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Hanusrichterova J, Kolomaznik M, Barosova R, Adamcakova J, Mokra D, Mokry J, Skovierova H, Kelly MM, de Heuvel E, Wiehler S, Proud D, Shen H, Mukherjee PG, Amrein MW, Calkovska A. Pulmonary surfactant and prostaglandin E 2 in airway smooth muscle relaxation of human and male guinea pigs. Physiol Rep 2024; 12:e70026. [PMID: 39245804 PMCID: PMC11381196 DOI: 10.14814/phy2.70026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/12/2024] [Accepted: 08/22/2024] [Indexed: 09/10/2024] Open
Abstract
Pulmonary surfactant serves as a barrier to respiratory epithelium but can also regulate airway smooth muscle (ASM) tone. Surfactant (SF) relaxes contracted ASM, similar to β2-agonists, anticholinergics, nitric oxide, and prostanoids. The exact mechanism of surfactant relaxation and whether surfactant relaxes hyperresponsive ASM remains unknown. Based on previous research, relaxation requires an intact epithelium and prostanoid synthesis. We sought to examine the mechanisms by which surfactant causes ASM relaxation. Organ bath measurements of isometric tension of ASM of guinea pigs in response to exogenous surfactant revealed that surfactant reduces tension of healthy and hyperresponsive tracheal tissue. The relaxant effect of surfactant was reduced if prostanoid synthesis was inhibited and/or if prostaglandin E2-related EP2 receptors were antagonized. Atomic force microscopy revealed that human ASM cells stiffen during contraction and soften during relaxation. Surfactant softened ASM cells, similarly to the known bronchodilator prostaglandin E2 (PGE2) and the cell softening was abolished when EP4 receptors for PGE2 were antagonized. Elevated levels of PGE2 were found in cultures of normal human bronchial epithelial cells exposed to pulmonary surfactant. We conclude that prostaglandin E2 and its EP2 and EP4 receptors are likely involved in the relaxant effect of pulmonary surfactant in airways.
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Grants
- APVV-17-0250 Agentúra na Podporu Výskumu a Vývoja (APVV)
- VEGA 1/0055/19 Vedecká Grantová Agentúra MŠVVaŠ SR a SAV (VEGA)
- 26246 Ministerstvo školstva, vedy, výskumu a športu SR | Agentúra Ministerstva Školstva, Vedy, Výskumu a Športu SR (Agency of the Ministry of Education, Science, Research and Sport of the Slovak Republic for the Structural Funds of EU)
- 34237 Ministerstvo školstva, vedy, výskumu a športu SR | Agentúra Ministerstva Školstva, Vedy, Výskumu a Športu SR (Agency of the Ministry of Education, Science, Research and Sport of the Slovak Republic for the Structural Funds of EU)
- University of Calgary (U of C)
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Affiliation(s)
- J Hanusrichterova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - M Kolomaznik
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - R Barosova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - J Adamcakova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - D Mokra
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - J Mokry
- Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - H Skovierova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - M M Kelly
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - E de Heuvel
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S Wiehler
- Department of Physiology and Pharmacology and Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - D Proud
- Department of Physiology and Pharmacology and Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - H Shen
- Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - P G Mukherjee
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M W Amrein
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Calkovska
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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2
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Polverino F, Sin DD. Type 2 airway inflammation in COPD. Eur Respir J 2024; 63:2400150. [PMID: 38485148 DOI: 10.1183/13993003.00150-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 05/30/2024]
Abstract
Globally, nearly 400 million persons have COPD, and COPD is one of the leading causes of hospitalisation and mortality across the world. While it has been long-recognised that COPD is an inflammatory lung disease, dissimilar to asthma, type 2 inflammation was thought to play a minor role. However, recent studies suggest that in approximately one third of patients with COPD, type 2 inflammation may be an important driver of disease and a potential therapeutic target. Importantly, the immune cells and molecules involved in COPD-related type 2 immunity may be significantly different from those observed in severe asthma. Here, we identify the important molecules and effector immune cells involved in type 2 airway inflammation in COPD, discuss the recent therapeutic trial results of biologicals that have targeted these pathways and explore the future of therapeutic development of type 2 immune modulators in COPD.
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Affiliation(s)
- Francesca Polverino
- Pulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia Division of Respiratory Medicine, Vancouver, BC, Canada
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3
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Kokelj S, Östling J, Fromell K, Vanfleteren LEGW, Olsson HK, Nilsson Ekdahl K, Nilsson B, Olin AC. Activation of the Complement and Coagulation Systems in the Small Airways in Asthma. Respiration 2023; 102:621-631. [PMID: 37423212 DOI: 10.1159/000531374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Several studies have shown the importance of the complement and coagulation systems in the pathogenesis of asthma. OBJECTIVES We explored whether we could detect differentially abundant complement and coagulation proteins in the samples obtained from the small airway lining fluid by collection of exhaled particles in patients with asthma and whether these proteins are associated with small airway dysfunction and asthma control. METHOD Exhaled particles were obtained from 20 subjects with asthma and 10 healthy controls (HC) with the PExA method and analysed with the SOMAscan proteomics platform. Lung function was assessed by nitrogen multiple breath washout test and spirometry. RESULTS 53 proteins associated with the complement and coagulation systems were included in the analysis. Nine of those proteins were differentially abundant in subjects with asthma as compared to HC, and C3 was significantly higher in inadequately controlled asthma as compared to well-controlled asthma. Several proteins were associated with physiological tests assessing small airways. CONCLUSIONS The study highlights the role of the local activation of the complement and coagulation systems in the small airway lining fluid in asthma and their association with both asthma control and small airway dysfunction. The findings highlight the potential of complement factors as biomarkers to identify different sub-groups among patients with asthma that could potentially benefit from a therapeutic approach targeting the complement system.
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Affiliation(s)
- Spela Kokelj
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Karin Fromell
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henric K Olsson
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Kristina Nilsson Ekdahl
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Linnaeus Centre for Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden
| | - Bo Nilsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gopallawa I, Dehinwal R, Bhatia V, Gujar V, Chirmule N. A four-part guide to lung immunology: Invasion, inflammation, immunity, and intervention. Front Immunol 2023; 14:1119564. [PMID: 37063828 PMCID: PMC10102582 DOI: 10.3389/fimmu.2023.1119564] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
Lungs are important respiratory organs primarily involved in gas exchange. Lungs interact directly with the environment and their primary function is affected by several inflammatory responses caused by allergens, inflammatory mediators, and pathogens, eventually leading to disease. The immune architecture of the lung consists of an extensive network of innate immune cells, which induce adaptive immune responses based on the nature of the pathogen(s). The balance of immune responses is critical for maintaining immune homeostasis in the lung. Infection by pathogens and physical or genetic dysregulation of immune homeostasis result in inflammatory diseases. These responses culminate in the production of a plethora of cytokines such as TSLP, IL-9, IL-25, and IL-33, which have been implicated in the pathogenesis of several inflammatory and autoimmune diseases. Shifting the balance of Th1, Th2, Th9, and Th17 responses have been the targets of therapeutic interventions in the treatment of these diseases. Here, we have briefly reviewed the innate and adaptive i3mmune responses in the lung. Genetic and environmental factors, and infection are the major causes of dysregulation of various functions of the lung. We have elaborated on the impact of inflammatory and infectious diseases, advances in therapies, and drug delivery devices on this critical organ. Finally, we have provided a comprehensive compilation of different inflammatory and infectious diseases of the lungs and commented on the pros and cons of different inhalation devices for the management of lung diseases. The review is intended to provide a summary of the immunology of the lung, with an emphasis on drug and device development.
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Affiliation(s)
- Indiwari Gopallawa
- Clinical Pharmacology & Safety Sciences, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, United States
| | - Ruchika Dehinwal
- Department of Microbiology, Division of Infectious Disease, Brigham Women’s Hospital, Harvard Medical School, Howard Hughes Medical Institute, Boston, MA, United States
| | | | - Vikramsingh Gujar
- Department of Anatomy and Cell Biology, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Narendra Chirmule
- R&D Department, SymphonyTech Biologics, Philadelphia, PA, United States
- *Correspondence: Narendra Chirmule,
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Scioscia G, Lacedonia D, Quarato CMI, Tondo P, Del Colle A, Sperandeo M, Carpagnano GE, Foschino Barbaro MP. Could transthoracic ultrasound be useful to suggest a small airways disease in severe uncontrolled asthma? Ann Allergy Asthma Immunol 2022; 129:461-466. [PMID: 35643297 DOI: 10.1016/j.anai.2022.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transthoracic ultrasound (TUS) is an accepted complementary tool in the diagnostic process of several pleuro-pulmonary diseases. However, to the best of our knowledge, TUS findings in patients with severe asthma have never been systematically described. OBJECTIVE To explore if TUS examination is a useful imaging method in suggesting the presence of a "small airways disease" in patients with severe uncontrolled asthma. METHODS Seventy-two consecutive subjects with a diagnosis of severe uncontrolled asthma were enrolled. The presence of a "small airways disease" was assessed through the execution of pulmonary function tests. All the patients underwent a complete TUS examination and a chest high resolution computed tomography (HRCT), which was regarded as the reference standard for comparison with TUS findings. RESULTS Pulmonary function tests results have confirmed a reduction in expiratory flows relative to the small airways and a condition of hyperinflation in 78% and 82% of our patients, respectively. The main signs observed in the TUS examination were a thickened and/or irregular pleural line and the lack or reduction of the "gliding sign." TUS showed high sensitivity and specificity in suggesting the presence of hyperinflation and distal airways inflammation according to the HRCT scan. K Cohen's coefficients showed substantial agreement between the 2 diagnostic tests. CONCLUSION TUS in patients with severe uncontrolled asthma can provide useful information on the state of the peripheral lung, suggesting the execution of a second-line HRCT scan for better assessment of eventual alterations that may represent the underlying causes of nonresponse to treatment.
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Affiliation(s)
- Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Diseases, Policlinico universitario "Riuniti" di Foggia, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Diseases, Policlinico universitario "Riuniti" di Foggia, Foggia, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Diseases, Policlinico universitario "Riuniti" di Foggia, Foggia, Italy.
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Diseases, Policlinico universitario "Riuniti" di Foggia, Foggia, Italy
| | - Anna Del Colle
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Diseases, Policlinico universitario "Riuniti" di Foggia, Foggia, Italy
| | - Marco Sperandeo
- Department of Internal Medicine, Unit of Interventional and Diagnostic Ultrasound, IRCCS, Fondazione "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University "Aldo Moro" of Bari, Bari, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Diseases, Policlinico universitario "Riuniti" di Foggia, Foggia, Italy
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6
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Tan YY, Zhou HQ, Lin YJ, Yi LT, Chen ZG, Cao QD, Guo YR, Wang ZN, Chen SD, Li Y, Wang DY, Qiao YK, Yan Y. FGF2 is overexpressed in asthma and promotes airway inflammation through the FGFR/MAPK/NF-κB pathway in airway epithelial cells. Mil Med Res 2022; 9:7. [PMID: 35093168 PMCID: PMC8800304 DOI: 10.1186/s40779-022-00366-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/09/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Airway inflammation is the core pathological process of asthma, with the key inflammatory regulators incompletely defined. Recently, fibroblast growth factor 2 (FGF2) has been reported to be an inflammatory regulator; however, its role in asthma remains elusive. This study aimed to investigate the immunomodulatory role of FGF2 in asthma. METHODS First, FGF2 expression was characterised in clinical asthma samples and the house dust mite (HDM)-induced mouse chronic asthma model. Second, recombinant mouse FGF2 (rm-FGF2) protein was intranasally delivered to determine the effect of FGF2 on airway inflammatory cell infiltration. Third, human airway epithelium-derived A549 cells were stimulated with either HDM or recombinant human interleukin-1β (IL-1β) protein combined with or without recombinant human FGF2. IL-1β-induced IL-6 or IL-8 release levels were determined using enzyme-linked immunosorbent assay, and the involved signalling transduction was explored via Western blotting. RESULTS Compared with the control groups, the FGF2 protein levels were significantly upregulated in the bronchial epithelium and alveolar areas of clinical asthma samples (6.70 ± 1.79 vs. 16.32 ± 2.40, P = 0.0184; 11.20 ± 2.11 vs. 21.00 ± 3.00, P = 0.033, respectively) and HDM-induced asthmatic mouse lung lysates (1.00 ± 0.15 vs. 5.14 ± 0.42, P < 0.001). Moreover, FGF2 protein abundance was positively correlated with serum total and anti-HDM IgE levels in the HDM-induced chronic asthma model (R2 = 0.857 and 0.783, P = 0.0008 and 0.0043, respectively). Elevated FGF2 protein was mainly expressed in asthmatic bronchial epithelium and alveolar areas and partly co-localised with infiltrated inflammatory cell populations in HDM-induced asthmatic mice. More importantly, intranasal instillation of rm-FGF2 aggravated airway inflammatory cell infiltration (2.45 ± 0.09 vs. 2.88 ± 0.14, P = 0.0288) and recruited more subepithelial neutrophils after HDM challenge [(110.20 ± 29.43) cells/mm2 vs. (238.10 ± 42.77) cells/mm2, P = 0.0392] without affecting serum IgE levels and Th2 cytokine transcription. In A549 cells, FGF2 was upregulated through HDM stimulation and promoted IL-1β-induced IL-6 or IL-8 release levels (up to 1.41 ± 0.12- or 1.44 ± 0.14-fold change vs. IL-1β alone groups, P = 0.001 or 0.0344, respectively). The pro-inflammatory effect of FGF2 is likely mediated through the fibroblast growth factor receptor (FGFR)/mitogen-activated protein kinase (MAPK)/nuclear factor kappa B (NF-κB) pathway. CONCLUSION Our findings suggest that FGF2 is a potential inflammatory modulator in asthma, which can be induced by HDM and acts through the FGFR/MAPK/NF-κB pathway in the airway epithelial cells.
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Affiliation(s)
- Yuan-Yang Tan
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Hui-Qin Zhou
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Yu-Jing Lin
- Department of Pathology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Liu-Tong Yi
- Department of Pathology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Zhuang-Gui Chen
- Department of Pediatrics, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China
| | - Qing-Dong Cao
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Yan-Rong Guo
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Zhao-Ni Wang
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Shou-Deng Chen
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Yang Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - De-Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, 119228, Singapore
| | | | - Yan Yan
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China. .,Central Laboratory, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
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Chan R, Lipworth BJ. Impact of Biologic Therapy on the Small Airways Asthma Phenotype. Lung 2022; 200:691-696. [PMID: 36239786 PMCID: PMC9675679 DOI: 10.1007/s00408-022-00579-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022]
Abstract
The small airways dysfunction (SAD) asthma phenotype is characterised by narrowing of airways < 2 mm in diameter between generations 8 and 23 of the bronchial tree. Recently, this has become particularly relevant as measurements of small airways using airway oscillometry for example, are strong determinants of asthma control and exacerbations in moderate-to-severe asthma. The small airways can be assessed using spirometry as forced expiratory flow rate between 25 and 75% of forced vital capacity (FEF25-75) and has been deemed more accurate in detecting small airways dysfunction than forced expiratory volume in 1 s (FEV1). Oscillometry as the heterogeneity in resistance between 5 and 20 Hz (R5-R20), low frequency reactance at 5 Hz (X5) or area under the reactance curve between 5 Hz and the resonant frequency can also be used to assess the small airways. The small airways can also be assessed using the multiple breath nitrogen washout (MBNW) test giving rise to values including functional residual capacity, lung clearance index and ventilation distribution heterogeneity in the conducting (Scond) and the acinar (Sacin) airways. The ATLANTIS group showed that the prevalence of small airways disease in asthma defined on FEF25-75, oscillometry and MBNW all increased with progressive GINA asthma disease stages. As opposed to topical inhaler therapy that might not adequately penetrate the small airways, it is perhaps more intuitive that systemic anti-inflammatory therapy with biologics targeting downstream cytokines and upstream epithelial anti-alarmins may offer a promising solution to SAD. Here we therefore aim to appraise the available evidence for the effect of anti-IgE, anti-IL5 (Rα), anti-IL4Rα, anti-TSLP and anti-IL33 biologics on small airways disease in patients with severe asthma.
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Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, DD1 9SY, UK
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, DD1 9SY, UK.
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Liu T, Yang D, Liu C. Extrafine HFA-beclomethasone-formoterol vs. nonextrafine combination of an inhaled corticosteroid and a long acting β2-agonist in patients with persistent asthma: A systematic review and meta-analysis. PLoS One 2021; 16:e0257075. [PMID: 34478483 PMCID: PMC8415610 DOI: 10.1371/journal.pone.0257075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 08/23/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Airway inflammation in asthma involves not only the central airways but extends to peripheral airways. Lung deposition may be key for an appropriate treatment of asthma. We compared the clinical effects of extrafine hydrofluoroalkane (HFA)-beclomethasone-formoterol (BDP-F) versus equipotent doses of nonextrafine combination of an inhaled corticosteroid and a long acting β2-agonist (ICS-LABA) in asthma. Methods We identified eligible studies by a comprehensive literature search of PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Data analysis was performed with the Review Manager 5.3.5 software (Cochrane IMS, 2014). Results A total of 2326 patients with asthma from ten published randomized controlled trials (RCTs) were enrolled for analysis. Change from baseline in morning pre-dose peak expiratory flow (PEF), evening pre-dose PEF and forced expiratory volume in one second (FEV1) were detected no significant differences between extrafine HFA-BDP-F and nonextrafine ICS-LABAs (p = 0.23, p = 0.99 and p = 0.23, respectively). Extrafine HFA-BDP-F did not show any greater benefit in forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75%), the parameter concerning peripheral airways (MD 0.03L/s, p = 0.65; n = 877). There were no substantial differences between interventions in fractional exhaled nitric oxide (FeNO) levels or in its alveolar fraction. The overall analysis showed no significant benefit of extrafine HFA-BDP-F over nonextrafine ICS-LABA in improving Asthma Control Test (ACT) score (p = 0.30) or decreasing the number of puffs of rescue medication use (p = 0.16). Extrafine HFA-BDP-F did not lead to less exacerbations than nonextrafine ICS-LABA (RR 0.61, 95% CI: 0.31 to 1.20; I2 = 0; p = 0.15). Conclusion Enrolled RCTs of extrafine HFA-BDP-F have demonstrated no significant advantages over the equivalent combination of nonextrafine ICS-LABA in improving pulmonary function concerning central airways or peripheral airways, improving asthma symptom control or reducing exacerbation rate.
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Affiliation(s)
- Ting Liu
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu Province, China
| | - Dan Yang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu Province, China
| | - Chuntao Liu
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu Province, China
- * E-mail:
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9
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Diagnostic Value of Fractional Exhaled Nitric Oxide and Small Airway Function in Differentiating Cough-Variant Asthma from Typical Asthma. Can Respir J 2021; 2021:9954411. [PMID: 34457097 PMCID: PMC8397554 DOI: 10.1155/2021/9954411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/09/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the diagnostic value of fractional exhaled nitric oxide (FeNO), small airway function, and a combined of both in differentiating cough-variant asthma (CVA) from typical asthma (TA). Methods A total of 206 asthma subjects, including 104 CVA and 102 TA, were tested for pulmonary function, bronchial provocation test and FeNO. The correlation between FeNO, small airway function and other pulmonary indicators was analyzed by single correlation and multiple regression analysis. The receiver operating characteristic (ROC) curve was established to evaluate the diagnostic efficiency of FeNO, small airway function, and their combination and to predict the optimal cut-off point. Results All the respiratory function parameters and small airway function indicators in TA group were significantly different from those in CVA group, and FeNO value was significantly higher than that in CVA group. In addition, the area under the ROC curve (AUC) was estimated to be 0.660 for FeNO, 0.895 for MMEF75%/25%, 0.873 for FEF50%, 0.898 for FEF25%, 0.695 for Fres, 0.650 for R5-R20, and 0.645 for X5. The optimal cut-off points of FeNO, MMEF75%/25%, FEF50%, FEF25%, Fres, R5-R20 and X5, were 48.50 ppb, 60.02%, 63.46%, 45.26%, 16.63 Hz, 0.38 kPa·L−1·s−1, and −1.32, respectively. And the AUC of FeNO combined with small airway function indexes FEF25%, Fres, R5-R20, and X5 were prior than single indicators. Conclusion FeNO and small airway function indexes might have great diagnostic value for differentiating CVA from TA. The combination of FeNO and FEF25%, Fres, R5-R20, and X5 provided a significantly better prediction than either alone.
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10
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Li Y, Yu HY, Zhao KC, Ding XH, Huang Y, Hu SP, Nie HX. Effects of Medication Use on Small Airway Function and Airway Inflammation in Patients with Clinically Controlled Asthma. Curr Med Sci 2021; 41:722-728. [PMID: 34403097 DOI: 10.1007/s11596-021-2403-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To observe effects of medication use on small airway function, airway inflammation and acute exacerbations in patients with clinically controlled asthma. METHODS Forced expiratory flow over the middle half of the forced expiratory curve (FEF25%-75%), percentage of eosinophil, concentrations of eosinophil cationic protein (ECP) and interleukin (IL)-5 in induced sputum were assessed in patients with clinically controlled asthma who were given oral anti-inflammatory agents alone or in combination with inhaled therapy and inhaled therapy alone. Subsequently, acute exacerbations were compared between two groups during the 24-week follow-up period. RESULTS FEF25%-75% in 43 patients with clinically controlled asthma given oral anti-inflammatory agents alone or in combination with inhaled therapy was significantly higher than that in 49 patients given inhaled therapy alone. Meanwhile, the percentage of eosinophils and levels of IL-5 and ECP in patients with clinically controlled asthma given oral anti-inflammatory agents alone or in combination with inhaled therapy were significantly lower than those in patients given inhaled therapy alone. Additionally, the patients with clinically controlled asthma given inhaled therapy were likely to have more acute exacerbation than the patients given oral anti-inflammatory agents alone or in combination with inhaled therapy during the 24-week follow-up period. CONCLUSION Systemic anti-inflammatory agents may have a greater effect on parameters reflecting small airway patency and reducing acute exacerbations, presumably secondary to reduction in airway inflammation.
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Affiliation(s)
- Yun Li
- Department of Respiratory and Critical Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hong-Ying Yu
- Department of Respiratory and Critical Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Kao-Chuang Zhao
- Department of Respiratory and Critical Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xu-Hong Ding
- Department of Respiratory and Critical Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yi Huang
- Department of Respiratory and Critical Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Su-Ping Hu
- Department of Respiratory and Critical Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Han-Xiang Nie
- Department of Respiratory and Critical Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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11
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González Vera R, Vidal Grell A, Yarur AM, Meneses CO, Castro-Rodriguez JA. "Reactance inversion" at low frequencies during lung function measurement by impulse oscillometry in children with persistent asthma . J Asthma 2021; 59:1597-1603. [PMID: 34255601 DOI: 10.1080/02770903.2021.1955376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Small airway dysfunction (SAD) in asthma can be measured by impulse oscillometry (IOS). Usually, the reactance should decrease with decreases in frequency oscillation. Sometimes an upward shift of the curve at low frequencies can be observed together with lower than expected reactance values. The actual value of the reactance at 5 Hz (X5) is calculated by the Sentry Suite application of the Jaeger Master screen iOS system™, providing the corrected X5 parameter (CX5). Our hypothesis is that correction of X5 is common in persistent asthma and it correlates better than X5 with the IOS parameters for evaluating SAD. METHODS In this transversal study, we evaluated 507 children (3-18 years old) using IOS-spirometry (Sentry Suite, Vyntus®). Resistance of all airways (R5), reactance area (AX), resonant frequency (Fres), X5, CX5, difference between R5 and R20 (D5-20), and spirometry parameters were analyzed. Reactance inversion and CX5 prevalence by age range was determined. The mean IOS-Spyrometry values in children with and without CX5 were compared, and correlations with each IOS-spirometry parameter in the age groups were performed. RESULTS CX5 was found in 83.5% of preschool children, 66.2% of schoolchildren, and 43.3% of adolescents (p < 0.001). The means of R5, AX, and D5-20 were significantly higher and FEV1 was significantly lower in children with CX5 (p < 0.05). In all ages, CX5 correlated better than X5 with IOS-spirometry parameters. CONCLUSION Reactance inversion and CX5 are frequent in asthmatic children, decrease with age, and correlate more closely than X5 with other IOS-spirometry parameters for evaluating SAD.
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Affiliation(s)
| | | | | | | | - Jose A Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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12
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Urbankowski T, Przybyłowski T. Methacholine Challenge Testing: Comparison of FEV 1 and Airway Resistance Parameters. Respir Care 2021; 66:449-459. [PMID: 33203723 PMCID: PMC9994076 DOI: 10.4187/respcare.08331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A 20% reduction in the FEV1 is routinely used as an end point for methacholine challenge testing (MCT). Measurement of FEV1 is effort dependent, and some patients are not able to perform acceptable and repeatable forced expiration maneuvers. The goal of the present study was to investigate the diagnostic value of airway resistance measurement by forced oscillation technique (FOT), body plethysmography, and interrupter technique compared with the traditionally accepted standard FEV1 measurement in evaluating the responsiveness to methacholine during MCT. METHODS We included in the study adult subjects referred for MCT because of asthma-like symptoms and with normal baseline spirometry. We modified routine MCT protocol by adding the assessment of airway resistance to the measurement of FEV1 at each step of MCT. RESULTS We observed, in the subjects with airway hyper-responsiveness versus those with normal airway responsiveness, a significantly greater percentage change in median (interquartile range) FOT resistance at 10 Hz (25.9% [13.7%-35.4%] vs 16% [15.7%-27.2%]), plethysmographic resistance (70.2% [39.5%-116.3%] vs 37.1% [23.9%-81.9%]), and mean ± SD conductance (-41.3 ± 15.4% vs -29.6 ± 15.9%); and a significantly greater change in mean ± SD FOT reactance at 10 Hz (-0.41 ± 0.48 cm H2O/L/s vs -0.09 ± 0.32 cm H2O/L/s) and at 15 Hz (-0.29 ± 0.2 cm H2O/L/s vs -0.1 ± 0.19 cm H2O/L/s). We also recorded significant differences in airway resistance parameters (FOT resistance at 10 Hz, FOT reactance at 15 Hz, plethysmographic airway resistance, and conductance indices as well as interrupter resistance) in FEV1 non-responders at the onset of respiratory symptoms during MCT compared with baseline. CONCLUSIONS Measurements of airway resistance could possibly be used as an alternative method to spirometry in airway challenge. Significant changes in airway mechanics during MCT are detectable by airway resistance measurement in FEV1 non-responders with methacholine-induced asthma-like symptoms. (ClinicalTrials.gov registration NCT02343419.).
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Affiliation(s)
- Tomasz Urbankowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
| | - Tadeusz Przybyłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
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13
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Calzetta L, Aiello M, Frizzelli A, Bertorelli G, Chetta A. Small airways in asthma: from bench-to-bedside. Minerva Med 2021; 113:79-93. [PMID: 33496163 DOI: 10.23736/s0026-4806.21.07268-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Historically, asthma was considered a disease predominantly of the large airways, but gradually small airways have been recognized as the major site of airflow obstruction. Small airway dysfunction (SAD) significantly contributes to the pathophysiology of asthma and it is present across all asthma severities. Promising pre-clinical findings documented enhanced beneficial effects of combination therapies on small airways compared to monocomponents, thus it was questioned whether this could translate into further clinical implications from bench-to-bedside. The aim of this review was to systematically assess the state of the art of small airway involvement in asthma, especially in response to different pharmacological treatments acting on the respiratory system. EVIDENCE ACQUISITION A comprehensive literature search was performed in MEDLINE for randomized controlled trials (RCTs) characterizing the impact on small airways of different pharmacological treatments acting on the respiratory system. The results were extracted and reported via qualitative synthesis. EVIDENCE SYNTHESIS Overall, 63 studies were identified from the literature search, whereas 23 RCTs met the inclusion criteria. Evidence confirms that both drug particle size and the type of inhalation devices represent two of the most important variables for an effective peripheral lung distribution. CONCLUSIONS Despite the numerous methodological tools to detect SAD, there is still no gold standard diagnostic method to assess small airways, especially in severe asthma. Further research should be directed to improve primary and secondary prevention strategies by supporting the combined approach of different non-invasive techniques for an early detection of peripheral abnormalities and optimization of asthma therapy.
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Affiliation(s)
- Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy -
| | - Marina Aiello
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Annalisa Frizzelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Giuseppina Bertorelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
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14
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Khan MA. Regulatory T cells mediated immunomodulation during asthma: a therapeutic standpoint. J Transl Med 2020; 18:456. [PMID: 33267824 PMCID: PMC7713035 DOI: 10.1186/s12967-020-02632-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022] Open
Abstract
Asthma is an inflammatory disease of the lung airway network, which is initiated and perpetuated by allergen-specific CD4+ T cells, IgE antibodies, and a massive release of Th2 cytokines. The most common clinical manifestations of asthma progression include airway inflammation, pathological airway tissue and microvascular remodeling, which leads to airway hyperresponsiveness (AHR), and reversible airway obstruction. In addition to inflammatory cells, a tiny population of Regulatory T cells (Tregs) control immune homeostasis, suppress allergic responses, and participate in the resolution of inflammation-associated tissue injuries. Preclinical and clinical studies have demonstrated a tremendous therapeutic potential of Tregs in allergic airway disease, which plays a crucial role in immunosuppression, and rejuvenation of inflamed airways. These findings supported to harness the immunotherapeutic potential of Tregs to suppress airway inflammation and airway microvascular reestablishment during the progression of the asthma disease. This review addresses the therapeutic impact of Tregs and how Treg mediated immunomodulation plays a vital role in subduing the development of airway inflammation, and associated airway remodeling during the onset of disease.
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Affiliation(s)
- Mohammad Afzal Khan
- Organ Transplant Research Section, Comparative Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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15
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Jakiela B, Soja J, Sladek K, Przybyszowski M, Plutecka H, Gielicz A, Rebane A, Bochenek G. Heterogeneity of lower airway inflammation in patients with NSAID-exacerbated respiratory disease. J Allergy Clin Immunol 2020; 147:1269-1280. [PMID: 32810516 DOI: 10.1016/j.jaci.2020.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) asthma is characterized by chronic rhinosinusitis and intolerance of aspirin and other COX1 inhibitors. Clinical data point to a heterogeneity within the N-ERD phenotype. OBJECTIVE Our aim was to investigate immune mediator profiles in the lower airways of patients with N-ERD. METHODS Levels of cytokines (determined by using Luminex assay) and eicosanoids (determined by using mass spectrometry) were measured in bronchoalveolar lavage fluid (BALF) from patients with N-ERD (n = 22), patients with NSAID-tolerant asthma (n = 21), and control subjects (n = 11). mRNA expression in BALF cells was quantified by using TaqMan low-density arrays. RESULTS Lower airway eosinophilia was more frequent in N-ERD (54.5%) than in NSAID-tolerant asthma (9.5% [P = .009]). The type-2 (T2) immune signature of BALF cells was more pronounced in the eosinophilic subphenotype of N-ERD. Similarly, BALF concentrations of periostin and CCL26 were significantly increased in eosinophilic N-ERD and correlated with T2 signature in BALF cells. Multiparameter analysis of BALF mediators of all patients with asthma revealed the presence of 2 immune endotypes: T2-like (with an elevated level of periostin in BALF) and non-T2/proinflammatory (with higher levels of matrix metalloproteinases and inflammatory cytokines). Patients with N-ERD were classified mostly as having the T2 endotype (68%). Changes in eicosanoid profile (eg, increased leukotriene E4 level) were limited to patients with N-ERD with airway eosinophilia. Blood eosinophilia appeared to be a useful predictor of airway T2 signature (area under the curve [AUC] = 0.83); however, surrogate biomarkers had moderate performance in distinguishing eosinophilic N-ERD (for blood eosinophils, AUC = 0.72; for periostin, AUC = 0.75). CONCLUSIONS Lower airway immune profiles show considerable heterogeneity of N-ERD, with skewing toward T2 response and eosinophilic inflammation. Increased production of leukotriene E4 was restricted to a subgroup of patients with eosinophilia in the lower airway.
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Affiliation(s)
- Bogdan Jakiela
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Soja
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Sladek
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Przybyszowski
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Hanna Plutecka
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Gielicz
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Ana Rebane
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Grazyna Bochenek
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
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16
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Combined Forced Expiratory Volume in 1 Second and Forced Vital Capacity Bronchodilator Response, Exacerbations, and Mortality in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2020; 16:826-835. [PMID: 30908927 DOI: 10.1513/annalsats.201809-601oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Rationale: The American Thoracic Society (ATS)/European Respiratory Society defines a positive bronchodilator response (BDR) by a composite of BDR in either forced expiratory volume in 1 second (FEV1) and/or forced vital capacity (FVC) greater than or equal to 12% and 200 ml (ATS-BDR). We hypothesized that ATS-BDR components would be differentially associated with important chronic obstructive pulmonary disease (COPD) outcomes. Objectives: To examine whether ATS-BDR components are differentially associated with clinical, functional, and radiographic features in COPD. Methods: We included subjects with COPD enrolled in the COPDGene study. In the main analysis, we excluded subjects with self-reported asthma. We categorized BDR into the following: 1) No-BDR, no BDR in either FEV1 or FVC; 2) FEV1-BDR, BDR in FEV1 but no BDR in FVC; 3) FVC-BDR, BDR in FVC but no BDR in FEV1; and 4) Combined-BDR, BDR in both FEV1 and FVC. We constructed multivariable logistic, linear, zero-inflated negative binomial, and Cox hazards models to examine the association of BDR categories with symptoms, computed tomography findings, change in FEV1 over time, respiratory exacerbations, and mortality. We also created models using the ATS BDR definition (ATS-BDR) as the main independent variable. Results: Of 3,340 COPD subjects included in the analysis, 1,083 (32.43%) had ATS-BDR, 182 (5.45%) had FEV1-BDR, 522 (15.63%) had FVC-BDR, and 379 (11.34%) had Combined-BDR. All BDR categories were associated with FEV1 decline compared with No-BDR. Compared with No-BDR, both ATS-BDR and Combined-BDR were associated with higher functional residual capacity %predicted, greater internal perimeter of 10 mm, and greater 6-minute-walk distance. In contrast to ATS-BDR, Combined-BDR was independently associated with less emphysema (adjusted beta regression coefficient, -1.67; 95% confidence interval [CI], -2.68 to -0.65; P = 0.001), more frequent respiratory exacerbations (incidence rate ratio, 1.25; 95% CI, 1.03-1.50; P = 0.02) and severe exacerbations (incidence rate ratio, 1.34; 95% CI, 1.05-1.71; P = 0.02), and lower mortality (adjusted hazards ratio, 0.76; 95% CI, 0.58-0.99; P = 0.046). Sensitivity analysis that included subjects with self-reported history of asthma showed similar findings. Conclusions: BDR in both FEV1 and FVC indicates a COPD phenotype with asthma-like characteristics, and provides clinically more meaningful information than current definitions of BDR.
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He L, Li Z, Teng Y, Cui X, Barkjohn KK, Norris C, Fang L, Lin L, Wang Q, Zhou X, Hong J, Li F, Zhang Y, Schauer JJ, Black M, Bergin MH, Zhang JJ. Associations of personal exposure to air pollutants with airway mechanics in children with asthma. ENVIRONMENT INTERNATIONAL 2020; 138:105647. [PMID: 32172043 DOI: 10.1016/j.envint.2020.105647] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/28/2020] [Accepted: 03/08/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The importance of airway mechanics has been increasingly recognized in pediatric asthma. However, no studies have examined responses of airway mechanics to air pollution exposure in asthmatic children. METHODS In this panel study involving indoor air filtration manipulation that created a large gradient of personal exposure to PM2.5, the airway mechanics and lung function of 43 asthmatic children 5-13 years old in a suburb of Shanghai were measured four times within 3 consecutive months. Concentrations of indoor and outdoor PM2.5 and ozone were coupled with individual time-activity data to calculate personal exposures. Linear mixed effects models were used to examine the relationships of personal exposure with indicators of airway mechanics and lung function, respectively. RESULTS An interquartile range (IQR) increase in 24-hour average PM2.5 personal exposure (30.3 µg/m3) in the prior day was associated with significant increases in small airway resistance (R5-R20) of 15.8%, total airway resistance (R5) of 6.3%, and airway inflammation (FeNO) of 9.6%. These associations were stronger in children with lower blood eosinophil counts (<450/µL). No significant associations were found between personal PM2.5 exposure and lung function. Low-level ozone exposure (daily maximum 8-hour exposure range 1.1-56.4 ppb) was not significantly associated with any of the outcomes. CONCLUSION Changes in personal PM2.5 exposure, partly enhanced by air filtration, were associated with significant changes in airway resistance and inflammation in children with asthma. These findings suggest the importance of reducing PM2.5 exposure, via personal air quality management, in improving airflow limitation in the airways, especially the small airways.
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Affiliation(s)
- Linchen He
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Zhen Li
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanbo Teng
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Xiaoxing Cui
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Karoline K Barkjohn
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, USA
| | - Christina Norris
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, USA
| | - Lin Fang
- Department of Building Science, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Lili Lin
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Wang
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojian Zhou
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguo Hong
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - James J Schauer
- Department of Civil and Environmental Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Michael H Bergin
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, USA
| | - Junfeng Jim Zhang
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China.
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18
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Chen LC, Zeng GS, Wu LL, Zi M, Fang ZK, Fan HZ, Yu HP. Diagnostic value of FeNO and MMEF for predicting cough variant asthma in chronic cough patients with or without allergic rhinitis. J Asthma 2019; 58:326-333. [PMID: 31820665 DOI: 10.1080/02770903.2019.1694035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of fractional exhaled nitric oxide (FeNO) and maximum mid-expiratory flow (MMEF) for differentiating cough variant asthma (CVA) from chronic cough in patients with or without allergic rhinitis. METHODS In total, 328 patients with chronic cough who underwent spirometry and FeNO testing were consecutively included in the retrospective analysis. Patients were divided into the CVA (n = 125) or NCVA (n = 203) groups according to the diagnostic criteria of CVA. Receiver operating characteristic (ROC) curves were established to assess the diagnostic efficiency and optimal cutoff points of FeNO and MMEF for the prediction of CVA. RESULTS The optimal cutoff values of FeNO and MMEF to discriminate CVA from chronic cough were 24.5 ppb (AUC, 0.765; sensitivity, 69.60%; specificity 72.91%; PPV, 61.27%; NPV, 79.57%) and 66.2% (AUC, 0.771; sensitivity, 67.20%; specificity 78.33%; PPV, 65.63%; NPV, 79.50%). The optimal cutoff values of combining FeNO with MMEF to discriminate CVA from chronic cough were >22 ppb for FeNO and <62.6% for MMEF (AUC, 0.877). In patients with and without allergic rhinitis, the optimal cutoff point of FeNO to discriminate CVA from chronic cough was 24.5 ppb (AUC, 0.820) and 33.5 ppb (AUC, 0.707), respectively. CONCLUSIONS FeNO and MMEF might have greater value as negative parameters for differentiating CVA from chronic cough. Combining FeNO and MMEF provided a significantly better prediction than either alone. The diagnostic accuracy of FeNO for predicting CVA in chronic cough patients with allergic rhinitis was higher than in chronic cough patients without allergic rhinitis.
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Affiliation(s)
- Li-Chang Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Guan-Sheng Zeng
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ling-Ling Wu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mei Zi
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ze-Kui Fang
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hui-Zhen Fan
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hua-Peng Yu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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19
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Guo X, Zheng M, Pan R, Zang B, Gao J, Ma H, Jin M. Hydroxysafflor yellow A (HSYA) targets the platelet-activating factor (PAF) receptor and inhibits human bronchial smooth muscle activation induced by PAF. Food Funct 2019; 10:4661-4673. [PMID: 31292579 DOI: 10.1039/c9fo00896a] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hydroxysafflor yellow A (HSYA) is the main active ingredient of edible plant safflower. HSYA has demonstrated anti-inflammatory effects. The inflammatory response is the key mechanism responsible for asthma, and the pro-inflammatory platelet-activating factor (PAF) is known to play a role in the pathology of bronchial asthma. In this study, we stimulated human bronchial smooth muscle cells (HBSMCs) with PAF and examined the effects of HSYA on the resulting asthma-related process. PAF stimulation induced HBSMC activation, induced proliferation, increased expression of the pro-inflammatory cytokines interleukin (IL)-6, IL-1β, and tumor necrosis factor-α, and activated asthma-related signaling pathways. All these effects were significantly inhibited by treatment with HSYA (9, 27, 81 μmol L-1). The effects of HSYA were prevented by the addition of a PAF receptor (PAFR) antagonist or by PAFR gene silencing with small interfering RNA. These results suggest that HSYA may inhibit PAF-induced activation of HBSMCs by targeting the PAFR. Overall, these findings provide evidence that HSYA can be applied as a potential therapeutic agent in the treatment of bronchial asthma.
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Affiliation(s)
- Xinjing Guo
- Department of Pharmacology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Chaoyang District, Beijing, China.
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20
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Zhu H, Zhang R, Hao C, Yu X, Tian Z, Yuan Y. Fractional Exhaled Nitric Oxide (FeNO) Combined with Pulmonary Function Parameters Shows Increased Sensitivity and Specificity for the Diagnosis of Cough Variant Asthma in Children. Med Sci Monit 2019; 25:3832-3838. [PMID: 31120043 PMCID: PMC6543875 DOI: 10.12659/msm.913761] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Cough variant asthma in children presents with a dry nonproductive cough. This study aimed to investigate the diagnostic value of fractional exhaled nitric oxide (FeNO) combined with small airway functional parameters in cough variant asthma. Material/Methods Children with asthma (n=136) were divided into a cough variant asthma (CVA) group (n=57; mean age, 8.03±2.1 years) and a non-cough variant asthma (nCVA) group (n=79; mean age, 8.61±1.7 years). In both groups, FeNO and other pulmonary function parameters were measured including forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximum mid-expiratory flow (MMEF), forced expiratory flow (FEF), and maximum expiratory flow at 25%, 50%, and 75% expired volume (MEF25, MEF50, and MEF75). Receiver-operating characteristic (ROC) curve analysis compared the sensitivity and specificity between the diagnostic parameters. Results The FeNO values were significantly increased in the CVA group compared with the nCVA group (Z=6.890, p<0.001). The MMEF, MEF25, MEF50, and MEF75 values were significantly lower in the CVA group compared with the nCVA group (p=0.000, p=0.014, p=0.000, and p=0.000, respectively). The FeNO values were negatively correlated with MEF25, MEF50, and MMEF (r=−0.334, r=−0.257 and r=−0.276, respectively). FeNO was significantly more efficient diagnosing cough variant asthma comparing with pulmonary parameters (p<0.05), and was most sensitive and specific when combined with MMEF/MEF50 compared with single diagnostic parameters (p<0.05). Conclusions FeNO combined with pulmonary function parameters of MMEF/MEF50 showed increased sensitivity and specificity for the diagnosis of cough variant asthma.
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Affiliation(s)
- Haiyan Zhu
- Department of Pediatrics, The Affiliated Huaian No.1 Peoples' Hospital of Nanjing Medical University, Huai'an, Jiangsu, China (mainland)
| | - Rongrong Zhang
- Department of Pediatrics, The Affiliated Huaian No.1 Peoples' Hospital of Nanjing Medical University, Huai'an, Jiangsu, China (mainland)
| | - Chuangli Hao
- Department of Respiratory Diseases, Childrens' Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xingmei Yu
- Department of Respiratory Diseases, Childrens' Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhaofang Tian
- Department of Pediatrics, The Affiliated Huaian No.1 Peoples' Hospital of Nanjing Medical University, Huai'an, Jiangsu, China (mainland)
| | - Yufang Yuan
- Department of Pediatrics, The Affiliated Huaian No.1 Peoples' Hospital of Nanjing Medical University, Huai'an, Jiangsu, China (mainland)
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21
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Langton D, Ing A, Sha J, Bennetts K, Hersch N, Kwok M, Plummer V, Thien F, Farah C. Measuring the effects of bronchial thermoplasty using oscillometry. Respirology 2018; 24:431-436. [PMID: 30419608 DOI: 10.1111/resp.13439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/29/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Bronchial thermoplasty (BT) has been consistently shown to reduce symptoms, exacerbations and the need for reliever medication in patients with severe asthma. Paradoxically, no consistent improvement in spirometry has been demonstrated. It has been suggested that this is due to a reduction in peripheral resistance in small airways, not captured by spirometry. Therefore, in this study, we evaluate the response to BT using oscillometry. METHODS A total of 43 patients with severe asthma from two centres were evaluated at baseline, 6 weeks and 6 months post BT, using spirometry, plethysmography and oscillometry, in addition to medication usage, exacerbation frequency and the Asthma Control Questionnaire (5-item version) (ACQ-5). RESULTS The mean age was 58.4 ± 11.2 years, forced expiratory volume in 1 s (FEV1 ) 55.5 ± 20.1% predicted, forced expiratory ratio 53.0 ± 14.5% and FEV1 response to salbutamol was 14.0 ± 14.5%. Following BT, the group responded to treatment with an improvement in ACQ-5 from 2.9 ± 0.9 at baseline to 1.7 ± 1.1 at 6 months (P < 0.005). There was an 81% reduction in exacerbation frequency (P < 0.001) and 50% of patients were weaned completely from maintenance oral corticosteroids. No changes after treatment were observed in spirometry but the residual volume reduced from 147 ± 38% to 139 ± 39% predicted (P < 0.01). Baseline oscillometry demonstrated high levels of resistance at 5 Hz with normal resistance at 20 Hz, indicating resistance in the small airways was elevated, but no changes were observed in any oscillometry parameter after BT treatment. CONCLUSION Lung impedance measured with oscillometry did not change following BT despite marked clinical improvements in patients with severe asthma.
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Affiliation(s)
- David Langton
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Alvin Ing
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Sydney Adventist Hospital Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Joy Sha
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, VIC, Australia
| | - Kim Bennetts
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, VIC, Australia
| | - Nicole Hersch
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - McKinny Kwok
- Sydney Adventist Hospital Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Virginia Plummer
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Francis Thien
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Department of Respiratory Medicine, Eastern Health, Melbourne, VIC, Australia
| | - Claude Farah
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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22
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Asthma control in preschool children with small airway function as measured by IOS and fractional exhaled nitric oxide. Respir Med 2018; 145:8-13. [PMID: 30509720 DOI: 10.1016/j.rmed.2018.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/04/2018] [Accepted: 10/10/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study investigated the accuracy of impulse oscillometry (IOS) combined with fractional exhaled nitric oxide (FeNO) to assess asthma control among preschool children. METHODS A total of 79 preschool children(3-6 year old) with asthma and 25 healthy preschool children who visited a paediatrician were enrolled in this study. All of the children were tested for allergens, respiratory system resistance (at 5 and 20 Hz [R5, R20]), respiratory system reactance (at 5 Hz [X5]), the resonant frequency of reactance (Fres), and the area under the reactance curve (between 5 Hz and Fres (reactance area [AX]) using IOS and FeNO. A paediatric respiratory specialist who was unaware of the IOS and FeNO results assigned children with asthma to either the asthma-controlled group (n = 27) or the asthma-uncontrolled group (n = 52) based on the Global Initiative for Asthma (GINA) criteria. A healthy control group (n = 25) was also included. The relationships between the FeNO and IOS values as well as the asthma control of the three groups were analysed, and the areas under the curve (AUCs) were calculated for each measure. RESULTS (1) During the controlled group, means±standard deviations of AX, R5-20, R5, X5 and FeNO were 26.15 ± 7.534, 3.52 ± 1.311,9.97 ± 1.576,-3.85 ± 0.572,-3.85 ± 0.572. During the uncontrolled group, means±standard deviations of AX,R5-20,R5,X5 and FeNO were 38.34 ± 13.563,5.36 ± 1.545,11.41 ± 2.029,-5.07 ± 1.554,36.40 ± 21.07. Among preschool children, significant differences were observed between the controlled and uncontrolled group with regard to the small airway functional parameters (AX, R5-20, R5, and X5) and FeNO(P <0.05).(2) A receiver operating characteristic (ROC) analysis showed that the AUCs were 0.786 for FeNO alone, 0.751 for X5 alone, and 0.866 for X5 combined with FeNO (cut-off value: 27 ppb). CONCLUSION FeNO combined with the small airway function parameter X5 accurately assessed asthma control among preschool children.
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23
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Langton D, Ing A, Bennetts K, Wang W, Farah C, Peters M, Plummer V, Thien F. Bronchial thermoplasty reduces gas trapping in severe asthma. BMC Pulm Med 2018; 18:155. [PMID: 30249234 PMCID: PMC6154954 DOI: 10.1186/s12890-018-0721-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background In randomized controlled trials, bronchial thermoplasty (BT) has been proven to reduce symptoms in severe asthma, but the mechanisms by which this is achieved are uncertain as most studies have shown no improvement in spirometry. We postulated that BT might improve lung mechanics by altering airway resistance in the small airways of the lung in ways not measured by FEV1. This study aimed to evaluate changes in measures of gas trapping by body plethysmography. Methods A prospective cohort of 32 consecutive patients with severe asthma who were listed for BT at two Australian university hospitals were evaluated at three time points, namely baseline, and then 6 weeks and 6 months post completion of all procedures. At each evaluation, medication usage, symptom scores (Asthma Control Questionnaire, ACQ-5) and exacerbation history were obtained, and lung function was evaluated by (i) spirometry (ii) gas diffusion (KCO) and (iii) static lung volumes by body plethysmography. Results ACQ-5 improved from 3.0 ± 0.8 at baseline to 1.5 ± 0.9 at 6 months (mean ± SD, p < 0.001, paired t-test). Daily salbutamol usage improved from 8.3 ± 5.6 to 3.5 ± 4.3 puffs per day (p < 0.001). Oral corticosteroid requiring exacerbations reduced from 2.5 ± 2.0 in the 6 months prior to BT, to 0.6 ± 1.3 in the 6 months after BT (p < 0.001). The mean baseline FEV1 was 57.8 ± 18.9%predicted, but no changes in any spirometric parameter were observed after BT. KCO was also unaltered by BT. A significant reduction in gas trapping was observed with Residual Volume (RV) falling from 146 ± 37% predicted at baseline to 136 ± 29%predicted 6 months after BT (p < 0.005). Significant improvements in TLC and FRC were also observed. These changes were evident at the 6 week time period and maintained at 6 months. The change in RV was inversely correlated with the baseline FEV1 (r = 0.572, p = 0.001), and in patients with a baseline FEV1 of < 60%predicted, the RV/TLC ratio fell by 6.5 ± 8.9%. Conclusion Bronchial thermoplasty improves gas trapping and this effect is greatest in the most severely obstructed patients. The improvement may relate to changes in the mechanical properties of small airways that are not measured with spirometry.
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Affiliation(s)
- David Langton
- Department of Thoracic Medicine, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC, 3199, Australia. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic, Australia.
| | - Alvin Ing
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Department of Thoracic Medicine, Concord Hospital, Concord, NSW, Australia
| | - Kim Bennetts
- Department of Thoracic Medicine, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC, 3199, Australia
| | - Wei Wang
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic, Australia
| | - Claude Farah
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Matthew Peters
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Department of Thoracic Medicine, Concord Hospital, Concord, NSW, Australia
| | - Virginia Plummer
- Department of Thoracic Medicine, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC, 3199, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic, Australia
| | - Francis Thien
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic, Australia.,Department of Respiratory Medicine, Eastern Health, Vic, Boxhill, Australia
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24
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Alcázar-Navarrete B, Castellano Miñán F, Santiago Díaz P, Ruiz Rodríguez O, Romero Palacios PJ. Alveolar and Bronchial Nitric Oxide in Chronic Obstructive Pulmonary Disease and Asthma–COPD Overlap. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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25
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Racette C, Lu Z, Kowalik K, Cheng O, Bendiak G, Amin R, Dubeau A, Jensen R, Balkovec S, Gustafsson P, Ratjen F, Subbarao P. Lung clearance index is elevated in young children with symptom-controlled asthma. Health Sci Rep 2018; 1:e58. [PMID: 30623093 PMCID: PMC6266588 DOI: 10.1002/hsr2.58] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/11/2018] [Accepted: 05/18/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pulmonary function testing has been recommended as an adjunct to symptom monitoring for assessment of asthma control. Lung clearance index (LCI) measures ventilation inhomogeneity and is thought to represent changes in the small airways. It has been proposed as a useful early marker of airway disease in asthmatic subjects, and determining it is feasible in preschool children. This study aims to assess whether LCI remains elevated in symptomatically controlled asthmatic children with a history of severe asthma, compared with healthy controls. A secondary aim was to determine whether the results were consistent across the preschool and school-aged populations. METHODS Using a case-control design, we compared 33 children with currently well-controlled symptoms who had a history of severe asthma, to 45 healthy controls (age 3-15 years) matched by age, height, and sex. We performed multiple breath washout tests using sulfur hexafluoride as a tracer gas, to determine their LCI and Scond values. RESULTS In the overall study, LCI z-score values were on average 0.86 units (95% confidence interval: 0.24-1.47, P = 0.01, t-test) higher in children with a history of severe asthma with current well-controlled symptoms compared with healthy controls. In addition, within the subgroup of preschool children (age ≤ 6), the asthmatic had significantly higher LCI z-score values than their healthy controls peers (mean (SD), 0.57 (2.18) vs -1.10 (1.00), P = 0.03, t-test). Twenty-seven percent (27%; 9/33) of subjects had an LCI value greater than the upper limit of our healthy controls despite being symptom controlled. Amongst preschool children, 5 (42%; 5/12) of the asthmatic children had abnormal LCI at the individual level. CONCLUSIONS LCI is elevated in children with asthma, which may be driven by differences in the preschool population. LCI may be useful in defining preschool asthma endotypes with persistent ventilation inhomogeneity despite symptomatic control.
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Affiliation(s)
- Christine Racette
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
| | - Zihang Lu
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Krzysztof Kowalik
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada
| | - Olivia Cheng
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
| | - Glenda Bendiak
- Department of PediatricsUniversity of CalgaryCalgaryAlbertaCanada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
| | - Aimee Dubeau
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
| | - Renée Jensen
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
| | - Susan Balkovec
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
| | | | - Felix Ratjen
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of PediatricsHospital for Sick Children and Research InstituteTorontoOntarioCanada
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada
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26
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Virchow JC, Poli G, Herpich C, Kietzig C, Ehlich H, Braeutigam D, Sommerer K, Häussermann S, Mariotti F. Lung Deposition of the Dry Powder Fixed Combination Beclometasone Dipropionate Plus Formoterol Fumarate Using NEXThaler ® Device in Healthy Subjects, Asthmatic Patients, and COPD Patients. J Aerosol Med Pulm Drug Deliv 2018; 31:269-280. [PMID: 29989511 PMCID: PMC6161336 DOI: 10.1089/jamp.2016.1359] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: This study evaluated the lung deposition and the distribution pattern in the airways of a fixed combination of beclometasone dipropionate (BDP) and formoterol fumarate (FF) (100/6 μg) delivered as an extrafine dry powder formulation (mass median aerodynamic diameter, MMAD (μm) BDP = 1.5; FF = 1.4) through the NEXThaler® device in healthy subjects, asthmatics, and patients with COPD. Methods: Healthy subjects (n = 10), asthmatic patients (n = 9; 30%≤FEV1 < 80%), and COPD patients (n = 9; FEV1/FVC ≤70%, 30%≤FEV1 < 50%) completed this open-label, single administration (inhalation of four actuations) parallel group study. After inhalation of 99mTc-radiolabeled BDP/FF combination (radiolabeled BDP + unlabeled FF), the drug deposition was assessed using a gamma-scintigraphy technique. Patients' lung function was assessed. Results: No significant difference in drug deposition was observed between the three study groups. Mean lung deposition, extrathoracic deposition, and amount exhaled ranged, respectively, between 54.9% and 56.2%, between 41.8% and 43.2%, and between 1.6% and 3.3% of BDP emitted dose (71.7 ± 2.5 μg) for the three study groups. The central to peripheral ratio (reflecting the lung distribution pattern) ranged between 1.23 and 2.02 for the three study groups, indicating a distribution of the drug throughout the airways, including periphery. The study treatment produced a forced expiratory volume in one second (FEV1) increase over time, reaching a maximum improvement generally within 1–4 hours. Conclusions: The fixed extrafine dry powder combination BDP/FF (100/6 μg) administered through the DPI NEXThaler® achieved similar intrapulmonary deposition in healthy subjects, in asthmatic patients, and COPD patients (approximately 55% of emitted dose) irrespective of the underlying lung disease with a negligible amount of exhaled particles. The study showed high reliability of the device, reproducible dosing, and distribution throughout the lungs. The results supported the concept of efficient delivery of the combination to the target pulmonary regions, thanks to the extrafine formulation. FEV1 profile confirmed a relevant pharmacodynamic effect of the product.
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Affiliation(s)
| | - Gianluigi Poli
- 2 Global Clinical Development, Chiesi Farmaceutici S.p.A , Parma, Italy
| | | | | | | | | | | | | | - Fabrizia Mariotti
- 2 Global Clinical Development, Chiesi Farmaceutici S.p.A , Parma, Italy
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27
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A Review of Airborne Particulate Matter Effects on Young Children’s Respiratory Symptoms and Diseases. ATMOSPHERE 2018. [DOI: 10.3390/atmos9040150] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Alveolar and Bronchial Nitric Oxide in Chronic Obstructive Pulmonary Disease and Asthma-COPD Overlap. Arch Bronconeumol 2018; 54:414-419. [PMID: 29627118 DOI: 10.1016/j.arbres.2018.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Exhaled nitric oxide (FENO) measurements differentiate COPD phenotypes from asthma-COPD overlap (ACO). To date, no study has been conducted to determine whether alveolar and bronchial components differ in this group of patients. METHODS This was an observational cross-sectional study recruiting ambulatory COPD patients. FENO was measured, differentiating alveolar (CANO) from bronchial (JawNO) components using a multiple-flow technique. CANO and JawNO values were compared between eosinophilic COPD patients (defined as ≥ 300 eosinophils/μL in peripheral blood test, or ≥ 2% eosinophils or ≥ 3% eosinophils), and a linear regression analysis was performed to determine clinical and biological variables related to these measurements. RESULTS 73 COPD patients were included in the study. Eosinophil counts were associated with increased values of CANO and JawNO (for the latter only the association with ≥ 300 or ≥ 3% eosinophils was significant). CANO was also associated with CRP, and JawNO with smoking. CONCLUSIONS Patients with COPD and ACO characteristics show increased inflammation in the large and small airways. CANO and JawNO are associated with clinical and biological variables.
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29
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Capaldi DPI, Eddy RL, Svenningsen S, Guo F, Baxter JSH, McLeod AJ, Nair P, McCormack DG, Parraga G. Free-breathing Pulmonary MR Imaging to Quantify Regional Ventilation. Radiology 2018; 287:693-704. [PMID: 29470939 DOI: 10.1148/radiol.2018171993] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To measure regional specific ventilation with free-breathing hydrogen 1 (1H) magnetic resonance (MR) imaging without exogenous contrast material and to investigate correlations with hyperpolarized helium 3 (3He) MR imaging and pulmonary function test measurements in healthy volunteers and patients with asthma. Materials and Methods Subjects underwent free-breathing 1H and static breath-hold hyperpolarized 3He MR imaging as well as spirometry and plethysmography; participants were consecutively recruited between January and June 2017. Free-breathing 1H MR imaging was performed with an optimized balanced steady-state free-precession sequence; images were retrospectively grouped into tidal inspiration or tidal expiration volumes with exponentially weighted phase interpolation. MR imaging volumes were coregistered by using optical flow deformable registration to generate 1H MR imaging-derived specific ventilation maps. Hyperpolarized 3He MR imaging- and 1H MR imaging-derived specific ventilation maps were coregistered to quantify regional specific ventilation within hyperpolarized 3He MR imaging ventilation masks. Differences between groups were determined with the Mann-Whitney test and relationships were determined with Spearman (ρ) correlation coefficients. Statistical analyses were performed with software. Results Thirty subjects (median age: 50 years; interquartile range [IQR]: 30 years), including 23 with asthma and seven healthy volunteers, were evaluated. Both 1H MR imaging-derived specific ventilation and hyperpolarized 3He MR imaging-derived ventilation percentage were significantly greater in healthy volunteers than in patients with asthma (specific ventilation: 0.14 [IQR: 0.05] vs 0.08 [IQR: 0.06], respectively, P < .0001; ventilation percentage: 99% [IQR: 1%] vs 94% [IQR: 5%], P < .0001). For all subjects, 1H MR imaging-derived specific ventilation correlated with plethysmography-derived specific ventilation (ρ = 0.54, P = .002) and hyperpolarized 3He MR imaging-derived ventilation percentage (ρ = 0.67, P < .0001) as well as with forced expiratory volume in 1 second (FEV1) (ρ = 0.65, P = .0001), ratio of FEV1 to forced vital capacity (ρ = 0.75, P < .0001), ratio of residual volume to total lung capacity (ρ = -0.68, P < .0001), and airway resistance (ρ = -0.51, P = .004). 1H MR imaging-derived specific ventilation was significantly greater in the gravitational-dependent versus nondependent lung in healthy subjects (P = .02) but not in patients with asthma (P = .1). In patients with asthma, coregistered 1H MR imaging specific ventilation and hyperpolarized 3He MR imaging maps showed that specific ventilation was diminished in corresponding 3He MR imaging ventilation defects (0.05 ± 0.04) compared with well-ventilated regions (0.09 ± 0.05) (P < .0001). Conclusion 1H MR imaging-derived specific ventilation correlated with plethysmography-derived specific ventilation and ventilation defects seen by using hyperpolarized 3He MR imaging. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Dante P I Capaldi
- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
| | - Rachel L Eddy
- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
| | - Sarah Svenningsen
- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
| | - Fumin Guo
- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
| | - John S H Baxter
- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
| | - A Jonathan McLeod
- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
| | - Parameswaran Nair
- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
| | - David G McCormack
- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
| | - Grace Parraga
- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
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- From the Robarts Research Institute (D.P.I.C., R.L.E., S.S., F.G., J.S.H.B., A.J.M., G.P.), Department of Medical Biophysics (D.P.I.C., R.L.E., G.P.), Graduate Program in Biomedical Engineering (F.G., J.S.H.B., A.J.M.), and Department of Medicine, Division of Respirology (D.G.M.), Western University, University of Western Ontario, 1151 Richmond St N, London, ON, Canada N6A 5B7; and Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada (S.S., P.N., G.P.)
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Abstract
Asthma is an inflammatory condition of both the small and large airways. Recently the small airways have gained attention as studies have shown significant inflammation in the small airways in all severities of asthma. This inflammation has correlated with peripheral airway resistance and as a result, noninvasive methods to reliably measure small airways have been pursued. In addition, recent changes in asthma inhalers have led to alterations in drug formulations and the development of extrafine particle inhalers that improve delivery to the distal airways.
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Affiliation(s)
- Lindsay K Finkas
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Richard Martin
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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31
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Feng-Jia C, Xin-Yan H, Geng-Peng L, Yang-Li L, Can-Mao X. Validity of fractional exhaled nitric oxide and small airway function indices in diagnosis of cough-variant asthma. J Asthma 2017; 55:750-755. [PMID: 28846444 DOI: 10.1080/02770903.2017.1366509] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Fractional exhaled nitric oxide (FeNO) is a non-invasive method used to reveal the eosinophilic inflammation of airway and to diagnose and manage asthma. The use of FeNO measurement or its combination with the small airway function in differentiating CVA patients from chronic cough patients is unexplored. METHODS From December 2012 to June 2016, patients with chronic non-productive cough for more than 8 weeks based on physician's opinion were subjected to FeNO, pulmonary function, and bronchial hyperresponsiveness (BHR) tests. Receiver operating characteristic (ROC) curves were obtained to evaluate the clinical value of FeNO and small airways indices in CVA diagnosis. The optimal cutoff point for the level of FeNO was also determined. RESULTS The FeNO value in the CVA group was significantly higher than that in the non-cough-variant asthma (NCVA) group [42(41) parts per billion (ppb) vs. (16(11) ppb), P < 0.05]. The area under the ROC curve was estimated to be 0.874 for FeNO. An optimal cutoff point of 25 ppb had respective sensitivity and specificity values of 81.3% and 84.0% in differentiating CVA patients from NCVA patients. The CVA group showed small airway dysfunction, and the small airway resistance was significantly higher than in the NCVA group. The area under the ROC curve of FeNO combined with maximal midexpiratory flow (MEF) (% predicted) was 0.883, and that combined with MEF50 (% predicted) was 0.886. CONCLUSIONS The measurement of FeNO is a non-invasive, reproducible, and sensitive method of differentiating CVA patients from NCVA patients. A combination of the level of FeNO (25 ppb) and the abnormal small airway function suggested higher CVA possibility, thereby resulting in a rapid diagnosis. Unnecessary treatments are avoided. This finding provides a new perspective for the management of patients with CVA.
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Affiliation(s)
- Chen Feng-Jia
- a Department of Respiratory Disease, Institute of Respiratory Diseases, The First Affiliated Hospital , Sun Yat-sen University , Guangzhou, Guangdong , P.R. China
| | - Huang Xin-Yan
- a Department of Respiratory Disease, Institute of Respiratory Diseases, The First Affiliated Hospital , Sun Yat-sen University , Guangzhou, Guangdong , P.R. China
| | - Lin Geng-Peng
- a Department of Respiratory Disease, Institute of Respiratory Diseases, The First Affiliated Hospital , Sun Yat-sen University , Guangzhou, Guangdong , P.R. China
| | - Liu Yang-Li
- a Department of Respiratory Disease, Institute of Respiratory Diseases, The First Affiliated Hospital , Sun Yat-sen University , Guangzhou, Guangdong , P.R. China
| | - Xie Can-Mao
- a Department of Respiratory Disease, Institute of Respiratory Diseases, The First Affiliated Hospital , Sun Yat-sen University , Guangzhou, Guangdong , P.R. China
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32
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Capaldi DP, Sheikh K, Eddy RL, Guo F, Svenningsen S, Nair P, McCormack DG, Parraga G. Free-breathing Functional Pulmonary MRI: Response to Bronchodilator and Bronchoprovocation in Severe Asthma. Acad Radiol 2017; 24:1268-1276. [PMID: 28551402 DOI: 10.1016/j.acra.2017.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/05/2017] [Accepted: 04/08/2017] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES Ventilation heterogeneity is a hallmark feature of asthma. Our objective was to evaluate ventilation heterogeneity in patients with severe asthma, both pre- and post-salbutamol, as well as post-methacholine (MCh) challenge using the lung clearance index, free-breathing pulmonary 1H magnetic resonance imaging (FDMRI), and inhaled-gas MRI ventilation defect percent (VDP). MATERIALS AND METHODS Sixteen severe asthmatics (49 ± 10 years) provided written informed consent to an ethics board-approved protocol. Spirometry, plethysmography, and multiple breath nitrogen washout to measure the lung clearance index were performed during a single visit within 15 minutes of MRI. Inhaled-gas MRI and FDMRI were performed pre- and post-bronchodilator to generate VDP. For asthmatics with forced expiratory volume in 1 second (FEV1) >70%predicted, MRI was also performed before and after MCh challenge. Wilcoxon signed-rank tests, Spearman correlations, and a repeated-measures analysis of variance were performed. RESULTS Hyperpolarized 3He (P = .02) and FDMRI (P = .02) VDP significantly improved post-salbutamol and for four asthmatics who could perform MCh (n = 4). 3He and FDMRI VDP significantly increased at the provocative concentration of MCh, resulting in a 20% decrease in FEV1 (PC20) and decreased post-bronchodilator (P = .02), with a significant difference between methods (P = .01). FDMRI VDP was moderately correlated with 3He VDP (ρ = .61, P = .01), but underestimated VDP relative to 3He VDP (-6 ± 9%). Whereas 3He MRI VDP was significantly correlated with the lung clearance index, FDMRI was not (ρ = .49, P = .06). CONCLUSIONS FDMRI VDP generated in free-breathing asthmatic patients was correlated with static inspiratory breath-hold 3He MRI VDP but underestimated VDP relative to 3He MRI VDP. Although less sensitive to salbutamol and MCh, FDMRI VDP may be considered for asthma patient evaluations at centers without inhaled-gas MRI.
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33
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Hoffman SM, Qian X, Nolin JD, Chapman DG, Chia SB, Lahue KG, Schneider R, Ather JL, Randall MJ, McMillan DH, Jones JT, Taatjes DJ, Aliyeva M, Daphtary N, Abdalla S, Lundblad LKA, Ho YS, Anathy V, Irvin CG, Wouters EFM, Reynaert NL, Dixon AE, van der Vliet A, Poynter ME, Janssen-Heininger YMW. Ablation of Glutaredoxin-1 Modulates House Dust Mite-Induced Allergic Airways Disease in Mice. Am J Respir Cell Mol Biol 2017; 55:377-86. [PMID: 27035878 DOI: 10.1165/rcmb.2015-0401oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Protein S-glutathionylation (PSSG) is an oxidant-induced post-translational modification of protein cysteines that impacts structure and function. The oxidoreductase glutaredoxin-1 (Glrx1) under physiological conditions catalyzes deglutathionylation and restores the protein thiol group. The involvement of Glrx1/PSSG in allergic inflammation induced by asthma-relevant allergens remains unknown. In the present study, we examined the impact of genetic ablation of Glrx1 in the pathogenesis of house dust mite (HDM)-induced allergic airways disease in mice. Wild-type (WT) or Glrx1(-/-) mice were instilled intranasally with HDM on 5 consecutive days for 3 weeks. As expected, overall PSSG was increased in Glrx1(-/-) HDM mice as compared with WT animals. Total cells in bronchoalveolar lavage fluid were similarly increased in HDM-treated WT and Glrx1(-/-) mice. However, in response to HDM, mice lacking Glrx1 demonstrated significantly more neutrophils and macrophages but fewer eosinophils as compared with HDM-exposed WT mice. mRNA expression of the Th2-associated cytokines IL-13 and IL-6, as well as mucin-5AC (Muc5ac), was significantly attenuated in Glrx1(-/-) HDM-treated mice. Conversely, mRNA expression of IFN-γ and IL-17A was increased in Glrx1(-/-) HDM mice compared with WT littermates. Restimulation of single-cell suspensions isolated from lungs or spleens with HDM resulted in enhanced IL-17A and decreased IL-5 production in cells derived from inflamed Glrx1(-/-) mice compared with WT animals. Finally, HDM-induced tissue damping and elastance were significantly attenuated in Glrx1(-/-) mice compared with WT littermates. These results demonstrate that the Glrx1-PSSG axis plays a pivotal role in HDM-induced allergic airways disease in association with enhanced type 2 inflammation and restriction of IFN-γ and IL-17A.
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Affiliation(s)
| | - Xi Qian
- Departments of 1 Pathology and Laboratory Medicine and
| | - James D Nolin
- Departments of 1 Pathology and Laboratory Medicine and
| | | | - Shi Biao Chia
- Departments of 1 Pathology and Laboratory Medicine and
| | | | | | | | | | | | - Jane T Jones
- Departments of 1 Pathology and Laboratory Medicine and
| | | | | | | | - Sarah Abdalla
- Departments of 1 Pathology and Laboratory Medicine and
| | | | - Ye-Shih Ho
- 3 Institute of Environmental Health Sciences, Wayne State University, Detroit, Michigan; and
| | - Vikas Anathy
- Departments of 1 Pathology and Laboratory Medicine and
| | | | - Emiel F M Wouters
- 4 Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Niki L Reynaert
- 4 Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anne E Dixon
- 2 Medicine, University of Vermont, Burlington, Vermont
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34
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Port J, Tao Z, Junger A, Joppek C, Tempel P, Husemann K, Singer F, Latzin P, Yammine S, Nagel JH, Kohlhäufl M. A simple method to reconstruct the molar mass signal of respiratory gas to assess small airways with a double-tracer gas single-breath washout. Med Biol Eng Comput 2017; 55:1975-1987. [PMID: 28357624 DOI: 10.1007/s11517-017-1633-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/13/2017] [Indexed: 01/13/2023]
Abstract
For the assessment of small airway diseases, a noninvasive double-tracer gas single-breath washout (DTG-SBW) with sulfur hexafluoride (SF6) and helium (He) as tracer components has been proposed. It is assumed that small airway diseases may produce typical ventilation inhomogeneities which can be detected within one single tidal breath, when using two tracer components. Characteristic parameters calculated from a relative molar mass (MM) signal of the airflow during the washout expiration phase are analyzed. The DTG-SBW signal is acquired by subtracting a reconstructed MM signal without tracer gas from the signal measured with an ultrasonic sensor during in- and exhalation of the double-tracer gas for one tidal breath. In this paper, a simple method to determine the reconstructed MM signal is presented. Measurements on subjects with and without obstructive lung diseases including the small airways have shown high reliability and reproducibility of this method.
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Affiliation(s)
- Johannes Port
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany.
| | - Ziran Tao
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Annika Junger
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Christoph Joppek
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Philipp Tempel
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Kim Husemann
- Klinik Schillerhöhe, Zentrum für Pneumologie und Thoraxchirurgie, Robert-Bosch-Hospital, Gerlingen, Germany.,Internistische Facharztpraxis für Pneumologie, Allergologie, Thoraxonkologie, Bronchoskopie und Schlafmedizin, MVZ Klinikum Kempten GmbH, Kempten, Germany
| | - Florian Singer
- University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp Latzin
- University Children's Hospital Basel, Basel, Switzerland
| | - Sophie Yammine
- University Children's Hospital Basel, Basel, Switzerland
| | - Joachim H Nagel
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Martin Kohlhäufl
- Klinik Schillerhöhe, Zentrum für Pneumologie und Thoraxchirurgie, Robert-Bosch-Hospital, Gerlingen, Germany
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35
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Stankiewicz B, Pałko KJ, Darowski M, Zieliński K, Kozarski M. A new infant hybrid respiratory simulator: preliminary evaluation based on clinical data. Med Biol Eng Comput 2017; 55:1937-1948. [PMID: 28343335 DOI: 10.1007/s11517-017-1635-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/13/2017] [Indexed: 11/28/2022]
Abstract
A new hybrid (numerical-physical) simulator of the respiratory system, designed to simulate spontaneous and artificial/assisted ventilation of preterm and full-term infants underwent preliminary evaluation. A numerical, seven-compartmental model of the respiratory system mechanics allows the operator to simulate global and peripheral obstruction and restriction of the lungs. The physical part of the simulator is a piston-based construction of impedance transformer. LabVIEW real-time software coordinates the work of both parts of the simulator and its interaction with a ventilator. Using clinical data, five groups of "artificial infants" were examined: healthy full-term infants, very low-birth-weight preterm infants successfully (VLBW) and unsuccessfully extubated (VLBWun) and extremely low-birth-weight preterm infants without (ELBW) and with bronchopulmonary dysplasia (ELBW_BPD). Pressure-controlled ventilation was simulated to measure peak inspiratory pressure, mean airway pressure, total (patient + endotracheal tube) airway resistance (R), total dynamic compliance of the respiratory system (C), and total work of breathing by the ventilator (WOB). The differences between simulation and clinical parameters were not significant. High correlation coefficients between both types of data were obtained for R, C, and WOB (γ R = 0.99, P < 0.0005; γ C = 0.85, P < 0.005; γWOB = 0.96, P < 0.05, respectively). Thus, the simulator accurately reproduces infant respiratory system mechanics.
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Affiliation(s)
- Barbara Stankiewicz
- Department of Biomedical Systems and Technologies, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Street, Warsaw, Poland.
| | - Krzysztof J Pałko
- Department of Biomedical Systems and Technologies, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Street, Warsaw, Poland
| | - Marek Darowski
- Department of Biomedical Systems and Technologies, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Street, Warsaw, Poland
| | - Krzysztof Zieliński
- Department of Biomedical Systems and Technologies, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Street, Warsaw, Poland
| | - Maciej Kozarski
- Department of Biomedical Systems and Technologies, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 4 Trojdena Street, Warsaw, Poland
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36
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Singhania A, Rupani H, Jayasekera N, Lumb S, Hales P, Gozzard N, Davies DE, Woelk CH, Howarth PH. Altered Epithelial Gene Expression in Peripheral Airways of Severe Asthma. PLoS One 2017; 12:e0168680. [PMID: 28045928 PMCID: PMC5207492 DOI: 10.1371/journal.pone.0168680] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 12/05/2016] [Indexed: 12/13/2022] Open
Abstract
Management of severe asthma remains a challenge despite treatment with glucocorticosteroid therapy. The majority of studies investigating disease mechanisms in treatment-resistant severe asthma have previously focused on the large central airways, with very few utilizing transcriptomic approaches. The small peripheral airways, which comprise the majority of the airway surface area, remain an unexplored area in severe asthma and were targeted for global epithelial gene expression profiling in this study. Differences between central and peripheral airways were evaluated using transcriptomic analysis (Affymetrix HG U133 plus 2.0 GeneChips) of epithelial brushings obtained from severe asthma patients (N = 17) and healthy volunteers (N = 23). Results were validated in an independent cohort (N = 10) by real-time quantitative PCR. The IL-13 disease signature that is associated with an asthmatic phenotype was upregulated in severe asthmatics compared to healthy controls but was predominantly evident within the peripheral airways, as were genes related to mast cell presence. The gene expression response associated with glucocorticosteroid therapy (i.e. FKBP5) was also upregulated in severe asthmatics compared to healthy controls but, in contrast, was more pronounced in central airways. Moreover, an altered epithelial repair response (e.g. FGFBP1) was evident across both airway sites reflecting a significant aspect of disease in severe asthma unadressed by current therapies. A transcriptomic approach to understand epithelial activation in severe asthma has thus highlighted the need for better-targeted therapy to the peripheral airways in severe asthma, where the IL-13 disease signature persists despite treatment with currently available therapy.
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Affiliation(s)
- Akul Singhania
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Hitasha Rupani
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Nivenka Jayasekera
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | | | | | - Donna E. Davies
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton Centre for Biomedical Research, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Christopher H. Woelk
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- * E-mail: (CHH); (PHH)
| | - Peter H. Howarth
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton Centre for Biomedical Research, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- * E-mail: (CHH); (PHH)
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37
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Braido F, Scichilone N, Lavorini F, Usmani OS, Dubuske L, Boulet LP, Mosges R, Nunes C, Sánchez-Borges M, Ansotegui IJ, Ebisawa M, Levi-Schaffer F, Rosenwasser LJ, Bousquet J, Zuberbier T, Canonica GW. Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA 2LEN). Asthma Res Pract 2016; 2:12. [PMID: 27965780 PMCID: PMC5142416 DOI: 10.1186/s40733-016-0027-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy. This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.
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Affiliation(s)
- F Braido
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - N Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - F Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - O S Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - L Dubuske
- Immunology Research Institute of New England, Harvard, USA
| | - L P Boulet
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - R Mosges
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - C Nunes
- Centro de ImmunoAlergologia de Algarve, Porto, Portugal
| | - M Sánchez-Borges
- Centro Medico Docente La Trinidad, Caracas, Venezuela ; Clinica El Avila, Caracas, Venezuela
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Carretera Leioa-Inbe, Erandio, Bilbao, Spain
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - F Levi-Schaffer
- Department of Pharmacology and Experimental Therapeutics, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - L J Rosenwasser
- University of Missouri - Kansas City, School of Medicine, Kansas City, Missouri USA
| | - J Bousquet
- Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Montpellier, France
| | - T Zuberbier
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Walter Canonica
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
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38
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Braido F, Scichilone N, Lavorini F, Usmani OS, Dubuske L, Boulet LP, Mosges R, Nunes C, Sanchez-Borges M, Ansotegui IJ, Ebisawa M, Levi-Schaffer F, Rosenwasser LJ, Bousquet J, Zuberbier T, Canonica GW, Cruz A, Yanez A, Yorgancioglu A, Deleanu D, Rodrigo G, Berstein J, Ohta K, Vichyanond P, Pawankar R, Gonzalez-Diaz SN, Nakajima S, Slavyanskaya T, Fink-Wagner A, Loyola CB, Ryan D, Passalacqua G, Celedon J, Ivancevich JC, Dobashi K, Zernotti M, Akdis M, Benjaponpitak S, Bonini S, Burks W, Caraballo L, El-Sayed ZA, Fineman S, Greenberger P, Hossny E, Ortega-Martell JA, Saito H, Tang M, Zhang L. Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA 2LEN). World Allergy Organ J 2016; 9:37. [PMID: 27800118 PMCID: PMC5084415 DOI: 10.1186/s40413-016-0123-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/24/2016] [Indexed: 12/21/2022] Open
Abstract
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy. This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.
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Affiliation(s)
- F Braido
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - N Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - F Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - O S Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - L Dubuske
- Immunology Research Institute of New England, Harvard, USA
| | - L P Boulet
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - R Mosges
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - C Nunes
- Centro de ImmunoAlergologia de Algarve, Porto, Portugal
| | - M Sanchez-Borges
- Centro Medico Docente La Trinidad, Caracas, Venezuela ; Clinica El Avila, Caracas, Venezuela
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Carretera Leioa-Inbe, Erandio, Bilbao Spain
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - F Levi-Schaffer
- Department of Pharmacology and Experimental Therapeutics, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - L J Rosenwasser
- University of Missouri - Kansas City, School of Medicine, Kansas City, Missouri USA
| | - J Bousquet
- Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Montpellier, France
| | - T Zuberbier
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Walter Canonica
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A Cruz
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A Yanez
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A Yorgancioglu
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - D Deleanu
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - G Rodrigo
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J Berstein
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - K Ohta
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - P Vichyanond
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - R Pawankar
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S N Gonzalez-Diaz
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S Nakajima
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - T Slavyanskaya
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A Fink-Wagner
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - C Baez Loyola
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - D Ryan
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J Celedon
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J C Ivancevich
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - K Dobashi
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - M Zernotti
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - M Akdis
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S Benjaponpitak
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S Bonini
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - W Burks
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - L Caraballo
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Z Awad El-Sayed
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S Fineman
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - P Greenberger
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - E Hossny
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J A Ortega-Martell
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - H Saito
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - M Tang
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - L Zhang
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
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Liu L, Liu W, Liu C, Wang D, Zhao J, Wang J, Wu J, Liu T, Zhang Y, Liu Y, Cao L, Dong L. Study on small airway function in asthmatics with fractional exhaled nitric oxide and impulse oscillometry. CLINICAL RESPIRATORY JOURNAL 2016; 12:483-490. [PMID: 27606596 DOI: 10.1111/crj.12548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/08/2016] [Accepted: 08/30/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The invasive techniques can be direct and objective to assess small airway function, but they have significant risks and inconveniences for patients and cannot be repeated often. Some sophisticated techniques such as fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) may surmount such restrictions. Therefore, we investigated the relation among FeNO, IOS, and small airway function in asthmatic patients. METHODS We recruited 140 asthmatic patients including 69 patients with small airway normal function and 71 patients with small airway dysfunction. FeNO, eosinophil(EOS)count and total immunoglobulin E (IgE) in peripheral blood, pulmonary function, as well as IOS were measured. RESULTS The levels of FeNO, the reactance area (AX), the resonant frequency Fres and EOS were significantly increased in small airway dysfunction group compared with small airway normal function group (P < 0.01 respectively). A multiple regression model showed that FeNO, AX and Fres were correlative factors of mid forced expiratory flow of percentages of predicted values [FEF25-75 (%pred)] (P < 0.01, respectively). A receiver operating characteristic (ROC) analysis showed that the combination of FeNO, AX and Fres had a greater area under the ROC curve (AUC) than each of them (AUC: 0.881, P < .001, 95%CI: 0.815-0.929). CONCLUSION FeNO and IOS are helpful in diagnosis of small airway dysfunction with high sensitivity and specificity, and FeNO combined with IOS can better evaluate the small airway function in asthmatic patients.
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Affiliation(s)
- Lin Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Wen Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China.,Department of Cadre Health Care, The Second Hospital of Shandong University, Jinan, 250033, P.R. China
| | - Chunhong Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Dexiang Wang
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Jiping Zhao
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Junfei Wang
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Jinxiang Wu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Tian Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Yuanyuan Zhang
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Yahui Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Liuzhao Cao
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Liang Dong
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
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Arora P, Ansari SH, Najmi AK, Anjum V, Ahmad S. Investigation of anti-asthmatic potential of dried fruits of Vitis vinifera L. in animal model of bronchial asthma. Allergy Asthma Clin Immunol 2016; 12:42. [PMID: 27536321 PMCID: PMC4988050 DOI: 10.1186/s13223-016-0145-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/21/2016] [Indexed: 12/28/2022] Open
Abstract
Background Fruits of Vitis vinifera L., commonly known as grapes, are largely consumed worldwide because of their high nutritional and medicinal benefits. Context and purpose The present study investigated effects of V. vinifera fruits in ovalbumin-induced animal model of bronchial asthma. Methods Male wistar rats (except group 1) were sensitized with allergen (ovalbumin, 40 mg/rat + aluminum hydroxide, 2 mg/rat). Groups of sensitized animals were treated orally with either vehicle (0.4 mL/kg), standard dexamethasone (2.5 mg/kg) or alcoholic extract of V. vinifera dried fruits (31 and 42.5 mg/kg) from day 1 to 28 (n = 6 for all groups). Inflammatory markers including cell counts, cytokines such as interleukin (IL)-4, IL-5, IL-1β, tumor necrosis factor, immunoglobulin E (IgE), leukotrienes and nitrite levels in both blood/serum and bronchoalveolar fluid were analysed. Breathing rate and tidal volume as lung function parameters were examined by spirometer. Lung tissues were studied for histamine content and histopathology. Results Treatment of sensitized animals with dexamethasone or two doses of V. vinifera fruits extract inhibited recruitment of inflammatory cytokines, IgE, nitrites and circulating cells particularly eosinophils in blood/serum and bronchoalveolar fluid (p < 0.001, p < 0.01 and p < 0.05). Dexamethasone and V. vinifera fruits extract treatment also normalized lung functions and histamine levels compared to ovalbumin-sensitized controls (p < 0.05 and p < 0.01). Moreover, both drugs exhibited protection against airway inflammation in lung histology. Conclusion Results of study demonstrate the effectiveness of V. vinifera fruits in allergic asthma possibly related to its ability to inhibit cellular response and subsequent production of inflammatory cytokines. Electronic supplementary material The online version of this article (doi:10.1186/s13223-016-0145-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Poonam Arora
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi, 110062 India
| | - S H Ansari
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi, 110062 India
| | - Abul Kalam Najmi
- Department of Pharmacology, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi, 110062 India
| | - Varisha Anjum
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi, 110062 India
| | - Sayeed Ahmad
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), New Delhi, 110062 India
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Faria ACD, Veiga J, Lopes AJ, Melo PL. Forced oscillation, integer and fractional-order modeling in asthma. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 128:12-26. [PMID: 27040828 DOI: 10.1016/j.cmpb.2016.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 01/04/2016] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to evaluate the use of fractional-order (FrOr) modeling in asthma. To this end, three FrOr models were compared with traditional parameters and an integer-order model (InOr). We investigated which model would best fit the data, the correlation with traditional lung function tests and the contribution to the diagnostic of airway obstruction. The data consisted of forced oscillation (FO) measurements obtained from healthy (n=22) and asthmatic volunteers with mild (n=22), moderate (n=19) and severe (n=19) obstructions. The first part of this study showed that a FrOr was the model that best fit the data (relative distance: FrOr=4.3±2.4; InOr=5.1±2.6%). The correlation analysis resulted in reasonable (R=0.36) to very good (R=0.77) associations between FrOr parameters and spirometry. The closest associations were observed between parameters related to peripheral airway obstruction, showing a clear relationship between the FrOr models and lung mechanics. Receiver-operator analysis showed that FrOr parameters presented a high potential to contribute to the detection of the mild obstruction in a clinical setting. The accuracy [area under the Receiver Operating Characteristic curve (AUC)] observed in these parameters (AUC=0.954) was higher than that observed in traditional FO parameters (AUC=0.732) and that obtained from the InOr model (AUC=0.861). Patients with moderate and severe obstruction were identified with high accuracy (AUC=0.972 and 0.977, respectively). In conclusion, the results obtained are in close agreement with asthma pathology, and provide evidence that FO measurement associated with FrOr models is a non-invasive, simple and radiation-free method for the detection of biomechanical abnormalities in asthma.
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Affiliation(s)
- Alvaro C D Faria
- Biomedical Instrumentation Laboratory, Institute of Biology Roberto Alcantara Gomes and Laboratory of Clinical and Experimental Research in Vascular Biology (BioVasc), State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Veiga
- Biomedical Instrumentation Laboratory, Institute of Biology Roberto Alcantara Gomes and Laboratory of Clinical and Experimental Research in Vascular Biology (BioVasc), State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo J Lopes
- Pulmonary Function Laboratory, Pedro Ernesto University Hospital, Brazil
| | - Pedro L Melo
- Biomedical Instrumentation Laboratory, Institute of Biology Roberto Alcantara Gomes and Laboratory of Clinical and Experimental Research in Vascular Biology (BioVasc), State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Cytopathological Aspects in the Bronchoalveolar Lavage Fluid in Chronic Obstructive Pulmonary Disease. CURRENT HEALTH SCIENCES JOURNAL 2015; 41:35-41. [PMID: 30151248 PMCID: PMC6057535 DOI: 10.12865/chsj.41.01.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/15/2015] [Indexed: 11/18/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a clinical syndrome characterised by a slow progressive decline in expiratory airflow [1], a process that has gradually developed over the years. Studies of patients with COPD show an inflammatory process in the small airways [2]. The aim of this paper is to identify the cytopathological aspects of the liquids present in the bronchoalveolar lavage in patients with COPD. We were performed a descriptive analytical case-control and prospective study on forty patients with COPD and ten asymptomatic smokers (healthy smokers or patients at risk). The percentage of marcophage, the type of the dominant inflamatory cell, in the bronchoalveolar lavage (BAL) liquid was significantly higher at patients with mild and moderate COPD as compared to patients with severe and very severe COPD. In the present work, the percentage of the neutrophil in the BAL liquid was significantly higher at patients with severe and very severe COPD, as compared to the patients with mild and moderate COPD and to aparently healthy smokers. In conclusion, we can say that COPD is characterized by an inflammatory process located in the small airways with predominant participation of macrophages, the procentage of macrophages in BAL fluid variyng inversely proportional to the severity of the disease.
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Scichilone N, Benfante A, Morandi L, Bellini F, Papi A. Impact of extrafine formulations of inhaled corticosteroids/long-acting beta-2 agonist combinations on patient-related outcomes in asthma and COPD. PATIENT-RELATED OUTCOME MEASURES 2014; 5:153-62. [PMID: 25473323 PMCID: PMC4251568 DOI: 10.2147/prom.s55276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are among the most common chronic diseases worldwide, characterized by a condition of variable degree of airway obstruction and chronic airway inflammation. A large body of evidence has demonstrated the importance of small airways as a pharmacological target in these clinical conditions. Despite a deeper understanding of the pathophysiological mechanisms, the epidemiological observations show that a significant proportion of asthmatic and COPD patients have a suboptimal (or lack of) control of their diseases. Different factors could influence the effectiveness of inhaled treatment in chronic respiratory diseases: patient-related (eg, aging); disease-related (eg, comorbid conditions); and drug-related/formulation-related factors. The presence of multiple illnesses is common in the elderly patient as a result of two processes: the association between age and incidence of degenerative diseases; and the development over time of complications of the existing diseases. In addition, specific comorbidities may contribute to impair the ability to use inhalers, such as devices for efficient drug delivery in the respiratory system. The inability to reach and treat the peripheral airways may contribute to the lack of efficacy of inhaled treatments. The recent development of inhaled extrafine formulations allows a more uniform distribution of the inhaled treatment throughout the respiratory tree to include the peripheral airways. The beclomethasone/formoterol extrafine formulation is available for the treatment of asthma and COPD. Different biomarkers of peripheral airways are improved by beclomethasone/formoterol extrafine treatment in comparison with equivalent nonextrafine inhaled corticosteroids/long-acting beta-2 agonist (ICS/LABA) combinations. These improvements are associated with improved lung function and clinical outcomes, along with reduced systemic exposure to inhaled corticosteroids. The increased knowledge in the pathophysiology of the peripheral airways may lead to identify specific phenotypes of obstructive lung diseases that would mostly benefit from the treatments specifically targeting the peripheral airways.
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Affiliation(s)
- Nicola Scichilone
- Biomedical Department of Internal and Specialist Medicine, Section of Pulmonology, University of Palermo, Italy
| | - Alida Benfante
- Biomedical Department of Internal and Specialist Medicine, Section of Pulmonology, University of Palermo, Italy
| | - Luca Morandi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Federico Bellini
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alberto Papi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Alfieri V, Aiello M, Pisi R, Tzani P, Mariani E, Marangio E, Olivieri D, Nicolini G, Chetta A. Small airway dysfunction is associated to excessive bronchoconstriction in asthmatic patients. Respir Res 2014; 15:86. [PMID: 25158694 PMCID: PMC4243812 DOI: 10.1186/s12931-014-0086-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/20/2014] [Indexed: 01/22/2023] Open
Abstract
Background We investigated whether a relationship between small airways dysfunction and bronchial hyperresponsiveness (BHR), expressed both in terms of ease of airway narrowing and of excessive bronchoconstriction, could be demonstrated in asthma. Methods 63 (36 F; mean age 42 yr ± 14) stable, mild-to-moderate asthmatic patients (FEV1 92% pred ±14; FEV1/FVC 75% ± 8) underwent the methacholine challenge test (MCT). The degree of BHR was expressed as PD20 (in μg) and as ∆FVC%. Peripheral airway resistance was measured pre- and post-MCT by impulse oscillometry system (IOS) and expressed as R5-R20 (in kPa sL−1). Results All patients showed BHR to methacholine (PD20 < 1600 μg) with a PD20 geometric (95% CI) mean value of 181(132–249) μg and a ∆FVC% mean value of 13.6% ± 5.1, ranging 2.5 to 29.5%. 30 out of 63 patients had R5-R20 > 0.03 kPa sL−1 (>upper normal limit) and showed ∆FVC%, but not PD20 values significantly different from the 33 patients who had R5-R20 ≤ 0.03 kPa sL−1 (15.8% ± 4.6 vs 11.5% ± 4.8, p < 0.01 and 156(96–254) μg vs 207 (134–322) μg, p = 0.382). In addition, ∆FVC% values were significantly related to the corresponding pre- (r = 0.451, p < 0.001) and post-MCT (r = 0.376, p < 0.01) R5-R20 values. Conclusions Our results show that in asthmatic patients, small airway dysfunction, as assessed by IOS, is strictly associated to BHR, expressed as excessive bronchoconstriction, but not as ease of airway narrowing.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alfredo Chetta
- Clinical & Experimental Medicine Department, University of Parma, Padiglione Rasori, via G, Rasori 10, Parma, 43125, Italy.
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Kondo T, Tanigaki T, Tajiri S, Ohe M, Hibino M, Akazawa K. Profiles of Inhaled Flow from Dry Powder Inhalers in Subjects Unfamiliar with the Devices. ACTA ACUST UNITED AC 2014. [DOI: 10.5649/jjphcs.40.344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tetsuri Kondo
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital
| | | | | | - Motoki Ohe
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital
| | - Makoto Hibino
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital
| | - Kenichiro Akazawa
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital
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Ticconi C, Pietropolli A, Piccione E. Estrogen replacement therapy and asthma. Pulm Pharmacol Ther 2013; 26:617-23. [PMID: 24035822 DOI: 10.1016/j.pupt.2013.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/27/2013] [Accepted: 08/29/2013] [Indexed: 01/18/2023]
Abstract
A growing body of clinical and experimental evidence indicates that female sex hormones, particularly estrogen, have significant effects on normal airway function as well as on respiratory disorders, such as asthma. These effects are very complex and are exerted at several levels, directly on airway reactivity or indirectly through regulation of the immune and inflammatory responses in the lung. They can have relevant clinical implications not only according to the phases of the reproductive life in women, but also in relation to the therapeutical administration of estrogen, as in the case of menopausal hormone therapy. Clinical evidence suggests that administration of estrogen to menopausal women is associated with increased rates of newly diagnosed asthma. Conversely, functional studies show that estrogen can improve objective indexes of respiratory functionality.
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Affiliation(s)
- Carlo Ticconi
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University Tor Vergata, Rome, Italy.
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Is health-related quality of life associated with upper and lower airway inflammation in asthmatics? BIOMED RESEARCH INTERNATIONAL 2013; 2013:539290. [PMID: 24073408 PMCID: PMC3773386 DOI: 10.1155/2013/539290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/29/2013] [Indexed: 12/31/2022]
Abstract
Background. Allergic diseases impair health-related quality of life (HR-QoL). However, the relationship between airway inflammation and HR-QoL in patients with asthma and rhinitis has not been fully investigated. We explored whether the inflammation of upper and lower airways is associated with HR-QoL. Methods. Twenty-two mild allergic asthmatics with concomitant rhinitis (10 males, 38 ± 17 years) were recruited. The Rhinasthma was used to identify HR-QoL, and the Asthma Control Test (ACT) was used to assess asthma control. Subjects underwent lung function and exhaled nitric oxide (eNO) test, collection of exhaled breath condensate (EBC), and nasal wash. Results. The Rhinasthma Global Summary score (GS) was 25 ± 11. No relationships were found between GS and markers of nasal allergic inflammation (% eosinophils: r = 0.34, P = 0.24; ECP: r = 0.06, P = 0.87) or bronchial inflammation (pH of the EBC: r = 0.12, P = 0.44; bronchial NO: r = 0.27, P = 0.22; alveolar NO: r = 0.38, P = 0.10). The mean ACT score was 18. When subjects were divided into controlled (ACT ≥ 20) and uncontrolled (ACT < 20), the alveolar NO significantly correlated with GS in uncontrolled asthmatics (r = 0.60, P = 0.04). Conclusions. Upper and lower airways inflammation appears unrelated to HR-QoL associated with respiratory symptoms. These preliminary findings suggest that, in uncontrolled asthma, peripheral airway inflammation could be responsible for impaired HR-QoL.
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Fine Particle Profile of Fluticasone Propionate/Formoterol Fumarate Versus Other Combination Products: the DIFFUSE Study. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13556-013-0003-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Improving asthma during pregnancy with dietary antioxidants: the current evidence. Nutrients 2013; 5:3212-34. [PMID: 23948757 PMCID: PMC3775250 DOI: 10.3390/nu5083212] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 12/16/2022] Open
Abstract
The complication of asthma during pregnancy is associated with a number of poor outcomes for the mother and fetus. This may be partially driven by increased oxidative stress induced by the combination of asthma and pregnancy. Asthma is a chronic inflammatory disease of the airways associated with systemic inflammation and oxidative stress, which contributes to worsening asthma symptoms. Pregnancy alone also intensifies oxidative stress through the systemic generation of excess reactive oxidative species (ROS). Antioxidants combat the damaging effects of ROS; yet antioxidant defenses are reduced in asthma. Diet and nutrition have been postulated as potential factors to combat the damaging effects of asthma. In particular, dietary antioxidants may play a role in alleviating the heightened oxidative stress in asthma. Although there are some observational and interventional studies that have shown protective effects of antioxidants in asthma, assessment of antioxidants in pregnancy are limited and there are no antioxidant intervention studies in asthmatic pregnancies on asthma outcomes. The aims of this paper are to (i) review the relationships between oxidative stress and dietary antioxidants in adults with asthma and asthma during pregnancy, and (ii) provide the rationale for which dietary management strategies, specifically increased dietary antioxidants, might positively impact maternal asthma outcomes. Improving asthma control through a holistic antioxidant dietary approach might be valuable in reducing asthma exacerbations and improving asthma management during pregnancy, subsequently impacting perinatal health.
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Fluticasone/formoterol: a new single-aerosol combination therapy for patients with asthma. Respir Med 2013; 106 Suppl 1:S20-8. [PMID: 23273163 DOI: 10.1016/s0954-6111(12)70006-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
International asthma management guidelines recommend a long-acting β(2)-agonist (LABA) as add-on therapy in patients whose asthma is not controlled by low-dose inhaled corticosteroid (ICS) monotherapy. Treatment with a single inhaler containing an ICS/LABA combination is advocated because it may facilitate adherence to a regimen. When prescribing ICS/LABA combination therapy, the potency of the ICS and the speed of onset of the LABA are considered important factors; therefore, an inhaled therapy containing components with these properties may be valued by physicians. The ICS fluticasone propionate (fluticasone) has potent and sustained anti-inflammatory effects, and the LABA formoterol fumarate (formoterol) provides rapid bronchodilation; the efficacy and safety profiles of these agents have been well established in clinical practice. Fluticasone and formoterol have been combined, for the first time, in a single hydrofluoroalkane-based aerosol (flutiform®; fluticasone propionate/formoterol fumarate). Here, we review data from the published randomized, controlled, clinical trials that demonstrate the efficacy and tolerability of this product. It has been shown that fluticasone/formoterol is more efficacious than fluticasone or formoterol given alone, and provides similar improvements in lung function to fluticasone and formoterol administered concurrently via separate inhalers. Fluticasone/formoterol has similar efficacy and tolerability profiles to budesonide/formoterol and fluticasone/salmeterol, but with the additional benefit of more rapid bronchodilation than fluticasone/salmeterol.
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