bronchoprovocation testing is frequently performed to support a diagnosis of asthma. However, BHR is also found in a spectrum of other lung diseases and can be provoked by a variety of specific stimuli. AIMS To review the pathophysiology of BHR, discuss various methods of testing for BHR and describe the epidemiology of BHR in a variety of previously studied populations. METHODS We performed a systematic review of references identified using Medline and hand searches of identified articles. Because of space limitations, we have included those reports that seem most representative of the overall BHR literature. RESULTS BHR can be induced by a variety of stimuli that trigger a number of different but overlapping physiological mechanisms. Bronchoprovocation testing can be performed using a variety of stimuli, various protocols and differing test criteria, yielding results that may be discordant. Elevated rates of BHR have been reported in studies of smokers, chronic obstructive pulmonary disease patients, atopics, athletes, exposed workers and the general population. CONCLUSIONS Due to the prevalence of BHR in a spectrum of clinical patients and working populations, clinicians should be aware that BHR is not specific for asthma. When performed correctly, the greatest clinical value of BHR testing is to rule out suspected asthma in patients in whom testing is negative. Assessment of BHR also provides insights into the pathological mechanisms of airway disease.
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Affiliation(s)
- J Borak
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT 06510, USA, Department of Internal Medicine (Yale Occupational and Environmental Medicine Program), Yale School of Medicine, Yale University, New Haven, CT 06510, USA.
| | - R Y Lefkowitz
- Department of Internal Medicine (Yale Occupational and Environmental Medicine Program), Yale School of Medicine, Yale University, New Haven, CT 06510, USA
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Yılmaz I, Bayraktar N, Ceyhan K, Seçil D, Yüksel S, Mısırlıgil Z, Bavbek S. Evaluation of vascular endothelial growth factor-A and Endostatin levels in induced sputum and relationship to bronchial hyperreactivity in patients with persistent allergic rhinitis monosensitized to house dust. Rev Port Pneumol (2006) 2015; 21:S2173-5115(15)00094-9. [PMID: 26051834 DOI: 10.1016/j.rppnen.2015.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/11/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Studies about the pathogenesis of bronchial hyperreactivity (BHR) in patients with persistent allergic rhinitis (PAR) and its relationship with lower airway remodeling are extremely limited. OBJECTIVE This study evaluated bronchial vascular remodeling via the measurement of angiogenic factor, vascular endothelial growth factor-A (VEGF-A), and anti-angiogenic factor, Endostatin, and evaluated their relationship with BHR in patients with PAR. METHODS The study group consisted of 30 patients with PAR monosensitized to house dust mites and 14 non-allergic healthy controls. All subjects underwent induced sputum and methacholine (M) bronchial provocation tests. VEGF-A and Endostatin levels were measured by ELISA in induced sputum supernatants. RESULTS The percentages of eosinophils in induced sputum were significantly increased in patients with PAR compared with healthy controls. There were no significant differences between patients with PAR and healthy controls in terms of levels of VEGF (37.9pg/ml, min-max: 5-373pg/ml vs. 24.9, min-max: 8-67pg/ml, p=0.8 respectively), Endostatin (532.5pg/ml, min-max: 150-2125pg/ml vs. 644, min-max: 223-1123pg/ml, p=0.2 respectively) and VEGF/Endostatin ratio (0.057 vs. 0.045, p=0.8 respectively). In addition, there were no significant differences between patients who are BHR positive (n=8), or negative to M (n=22) in terms of levels of VEGF, Endostatin and VEGF/Endostatin ratio and no correlations among value of PD20 to M and levels of VEGF, Endostatin and VEGF/Endostatin ratio. CONCLUSION We conclude that VEGF-A and Endostatin did not differ between patients with PAR and healthy controls regardless of BHR to M.
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Affiliation(s)
- I Yılmaz
- Ankara University, School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara, Turkey.
| | - N Bayraktar
- Baskent University, Department of Biochemistry, Ankara, Turkey
| | - K Ceyhan
- Ankara University, School of Medicine, Department of Pathology, Division of Clinical Cytology, Ankara, Turkey
| | - D Seçil
- Ankara University, School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara, Turkey
| | - S Yüksel
- Ankara University, Department of Biostatistics, Ankara, Turkey
| | - Z Mısırlıgil
- Ankara University, School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara, Turkey
| | - S Bavbek
- Ankara University, School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Ankara, Turkey
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7
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Panzner P, Malkusová I, Vachová M, Liška M, Brodská P, Růžičková O, Malý M. Bronchial inflammation in seasonal allergic rhinitis with or without asthma in relation to natural exposure to pollen allergens. Allergol Immunopathol (Madr) 2015; 43:3-9. [PMID: 24075536 DOI: 10.1016/j.aller.2013.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/29/2013] [Accepted: 06/03/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nasal inflammation in allergic rhinitis enhances bronchial Th2 driven inflammation and development of asthma. We assessed bronchial inflammation induced by natural allergen exposure during pollen season in patients with pollinosis with or without asthma to show the intensity of inflammation in asthma and rhinitis and possible persistence of inflammation in periods without allergen exposure. METHODS Sputum was induced in 52 patients with seasonal allergic rhinitis without asthma, 38 patients with seasonal allergic rhinitis and seasonal asthma and 23 healthy volunteers. Sampling was performed 6-8 weeks before the expected beginning of symptoms, during symptomatic period and 6-8 weeks after the end of symptoms. Sputum ECP was measured by means of chemi-luminiscent immunometric assay and sputum cell counts were assessed by classical staining and immunocytochemistry. RESULTS Sputum eosinophils were on the whole higher in both asthma and rhinitis compared to controls (p<0.001, p=0.003). The rise of eosinophils during pollen season compared with values out of pollen season was significant in asthma (classical staining) (p=0.014) and slightly apparent in rhinitis (immunocytochemistry) (p=0.073). The seasonal rise of sputum ECP was observed only in rhinitis (p=0.006). CONCLUSIONS Inflammation of the lower airway in patients with allergic rhinitis with and without asthma has been confirmed by means of both sputum eosinophil count and sputum ECP level. Persistent inflammation of lower airway in periods without allergen exposure was proven in seasonal asthma. This may have implications for the therapy of seasonal allergic rhinitis with and without asthma in terms of promoting long-term anti-inflammatory treatment.
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Affiliation(s)
- P Panzner
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University Prague, Czech Republic.
| | - I Malkusová
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University Prague, Czech Republic
| | - M Vachová
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University Prague, Czech Republic
| | - M Liška
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University Prague, Czech Republic
| | - P Brodská
- Department of Dermatology, Faculty of Medicine in Pilsen, Charles University Prague, Czech Republic
| | - O Růžičková
- Department of Respiratory Medicine, Faculty of Medicine in Pilsen, Charles University Prague, Czech Republic
| | - M Malý
- National Institute of Public Health, Prague, Czech Republic
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Abstract
The prevalence of allergic rhinitis (AR) is on the increase and this condition is frequently associated with asthma, thus leading to the concept that these two conditions are different aspects of the same disease. There is now accumulating evidence that AR often precedes the onset of asthmatic symptoms. This notion has important implications, not only for the diagnosis and management of these common allergic conditions but also for the potential progression of disease. Very little is known about the risk factors responsible for the progression of AR to asthma; current treatment options can control symptoms but do not prevent or cure the disease. However, there are recent data supporting the notion that it is possible to prevent new asthma cases by modifying the immune response and clinical outcome with allergen immunotherapy. This review article evaluates the impact of AR on the development of asthma, examines putative predictors for the progression of AR to asthma, and reviews recent, promising literature suggesting that early treatment of allergic individuals with immunotherapy may aid in asthma prevention.
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Yu L, Xu X, Wang L, Yang Z, Lü H, Qiu Z. Capsaicin-sensitive cough receptors in lower airway are responsible for cough hypersensitivity in patients with upper airway cough syndrome. Med Sci Monit 2013; 19:1095-101. [PMID: 24296694 PMCID: PMC3862142 DOI: 10.12659/msm.889118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Cough hypersensitivity may be related to the pathogenesis of upper airway cough syndrome (UACS). The purpose of the study was to investigate the role of capsaicin-sensitive cough receptors on the laryngopharynx and lower airway in the cough hypersensitivity of patients with UACS. Material/Methods 59 patients with UACS, 33 patients with rhinitis/sinusitis without cough, and 39 healthy volunteers were recruited for the study. Cough threshold C5, defined as the lowest concentration of capsaicin required for the induction of ≥5 coughs upon esposure to capsaicin, were determined at baseline and after laryngopharngeal anesthesia with lidocaine in all the subjects. After induced sputum cytology, the concentrations of histamine, prostaglandin E2 (PGE2), and calcitonin-gene-related peptide (CGPR) in the induced sputum were measured by ELISA. In 15 patients with UACS, sputum cytology and measurement of the above mediators were repeated after successful therapy. Results C5 response to capsaicin was significantly lower in the UACS group than in the rhinitis/sinusitis group and healthy control groups [3.9 (0.98, 7.8) μmol/L vs. 7.8 (3.9, 93.75) μmol/L vs. 31.2 (15.6, 62.5) μmol/L, H=40.12, P=0.000]. Laryngopharngeal anesthesia with lidocaine dramatically increased C5 to capsaicin in the subjects of all 3 groups by a similar degree, but the increase in the UACS group was still the lowest, with an increased level of histamine, PGE2, and CGRP in the induced sputum. When cough resolved with the treatment of cetirizine alone or in combination with erythromycin, the levels of CGRP and histamine in the induced sputum decreased significantly in 15 patients with UACS, with no obvious change in cell differential or concentration of PGE2 in the induced sputum. Conclusions Laryngeal TRPV1 plays an important role in cough sensitivity, but sensitization of capsaicin-sensitive cough receptors in the lower airway may be more responsible for the cough hypersensitivity in patients with UACS.
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Affiliation(s)
- Li Yu
- Department of Respiratory Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China (mainland)
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10
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Spicuzza L, Scuderi V, Morjaria JB, Prosperini G, Arcidiacono G, Caruso M, Folisi C, Di Maria GU, Polosa R. Airway responsiveness to adenosine after a single dose of fluticasone propionate discriminates asthma from COPD. Pulm Pharmacol Ther 2013; 27:70-5. [PMID: 23688422 DOI: 10.1016/j.pupt.2013.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/05/2013] [Accepted: 05/09/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Regular treatment with inhaled corticosteroids (ICS) is known to reduce airway hyperresponsiveness (AHR) to adenosine 5'-monophosphate (AMP) in asthma even after a single dose of fluticasone propionate (FP). AIM To determine whether this rapid protective effect of a single dose of FP is also present in COPD. METHODS 23 mild asthmatic and 24 COPD subjects with documented AHR to both AMP and methacholine took part in a randomized, double-blind, placebo-controlled, crossover study to measure AHR to inhaled AMP and methacholine 2 h after either 1000 μg FP or matched placebo. RESULTS In subjects with asthma, 1000 μg FP in a single dose significantly attenuated the constrictor response to AMP, geometric mean (range) PC20AMP values increasing from a 19.2 (1.3-116.3) to 81.5 (9.6-1600.0) (p < 0.001; post-placebo vs post-FP) mg/ml. Change in the airways response to inhaled AMP after FP was well within test variability in patients with COPD, with PC20AMP values 59.6 (11.3-183.9) and 76.3 (21.0-445.3) (p = 0.022; post-placebo vs post-FP) mg/ml. Additionally, FP failed to significantly attenuate the bronchial response to methacholine in both asthma and COPD subjects. A change in doubling dilution, between placebo and following a single dose of FP, in AMP had a better sensitivity and specificity of 95.8% and 65.2%, compared to methacholine of 79.2% and 43.5% respectively in delineating between COPD and asthma. CONCLUSION A single dose of 1000 μg FP rapidly improves AHR to AMP in asthmatics but not in COPD subjects. This may provide a convenient way by which provocation challenge with inhaled AMP may help in discriminating asthma from COPD.
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Affiliation(s)
- Lucia Spicuzza
- Dipartimento di Medicina Interna e Specialistica, Sez. Malattie Apparato Respiratorio, Università di Catania, Catania, Italy
| | - Vincenza Scuderi
- Dipartimento di Medicina Interna e Specialistica, Sez. Malattie Apparato Respiratorio, Università di Catania, Catania, Italy
| | - Jaymin B Morjaria
- Dept of Cardiovascular and Respiratory Studies, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Gaetano Prosperini
- Dipartimento di Medicina Interna e Specialistica, Sez. Medicina Interna, Università di Catania, Catania, Italy
| | - Giuseppe Arcidiacono
- Dipartimento di Medicina Interna e Specialistica, Sez. Medicina Interna, Università di Catania, Catania, Italy
| | - Massimo Caruso
- Dipartimento di Medicina Interna e Specialistica, Sez. Medicina Interna, Università di Catania, Catania, Italy
| | - Caterina Folisi
- Dipartimento di Medicina Interna e Specialistica, Sez. Malattie Apparato Respiratorio, Università di Catania, Catania, Italy
| | - Giuseppe U Di Maria
- Dipartimento di Medicina Interna e Specialistica, Sez. Malattie Apparato Respiratorio, Università di Catania, Catania, Italy
| | - Riccardo Polosa
- Dipartimento di Medicina Interna e Specialistica, Sez. Medicina Interna, Università di Catania, Catania, Italy.
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Marcon A, Cerveri I, Wjst M, Antó J, Heinrich J, Janson C, Jarvis D, Leynaert B, Probst-Hensch N, Svanes C, Toren K, Burney P, de Marco R. Can an airway challenge test predict respiratory diseases? A population-based international study. J Allergy Clin Immunol 2013; 133:104-10.e1-4. [PMID: 23683511 DOI: 10.1016/j.jaci.2013.03.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/21/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evidence on the longitudinal association of airway responsiveness with respiratory diseases is scarce. The best indicator of responsiveness is still undetermined. OBJECTIVE We investigated the association of airway responsiveness with the incidence of asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis. METHODS We studied 3851 subjects who underwent spirometry and methacholine challenge tests both at baseline (1991-1993), when they were 20 to 44 years old, and at follow-up (1999-2002) in the European Community Respiratory Health Survey. Airway responsiveness was defined based on the methacholine dose-response slope on both occasions. Incidence rate ratios for the association of airway responsiveness with disease occurrence were computed by using Poisson regression. RESULTS With respect to reference (slope of the fourth quintile or greater), subjects with the greatest degree of airway responsiveness (slope less than the first quintile) showed the greatest risk of developing asthma, COPD, and allergic rhinitis (incidence rate ratios of 10.82, 5.53, and 4.84, respectively; all P < .01). A low slope predicted disease occurrence, even in subjects who did not reach a 20% decrease in FEV1 at the cumulative dose of 1 mg of methacholine (PD20 >1 mg). A decrease in slope over time was an independent predictor of disease risk. CONCLUSION Airway responsiveness predicted new-onset asthma, COPD, and allergic rhinitis. Our study supports the use of a continuous noncensored indicator of airway responsiveness, such as the slope of the methacholine dose-response curve, in clinical practice and research because it showed clear advantages over PD20.
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Affiliation(s)
- Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
| | - Isa Cerveri
- Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Matthias Wjst
- Comprehensive Pneumology Center (CPC), Institute of Lung Biology and Disease (iLBD), Helmholtz Zentrum Muenchen, German Research Center for Environmental Health (GmbH), Munich, Germany; Institute of Medical Statistics and Epidemiology, Technische Universitaet Muenchen, Munich, Germany
| | - Josep Antó
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Munich, Germany
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden
| | - Deborah Jarvis
- Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Bénédicte Leynaert
- Institut National de la Santé et de la Recherche Médicale, U700-Epidemiology, Faculté Paris Diderot, Paris VII, Paris, France
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Cecilie Svanes
- Bergen Respiratory Research Group, Institute of Medicine, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kjell Toren
- Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Burney
- Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
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12
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Yang MS, Lee HS, Kim MH, Song WJ, Kim TW, Kwon JW, Kim SH, Park HW, Chang YS, Cho SH, Min KU. Rhinitis patients with sputum eosinophilia show decreased lung function in the absence of airway hyperresponsiveness. Allergy Asthma Immunol Res 2013; 5:232-8. [PMID: 23814677 PMCID: PMC3695238 DOI: 10.4168/aair.2013.5.4.232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/13/2012] [Accepted: 12/04/2012] [Indexed: 12/02/2022]
Abstract
Purpose Sputum eosinophilia is observed frequently in patients with rhinitis. Sputum eosinophilia in patients with non-asthmatic allergic rhinitis has been suggested to be related to nonspecific airway hyperresponsiveness (AHR). However, the clinical significance of sputum eosinophilia in patients with non-asthmatic rhinitis without AHR has not been determined. We conducted a retrospective study examining the influence of sputum eosinophilia in patients with non-asthmatic rhinitis without AHR on pulmonary function and expression of fibrosis-related mediators. Methods Eighty-nine patients with moderate-to-severe perennial rhinitis without AHR were included. All underwent lung function tests (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]), skin tests to inhalant allergens, methacholine bronchial challenge tests, and hypertonic saline-induced sputum to determine eosinophil counts. Sputum mRNA levels for transforming growth factor-β (TGF-β), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were also examined. Patients were divided into two groups according to the presence of sputum eosinophilia (≥3%, eosinophilia-positive [EP] and <3%, eosinophilia-negative [EN] groups). Results FEV1 was significantly lower (P=0.04) and FEV1/FVC tended to be lower (P=0.1) in the EP group than in the EN group. In sputum analyses, the MMP-9 mRNA level (P=0.005) and the ratio of MMP-9 to TIMP-1 expression (P=0.01) were significantly higher in the EP group than in the EN group. There was no significant difference in TGF-β mRNA expression between the two groups. Conclusions Sputum eosinophilia in patients with moderate-to-severe perennial rhinitis without AHR influenced FEV1 and the expression pattern of fibrosis-related mediators.
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Affiliation(s)
- Min-Suk Yang
- Department of Internal medicine, SMG-SNU Boramae Medical Center, Seoul, Korea. ; 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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13
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Yılmaz İ, Bayraktar N, Ceyhan K, Seçil D, Yüksel S, Mısırlıgil Z, Bavbek S. Evaluation of Vascular Endothelial Growth Factor A and Endostatin Levels in Induced Sputum and Relationship to Bronchial Hyperreactivity in Patients with Seasonal Allergic Rhinitis. Am J Rhinol Allergy 2013; 27:181-6. [DOI: 10.2500/ajra.2013.27.3867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Studies about the pathogenesis of bronchial hyperreactivity (BHR) in patients with allergic rhinitis (AR) and its relationship with lower airway remodeling are extremely limited. In this study, bronchial vascular remodeling and its relationship with BHR were evaluated by measurement of vascular endothelial growth factor A (VEGF-A) and endostatin in patients with seasonal AR (SAR). Methods The study group consisted of 30 patients with SAR (positive skin test to grass pollens) and 14 healthy controls. Induced sputum and bronchial provocation test (BPT) to methacholine (M) were performed in season. VEGF-A and endostatin levels were measured by ELISA in induced sputum supernatant. Results The percentages of eosinophils in induced sputum were significantly increased in BHR+ patients (n = 10) with SAR compared with BHR– patients (n = 20) with SAR (p < 0.001). There was no correlation between eosinophils and provocative concentration of M required to produce a 20% decrease in forced expiratory volume in 1 second. The levels of VEGF-A were significantly higher in SAR patients with BHR than in SAR patients without BHR and healthy controls (respectively, p = 0.014 and p = 0.04). The levels of endostatin were significantly lower in SAR patients with BHR than in SAR patients without BHR and healthy controls (respectively, p = 0.020 and p = 0.014). The ratio of VEGF-A/endostatin was significantly higher in SAR patients with BHR than in SAR patients without BHR and healthy controls (respectively, p = 0.009 and p = 0.019). Conclusion In this first study comparing the VEGF-A and endostatin levels of patients with SAR in sputum supernatant, the presence of BHR was shown to be associated with the vascular component of remodeling “angiogenesis.”
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Affiliation(s)
- İnsu Yılmaz
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | | | - Koray Ceyhan
- Division of Clinical Cytology, Department of Pathology
| | - Derya Seçil
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | - Selcen Yüksel
- Department of Biostatistics, Ankara University, Ankara, Turkey
| | - Zeynep Mısırlıgil
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | - Sevim Bavbek
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey
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14
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Abstract
BACKGROUND Nonasthmatic subjects with allergic rhinitis often have bronchial hyperresponsiveness (BHR), characteristic of asthma. The presence and degree of atopy is suggested to be important for BHR in patients with asthma. We aimed to assess BHR to methacholine (direct stimulus) and to adenosine 5'-monophosphate (AMP; indirect stimulus) in preschool children with allergic rhinitis and to investigate their relationship with the degree of atopy. METHODS Methacholine and AMP bronchial challenges were performed in preschool children with allergic rhinitis (n = 96), using a modified auscultation method. The end point concentration, resulting in audible wheezing and/or oxygen desaturation, was determined for each challenge. The degree of atopy was assessed using serum total IgE levels, the number of positive skin-prick tests, and atopic scores (sum of graded wheal size). RESULTS BHR to methacholine (end point concentration, ≤8 mg/mL) and to AMP (end point concentration, ≤200 mg/mL) was observed in 32 (33.3%) and 26 (27.1%) subjects, respectively. No significant relationship was observed between BHR to methacholine and any atopy parameter. In contrast, the atopic scores were higher in the AMP-BHR(+) group compared with the AMP-BHR(-) group, and a significant association was found between the degree of atopic scores and the frequency of BHR to AMP (score for trend, p = 0.006). Such a relationship was not observed for serum total IgE levels and the number of positive SPTs. CONCLUSION BHR to methacholine and BHR to AMP were detected in a significant proportion of preschool children with allergic rhinitis. The degree of atopy in terms of atopic scores seems to be an important factor for BHR to AMP but not for BHR to methacholine.
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Affiliation(s)
- Dong In Suh
- Department of Pediatrics, Seoul National University Hospital, Korea
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15
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Kim CK, Choi SJ, Lee JK, Suh DI, Koh YY. Bronchial hyperresponsiveness to methacholine and adenosine monophosphate and the degree of atopy in children with allergic rhinitis. Ann Allergy Asthma Immunol 2011; 106:36-41. [PMID: 21195943 DOI: 10.1016/j.anai.2010.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 09/27/2010] [Accepted: 10/12/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND nonasthmatic patients with allergic rhinitis often have bronchial hyperresponsiveness (BHR). Not only the presence but also the degree of atopy are important factors in BHR of patients with asthma. BHR is commonly evaluated by bronchial challenges using direct or indirect stimuli. OBJECTIVES to assess BHR to methacholine (direct) and to adenosine monophosphate (AMP) (indirect) in children with allergic rhinitis and to compare their relationships with the degree of atopy. METHODS methacholine and AMP challenges were performed in 88 children with allergic rhinitis, and a provocative concentration causing a 20% decrease in forced expiratory volume in 1 second (PC(20)) was calculated for each challenge. The degree of atopy was measured using serum total IgE levels, number of positive skin prick test results, and atopic scores (sum of graded wheal size). RESULTS BHR to methacholine (PC(20) <8 mg/mL) and to AMP (PC(20) <200 mg/mL) was observed in 22 (25%) and 30 (34%) patients, respectively. No association was found between BHR to methacholine and any atopy parameter. In contrast, serum total IgE levels and atopic scores were higher in the group with BHR to AMP than in the group without BHR to AMP. Furthermore, a significant association was found between the degree of these 2 parameters and BHR to AMP (score for trend, P < .001 and P = .03, respectively). CONCLUSIONS both BHR to methacholine and BHR to AMP were detected in a significant proportion of children with allergic rhinitis. The degree of atopy seems to be an important factor in BHR to AMP but not in BHR to methacholine.
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Affiliation(s)
- Chang Keun Kim
- Asthma and Allergy Center, Inje University Sanggye-Paik Hospital, Seoul, Korea
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16
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Abstract
OBJECTIVE Exhaled nitric oxide has been proposed as a noninvasive marker of eosinophilic airway inflammation in lower airways. The aim of the study was to investigate the impact of atopy, pollen exposure, and pharmacological treatment on NO production in lower airways of patients with allergic rhinitis. SUBJECTS AND METHODS Measurements of exhaled NO were performed in 79 non-asthmatic subjects with seasonal allergic rhinitis outside and in pollen season, before and after pharmacological treatment, and in 54 healthy controls. RESULTS Patients with allergic rhinitis had significantly higher levels of exhaled NO (18.3 +/-11.0 ppb) than healthy controls (13.0 +/-7.2 ppb) measured outside the pollen season (P=;0.0024). Increased exhaled NO levels were also found in patients with allergic rhinitis in the pollen season (27.0 +/-20.0 ppb) compared with the levels outside pollen season (P=0.0001), before pharmacological treatment. In rhinitic patients treated by nasal corticosteroids and antihistamines in the pollen season, the levels of exhaled NO were significantly lower (17.0 +/-16.4 ppb; P=0.045) than those before treatment. No difference was found in NO levels in rhinitic patients outside and in pollen season after pharmacological treatment. CONCLUSIONS This study has shown the presence of eosinophilic airway inflammation in the lower airways in allergic rhinitis patients. A significant increase of exhaled NO after pollen exposure in rhinitic patients underlies the impact of inflammation on the upper respiratory tract. A bidirectional link between upper and lower airways is confirmed by a decrease in exhaled NO in the pollen season, almost to the starting levels, after application of topic corticosteroids and antihistamines.
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Affiliation(s)
- A Bencova
- Clinic of Tuberculosis and Respiratory Diseases, Jessenius Faculty of Medicine, Comenius University, Martin 03601, Slovakia.
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17
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Demange V, Wild P, Zmirou-Navier D, Tossa P, Bohadana A, Barbaud A, Paris C. Associations of airway inflammation and responsiveness markers in non asthmatic subjects at start of apprenticeship. BMC Pulm Med 2010; 10:37. [PMID: 20604945 PMCID: PMC2913998 DOI: 10.1186/1471-2466-10-37] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 07/06/2010] [Indexed: 11/16/2022] Open
Abstract
Background Bronchial Hyperresponsiveness (BHR) is considered a hallmark of asthma. Other methods are helpful in epidemiological respiratory health studies including Fractional Exhaled Nitric Oxide (FENO) and Eosinophils Percentage (EP) in nasal lavage fluid measuring markers for airway inflammation along with the Forced Oscillatory Technique measuring Airway resistance (AR). Can their outcomes discriminate profiles of respiratory health in healthy subjects starting apprenticeship in occupations with a risk of asthma? Methods Rhinoconjunctivitis, asthma-like symptoms, FEV1 and AR post-Methacholine Bronchial Challenge (MBC) test results, FENO measurements and EP were all investigated in apprentice bakers, pastry-makers and hairdressers not suffering from asthma. Multiple Correspondence Analysis (MCA) was simultaneously conducted in relation to these groups and this generated a synthetic partition (EI). Associations between groups of subjects based on BHR and EI respectively, as well as risk factors, symptoms and investigations were also assessed. Results Among the 441 apprentice subjects, 45 (10%) declared rhinoconjunctivitis-like symptoms, 18 (4%) declared asthma-like symptoms and 26 (6%) suffered from BHR. The mean increase in AR post-MBC test was 21% (sd = 20.8%). The median of FENO values was 12.6 ppb (2.6-132 range). Twenty-six subjects (6.7%) had EP exceeding 14%. BHR was associated with atopy (p < 0.01) and highest FENO values (p = 0.09). EI identified 39 subjects with eosinophilic inflammation (highest values of FENO and eosinophils), which was associated with BHR and atopy. Conclusions Are any of the identified markers predictive of increased inflammatory responsiveness or of development of symptoms caused by occupational exposures? Analysis of population follow-up will attempt to answer this question.
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Affiliation(s)
- Valérie Demange
- Department of Epidemiology, INRS, Rue du Morvan, Vandoeuvre-lès-Nancy 54500, France.
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18
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Mastruzzo C, Contrafatto MR, Crimi C, Palermo F, Vancheri C, Crimi N. Acute additive effect of montelukast and beclomethasone on AMP induced bronchoconstriction. Respir Med 2010; 104:1417-24. [PMID: 20471234 DOI: 10.1016/j.rmed.2010.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Revised: 04/13/2010] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
Abstract
Bronchial hyperresponsiveness to 5-adenosine mono-phosphate (AMP) is a marker of airway inflammation. Inhaled corticosteroids and antileukotrienes are used as anti-inflammatory drugs for the treatment of asthma. To find out if these two drugs exert their protection in an additive fashion, we compared the effects of acute treatment with inhaled beclomethasone (BDP) and montelukast (ML), alone or in combination, on methacholine and AMP induced bronchoconstriction. 15 asthmatic patients undertook methacholine and AMP challenges at baseline and after receiving ML or BDP, alone or in combination, in a randomized, double-blind, double-dummy placebo-controlled, crossover design. BDP pretreatment significantly increased the AMP PC(20) value (68.34+/-15.9mg/mL) as compared to placebo (22.87+/-5.7mg/mL). Combined treatment, BDP plus ML, afforded a further significant increase of AMP PC(20) (154.57+/-55.0mg/mL) as compared to each single treatment. The significant protection exerted by combined treatment as compared to each single active treatment was also demonstrated by the change of AMP PC(20) doubling dose as compared to placebo and each single active treatment. Our findings suggest that these two agents exert their acute additive protection against AMP induced bronchoconstriction acting on distinct inflammatory pathways and their combined use might provide greater protection against inflammatory response elicited by AMP than either drug alone.
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Affiliation(s)
- Claudio Mastruzzo
- Department of Internal and Specialistic Medicine, Section of Respiratory and Section of Infectious Diseases, University of Catania, Via Passo Gravina 187, Catania, Italy.
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19
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Raja S, Xu Y, Ferro AR, Jaques PA, Hopke PK. Resuspension of indoor aeroallergens and relationship to lung inflammation in asthmatic children. Environ Int 2010; 36:8-14. [PMID: 19796820 DOI: 10.1016/j.envint.2009.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 08/24/2009] [Accepted: 09/03/2009] [Indexed: 05/22/2023]
Abstract
Studies have shown links between the concentration of allergens found in homes and asthma. Inhalation of allergens present in settled residential dust can occur when the dust is resuspended via human activity or air currents. Although previous studies have measured allergen concentrations in homes, the focus has been on the presence of the allergens in settled dust samples. However, the actual inhalation exposure is to airborne allergens. The relationship between the settled dust composition and suspended allergens and endotoxin and the effect of exposure of these aeroallergens to asthmatics are not well understood for species typically present indoors. In this study, settled dust and airborne particulate matter samples were collected in the homes and school classrooms of asthmatic children of ages 9 to 16 and analyzed for endotoxin and allergens including dust mite and cockroach allergen, and dog and cat dander (Der p1, Der f1, Bla g1, Can f1, and Fel d1, respectively). Concentrations of cockroach allergen were below detection limit for all samples. Measurements of the settled dust samples show higher dust mite allergen in bedroom samples than in living room samples. Concentrations of airborne endotoxin and indoor allergens were generally higher in the homes than those measured at school. Within the homes, higher concentrations of airborne allergens and endotoxin were observed in the living rooms compared to the bedrooms. Resuspension rates for endotoxin, dust mite allergen, and, cat and dog dander were estimated in this study. Calculated resuspension rates for cat dander (8.1x10(-7)+/-3.5x10(-7)min(-1)) and dust mite allergen (2.1x10(-6)+/-7.6x10(-7)min(-1)and 1.4x10(-5)+/-4.6x10(-6)min(-1) for Der p 1 and Der f 1, respectively) were found to be higher than those for dog dander (3.1x10(-7)+/-1.3x10(-7)min(-1)) and endotoxin (3.6x10(-7)+/-1.6x10(-7)min(-1)). Markers of asthma inflammation including nitrate in exhaled breath condensate (EBC) and exhaled nitric oxide (eNO), were correlated with the concentrations of dust mite allergen (Der p 1) (Spearman r=0.598; p-value=0.068 for EBC and Spearman r=0.819; p-value=0.007 for eNO) and cat dander (Fel d 1) (Spearman r=0.917; p-value=0.0002 for EBC and Spearman r=0.697; p-value=0.054 for eNO) present in PM(10) samples.
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Affiliation(s)
- Suresh Raja
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY 13699, United States
| | - Ying Xu
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY 13699, United States
| | - Andrea R Ferro
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY 13699, United States
| | - Peter A Jaques
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY 13699, United States
| | - Philip K Hopke
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY 13699, United States.
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20
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Borin A, Abib E, Araujo CI, Martinez LL, Rodrigues H. Standardizing selection criteria in nasal medication studies. Braz J Otorhinolaryngol 2009; 75:872-8. [PMID: 20209290 PMCID: PMC9446061 DOI: 10.1016/s1808-8694(15)30552-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 01/24/2009] [Indexed: 10/26/2022] Open
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21
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Yu L, Wei W, Wang L, Huang Y, Shi C, Lü H, Qiu Z. Upper-airway cough syndrome with latent eosinophilic bronchitis. Lung 2009; 188:71-6. [PMID: 19862573 DOI: 10.1007/s00408-009-9192-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 09/29/2009] [Indexed: 12/15/2022]
Abstract
Upper-airway cough syndrome often coexists with other diseases that elicit chronic cough. However, the concomitant conditions are not always relevant to chronic cough, which complicates the cause diagnosis of chronic cough. The objective of this study was to explore the diagnosis and clinical implication of upper-airway cough syndrome with latent eosinophilic bronchitis. Eleven patients with upper-airway cough syndrome and latent eosinophilic bronchitis were retrospectively analyzed for their clinical manifestations, changes of eosinophilia in induced sputum, and cough threshold with capsaicin defined as capsaicin concentration that elicits two or more coughs (C2) and five or more coughs (C5) between pretreatment and post-treatment. All patients reported a history of allergic rhinitis, showed persistent dry cough or small amounts of viscid sputum with a time course of 2-60 months (median = 7 months), and presented with symptoms and signs of rhinitis, normal lung function, and airway responsiveness. Initial eosinophil percentage in induced sputum was 3.5-8.0%. Cough disappeared after 2-5 (3 +/- 1) weeks of only oral antihistamine. With successful treatment, cough threshold C2 increased from 1.73 +/- 1.45 to 4.43 +/- 4.50 micromol/L (t = 2.64, P = 0.025) and C5 increased from 2.79 +/- 2.16 to 10.10 +/- 8.22 micromol/L (t = 3.10, P = 0.011). However, there was no significant change of eosinophil percentage in induced sputum (4.8 +/- 1.5% vs. 4.4 +/- 1.4%, t = 0.84, P = 0.427). Upper-airway cough syndrome with latent eosinophilic bronchitis is a unique condition. The recognition of the entity may avoid unnecessary use of corticosteroids.
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Affiliation(s)
- Li Yu
- Department of Respiratory Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, 200065, Shanghai, China
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22
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Abstract
The diagnosis of asthma depends on what we mean by the word. Its definition continues to be controversial because there is no single genetic or environmental cause. Addressed from a descriptive point of view, the disease components include airway inflammation, symptoms, variable airflow limitation and chronic airflow limitation. The essentialist definition conveys the message that asthma is a separate disease entity, fails to identify a primary defining characteristic which separates it from other diseases and is long winded. These disadvantages are overcome by the nominalist definition of asthma in which the word 'asthma'refers to an abnormality of airway function, specifically to wide variations in airflow limitation over short periods of time. In patients with asthma the other components of airway disease need to be considered. These have separate nominalist definitions and especially include different types of bronchitis for airway inflammation and chronic obstructive pulmonary disease for chronic airflow limitation. What is present will vary between and within patients. The accurate diagnosis of asthma and of other components of disease all require objective measurements. Currently spirometry and airway responsiveness should be available to the general practitioner, who sees milder disease, and additional quantitative sputum cell counts in specialist practice, where moderate to severe disease is more prevalent. Such measurements characterize the patient, identify heterogeneity and allow treatment to be personalized.
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Affiliation(s)
- F E Hargreave
- Department of Medicine, Firestone Institute for Respiratory Health, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada.
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Sin BA, Yildiz OA, Dursun AB, Misirligil Z, Demirel YS. Airway hyperresponsiveness: a comparative study of methacholine and exercise challenges in seasonal allergic rhinitis with or without asthma. J Asthma 2009; 46:486-91. [PMID: 19544170 DOI: 10.1080/02770900902855936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asymptomatic airway hyperreactivity in allergic rhinitis is a risk factor for later development of asthma. Although non-specific bronchial hyperresponsiveness (BHR) has been measured by several stimuli, the most appropriate measurement technique still remains unclear. OBJECTIVE To investigate whether an exercise challenge can be used to predict BHR in seasonal allergic rhinitis patients with or without asthma and to compare this bronchial reactivity with a methacholine challenge technique. METHODS Forty-six consecutive patients with seasonal allergic rhinitis only (n = 31) and with both seasonal allergic rhinitis and asthma (n = 15) were included in the study during the pollination period. Subjects underwent first methacholine (mch) and then exercise challenge testing (ECT). There was a 1-week interval between the tests. ECT was performed on a bicycle ergometer. Positive result was defined as a 15% decrease in forced expiratory volume in 1 second (FEV(1)) post-exercise. A patient's bronchial reactivity to methacholine was considered as hyperresponsive if PC(20) was less than 8 mg/mL. RESULTS Mch PC(20) values were significantly lower in patients with both rhinitis and asthma (p < 0.062). Among the 46 patients, mch PC(20) values were significantly different between patients who had positive and negative exercise challenge tests (p = 0.007). All patients with rhinitis alone had a negative ECT and 10 had a positive mch challenge. Change in FEV(1) values after ECT was significantly higher in patients with both rhinitis and asthma compared to those with rhinitis alone (p = 0.009). There was a significant relation between positivity of mch and exercise challenges (p = 0.025). ECT positivity was found to be a significant confounding factor in the diagnosis of asthma (p = 0.001). Specificity and sensitivity values were 100% and 24% for ECT and 68% and 100% for mch, respectively. CONCLUSION Exercise challenge presents poor diagnostic value for detecting bronchial responsiveness in individuals with allergic rhinitis alone during the pollen season.
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Affiliation(s)
- Betül Ayse Sin
- School of Medicine, Division of Allergic Diseases, Ankara University, Dikimevi, 06100-Ankara, Turkey.
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Abstract
Regular physical activity is recognized as an effective health promotion measure. Among various activities, swimming is preferred by a large portion of the population. Although swimming is generally beneficial to a person's overall health, recent data suggest that it may also sometimes have detrimental effects on the respiratory system. Chemicals resulting from the interaction between chlorine and organic matter may be irritating to the respiratory tract and induce upper and lower respiratory symptoms, particularly in children, lifeguards and high-level swimmers. The prevalence of atopy, rhinitis, asthma and airway hyper-responsiveness is increased in elite swimmers compared with the general population. This may be related to the airway epithelial damage and increased nasal and lung permeability caused by the exposure to chlorine subproducts in indoor swimming pools, in association with airway inflammatory and remodelling processes. Currently, the recommended management of swimmers' respiratory disorders is similar to that of the general population, apart from the specific rules for the use of medications in elite athletes. Further studies are needed to better understand the mechanisms related to the development or worsening of respiratory disorders in recreational or competitive swimmers, to determine how we can optimize treatment and possibly help prevent the development of asthma.
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Affiliation(s)
- Valérie Bougault
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
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25
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Kokturk N, Mullaoglu S, Ozyilmaz E, Turktas H. The effect of low-dose inhaled budesonide on PC20 AMP levels in patients with mild asthma: a 3-month follow-up study. J Asthma 2009; 46:259-64. [PMID: 19373633 DOI: 10.1080/02770900802647540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adenosine monophosphate (AMP) challenge is a diagnostic tool for asthma. The aim of this study is to evaluate the effect of low dose inhaled budesonide (IB) on PC(20)AMP levels. Seventeen stable mild asthmatic patients were prospectively recruited. After initial testing, patients were administered 400 microg of inhaled budesonide. AMP challenge was then repeated at the 12th hour and 5th,15th, 30th, and 90th days of the treatment. AMP challenge resulted in negative in 47% of the patients at 12(-)hour testing. This study suggests that low-dose IB may return airway responsiveness as early as 12 hours and AMP challenge may be effectively used for treatment monitorization.
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Affiliation(s)
- Nurdan Kokturk
- School of Medicine, Department of Pulmonary Medicine, Gazi University, Ankara, Turkey.
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Abstract
BACKGROUND Allergic rhinitis is a common disease, in which some patients will deteriorate or develop asthma. It is important to characterize these patients, thereby offering the possibility for prevention. This study evaluated eosinophil parameters as potential indicators of deteriorating allergic airway disease. METHODS The subjects of the study included all patients who suffered seasonal allergic rhinitis and had participated in a study 6 years earlier, in which blood eosinophils, serum eosinophil cationic protein (ECP) serum eosinophil peroxidase (EPO), nasal lavage ECP and nasal lavage EPO levels were measured. Patients in the present study were interviewed on occurrence of rhinitis symptoms during the last season, rhinitis outside season, asthma-like symptoms and asthma diagnosis, and were skin-prick tested for common aeroallergens. Eosinophil parameters from the study 6 years earlier were then tested for the ability to predict occurrence of new allergies, worsening of rhinitis and occurrence of asthma. RESULTS Forty-four patients participated in the study. In four patients seasonal rhinitis symptoms had deteriorated, 10 had experienced perennial rhinitis symptoms, 14 reported asthma-like symptoms and seven had been diagnosed with asthma. Thirteen had developed additional sensitization. Patients developing asthma-like symptoms compared with patients with no such symptoms had significantly higher serum ECP (16.7 microg/l vs 8.2 microg/l; P < or = 0.01) and serum EPO (17.9 microg/l vs 8.8 microg/l; P < or = 0.05). Results were similar, considering patients diagnosed with asthma. Blood eosinophils and nasal lavage parameters were not related to development of asthma and asthma-like symptoms. No eosinophil parameter was related to deterioration of rhinitis or additional sensitization. CONCLUSION Serum ECP and EPO in patients with seasonal rhinitis demonstrated a high predictive ability for later development of asthma.
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Affiliation(s)
- L P Nielsen
- Departments of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark
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27
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Abstract
Airway smooth muscles of asthmatics tend to be hyperresponsive when provoked. The exaggerated bronchial constriction can be measured by the airflow limitation seen following bronchial provocation. Measuring bronchial hyperresponsiveness by broncho provocation testing is helpful in diagnosing and optimizing therapy. While numerous agents have been used to provoke a measurable airflow limitation, standardized protocols are available for only a few. This article aims to discuss the various methods that have been reported for bronchoprovocation testing.
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Affiliation(s)
- Chakravarthy Reddy
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA.
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28
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Abstract
PURPOSE OF THE REVIEW More than 10 years ago the category of mild asthma was split into mild intermittent and mild persistent asthma and maintenance therapy with low dose inhaled corticosteroids (ICS) was recommended for mild persistent asthma. The threshold for instituting regular ICS therapy was arbitrarily chosen, in the absence of clinical studies specifically addressing this issue. RECENT FINDINGS The results of recent trials have questioned the assumption that all patients at the mild end of the asthma severity spectrum should be committed to regular anti-inflammatory treatment with inhaled corticosteroids. As a consequence, the identification of the relevant outcomes for the treatment of mild persistent asthma has become a matter of discussion, which has provided the rationale to test the efficacy and well tolerance of new strategies, other than guidelines-recommended regular low-dose ICS, for the treatment of mild persistent asthma. SUMMARY Several approaches have been evaluated with some promising results, to include the combination of ICS and long-acting b2-agonists, oral leukotriene antagonists, and the intermittent or as-needed use of ICS in the absence of regular treatment. Conversely, little effort has been made to evaluate therapeutic options other than as-needed bronchodilation in mild intermittent asthma.
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Abstract
Airway hyperresponsiveness (AHR) is a fundamental abnormality in asthma. There are many potential factors contributing to the excessive airway response demonstrable on airway challenge. These range from abnormalities of airway smooth muscle, airway remodelling and airway inflammation to abnormalities in the neural control of airway calibre. None of these by themselves fully explains the abnormalities seen on the dose response curves of the asthmatic. In this review, the main mechanisms are described, together with recent evidence providing a pathway by which a number of these mechanisms may interact to cause AHR through abnormality in ventilation distribution and airway closure. There is now evidence for a close relationship between ventilation heterogeneity and AHR which could be exploited clinically.
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Affiliation(s)
- Norbert Berend
- Woolcock Institute of Medical Research, University of Sydney, CRC for Asthma and Airways, Sydney, NSW, Australia.
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31
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Mroczkowski E, Wielgosz R. [The new insight into the pathogenic unity of the upper and lower airways]. Otolaryngol Pol 2008; 62:31-6. [PMID: 18637418 DOI: 10.1016/s0030-6657(08)70205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Between the upper and the lower respiratory tracts exists a link. Numerous epidemiological, immunological studies and clinical observations suggest the pathogenic unity of the upper and lower airways. The most important observations regarding the nose-lung interaction is rhinitis and asthma. The inflammatory process in the nose is the same as in the bronchi, clinically defined as rhinosinusitis, nasal polyps, asthma, bronchial hyperreactivity, allergy, viral infections. The strict link between the rhinosinusitis and asthma implies new possibility of influencing one of the two complaints by treating the other one with an integrated therapy (pharmacotherapy, endonasal microsurgery).
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Affiliation(s)
- Edward Mroczkowski
- Poradnia Konsultacyjna Centralnego Szpitala Klinicznego MSWiA w Warszawie
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32
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Polosa R, Knoke JD, Russo C, Piccillo G, Caponnetto P, Sarvà M, Proietti L, Al-Delaimy WK. Cigarette smoking is associated with a greater risk of incident asthma in allergic rhinitis. J Allergy Clin Immunol 2008; 121:1428-34. [PMID: 18436295 DOI: 10.1016/j.jaci.2008.02.041] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 01/18/2008] [Accepted: 02/15/2008] [Indexed: 12/21/2022]
Abstract
BACKGROUND Asthma and rhinitis are often comorbid conditions, and several studies have suggested that rhinitis often precedes asthma. Sensitization to allergen has been shown to be one of the strongest determinants of incident asthma, but little is known about the effects of cigarette smoking among individuals with allergic rhinitis. OBJECTIVE We sought to evaluate the importance of cigarette smoking as an additional risk factor for incident asthma in a cohort of hospital-referred nonasthmatic adult subjects with allergic rhinitis. METHODS The study population selected at baseline was invited for a follow-up visit 10 years later to check for possible asthma features. Categories of smokers, exsmokers, and never smokers were used in the analyses together with pack-years to calculate the level of cumulative exposure. RESULTS Complete data were available from 325 patients. Smoking was significantly related to the risk of incident asthma, with the odds ratio (OR) being 2.67 (95% CI, 1.70-4.19) for univariate and 2.98 (95% CI, 1.81-4.92) for multivariate analyses. A clear dose-response association for exposure to tobacco and risk of new-onset asthma was observed in the multivariate analyses: those with 1 to 10 pack-years had an OR of 2.05 (95% CI, 0.99-4.27), those with 11 to 20 pack years had an OR of 3.71 (95% CI, 1.77-7.78), and those with 21 or more pack-years had an OR of 5.05 (95% CI, 1.93-13.20) compared with never smokers. CONCLUSIONS The current findings support the hypothesis that cigarette smoking is an important independent risk factor for the development of new asthma cases in adults with allergic rhinitis.
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Affiliation(s)
- Riccardo Polosa
- Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, Italy.
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Reynolds SM, Docherty R, Robbins J, Spina D, Page CP. Adenosine induces a cholinergic tracheal reflex contraction in guinea pigs in vivo via an adenosine A1 receptor-dependent mechanism. J Appl Physiol (1985) 2008; 105:187-96. [PMID: 18420718 DOI: 10.1152/japplphysiol.01048.2007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Adenosine induces dyspnea, cough, and airways obstruction in asthma, a phenomenon that also occurs in various sensitized animal models in which a neuronal involvement has been implicated. Although adenosine has been suggested to activate cholinergic nerves, the precise mechanism has not been established. In the present study, the adenosine A(1) receptor agonist N(6)-cyclopentyladenosine (CPA) induced a cholinergic reflex, causing tracheal smooth muscle contraction that was significantly inhibited by the adenosine A(1) receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX; 100 microg/kg) (P < 0.05) in anesthetized animals. Furthermore, the adenosine A(2) agonist 2-p-(2-carboxyethyl) phenethylamino-5'-N-ethylcarboxamidoadenosine (CGS-21680) induced a small reflex, whereas the A(3) selective agonist N(6)-(3-iodobenzyl)-5'-N-methylcarbamoyladenosine (IB-MECA) was without effect. The tracheal reflex induced by CPA was also inhibited by recurrent nerve ligation or muscarinic receptor blockade (P < 0.001), indicating that a cholinergic neuronal mechanism of action accounted for this response. The cholinergic reflex in response to aerosolized CPA was significantly greater in passively sensitized compared with naive guinea pigs (P < 0.01). Chronic capsaicin treatment, which inhibited sensory nerve function, failed to inhibit CPA-induced reflex tracheal contractions in passively sensitized guinea pigs, although the local anesthetic lidocaine inhibited CPA-induced tracheal contractions. The effects of CPA on the reflex response was not dependent on the release of histamine from tissue mast cells or endogenous prostaglandins as shown by the lack of effect of the histamine H(1) receptor antagonist pyrilamine (1 mg/kg) or the cyclooxygenase inhibitor meclofenamic acid (3 mg/kg), respectively. In conclusion, activation of pulmonary adenosine A(1) receptors can stimulate cholinergic reflexes, and these reflexes are increased in allergic guinea pigs.
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Affiliation(s)
- Sandra M Reynolds
- Pharmaceutical Science Research Division, The Sackler Institute of Pulmonary Pharmacology, School of Biomedical and Health Science, King's College London, London SE1 1UL, UK
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Abstract
PURPOSE OF REVIEW During the past few decades, the incidence of sensitization to inhaled allergens as well as allergic airways disease has grown steadily. Genetic and environmental factors are recognized as etiologic factors in the development of allergic airway disease, with allergic rhinitis often preceding the development of asthma. Allergic rhinitis is considered a risk factor for the development of asthma, and almost all allergic asthmatic patients have rhinitis. Insight into the risk factors responsible for allergic airways disease and the interaction between the involved organs results in a better diagnostic and therapeutic approach in global airway allergy syndrome. RECENT FINDINGS Recent studies have shown that local tissue factors, such as microbial stimuli and systemic inflammatory mechanisms, play a role in the clinical expression of the allergic airway syndrome. In addition, impaired nasal function affects the lower airways of asthmatic patients via different pathways. To date, most human and animal data point towards a systemic pathway linking the upper and lower airways, involving both bloodstream and bone marrow. Recent clinical trials and current guidelines underline the importance of an integrated treatment strategy involving both ends of the respiratory tract. SUMMARY This review provides an overview of recent epidemiological and immunopathologic evidence concerning the link between upper and lower airways in allergic disease and its therapeutic implications.
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Affiliation(s)
- Gert-Jan Braunstahl
- Department of Pulmonary Medicine, Erasmus Medical Center Rotterdam, The Netherlands.
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35
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Piccillo G, Caponnetto P, Barton S, Russo C, Origlio A, Bonaccorsi A, Di Maria A, Oliveri C, Polosa R. Changes in airway hyperresponsiveness following smoking cessation: comparisons between Mch and AMP. Respir Med 2007; 102:256-65. [PMID: 17964770 DOI: 10.1016/j.rmed.2007.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 09/09/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Given the observed association between smoking, inflammation and airway hyperresponsiveness (AHR) one may predict that smoking cessation may improve AHR. However, only a few studies have investigated the effect of smoking on AHR and their results appear to be conflicting depending on the stimulus used in their bronchoprovocation protocol. The aim of the current study was to compare changes in AHR between direct (methacholine (Mch)) and indirect (adenosine 5'monophosphate (AMP)) stimuli before and at different time points after smoking cessation in smokers with allergic rhinitis (+/-asthma). METHODS We have prospectively studied changes in AHR to inhaled Mch and AMP in smokers with allergic rhinitis (+/-asthma), before and at 6 and 12 months after smoking cessation. RESULTS It was found that 28% (16/57) of the participants had quit smoking by the end of the study. No significant change in AHR was observed in smoking cessation failures. A significant improvement in AHR to AMP but not Mch was observed 6 months after smoking cessation in quitters; a 1.2 doubling concentrations change in PC20 AMP was measured whereas only a 0.4 doubling concentrations change was observed for PC20 Mch. However, after 12 months smoking cessation the improvement in AHR became significant for both AMP and Mch, their dose-response curves being displaced to the right to a similar extent (1.4 and 1.1 doubling concentrations for AMP and Mch, respectively). CONCLUSION Smoking cessation can improve AHR in smokers who quit with a 6 months improvement being reported for the airways response to AMP but not Mch. AMP challenge may detect earlier changes in AHR in smokers during smoking cessation.
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Affiliation(s)
- Giovita Piccillo
- Smoking Cessation Research Centre, Department of Internal and Specialistic Medicine, University of Catania, Ascoli-Tomaselli Hospitals, 95125 Catania, Italy
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36
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Abstract
Exercises testing and cold air challenges are frequently used to assess airway hyperresponsiveness (AHR), but different goals are set for the two tests. We, therefore, wished to determine whether cold air and exercise challenge testing yielded similar responses and if any differences were due to differences in the maximum minute ventilation achieved. Twenty asthmatic subjects each performed a cold air (CACh) and an exercise (EXCh) challenge. Baseline forced expiratory volume in one second (FEV(1)) was recorded immediately pre-challenge and then serially for at least 10 minutes post-challenge. The maximum minute ventilation achieved was recorded. In the subjects who had at least a decrease in FEV(1) of 15% in response to the first CACh, a second CACh was performed, but at the maximum minute ventilation achieved during EXCh. Eleven subjects after CACh and four after EXCh had a greater than 15% decrease in FEV(1) (p = 0.05). The median decrease in FEV(1) was greater following the CACh (16.7%[25th to 75th percentile 10.4 to 19.9]) than the EXCh (6.9%[25th to 75th percentile 4.3 to 14.6]); (p = 0.0004). The median maximum minute ventilation achieved was greater with the CACh (89[66-141] L/min) than with the EXCh (61(40 to 102)L/min); (p < 0.0001). Only one of seven subjects who had previously responded to the CACh had a 15% decrease in FEV(1) when the CACh was repeated at the same maximum minute ventilation achieved during EXCh (p = 0.007). In conclusion, cold air and exercise challenges do not produce the same response. Our results highlight than an explanation is the differences in the maximum-minimum ventilation achieved.
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Affiliation(s)
- Karl P Sylvester
- Division of Asthma, Allergy and Lung Biology, Guy's, King's & St. Thomas' School of Medicine, King's College, London, United Kingdom
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37
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Marcucci F, Passalacqua G, Canonica GW, Frati F, Salvatori S, Di cara G, Petrini I, Bernini M, Novembre E, Bernardini R, Incorvaia C, Sensi LG. Lower airway inflammation before and after house dust mite nasal challenge: an age and allergen exposure-related phenomenon. Respir Med 2007; 101:1600-8. [PMID: 17482451 DOI: 10.1016/j.rmed.2006.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Revised: 06/05/2006] [Accepted: 06/09/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Upper and lower airways allergic disease is currently considered unitarily. Allergic inflammation in one site can extend to other sites of the respiratory tract. OBJECTIVE To evaluate bronchial inflammation before and after allergen-specific nasal challenge (ASNC) in rhinitic and asthmatic children, considering the different levels of allergen exposure, i.e. summer (low) and winter (high). METHODS Fourteen children with rhinitis and 15 with rhinitis and asthma, all monosensitized to mites and 10 healthy controls were studied. Nasal IgE were measured before ASNC in summer and in winter season. Nasal clinical score, eosinophil cationic protein (ECP), nasal tryptase, bronchial clinical score, FEV(1), PEF, sputum ECP, sputum tryptase and exhaled nitric oxide (eNO) were evaluated before and after ASNC in summer and winter season. RESULTS Nasal scores significantly increased after ASNC in rhinitic and asthmatic children in both seasons. Nasal IgE were significantly higher in summer compared to winter. Bronchial symptoms, FEV(1) and PEF showed no mean differences in rhinitic and asthmatic children after ASNC, with an increase of bronchial symptoms and a decrease of FEV(1) and PEF occurring in 3/15 asthmatic children. In both groups nasal tryptase and ECP after ASNC significantly increased in summer and winter, while sputum tryptase was undetectable before or after ASNC in both groups. Sputum ECP and eNO at baseline were significantly higher in patients than in controls (summer P=0.002, winter P=0.001). Sputum ECP significantly increased after ASNC in 3/15 asthmatics in summer and in 11/15 in winter, as well as in 3/14 rhinitics in summer and in 4/14 in winter. eNO significantly increased after ASNC in 3/15 asthmatics in summer and in 10/15 in winter, and in 1/14 rhinitics in summer and in 4/14 in winter. A significant median increase of sputum ECP (P=0.0007) and eNO (P=0.0012) after ASNC in asthmatic and of eNO (P=0.013) in rhinitic children was also found in winter. CONCLUSIONS Basal sputum ECP and eNO values, significantly higher before ASNC in rhinitic patients compared to control subjects, confirm the inflammatory link of upper and lower airways. The more frequent detection of inflammatory changes induced by ASNC in winter suggests that allergen exposure favours the transfer of nasal inflammation to lower airways.
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Affiliation(s)
- F Marcucci
- Department of Obstetric, Gynaecologic, Pediatric Sciences, University of Perugia, Policlinico Monteluce, Via Brunamonti, 06122 Perugia, Italy.
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Hua X, Erikson CJ, Chason KD, Rosebrock CN, Deshpande DA, Penn RB, Tilley SL. Involvement of A1 adenosine receptors and neural pathways in adenosine-induced bronchoconstriction in mice. Am J Physiol Lung Cell Mol Physiol 2007; 293:L25-32. [PMID: 17468137 DOI: 10.1152/ajplung.00058.2007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
High levels of adenosine can be measured from the lungs of asthmatics, and it is well recognized that aerosolized 5'AMP, the precursor of adenosine, elicits robust bronchoconstriction in patients with this disease. Characterization of mice with elevated adenosine levels secondary to the loss of adenosine deaminase (ADA) expression, the primary metabolic enzyme for adenosine, further support a role for this ubiquitous mediator in the pathogenesis of asthma. To begin to identify pathways by which adenosine can alter airway tone, we examined adenosine-induced bronchoconstriction in four mouse lines, each lacking one of the receptors for this nucleoside. We show, using direct measures of airway mechanics, that adenosine can increase airway resistance and that this increase in resistance is mediated by binding the A(1) receptor. Further examination of this response using pharmacologically, surgically, and genetically manipulated mice supports a model in which adenosine-induced bronchoconstriction occurs indirectly through the activation of sensory neurons.
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Affiliation(s)
- Xiaoyang Hua
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7219, USA
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Abstract
PURPOSE OF REVIEW To review the current knowledge of noninvasive monitoring of allergic airway inflammation by analysis of leukotrienes in the exhaled breath condensate. RECENT FINDINGS Treatment of respiratory allergies involves chronic treatment based on clinical symptoms and pulmonary function tests. Evaluation of local inflammation would be desirable but is currently not feasible because of the difficulty in sampling the airways. Recently, exhaled breath condensate collection and analysis has polarized much interest in the respiratory field. Although some methodological issues are still under scrutiny, airways inflammatory markers can be assayed with this technique. In particular, exhaled breath condensate leukotrienes have been thoroughly investigated in the setting of bronchial asthma and allergic rhinitis in adults and children. Exhaled leukotrienes are increased in patients with asthma and rhinitis during the pollen season, correlate with exacerbations and asthma severity, and are reduced by specific anti-inflammatory treatment and allergen avoidance. SUMMARY Some issues still prevent the use of exhaled breath condensate in clinical practice but in the research setting it has been proved to be useful for noninvasive monitoring of allergic inflammation in the lung. In particular, exhaled leukotrienes may represent valuable biomarkers for diagnostic and therapeutic purposes in allergic patients.
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Affiliation(s)
- Marco Failla
- Department of Internal and Specialist Medicine, Section of Respiratory Medicine, University of Catania, Catania, Italy
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Sylvester KP, Patey RA, Rafferty GF, Rees D, Thein SL, Greenough A. Airway hyperresponsiveness and acute chest syndrome in children with sickle cell anemia. Pediatr Pulmonol 2007; 42:272-6. [PMID: 17262858 DOI: 10.1002/ppul.20571] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To determine the occurrence and magnitude of airway hyperresponsiveness (AHR) in children with sickle cell anemia (SCA) who had or had not had acute chest syndrome (ACS) episodes. A subsidiary aim was to determine whether cold air and exercise challenge testing gave similar results in children with SCA. AHR would be greater in SCA children who had had an ACS episode compared to those who had not. Prospective observational study. Forty-two SCA children (median age of 11.5 [range 6.1-16.8] years); 12 children had been previously hospitalized for an ACS episode. AHR was assessed by the change in forced expiratory volume in 1 sec (FEV1) to a cold air challenge and in a subset of the children to an exercise challenge. A positive result to either challenge was deemed to have occurred if the FEV1 fell by at least 10% from the pre-challenge baseline. The magnitude of change in FEV1 following the cold air challenge was similar in children who had or had not had an ACS episode. Six children had a positive response to the cold air challenge (AHR); none had had an ACS hospitalization. Similar proportions of children responded to the cold air and exercise challenge and the magnitude of response to the two tests was similar. Some children, however, responded only to a cold air challenge and others only to an exercise challenge. SCA children who had had an ACS hospitalization episode compared to those who had not were not more likely to respond to a cold air challenge. Importantly, if AHR is to be correctly diagnosed, some SCA children will require to undergo both cold air and exercise challenge testing.
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Affiliation(s)
- Karl P Sylvester
- Division of Asthma, Allergy and Lung Biology, MRC-Asthma Centre, King's College London, UK
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41
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Abstract
PURPOSE OF REVIEW The relationship between allergic rhinitis and asthma has intrigued practicing physicians since the turn of the century. Investigations during the past two decades have led to an increased understanding of this relationship. RECENT FINDINGS A growing body of evidence clearly demonstrates that patients with allergic rhinitis, in the absence of asthma, have distinct abnormalities of lower airway function, including alterations in physiology, histology and biochemistry. In addition, epidemiologic surveys have consistently shown allergic rhinitis as an independent risk factor for developing asthma, and that preexisting abnormalities in lung function may predispose to lower airway disease development. Clinical trials show that specific allergen immunotherapy for children and adults with seasonal allergic rhinitis reduces the risk of developing asthma. In patients with established asthma and concomitant allergic rhinitis, several medications have significant effects upon the upper and lower airways, including intranasal corticosteroids, oral antihistamines, and leukotriene receptor antagonists. SUMMARY Our understanding of the natural history of allergic rhinitis could lead to improvements in early intervention, potentially preventing the progression of allergic rhinitis to asthma. Aggressive treatment of rhinitis in patients with concomitant asthma may enhance asthma outcomes and quality of life for all patients with these chronic diseases.
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Affiliation(s)
- Jonathan Corren
- Allergy Research Foundation, Los Angeles, California 90025, USA.
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42
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Xie QM, Deng JF, Deng YM, Shao CS, Zhang H, Ke CK. Effects of cryptoporus polysaccharide on rat allergic rhinitis associated with inhibiting eotaxin mRNA expression. J Ethnopharmacol 2006; 107:424-30. [PMID: 16765544 DOI: 10.1016/j.jep.2006.03.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 03/15/2006] [Accepted: 03/31/2006] [Indexed: 05/10/2023]
Abstract
Aqueous extract from the fruiting body of Cryptoporus volvatus has been reported to present anti-tumor, anti-allergy, anti-inflammation and immunomodulatory activities. However, the effect mechanisms of anti-allergy and anti-inflammation are poorly understood. The aim of study is to evaluate whether Cryptoporus polysaccharides (CP) extracted from fruiting body of Cryptoporus volvatus decrease the development of nasal symptoms, airway hyperresponsiveness (AHR) to methacholine (MCh) and the infiltration of eosinophils in nasal mucosa in rat model of allergic rhinitis, and investigate a possible action mechanism of CP by detecting the expression of eotaxin mRNA in nasal mucosa and lung tissues. Rats were immunized with ovalbumin and consecutive topical antigen instillation was performed. Repeated intranasal ovalbumin challenge caused rhinitis symptom, AHR to MCh, eosinophil infiltration and histological alterations into the nasal mucosa and increase of eotaxin mRNA expression in nasal mucosa and lung tissue were examined. Pretreatment with CP 3, 9 and 27 mg kg(-1) (ig) decreased the numbers of sneezing 27.4%, 38.4% and 44.3% and nasal rubbing 27.5%, 34.9% and 47.7% comparison with model group, respectively. CP caused a dose-related inhibition of MCh-induced AHR. CP 27 mg kg(-1) decreased the expression of eotaxin mRNA in the nasal mucosa by 35%. These results suggest CP can relieve the symptom, eosinophil infiltration and injury of tissue in nasal mucosa and lung tissue and AHR of allergic rhinitis in rats. Its action mechanism may be associated with the decrease of eotaxin mRNA expression.
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MESH Headings
- Airway Resistance/drug effects
- Animals
- Anti-Allergic Agents/isolation & purification
- Anti-Allergic Agents/pharmacology
- Anti-Allergic Agents/therapeutic use
- Bronchial Hyperreactivity/prevention & control
- Bronchial Provocation Tests
- Chemokine CCL11
- Chemokines, CC/genetics
- Chemokines, CC/metabolism
- Chemotaxis, Leukocyte/drug effects
- Disease Models, Animal
- Eosinophils/drug effects
- Fruiting Bodies, Fungal/chemistry
- Gene Expression Regulation/drug effects
- Lung/drug effects
- Lung/metabolism
- Lung Compliance/drug effects
- Methacholine Chloride
- Nasal Mucosa/drug effects
- Nasal Mucosa/metabolism
- Nasal Mucosa/pathology
- Ovalbumin/immunology
- Polyporaceae/chemistry
- Polysaccharides/isolation & purification
- Polysaccharides/pharmacology
- Polysaccharides/therapeutic use
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/metabolism
- Rhinitis, Allergic, Seasonal/pathology
- Rhinitis, Allergic, Seasonal/prevention & control
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Affiliation(s)
- Qiang-Min Xie
- Medical School of Zhejiang University, Hnagzhou 310031, China.
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Gorska-Ciebiada M, Ciebiada M, Gorska MM, Gorski P, Grzelewska-Rzymowska I. Intercellular adhesion molecule 1 and tumor necrosis factor alpha in asthma and persistent allergic rhinitis: relationship with disease severity. Ann Allergy Asthma Immunol 2006; 97:66-72. [PMID: 16892784 DOI: 10.1016/s1081-1206(10)61372-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Tumor necrosis factor alpha (TNF-alpha) is involved in the up-regulation of intercellular adhesion molecule 1 (ICAM-1). Allergic rhinitis is often associated with bronchial hyperresponsiveness. OBJECTIVE We investigated the relationship between allergic airway disease severity and serum concentrations of soluble ICAM-1 (sICAM-1) and TNF-alpha and nasal expression of ICAM-1. METHODS Serum concentrations of TNF-alpha and sICAM-1 were investigated in 85 adults with persistent rhinitis and 90 patients with asthma. Seventy patients with rhinitis were challenged with methacholine. Nasal biopsy for ICAM-1 expression was performed in 6 patients with moderate-severe rhinitis and in 6 patients with mild rhinitis. RESULTS In patients with rhinitis, serum sICAM-1 concentrations were as follows: group without bronchial hyperresponsiveness (n = 29), 206.85 ng/mL; group with bronchial hyperresponsiveness but without asthma symptoms (n = 20), 233.39 ng/mL; and group with newly recognized asthma (n = 21), 260.06 ng/mL. The sICAM-1 level was significantly lower in patients with mild rhinitis (216.21 ng/mL) than in patients with moderate-severe rhinitis (244.08 ng/mL). Nasal ICAM-1 expression was significantly higher in the moderate-severe rhinitis group than in the mild rhinitis group. In patients with asthma, serum concentrations of sICAM-1 were as follows: patients with mild asthma, 272.8 ng/mL; patients with moderate asthma, 340.16 ng/mL; patients with severe asthma without oral corticosteroids therapy, 426.74 ng/mL; and patients with severe asthma with oral corticosteroids therapy, 314 ng/mL. The serum TNF-alphaa concentration differed between patients with rhinitis (n = 15) (1.065 pg/mL) and patients with asthma (n = 12) (3.46 pg/mL). Among patients with asthma, TNF-alpha concentrations were similar in all groups classified according to the disease severity. CONCLUSIONS sICAM and ICAM-1 expression correlates with airways diseases severity.
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Abstract
Inhaled adenosine induces airway obstruction in asthmatic but not healthy subjects, a phenomenon that is also observed in various animal species when they are immunised to a relevant antigen, but which does not occur in naïve animals. The purpose of this study was to investigate the mechanisms of airway responsiveness to adenosine receptor agonists in anaesthetised allergic guinea pigs. Inhaled adenosine 5'-monophosphate (AMP), the A1-selective adenosine receptor agonist N6-cyclopentyladenosine (CPA) and ovalbumin all caused airway obstruction in allergic guinea pigs, but not naïve animals, as assessed by changes in total lung resistance. In contrast, the A(2a)-selective (CGS 21680; 2-p-(2-carboxyethyl)phenethylamino-5'-N-ethylcarboxoamido adenosine) and A3-selective (IB-MECA; 1-deoxy-1-[6-[[3-iodophenyl)-methyl]amino]-9H-purin-9-yl]-N-methyl-beta-D-ribofuranuronamide) adenosine receptor agonists failed to elicit airway obstruction in passively sensitised guinea pigs. Airway obstruction induced by AMP or CPA was not inhibited by the H1 receptor antagonist, mepyramine (1 mg kg(-1)) in passively sensitised guinea-pigs. In contrast, airway obstruction to ovalbumin was significantly inhibited by this antagonist. Airway obstruction induced by AMP and CPA was significantly inhibited in sensitised animals chronically treated with capsaicin. In contrast, airway obstruction to ovalbumin was not inhibited by this treatment. Airway obstruction induced by AMP, CPA and ovalbumin was significantly inhibited following bilateral vagotomy or pharmacological treatment with atropine (2 mg kg(-1)). Airway obstruction to CPA was inhibited by the adenosine A1 receptor antagonist, 8-cyclopentyl-1,3-dipropylxanthine (DPCPX: 0.1-1 mg kg(-1)). In contrast, airway obstruction to ovalbumin was not inhibited by this treatment. These observations provide evidence indicating that AMP and CPA may induce airway obstruction in sensitised guinea pigs by a mechanism unrelated to histamine release from mast cells, but is mediated via an adenosine A1-receptor-dependent mechanism. The inhibition of AMP- and CPA-induced airway obstruction by atropine, capsaicin and bilateral vagotomy suggests a neuronal-dependent mechanism with the particular involvement of capsaicin-sensitive nerves.
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Affiliation(s)
- Sandra Keir
- King's College London School of Biomedical and Health and Life Sciences, Sackler Institute of Pulmonary Pharmacology, Division of Pharmacology and Therapeutics, 5th Floor Hodgkin Building, Guy's Campus, King's College London, London SE1 1UL
| | - Victoria Boswell-Smith
- King's College London School of Biomedical and Health and Life Sciences, Sackler Institute of Pulmonary Pharmacology, Division of Pharmacology and Therapeutics, 5th Floor Hodgkin Building, Guy's Campus, King's College London, London SE1 1UL
| | - Domenico Spina
- King's College London School of Biomedical and Health and Life Sciences, Sackler Institute of Pulmonary Pharmacology, Division of Pharmacology and Therapeutics, 5th Floor Hodgkin Building, Guy's Campus, King's College London, London SE1 1UL
- Author for correspondence:
| | - Clive Page
- King's College London School of Biomedical and Health and Life Sciences, Sackler Institute of Pulmonary Pharmacology, Division of Pharmacology and Therapeutics, 5th Floor Hodgkin Building, Guy's Campus, King's College London, London SE1 1UL
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Hara J, Fujimura M, Myou S, Furusho S, Abo M, Oribe Y, Ohkura N, Herai Y, Sone T, Waseda Y, Yasui M, Kasahara K. Eosinophilic inflammation, remodeling of lower airway, bronchial responsiveness and cough reflex sensitivity in non-asthmatic subjects with nasal allergy. Int Arch Allergy Immunol 2006; 140:327-33. [PMID: 16757921 DOI: 10.1159/000093711] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 02/07/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It has been reported that nasal allergy influences the lower airway inflammation and functions. We elucidated whether nasal allergy would contribute to lower airway inflammation and functions. METHODS 266 subjects aged 21-39 years were interviewed with special emphasis on history of asthma and nasal allergies (perennial allergic rhinitis (PAR) and seasonal allergic rhinitis (Japanese cedar pollinosis; PO)). Symptomatic subject was defined when nasal symptoms were present during a 3-week study period. Pulmonary function, provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 s (PC20), capsaicin cough threshold defined as capsaicin concentration eliciting 5 or more coughs (C5) and eosinophil percentage in hypertonic saline-induced sputum were measured. RESULTS Based on the interview, 232 subjects without asthma were divided into symptomatic (n = 25) and asymptomatic (n = 22) PAR, PO on-season (n = 15) and off-season (n = 36), and non-nasal allergy subjects (control) (n = 134). Sputum eosinophils were significantly greater in symptomatic PAR than another four groups (p < 0.01). FEV1/FVC ratio was significantly lower in PAR than control (p < 0.05). Maximum mean expiratory flow was lower in PAR than control (asymptomatic: p < 0.05, symptomatic: p = 0.06). C5 was not different among groups. PAR tended to have a lower PC20 compared to control (symptomatic: p = 0.078; asymptomatic: p = 0.086). CONCLUSIONS These results suggest that eosinophilic inflammation occurred in symptomatic period of PAR may contribute to development of lower airway remodeling and bronchial hyperresponsiveness. Reversely, PO may not be associated with lower airway eosinophilic inflammation or abnormal bronchial functions. Nasal allergy dose not influence the cough reflex sensitivity.
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Affiliation(s)
- Johsuke Hara
- Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa City, Ishikawa, Japan.
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Abstract
Adenosine in a signaling nucleoside eliciting many physiological responses. Elevated levels of adenosine have been found in bronchoalveolar lavage, blood and exhaled breath condensate of patients with asthma a condition characterized by chronic airway inflammation. In addition, inhaled adenosine-5'-monophosphate induces bronchoconstriction in asthmatics but not in normal subjects. Studies on animals and humans have shown that bronchoconstriction is most likely due to the release of inflammatory mediators from mast cells. However a number of evidences suggest that adenosine modulates the function of many other cells involved in airway inflammation such as neutrophils, eosinophils, lymphocytes and macrophages. Although this clear pro-inflammatory role in the airways, adenosine may activate also protective mechanisms particularly against lung injury. For many years this dual role of adenosine in the respiratory system has represented an enigma, and only recently it has become clear that biological functions of adenosine are mediated by four distinct subtypes of receptors (A1, A2A, A2B, and A3) and that biological responses are determined by the different pattern of receptors distribution in specific cells. Therefore, pharmacological modulation of adenosine receptors, particularly A2B, may represent a novel therapeutic approach for inflammatory diseases. Moreover, as bronchial response to adenosine strictly reflects airway inflammation in asthma, bronchial challenge with adenosine is considered a valuable clinical tool to monitor airway inflammation, to follow the response to anti-inflammatory treatments and to help in the diagnostic discrimination between asthma and chronic obstructive lung disease.
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MESH Headings
- Adenosine/metabolism
- Adenosine/pharmacology
- Animals
- Anti-Inflammatory Agents/pharmacology
- Asthma/diagnosis
- Asthma/drug therapy
- Asthma/physiopathology
- Bronchial Hyperreactivity/metabolism
- Bronchial Hyperreactivity/physiopathology
- Bronchoconstriction/drug effects
- Diagnosis, Differential
- Humans
- Pulmonary Disease, Chronic Obstructive/diagnosis
- Pulmonary Disease, Chronic Obstructive/metabolism
- Pulmonary Disease, Chronic Obstructive/physiopathology
- Receptor, Adenosine A1/drug effects
- Receptor, Adenosine A1/metabolism
- Receptor, Adenosine A2A/drug effects
- Receptor, Adenosine A2A/metabolism
- Receptor, Adenosine A2B/drug effects
- Receptor, Adenosine A2B/metabolism
- Respiratory System/metabolism
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Affiliation(s)
- Lucia Spicuzza
- Dipartimento di Medicina Interna e Medicina Specialistica Sezione Malattie Respiratorie-Università di Catania, Italy.
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Polosa R, Al-Delaimy WK, Russo C, Piccillo G, Sarvà M. Greater risk of incident asthma cases in adults with allergic rhinitis and effect of allergen immunotherapy: a retrospective cohort study. Respir Res 2005; 6:153. [PMID: 16381607 PMCID: PMC1351177 DOI: 10.1186/1465-9921-6-153] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Accepted: 12/28/2005] [Indexed: 11/23/2022] Open
Abstract
Asthma and rhinitis are often co-morbid conditions. As rhinitis often precedes asthma it is possible that effective treatment of allergic rhinitis may reduce asthma progression. The aim of our study is to investigate history of allergic rhinitis as a risk factor for asthma and the potential effect of allergen immunotherapy in attenuating the incidence of asthma. Hospital-referred non-asthmatic adults, aged 18–40 years between 1990 and 1991, were retrospectively followed up until January and April 2000. At the end of follow up, available subjects were clinically examined for asthma diagnosis and history of allergen specific immunotherapy, second-hand smoking and the presence of pets in the household. A total of 436 non-asthmatic adults (332 subjects with allergic rhinitis and 104 with no allergic rhinitis nor history of atopy) were available for final analyses. The highest OR (odds ratio) associated with a diagnosis of asthma at the end of follow-up was for the diagnosis of allergic rhinitis at baseline (OR, 7.8; 95%CI, 3.1–20.0 in the model containing the covariates of rhinitis diagnosis, sex, second-hand smoke exposure, presence of pets at home, family history of allergic disorders, sensitization to Parietaria judaica; grass pollen; house dust mites; Olea europea: orchard; perennial rye; and cat allergens). Female sex, sensitization to Parietaria judaica and the presence of pets in the home were also significantly predictive of new onset asthma in the same model. Treatment with allergen immunotherapy was significantly and inversely related to the development of new onset asthma (OR, 0.53; 95%CI, 0.32–0.86). In the present study we found that allergic rhinitis is an important independent risk factor for asthma. Moreover, treatment with allergen immunotherapy lowers the risk of the development of new asthma cases in adults with allergic rhinitis.
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Affiliation(s)
- Riccardo Polosa
- Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, Italy
| | - Wael K Al-Delaimy
- Department of Family and Preventive Medicine, University of California, San Diego, USA
| | - Cristina Russo
- Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, Italy
| | - Giovita Piccillo
- Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, Italy
| | - Maria Sarvà
- Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, Italy
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Kurt E, Bavbek S, Aksu O, Erekul S, Misirligil Z. The effect of natural pollen exposure on eosinophil apoptosis and its relationship to bronchial hyperresponsiveness in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2005; 95:72-8. [PMID: 16095145 DOI: 10.1016/s1081-1206(10)61191-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limited data suggest that there is increased eosinophilic inflammation in the airways of patients with seasonal allergic rhinitis (SAR) during pollen season even if they do not have asthma. OBJECTIVE To investigate the effect of natural pollen exposure on inflammatory cells and apoptosis of eosinophils and its association with bronchial hyperresponsiveness (BHR) during and out of pollen season in SAR patients sensitized to only grass pollens. METHODS Forty SAR patients and 10 patients with nonallergic rhinitis (NAR) from Ankara, Turkey, were recruited to participate in the study. Two induced sputum samples were taken from SAR patients during pollen season (May-June) and out of pollen season (November-January), but only 1 induced sputum sample was taken from NAR patients. Slides of induced sputum were evaluated by 2 cytologists with the use of light microscopy after cytocentrifuged and dyed with May-Grünwald-Giemsa stain. Induced sputum samples were sufficient for differential cell counts in 14 SAR and 7 NAR patients. RESULTS Eosinophil counts in SAR patients were statistically higher in pollen season (19.4% +/- 16.2%) compared with out of season (4.6% +/- 6.9%, P = .003) and with NAR patients (4.7% +/- 9.5%, P = .01). The apoptotic eosinophil counts in SAR patients were statistically higher out of pollen season (3.0% +/- 4.5%) than in pollen season (0.38% +/- 0.80%, P = .02) and higher than those of NAR patients (0.14% +/- 0.26%, P = .005). The apoptotic ratio was statistically higher after pollen season compared with pollen season (0.720% +/- 0.394% vs 0.044% +/- 0.116%, P = .002). Blood eosinophil counts of SAR patients were increased during the pollen season (364 +/- 187/mm3) compared with out of season (278 +/- 219/mm3, P = .04) and with NAR patients (85 +/- 54/mm3, P = .001). The number of SAR patients who had BHR during the pollen season (7/14) was higher than the number who had BHR out of season (2/14, chi2 = 4.2, P = .04). CONCLUSION Our data indicate that changes in eosinophil counts and eosinophil apoptosis may be related to the changes of natural pollen exposure and seasonal changes of BHR in SAR patients.
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Affiliation(s)
- Emel Kurt
- Department of Allergic Diseases, Ankara University, Medical Faculty, Ankara, Turkey.
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Abstract
There is still active debate on the acute mechanism of exercise-induced bronchoconstriction (EIB). Although it is unlikely that vasoconstriction and hyperemia of the bronchial vasculature are essential events for EIB, it is likely that this vasculature enhances the airway response to dehydration and contributes to the pathogenesis of EIB, particularly in elite athletes. Accumulating evidence suggests that airway smooth muscle (ASM) becomes more sensitive as a result of repeated exposure to bulk plasma in response to airway injury from dehydration. Recent evidence also demonstrates sufficient concentrations of mediators that could affect ASM. Paradoxically, mediator release from mast cells may be enhanced and their contractile effects greater when beta(2)-receptor agonists are taken daily. The effect of drugs that have the potential to reduce microvascular leak and reduce or inhibit release or action of these mediators needs to be investigated in elite athletes.
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Affiliation(s)
- Sandra D Anderson
- Department of Respiratory Medicine, 11 West, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia.
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Abstract
PURPOSE OF REVIEW Allergic rhinitis and asthma are examples of a continuum of airway diseases with diverse clinical manifestations. This review examines the most recent work in mouse models studying upper and lower airway links and interactions. RECENT FINDINGS The concept of united airways has been supported by investigative and epidemiological studies. Studies using mouse models of asthma and models of allergic rhinitis have demonstrated that analogous pathways lead to inflammation and airway hyperresponsiveness. Th2-type T cells and IL-13 play important immunopathologic roles. Recent studies have examined upper airway mucosal immune responses and development of both allergic and tolerant phenotypes. In a model of allergic airways disease, there is evidence of lower airway inflammation and airways hyperresponsiveness following application of allergen only to the nares, suggesting local stimulation can activate distal allergic responses. Immunomodulatory properties of the airway mucosa have also been explored. Allergen-specific tolerance can be induced by appropriate stimulation of airway mucosa and is associated with activation of IL-10-producing T cells. This effect is mediated by antigen presenting cells, especially dendritic cells. SUMMARY Immune stimulation of the airway mucosa, both in the upper and lower airways, results in active T-cell-mediated immune responses leading toward tolerance or asthma and allergic rhinitis. Regulation of these T-cell responses is currently under investigation. It is clear from these studies that antigenic stimulation of any part of the respiratory mucosa can have ripple effects along the entire airway and supports the concept of united airways.
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Affiliation(s)
- Christine T McCusker
- Division of Allergy and Immunology, Montreal Children's Hospital and Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada.
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