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Drazen JM, Fredberg JJ. Epithelial cells crowded out in asthma. Science 2024; 384:30-31. [PMID: 38574157 DOI: 10.1126/science.ado4514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Bronchoconstriction causes epithelial cell extrusion that promotes airway inflammation.
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Affiliation(s)
- Jeffrey M Drazen
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Jeffrey J Fredberg
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
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Dreßler M, Lassmann H, Eichhorn C, Trischler J, Hutter M, Zielen S, Schulze J. Are Questionnaires Helpful To Predict Exercise-Induced Bronchoconstriction (EIB) And Exercise-Induced Laryngeal Obstruction (EILO)? Klin Padiatr 2024; 236:139-144. [PMID: 38286408 DOI: 10.1055/a-2151-2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Exercise induced laryngeal obstruction (EILO) is an important differential diagnosis to exercise induced bronchoconstriction (EIB) and diagnosed via continuous laryngoscopy while exercising (CLE). However, availability of CLE is limited to specialized centres. And without CLE EILO is often misdiagnosed as EIB. Therefore it is essential to carefully preselect potential EILO candidates. Aim of this study was to investigate whether two short questionnaires -Asthma Control Test (ACT) and Dyspnea Index (DI) evaluating upper airway-related dyspnea- can differentiate between EIB and EILO. METHODS Patients with dyspnea while exercising were analysed with an exercise challenge in the cold chamber (ECC) to diagnose EIB in visit 1 (V1), as appropriate a CLE in visit 2 (V2, 4-6 weeks after V1) and ACT and DI in V1 and V2. EIB patients were treated with asthma medication after V1. RESULTS Complete dataset of 36 subjects were gathered. The ACT showed lower values in V2 in EILO compared to EIB patients. A lack of improvement in ACT in V2 after asthma medication of EIB patients is suspicious for additional EILO diagnosis. The DI showed higher values in V1 in EILO compared to EIB patients. A score≥30 can predict a positive CLE reaction. CONCLUSION ACT and DI are valuable tools in preselecting CLE candidates to assure timely diagnostic despite limited diagnostic capabilities.
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Affiliation(s)
- Melanie Dreßler
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Hannah Lassmann
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Celine Eichhorn
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Jordis Trischler
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Martin Hutter
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Stefan Zielen
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
| | - Johannes Schulze
- Goethe-University Frankfurt, University Hospital, Department of Pediatrics, Pneumology, Allergology, Infectious Diseases, Gastroenterology, Germany
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Tolnai J, Ballók B, Südy R, Schranc Á, Varga G, Babik B, Fodor GH, Peták F. Changes in lung mechanics and ventilation-perfusion match: comparison of pulmonary air- and thromboembolism in rats. BMC Pulm Med 2024; 24:27. [PMID: 38200483 PMCID: PMC10782734 DOI: 10.1186/s12890-024-02842-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Pulmonary air embolism (AE) and thromboembolism lead to severe ventilation-perfusion defects. The spatial distribution of pulmonary perfusion dysfunctions differs substantially in the two pulmonary embolism pathologies, and the effects on respiratory mechanics, gas exchange, and ventilation-perfusion match have not been compared within a study. Therefore, we compared changes in indices reflecting airway and respiratory tissue mechanics, gas exchange, and capnography when pulmonary embolism was induced by venous injection of air as a model of gas embolism or by clamping the main pulmonary artery to mimic severe thromboembolism. METHODS Anesthetized and mechanically ventilated rats (n = 9) were measured under baseline conditions after inducing pulmonary AE by injecting 0.1 mL air into the femoral vein and after occluding the left pulmonary artery (LPAO). Changes in mechanical parameters were assessed by forced oscillations to measure airway resistance, lung tissue damping, and elastance. The arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) were determined by blood gas analyses. Gas exchange indices were also assessed by measuring end-tidal CO2 concentration (ETCO2), shape factors, and dead space parameters by volumetric capnography. RESULTS In the presence of a uniform decrease in ETCO2 in the two embolism models, marked elevations in the bronchial tone and compromised lung tissue mechanics were noted after LPAO, whereas AE did not affect lung mechanics. Conversely, only AE deteriorated PaO2, and PaCO2, while LPAO did not affect these outcomes. Neither AE nor LPAO caused changes in the anatomical or physiological dead space, while both embolism models resulted in elevated alveolar dead space indices incorporating intrapulmonary shunting. CONCLUSIONS Our findings indicate that severe focal hypocapnia following LPAO triggers bronchoconstriction redirecting airflow to well-perfused lung areas, thereby maintaining normal oxygenation, and the CO2 elimination ability of the lungs. However, hypocapnia in diffuse pulmonary perfusion after AE may not reach the threshold level to induce lung mechanical changes; thus, the compensatory mechanisms to match ventilation to perfusion are activated less effectively.
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Affiliation(s)
- József Tolnai
- Department of Medical Physics and Informatics, University of Szeged, 9 Korányi fasor, Szeged, H-6720, Hungary
| | - Bence Ballók
- Department of Medical Physics and Informatics, University of Szeged, 9 Korányi fasor, Szeged, H-6720, Hungary
| | - Roberta Südy
- Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, 1 Rue Michel-Servet, 1206, Geneva, Switzerland
| | - Álmos Schranc
- Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, 1 Rue Michel-Servet, 1206, Geneva, Switzerland
| | - Gabriella Varga
- Institute of Surgical Research, University of Szeged, 1 Pulz utca, Szeged, H-6724, Hungary
| | - Barna Babik
- Department of Anesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis str., Szeged, H-6725, Hungary
| | - Gergely H Fodor
- Department of Medical Physics and Informatics, University of Szeged, 9 Korányi fasor, Szeged, H-6720, Hungary
| | - Ferenc Peták
- Department of Medical Physics and Informatics, University of Szeged, 9 Korányi fasor, Szeged, H-6720, Hungary.
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Hostrup M, Hansen ESH, Rasmussen SM, Jessen S, Backer V. Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges. Scand J Med Sci Sports 2024; 34:e14358. [PMID: 36965010 DOI: 10.1111/sms.14358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
Athletes often experience lower airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and management are essential. Not only because untreated or poorly managed asthma and EIB potentially affects competition performance and training, but also because untreated airway inflammation can result in airway epithelial damage, remodeling, and fibrosis. Asthma and EIB do not hinder performance, as advancements in treatment strategies have made it possible for affected athletes to compete at the highest level. However, practitioners and athletes must ensure that the treatment complies with general guidelines and anti-doping regulations to prevent the risk of a doping sanction because of inadvertently exceeding specified dosing limits. In this review, we describe considerations and challenges in diagnosing and managing athletes with asthma and EIB. We also discuss challenges facing athletes with asthma and EIB, while also being subject to anti-doping regulations.
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Affiliation(s)
- Morten Hostrup
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erik S H Hansen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
| | - Søren M Rasmussen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Søren Jessen
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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He T, Song T. Exercise-induced bronchoconstriction in elite athletes: a narrative review. PHYSICIAN SPORTSMED 2023; 51:549-557. [PMID: 36373406 DOI: 10.1080/00913847.2022.2148137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is the most common chronic disease among elite athletes and when left untreated, can impact both respiratory health and sports performance. In recent years, there has been an increase in the awareness and detection of EIB in elite athletes. This narrative review aims to evaluate the risk, prevention, diagnosis, medication, and anti-doping policies of EIB in elite athletes, and to provide more references for athletes with EIB. The results showed that athletes of endurance, winter, and water sports generally have a higher prevalence of EIB than athletes of other sports. Adaptive warm-up before formal exercise and using heat exchange masks at low temperatures are effective ways for athletes to prevent EIB. For physicians, the exercise challenge test and eucapnic voluntary hyperpnea are the recommended diagnostic methods for EIB in athletes. The treatment of athletes with EIB is medication-based, such as inhaled corticosteroids and beta-2 agonists, but current anti-doping policies should be considered when used.
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Affiliation(s)
- Tianchang He
- Department of research, Shenyang Sport University, Shenyang, Liaoning, China
| | - Tienan Song
- Department of research, Shenyang Sport University, Shenyang, Liaoning, China
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Wang L, Wu S, He B, Liu S, Liang S, Luo Y. Exercise-induced bronchoconstriction assessed by a ratio of surface diaphragm EMG to tidal volume. Physiol Rep 2023; 11:e15860. [PMID: 37960999 PMCID: PMC10643992 DOI: 10.14814/phy2.15860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is usually assessed by changes in forced expiratory volume in 1 s (FEV1 ) which is effort dependent. The purpose of this study was to determine whether the diaphragm electromyogram (EMGdi ) recorded from chest wall surface electrodes could be used to reflect changes in airway resistance during an exercise challenge test and to distinguish patients with EIB from those without EIB. Ninety participants with or without asthma history were included in the study. FEV1 was recorded before and 5, 10, 15, and 20 min after exercise. EIB was defined as an FEV1 decline greater than 10% after exercise. A ratio of root mean square of EMGdi to tidal volume (EMGdi /VT ) was used to assess changes in airway resistance. Based on changes in FEV1 , 25 of 90 participants exhibited EIB; the remainder were defined as non-EIB participants. EMGdi /VT in EIB increased by 124% (19%-478%) which was significantly higher than that of 21% (-39% to 134%) in non-EIB participants (p < 0.001). At the optimal cutoff point (54% in EMGdi /VT ), the area under the ROC curve (AUC) for detection of a positive test was 0.92 (p < 0.001) with sensitivity 92% and specificity 88%. EMGdi /VT can be used to assess changes in airway resistance after exercise and could be used to distinguish participants with EIB from those without EIB.
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Affiliation(s)
- Lishuang Wang
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Senrui Wu
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Baiting He
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Simin Liu
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Shanfeng Liang
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Yuanming Luo
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
- Division of Sleep and Circadian DisordersBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- College of Medicine and Public Health, Adelaide Institute for Sleep HealthFlinders UniversityAdelaideSouth AustraliaAustralia
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Hempel P, Klein V, Michely A, Böll S, Rieg AD, Spillner J, Braunschweig T, von Stillfried S, Wagner N, Martin C, Tenbrock K, Verjans E. Amitriptyline inhibits bronchoconstriction and directly promotes dilatation of the airways. Respir Res 2023; 24:262. [PMID: 37907918 PMCID: PMC10617234 DOI: 10.1186/s12931-023-02580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION The standard therapy for bronchial asthma consists of combinations of acute (short-acting ß2-sympathomimetics) and, depending on the severity of disease, additional long-term treatment (including inhaled glucocorticoids, long-acting ß2-sympathomimetics, anticholinergics, anti-IL-4R antibodies). The antidepressant amitriptyline has been identified as a relevant down-regulator of immunological TH2-phenotype in asthma, acting-at least partially-through inhibition of acid sphingomyelinase (ASM), an enzyme involved in sphingolipid metabolism. Here, we investigated the non-immunological role of amitriptyline on acute bronchoconstriction, a main feature of airway hyperresponsiveness in asthmatic disease. METHODS After stimulation of precision cut lung slices (PCLS) from mice (wildtype and ASM-knockout), rats, guinea pigs and human lungs with mediators of bronchoconstriction (endogenous and exogenous acetylcholine, methacholine, serotonin, endothelin, histamine, thromboxane-receptor agonist U46619 and leukotriene LTD4, airway area was monitored in the absence of or with rising concentrations of amitriptyline. Airway dilatation was also investigated in rat PCLS by prior contraction induced by methacholine. As bronchodilators for maximal relaxation, we used IBMX (PDE inhibitor) and salbutamol (ß2-adrenergic agonist) and compared these effects with the impact of amitriptyline treatment. Isolated perfused lungs (IPL) of wildtype mice were treated with amitriptyline, administered via the vascular system (perfusate) or intratracheally as an inhalation. To this end, amitriptyline was nebulized via pariboy in-vivo and mice were ventilated with the flexiVent setup immediately after inhalation of amitriptyline with monitoring of lung function. RESULTS Our results show amitriptyline to be a potential inhibitor of bronchoconstriction, induced by exogenous or endogenous (EFS) acetylcholine, serotonin and histamine, in PCLS from various species. The effects of endothelin, thromboxane and leukotrienes could not be blocked. In acute bronchoconstriction, amitriptyline seems to act ASM-independent, because ASM-deficiency (Smdp1-/-) did not change the effect of acetylcholine on airway contraction. Systemic as well as inhaled amitriptyline ameliorated the resistance of IPL after acetylcholine provocation. With the flexiVent setup, we demonstrated that the acetylcholine-induced rise in central and tissue resistance was much more marked in untreated animals than in amitriptyline-treated ones. Additionally, we provide clear evidence that amitriptyline dilatates pre-contracted airways as effectively as a combination of typical bronchodilators such as IBMX and salbutamol. CONCLUSION Amitriptyline is a drug of high potential, which inhibits acute bronchoconstriction and induces bronchodilatation in pre-contracted airways. It could be one of the first therapeutic agents in asthmatic disease to have powerful effects on the TH2-allergic phenotype and on acute airway hyperresponsiveness with bronchoconstriction, especially when inhaled.
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Affiliation(s)
- Paulina Hempel
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Virag Klein
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Anna Michely
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Svenja Böll
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Annette D Rieg
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Jan Spillner
- Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Saskia von Stillfried
- Institute of Pathology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Norbert Wagner
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christian Martin
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany
| | - Klaus Tenbrock
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Eva Verjans
- Department of Pediatrics, Medical Faculty, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Pharmacology and Toxicology, Medical Faculty, RWTH Aachen, University Hospital Aachen, Aachen, Germany.
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Gómez Román M, García Ródenas MDM, Moreno Navarro L, Asensio Sánchez S, Pérez Sempere Á. Dyspnea and Bronchoconstriction in a Young Patient With Multiple Sclerosis Treated With Ponesimod. Arch Bronconeumol 2023; 59:676-677. [PMID: 37391299 DOI: 10.1016/j.arbres.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Marta Gómez Román
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Spain; Instituto de Investigación Sanitaria Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - Maria Del Mar García Ródenas
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Spain; Instituto de Investigación Sanitaria Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Luis Moreno Navarro
- Servicio de Neurología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria Biomédica de Alicante (ISABIAL), Grupo 1: Investigación en Neurociencias, Spain
| | - Santos Asensio Sánchez
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Spain; Instituto de Investigación Sanitaria Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Ángel Pérez Sempere
- Servicio de Neurología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria Biomédica de Alicante (ISABIAL), Grupo 1: Investigación en Neurociencias, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Spain
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Belikova M, Al-Ameri M, Orre AC, Säfholm J. Defining the contractile prostanoid component in hyperosmolar-induced bronchoconstriction in human small airways. Prostaglandins Other Lipid Mediat 2023; 168:106761. [PMID: 37336434 DOI: 10.1016/j.prostaglandins.2023.106761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/21/2023]
Abstract
Exercise-induced bronchoconstriction (EIB) is thought to be triggered by increased osmolarity at the airway epithelium. The aim of this study was to define the contractile prostanoid component of EIB, using an ex vivo model where intact segments of bronchi (inner diameter 0.5-2 mm) isolated from human lung tissue and subjected to mannitol. Exposure of bronchial segments to hyperosmolar mannitol evoked a contraction (64.3 ± 3.5 %) which could be prevented either by elimination of mast cells (15.8 ± 4.3 %) or a combination of cysteinyl leukotriene (cysLT1), histamine (H1) and thromboxane (TP) receptor antagonists (11.2 ± 2.3 %). Likewise, when antagonism of TP receptor was exchanged for inhibition of either cyclooxygenase-1 (8 ± 2.5 %), hematopoietic prostaglandin (PG)D synthase (20.7 ± 5.6 %), TXA synthase (14.8 ± 4.9 %), or the combination of the latter two (12.2 ± 4.6 %), the mannitol-induced contraction was prevented, suggesting that the TP-mediated component is induced by PGD2 and TXA2 generated by COX-1 and their respective synthases.
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Affiliation(s)
- Maria Belikova
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Centre for Allergy Research, Karolinska Institutet, Sweden
| | - Mamdoh Al-Ameri
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Sweden
| | | | - Jesper Säfholm
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Centre for Allergy Research, Karolinska Institutet, Sweden.
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Spivak I, Gut G, Hanna M, Gur M, Shallufi G, Ben-David Y, Nir V, Hakim F, Bentur L, Bar-Yoseph R. The effect of nose clip on exercise-induced bronchoconstriction in adolescents. Pediatr Pulmonol 2023; 58:2647-2655. [PMID: 37378471 DOI: 10.1002/ppul.26569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Oral breathing is considered to increase hyper-responsiveness of the airways. Data on the need for nose clip (NC) during exercise challenge test (ECT) in children and adolescents is scarce. Ouraim was to evaluate the role of NC during ECT in children and adolescents. METHODS A prospective, cohort study; children referred for ECT were evaluated on two separate visits, with and without a NC. Demographic, clinical data and measurements of lung functions were recorded. Allergy and asthma control were evaluated by Total Nasal Symptoms Score (TNSS) and Asthma Control Test (ACT) questionnaires. RESULTS Sixty children and adolescents (mean age 16.7 ± 1.1 years, 38% Female,) performed ECT with NC and 48 (80%) completed visit 2 (ECT without NC), 8.7 ± 7.9 days after visit 1. Following exercise, 29/48 patients (60.4%) with NC had a decline of ≥12% in forced expiratory volume in the first second (FEV1 ) (positive ECT) compared to only 16/48 (33.3%) positive tests without NC (p = 0.0008). Test result was changed in 14 patients from positive ECT (with NC) to negative ECT (no NC) and in only one patient from negative to positive. The use of NC resulted in greater FEV1 decline (median 16.3% predicted, IQR 6.0-19.1% predicted vs. median 4.5% predicted, IQR 1.6-18.4% predicted, p = 0.0001), and better FEV1 increase after bronchodil at or inhalation compared to ECT without NC. Higher TNSS scores did not predict higher probability to positive ECT. CONCLUSIONS The use of NC during ECT increases detection rate of exercise induced bronchoconstriction during ECT in the pediatric population. These findings strengthen the recommendation of nasal blockage during ECT in children and adolescents.
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Affiliation(s)
- Ilia Spivak
- Department of Pediatrics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Moneera Hanna
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - George Shallufi
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yael Ben-David
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Vered Nir
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Fahed Hakim
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Gill R, Rojas‐Ruiz A, Boucher M, Henry C, Bossé Y. More airway smooth muscle in males versus females in a mouse model of asthma: A blessing in disguise? Exp Physiol 2023; 108:1080-1091. [PMID: 37341687 PMCID: PMC10988431 DOI: 10.1113/ep091236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
NEW FINDINGS What is the central question of this study? The lung response to inhaled methacholine is reputed to be greater in male than in female mice. The underpinnings of this sex disparity are ill defined. What is the main finding and its importance? We demonstrated that male airways exhibit a greater content of airway smooth muscle than female airways. We also found that, although a more muscular airway tree in males might contribute to their greater responsiveness to inhaled methacholine than females, it might also curb the heterogeneity in small airway narrowing. ABSTRACT Mouse models are helpful in unveiling the mechanisms underlying sex disparities in asthma. In comparison to their female counterparts, male mice are hyperresponsive to inhaled methacholine, a cardinal feature of asthma that contributes to its symptoms. The physiological details and the structural underpinnings of this hyperresponsiveness in males are currently unknown. Herein, BALB/c mice were exposed intranasally to either saline or house dust mite once daily for 10 consecutive days to induce experimental asthma. Twenty-four hours after the last exposure, respiratory mechanics were measured at baseline and after a single dose of inhaled methacholine that was adjusted to trigger the same degree of bronchoconstriction in both sexes (it was twice as high in females). Bronchoalveolar lavages were then collected, and the lungs were processed for histology. House dust mite increased the number of inflammatory cells in bronchoalveolar lavages to the same extent in both sexes (asthma, P = 0.0005; sex, P = 0.96). The methacholine response was also markedly increased by asthma in both sexes (e.g., P = 0.0002 for asthma on the methacholine-induced bronchoconstriction). However, for a well-matched bronchoconstriction between sexes, the increase in hysteresivity, an indicator of airway narrowing heterogeneity, was attenuated in males for both control and asthmatic mice (sex, P = 0.002). The content of airway smooth muscle was not affected by asthma but was greater in males (asthma, P = 0.31; sex, P < 0.0001). These results provide further insights regarding an important sex disparity in mouse models of asthma. The increased amount of airway smooth muscle in males might contribute functionally to their greater methacholine response and, possibly, to their decreased propensity for airway narrowing heterogeneity.
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Affiliation(s)
- Rebecka Gill
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
| | - Andrés Rojas‐Ruiz
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
| | - Magali Boucher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
| | - Cyndi Henry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
| | - Ynuk Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
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12
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Moore LE, Brotto AR, Fuhr DP, Rosychuk RJ, Wong E, Bhutani M, Stickland MK. Impact of airway challenges on cardiovascular risk in asthma - a randomized controlled trial. PLoS One 2023; 18:e0288623. [PMID: 37459335 PMCID: PMC10351735 DOI: 10.1371/journal.pone.0288623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND People experiencing asthma exacerbations are at increased risk of cardiovascular events. To better understand the relationship between asthma exacerbations and cardiovascular risk, this randomized case-control, cross-over controlled trial assessed the immediate systemic inflammatory and vascular responses to acutely induced pulmonary inflammation and bronchoconstriction in people with asthma and controls. METHODS Twenty-six people with asthma and 25 controls underwent three airway challenges (placebo, mannitol, and methacholine) in random order. Markers of cardiovascular risk, including serum C-reactive protein, interleukin-6, and tumor necrosis factor, endothelial function (flow-mediated dilation), microvascular function (blood-flow following reactive hyperemia), and arterial stiffness (pulse wave velocity) were evaluated at baseline and within one hour following each challenge. The systemic responses in a) asthma/control and b) positive airway challenges were analyzed. (ClinicalTrials.gov reg# NCT02630511). RESULTS Both the mannitol and methacholine challenges resulted in clinically significant reductions in forced expiratory volume in 1 second (FEV1) in asthma (-7.6% and -17.9%, respectively). Following positive challenges, reduction in FEV1 was -27.6% for methacholine and -14.2% for mannitol. No meaningful differences in predictors of cardiovascular risk were observed between airway challenges regardless of bronchoconstrictor response. CONCLUSION Neither acutely induced bronchoconstriction nor pulmonary inflammation and bronchoconstriction resulted in meaningful changes in systemic inflammatory or vascular function. These findings question whether the increased cardiovascular risk associated with asthma exacerbations is secondary to acute bronchoconstriction or inflammation, and suggest that other factors need to be further evaluated such as the cardiovascular impacts of short-acting inhaled beta-agonists.
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Affiliation(s)
- Linn E. Moore
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew R. Brotto
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Desi P. Fuhr
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda J. Rosychuk
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Wong
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mohit Bhutani
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K. Stickland
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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13
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Calco GN, Alharithi YJ, Williams KR, Jacoby DB, Fryer AD, Maloyan A, Nie Z. Maternal high-fat diet increases airway sensory innervation and reflex bronchoconstriction in adult offspring. Am J Physiol Lung Cell Mol Physiol 2023; 325:L66-L73. [PMID: 37280517 PMCID: PMC10390047 DOI: 10.1152/ajplung.00115.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
Children born to obese mothers are prone to develop asthma and airway hyperresponsiveness, but the mechanisms behind this are unclear. Here we developed a mouse model of maternal diet-induced obesity that recapitulates metabolic abnormalities seen in humans born to obese mothers. Offspring of dams fed a high-fat diet (HFD) showed increased adiposity, hyperinsulinemia, and insulin resistance at 16 wk of age despite being fed only a regular diet (RD). Bronchoconstriction induced by inhaled 5-hydroxytriptamine was also significantly increased in offspring of HFD-fed versus RD-fed dams. Increased bronchoconstriction was blocked by vagotomy, indicating this reflex was mediated by airway nerves. Three-dimensional (3-D) confocal imaging of tracheas collected from 16-wk-old offspring showed that both epithelial sensory innervation and substance P expression were increased in the offspring of HFD-fed dams compared with offspring of RD-fed dams. For the first time, we show that maternal high-fat diet increases airway sensory innervation in offspring, leading to reflex airway hyperresponsiveness.NEW & NOTEWORTHY Our study reveals a novel potential mechanism, by which maternal high-fat diet increases the risk and severity of asthma in offspring. We found that exposure to maternal high-fat diet in mice leads to hyperinnervation of airway sensory nerves and increased reflex bronchoconstriction in offspring fed a regular diet only. These findings have important clinical implications and provide new insights into the pathophysiology of asthma, highlighting the need for preventive strategies in this patient population.
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Affiliation(s)
- Gina N Calco
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Yem J Alharithi
- Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Kayla R Williams
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - David B Jacoby
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Allison D Fryer
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Alina Maloyan
- Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Zhenying Nie
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States
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14
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Gareis H, Hörner-Schmid L, Zablotski Y, Palić J, Schulz B. Evaluation of barometric whole-body plethysmography for therapy monitoring in cats with feline lower airway disease. PLoS One 2022; 17:e0276927. [PMID: 36301875 PMCID: PMC9612479 DOI: 10.1371/journal.pone.0276927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Feline lower airway disease (FLAD) is a common respiratory condition in cats. Traditionally, response to therapy is monitored only by evaluation of clinical signs and radiographic examination of the lungs. Barometric whole-body plethysmography (BWBP) is considered a non-invasive, well-tolerated form of measuring airway reactivity in cats. The aim of the study was to assess pulmonary function testing by BWBP for non-invasive evaluation of response to therapy in cats with FLAD and to investigate whether BWBP parameters correlate with clinical severity. MATERIAL AND METHODS The prospective study included 25 client-owned cats, diagnosed with FLAD on the basis of their medical history, clinical signs, radiographic findings, and bronchoalveolar lavage fluid (BALF) examination. At three time points (day 0, 14, and 60), a standardised owner questionnaire, a clinical examination and BWBP measurements were carried out. Results of the questionnaire and the clinical examination were evaluated using a clinical 12-point score. Individual therapy was administered to all patients after diagnosis, based on the severity of disease and compliance of the cat. RESULTS The total clinical score significantly improved over the entire study period (p<0.001). Significant improvement was detected for the frequency of coughing (p = 0.009), respiratory distress (p = 0.001), lung auscultation findings (p = 0.002), and general condition and appetite (p = 0.045). The BWBP parameter Penh, an indicator of bronchoconstriction, improved significantly under initial therapy between day 0 and 14 (p = 0.009). A significant correlation between Penh and the severity of auscultation findings was seen on day 0 (r = 0.40; p = 0.013). CONCLUSION The study supports the role of Penh as a non-invasive parameter for monitoring initial treatment response in cats with FLAD. Further studies are needed to address whether other BWBP parameters might be suitable for non-invasive therapy monitoring of FLAD. Clinical evaluation is always essential in cats with FLAD to evaluate treatment response.
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Affiliation(s)
- Hannah Gareis
- Clinic of Small Animal Medicine, Ludwig Maximilian University of Munich, Munich, Germany
- * E-mail:
| | - Lina Hörner-Schmid
- Clinic of Small Animal Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Yury Zablotski
- Clinic of Small Animal Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jelena Palić
- Division of IDEXX Laboratories, Vet Med Labor GmbH, Kornwestheim, Germany
| | - Bianka Schulz
- Clinic of Small Animal Medicine, Ludwig Maximilian University of Munich, Munich, Germany
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15
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Imamura T, Enseki M, Murayama Y, Furuya H, Mochizuki H. Characteristics of Breath Sounds During Methacholine-induced Bronchoconstriction in Children with Asthma. Tokai J Exp Clin Med 2022; 47:125-130. [PMID: 36073283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The utility of an analysis of breath sounds as a non-invasive lung function test in children and adults has been studied. Analyzing specific breath sounds during methacholine inhalation challenge is useful for evaluating airway constriction in asthmatic patients. PATIENTS AND METHODS The study population included 57 children with atopic asthma (male: female = 38: 19; median age, 10 years [range, 5-16 years]). The breath sound spectrum was measured before a methacholine inhalation test, just after the methacholine inhalation challenge and after β2 agonist inhalation. The values of breath sound parameters were analyzed and the direct changes of the sound spectrum during methacholine inhalation challenge were evaluated. RESULTS The values of breath sound parameters, RPF75 and RPF50, were significantly decreased after methacholine inhalation (P < 0.001, p < 0.001, respectively), indicationg bronchoconstriction, and increased after β2 agonist inhalation (P < 0.001, p < 0.001, respectively), indicating bronchodilation. The high-pitch area of the sound spectrum curve around 1,500 Hz was significantly increased after methacholine inhalation (P < 0.001). The values returned to the baseline level after β2 agonist inhalation. CONCLUSIONS Bronchoconstriction by methacholine inhalation induced a reversible high-pitch sound. The assessment of changes in the high-pitch area of the breath sound spectrum may be useful for the detection of airway narrowing in asthmatic patients.
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Affiliation(s)
| | | | | | | | - Hiroyuki Mochizuki
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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16
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Kang N, Koh E, Lee JY, Song WJ, Choi DC, Lee BJ. Cut-off value for exercise-induced bronchoconstriction based on the features of the airway obstruction. PLoS One 2022; 17:e0268969. [PMID: 35617173 PMCID: PMC9135203 DOI: 10.1371/journal.pone.0268969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
The current cut-off value for diagnosing exercise-induced bronchoconstriction (EIB) in adults—percent fall in FEV1 (ΔFEV1) ≥ 10% after exercise challenge test (ECT)—has low specificity and weak evidences. Therefore, this study aimed to identify the cut-off value for EIB that provides the highest diagnostic sensitivity and specificity. Participants who underwent the ECT between 2007 and 2018 were categorized according to ΔFEV1: definite EIB (ΔFEV1 ≥ 15%), borderline (10% ≤ ΔFEV1 < 15%), and normal (ΔFEV1 < 10%). Distinct characteristics of the definite EIB group were identified and explored in the borderline EIB group. A receiver operating characteristic curve was plotted to determine the optimal cut-off value. Of 128 patients, 60 were grouped as the definite EIB group, 23 as the borderline group, and 45 as the normal group. All participants were men, with a median age of 20 years (interquartile range [IQR:] 19–23 years). The definite EIB group exhibited wheezing on auscultation (P < 0.001), ΔFEV1/FVC ≥ 10% (P < 0.001), and ΔFEF25–75% ≥ 25% (P < 0.001) compared to other groups. Eight (8/23, 34.8%) patients in the borderline group had at least one of these features, but the trend was more similar to that of the normal group than the definite EIB group. A cut-off value of ΔFEV1 ≥ 13.5% had a sensitivity of 98.5% and specificity of 93.5% for EIB. Wheezing on auscultation, ΔFEV1/FVC ≥ 10%, and ΔFEF25–75% ≥ 25% after ECT may be useful for the diagnosis of EIB, particularly in individuals with a ΔFEV1 of 10–15%. For EIB, a higher cut-off value, possibly ΔFEV1 ≥ 13.5%, should be considered as the diagnostic criterion.
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Affiliation(s)
- Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eunsil Koh
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Young Lee
- Health Promotion Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Chull Choi
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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17
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Nayak AP, Deshpande DA, Shah SD, Villalba DR, Yi R, Wang N, Penn RB. OGR1-dependent regulation of the allergen-induced asthma phenotype. Am J Physiol Lung Cell Mol Physiol 2021; 321:L1044-L1054. [PMID: 34668419 PMCID: PMC8715030 DOI: 10.1152/ajplung.00200.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022] Open
Abstract
The proton-sensing receptor, ovarian cancer G protein-coupled receptor (OGR1), has been shown to be expressed in airway smooth muscle (ASM) cells and is capable of promoting ASM contraction in response to decreased extracellular pH. OGR1 knockout (OGR1KO) mice are reported to be resistant to the asthma features induced by inhaled allergen. We recently described certain benzodiazepines as OGR1 activators capable of mediating both procontractile and prorelaxant signaling in ASM cells. Here we assess the effect of treatment with the benzodiazepines lorazepam or sulazepam on the asthma phenotype in wild-type (WT) and OGR1KO mice subjected to inhaled house dust mite (HDM; Dermatophagoides pteronyssius) challenge for 3 wk. In contrast to previously published reports, both WT and OGR1KO mice developed significant allergen-induced lung inflammation and airway hyperresponsiveness (AHR). In WT mice, treatment with sulazepam (a Gs-biased OGR1 agonist), but not lorazepam (a balanced OGR1 agonist), prevented allergen-induced AHR, although neither drug inhibited lung inflammation. The protection from development of AHR conferred by sulazepam was absent in OGR1KO mice. Treatment of WT mice with sulazepam also resulted in significant inhibition of HDM-induced collagen accumulation in the lung tissue. These findings suggest that OGR1 expression is not a requirement for development of the allergen-induced asthma phenotype, but OGR1 can be targeted by the Gs-biased OGR1 agonist sulazepam (but not the balanced agonist lorazepam) to protect from allergen-induced AHR, possibly mediated via suppression of chronic bronchoconstriction and airway remodeling in the absence of effects on airway inflammation.
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Affiliation(s)
- Ajay P Nayak
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Deepak A Deshpande
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sushrut D Shah
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dominic R Villalba
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Roslyn Yi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nadan Wang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Raymond B Penn
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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18
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Zeng Y, Zhang Y, Huang X, Song L, Polsky K, Wu Y, Kheradmand F, Guo Y, Green LK, Corry DB, Knight JM. Novel acute hypersensitivity pneumonitis model induced by airway mycosis and high dose lipopolysaccharide. Respir Res 2021; 22:263. [PMID: 34629055 PMCID: PMC8503997 DOI: 10.1186/s12931-021-01850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Inhalation of fungal spores is a strong risk factor for severe asthma and experimentally leads to development of airway mycosis and asthma-like disease in mice. However, in addition to fungal spores, humans are simultaneously exposed to other inflammatory agents such as lipopolysaccharide (LPS), with uncertain relevance to disease expression. To determine how high dose inhalation of LPS influences the expression of allergic airway disease induced by the allergenic mold Aspergillus niger (A. niger). METHODS C57BL/6J mice were intranasally challenged with the viable spores of A. niger with and without 1 μg of LPS over two weeks. Changes in airway hyperreactivity, airway and lung inflammatory cell recruitment, antigen-specific immunoglobulins, and histopathology were determined. RESULTS In comparison to mice challenged only with A. niger, addition of LPS (1 μg) to A. niger abrogated airway hyperresponsiveness and strongly attenuated airway eosinophilia, PAS+ goblet cells and TH2 responses while enhancing TH1 and TH17 cell recruitment to lung. Addition of LPS resulted in more severe, diffuse lung inflammation with scattered, loosely-formed parenchymal granulomas, but failed to alter fungus-induced IgE and IgG antibodies. CONCLUSIONS In contrast to the strongly allergic lung phenotype induced by fungal spores alone, addition of a relatively high dose of LPS abrogates asthma-like features, replacing them with a phenotype more consistent with acute hypersensitivity pneumonitis (HP). These findings extend the already established link between airway mycosis and asthma to HP and describe a robust model for further dissecting the pathophysiology of HP.
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Affiliation(s)
- Yuying Zeng
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yun Zhang
- Department of Medicine, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
- Department of Pathology & Immunology, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Xinyan Huang
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Lizhen Song
- Department of Medicine, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Katherine Polsky
- Department of Medicine, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Yifan Wu
- Department of Medicine, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Farrah Kheradmand
- Department of Medicine, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
- Department of Pathology & Immunology, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
- Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
- Michael E. DeBakey VA Center for Translational Research on Inflammatory Diseases, Houston, TX, 77030, USA
| | - Yubiao Guo
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
| | - Linda K Green
- Department of Pathology and Immunology, Michael E. DeBakey VA Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA
| | - David B Corry
- Department of Medicine, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
- Department of Pathology & Immunology, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
- Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
- Michael E. DeBakey VA Center for Translational Research on Inflammatory Diseases, Houston, TX, 77030, USA.
| | - John M Knight
- Department of Pathology & Immunology, Biology of Inflammation Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
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19
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Secombe C, Adler A, Hosgood G, Raisis A, Mosing M. Can bronchoconstriction and bronchodilatation in horses be detected using electrical impedance tomography? J Vet Intern Med 2021; 35:2035-2044. [PMID: 33977584 PMCID: PMC8295671 DOI: 10.1111/jvim.16152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Electrical impedance tomography (EIT) generates images of the lungs based on impedance change and was able to detect changes in airflow after histamine challenge in horses. OBJECTIVES To confirm that EIT can detect histamine-provoked changes in airflow and subsequent drug-induced bronchodilatation. Novel EIT flow variables were developed and examined for changes in airflow. METHODS Bronchoconstriction was induced using stepwise histamine bronchoprovocation in 17 healthy sedated horses. The EIT variables were recorded at baseline, after saline nebulization (control), at the histamine concentration causing bronchoconstriction (Cmax ) and 2 and 10 minutes after albuterol (salbutamol) administration. Peak global inspiratory (PIFEIT ) and peak expiratory EIT (PEFEIT ) flow, slope of the global expiratory flow-volume curve (FVslope ), steepest FVslope over all pixels in the lung field, total impedance change (surrogate for tidal volume; VTEIT ) and intercept on the expiratory FV curve normalized to VTEIT (FVintercept /VTEIT ) were indexed to baseline and analyzed for a difference from the control, at Cmax , 2 and 10 minutes after albuterol. Multiple linear regression explored the explanation of the variance of Δflow, a validated variable to evaluate bronchoconstriction using all EIT variables. RESULTS At Cmax , PIFEIT , PEFEIT , and FVslope significantly increased whereas FVintercept /VT decreased. All variables returned to baseline 10 minutes after albuterol. The VTEIT did not change. Multivariable investigation suggested 51% of Δflow variance was explained by a combination of PIFEIT and PEFEIT . CONCLUSIONS AND CLINICAL IMPORTANCE Changes in airflow during histamine challenge and subsequent albuterol administration could be detected by various EIT flow volume variables.
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Affiliation(s)
- Cristy Secombe
- School of Veterinary Medicine, Murdoch UniversityPerthAustralia
| | - Andy Adler
- Systems and Computer Engineering, Carleton UniversityOttawaCanada
| | - Giselle Hosgood
- School of Veterinary Medicine, Murdoch UniversityPerthAustralia
| | - Anthea Raisis
- School of Veterinary Medicine, Murdoch UniversityPerthAustralia
| | - Martina Mosing
- School of Veterinary Medicine, Murdoch UniversityPerthAustralia
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20
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Abstract
Historically, the drugs used to manage obstructive lung diseases (OLDs), asthma, and chronic obstructive pulmonary disease (COPD) either (1) directly regulate airway contraction by blocking or relaxing airway smooth muscle (ASM) contraction or (2) indirectly regulate ASM contraction by inhibiting the principal cause of ASM contraction/bronchoconstriction and airway inflammation. To date, these tasks have been respectively assigned to two diverse drug types: agonists/antagonists of G protein-coupled receptors (GPCRs) and inhaled or systemic steroids. These two types of drugs "stay in their lane" with respect to their actions and consequently require the addition of the other drug to effectively manage both inflammation and bronchoconstriction in OLDs. Indeed, it has been speculated that safety issues historically associated with beta-agonist use (beta-agonists activate the beta-2-adrenoceptor (β2AR) on airway smooth muscle (ASM) to provide bronchoprotection/bronchorelaxation) are a function of pro-inflammatory actions of β2AR agonism. Recently, however, previously unappreciated roles of various GPCRs on ASM contractility and on airway inflammation have been elucidated, raising the possibility that novel GPCR ligands targeting these GPCRs can be developed as anti-inflammatory therapeutics. Moreover, we now know that many GPCRs can be "tuned" and not just turned "off" or "on" to specifically activate the beneficial therapeutic signaling a receptor can transduce while avoiding detrimental signaling. Thus, the fledging field of biased agonism pharmacology has the potential to turn the β2AR into an anti-inflammatory facilitator in asthma, possibly reducing or eliminating the need for steroids.
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Affiliation(s)
- Pawan Sharma
- Center for Translational Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine Jane & Leonard Korman Respiratory Institute, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA
| | - Raymond B Penn
- Center for Translational Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine Jane & Leonard Korman Respiratory Institute, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, PA, USA.
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21
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Chapman DG, Thamrin C, King GG. Perception of Symptoms as the Next Frontier for Personalized Medicine. J Allergy Clin Immunol Pract 2021; 8:2651-2652. [PMID: 32888531 DOI: 10.1016/j.jaip.2020.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/17/2022]
Affiliation(s)
- David G Chapman
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia; School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia; School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - Gregory G King
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia; The Northern Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia; NHMRC Centre of Excellence in Severe Asthma, New Lambton Heights, NSW, Australia.
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22
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Fang L, Zhou F, Wu F, Yan Y, He Z, Yuan X, Zhang X, Zhang T, Yu D. A mouse allergic asthma model induced by shrimp tropomyosin. Int Immunopharmacol 2021; 91:107289. [PMID: 33370683 DOI: 10.1016/j.intimp.2020.107289] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/28/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
Allergic asthma remains an important worldwide health issue. Animal models are valuable for understanding the pathophysiological mechanisms of asthma and the development of effective therapeutics. This study aims to develop an alternative murine model induced by shrimp tropomyosin (ST) instead of ovalbumin (OVA). To investigate responses to short-term exposure to antigens, mice were sensitized with intraperitoneal injections of ST or ST plus aluminum adjuvant on days 0, 7, 14 followed by an intranasal challenge with ST for seven consecutive days. We reveal that sensitization with ST alone or ST plus aluminum induces significant levels of serum total IgE and ST-specific IgE in mice. Challenge results show that ST causes severe eosinophilic airway inflammation. Histology analysis of the lung tissues demonstrates airway inflammation and mucus hypersecretion within the bronchi in mice exposed to ST. Analysis of the cell composition in bronchoalveolar lavage fluid (BALF) shows a significant increase in eosinophil count in ST alone and ST plus aluminum groups. We also detect increased CD4+ T lymphocytes in lung tissues and production of helper T cell type 2-associated cytokines (IL-4 and IL-5) in BALF. In addition, airway hyperresponsiveness to methacholine in ST alone and ST plus aluminum groups is much higher than that in control groups. For the chronic model, mice were sensitized by ST or ST plus aluminum adjuvant for 3weeks and challenged with ST for 6weeks. We find severe structural changes in animals upon prolonged exposure to ST, including goblet cell hyperplasia, collagen deposition, and smooth muscle thickening. In conclusion, ST-induced asthma is a simple murine model for studying pathogenesis of asthma and evaluating new therapeutic drugs.
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Affiliation(s)
- Lei Fang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225009, China; Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Yangzhou University Medical College, Yangzhou 225009, China
| | - Fangchao Zhou
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225009, China; Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Yangzhou University Medical College, Yangzhou 225009, China
| | - Fan Wu
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225009, China; Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Yangzhou University Medical College, Yangzhou 225009, China
| | - Ying Yan
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225009, China
| | - Zhenpeng He
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225009, China
| | - Xiaoling Yuan
- Yangzhou Maternal & Child Care Service Center, Yangzhou University, Yangzhou, Jiangsu 225002, China
| | - Xiumei Zhang
- Xinghua People's Hospital, Yangzhou University, Xinghua, Jiangsu 225700, China
| | - Tong Zhang
- Xinghua People's Hospital, Yangzhou University, Xinghua, Jiangsu 225700, China
| | - Duonan Yu
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou 225009, China; Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Yangzhou University Medical College, Yangzhou 225009, China; Xinghua People's Hospital, Yangzhou University, Xinghua, Jiangsu 225700, China.
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23
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Koch S, Welch JF, Tran R, Ramsook AH, Hung A, Carlsten C, Guenette JA, Koehle MS. Ventilatory responses to constant load exercise following the inhalation of a short-acting ß 2-agonist in a laboratory-controlled diesel exhaust exposure study in individuals with exercise-induced bronchoconstriction. Environ Int 2021; 146:106182. [PMID: 33395924 DOI: 10.1016/j.envint.2020.106182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Individuals with exercise-induced bronchoconstriction (EIB) use ß2-agonists to reduce respiratory symptoms during acute exercise. The resultingbronchodilation could increase the dose of inhaled pollutants and impair respiratory function when exercise is performedin air pollution. We aimed to assess respiratory responses in individuals with EIB when completing a cycling bout while being exposed to diesel exhaust (DE) or filtered air (FA) with and without the inhalation of salbutamol (SAL), a short-acting ß2-agonist. METHODS In a double-blind, repeated-measures design, 19 participants with EIB (22-33 years of age) completed four visits: FA-placebo (FA-PLA), FA-SAL, DE-PLA, DE-SAL. After the inhalation of either 400 µg of SAL or PLA, participants sat in the exposure chamber for 60 min, breathing either FA or DE (PM2.5 = 300 μg/m3). Participants then cycled for 30 min at 50 % of peak work rate while breathing FA or DE. Respiratory responses were assessed via spirometry, work of breathing (WOB), fractional use of ventilatory capacity (V̇E/V̇E,CAP), area under the maximal expiratory flow-volume curve (MEFVAUC), and dyspnea during and following cycling. RESULTS Bronchodilation in response to SAL and acute cycling was observed, independent of FA/DE exposure. Specifically, FEV1 was increased by 7.7 % (confidence interval (CI): 7.2-8.2 %; p < 0.01) in response to SAL, and MEFVAUC was increased after cycling by 1.1 % (0.9-1.3 %; p = 0.03). Despite a significant decrease in total WOB by 6.2 J/min (4.7-7.5 J/min; p = 0.049) and a reduction in V̇E/V̇E,CAP by 5.8 % (5-6 %, p < 0.01) in the SAL exposures, no changes were observed in dyspnea. The DE exposure significantly increased V̇E/V̇E,CAP by 2.4 % (0.9-3.9 %; p < 0.01), but this did not affect dyspnea. DISCUSSION Our findings suggest that the use of SAL prior to moderate-intensity exercise when breathing high levels of DE, does not reduce respiratory function or exercise ventilatory responses for up to 60 min following exercise.
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Affiliation(s)
- Sarah Koch
- School of Kinesiology, University of British Columbia, Vancouver, Canada.
| | - Joseph F Welch
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Raymond Tran
- School of Kinesiology, University of British Columbia, Vancouver, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrew H Ramsook
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andy Hung
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Christopher Carlsten
- Faculty of Medicine, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jordan A Guenette
- School of Kinesiology, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, Vancouver, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada
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24
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Abstract
In asthma, progressive structural changes of the airway wall are collectively termed airway remodelling. Despite its deleterious effect on lung function, airway remodelling is incompletely understood. As one of the important causes leading to airway remodelling, here we discuss the significance of mechanical forces that are produced in the narrowed airway during asthma exacerbation, as a driving force of airway remodelling. We cover in vitro, ex vivo and in vivo work in this field, and discuss up-to-date literature supporting the idea that bronchoconstriction may be the missing link in a comprehensive understanding of airway remodelling in asthma.
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Affiliation(s)
| | | | - Jin-Ah Park
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, USA
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26
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Rodriguez Bauza DE, Silveyra P. Sex Differences in Exercise-Induced Bronchoconstriction in Athletes: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2020; 17:ijerph17197270. [PMID: 33027929 PMCID: PMC7579110 DOI: 10.3390/ijerph17197270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is a common complication of athletes and individuals who exercise regularly. It is estimated that about 90% of patients with underlying asthma (a sexually dimorphic disease) experience EIB; however, sex differences in EIB have not been studied extensively. With the goal of better understanding the prevalence of EIB in males and females, and because atopy has been reported to occur at higher rates in athletes, in this study, we investigated sex differences in EIB and atopy in athletes. A systematic literature review identified 60 studies evaluating EIB and/or atopy in post-pubertal adult athletes (n = 7501). Collectively, these studies reported: (1) a 23% prevalence of EIB in athletes; (2) a higher prevalence of atopy in male vs. female athletes; (3) a higher prevalence of atopy in athletes with EIB; (4) a significantly higher rate of atopic EIB in male vs. female athletes. Our analysis indicates that the physiological changes that occur during exercise may differentially affect male and female athletes, and suggest an interaction between male sex, exercise, and atopic status in the course of EIB. Understanding these sex differences is important to provide personalized management plans to athletes with underlying asthma and/or atopy.
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Affiliation(s)
| | - Patricia Silveyra
- Biobehavioral Laboratory, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27713, USA
- Correspondence:
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27
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Chang RYK, Kwok PCL, Ghassabian S, Brannan JD, Koskela HO, Chan H. Cough as an adverse effect on inhalation pharmaceutical products. Br J Pharmacol 2020; 177:4096-4112. [PMID: 32668011 PMCID: PMC7443471 DOI: 10.1111/bph.15197] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 01/06/2023] Open
Abstract
Cough is an adverse effect that may hinder the delivery of drugs into the lungs. Chemical or mechanical stimulants activate the transient receptor potential in some airway afferent nerves (C-fibres or A-fibres) to trigger cough. Types of inhaler device and drug, dose, excipients and formulation characteristics, including pH, tonicity, aerosol output and particle size may trigger cough by stimulating the cough receptors. Release of inflammatory mediators may increase the sensitivity of the cough receptors to stimulants. The cough-provoking effect of aerosols is enhanced by bronchoconstriction in diseased airways and reduces drug deposition in the target pulmonary regions. In this article, we review the factors by which inhalation products may cause cough.
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Affiliation(s)
- Rachel Yoon Kyung Chang
- Advanced Drug Delivery Group, Sydney Pharmacy School, Faculty of Medicine and HealthThe University of SydneyCamperdownNSWAustralia
| | - Philip Chi Lip Kwok
- Advanced Drug Delivery Group, Sydney Pharmacy School, Faculty of Medicine and HealthThe University of SydneyCamperdownNSWAustralia
| | - Sussan Ghassabian
- Advanced Drug Delivery Group, Sydney Pharmacy School, Faculty of Medicine and HealthThe University of SydneyCamperdownNSWAustralia
| | - John D. Brannan
- Department of Respiratory and Sleep MedicineJohn Hunter HospitalNewcastleNSWAustralia
| | - Heikki O. Koskela
- Unit for Medicine and Clinical Research, Pulmonary DivisionKuopio University HospitalKuopioFinland
- School of Medicine, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
| | - Hak‐Kim Chan
- Advanced Drug Delivery Group, Sydney Pharmacy School, Faculty of Medicine and HealthThe University of SydneyCamperdownNSWAustralia
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28
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Burman J, Elenius V, Lukkarinen H, Kuusela T, Mäkelä MJ, Kesti O, Väätäinen K, Maunula M, Remes S, Jartti T. Cut-off values to evaluate exercise-induced asthma in eucapnic voluntary hyperventilation test for children. Clin Physiol Funct Imaging 2020; 40:343-350. [PMID: 32491255 PMCID: PMC7496314 DOI: 10.1111/cpf.12647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 05/25/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM The eucapnic voluntary hyperventilation (EVH) testing is a diagnostic tool for diagnostics of exercise-induced bronchoconstriction; while the testing has become more common among children, data on the test's feasibility among children remain limited. Our aim was to investigate EVH testing feasibility among children, diagnostic testing cut-off values, and which factors affect testing outcomes. METHODS We recruited 134 patients aged 10-16 years with a history of exercise-induced dyspnoea and 100 healthy control children to undergo 6-min EVH testing. Testing feasibility was assessed by the children's ability to achieve ≥70% of the target minute ventilation of 30 times forced expiratory volume in 1 s (FEV1). Bronchoconstriction was assessed as a minimum of 8%, 10%, 12%, 15% or 20% fall in FEV1. Patient characteristics were correlated with EVH outcomes. RESULTS Overall, 98% of the children reached ≥70%, 88% reached ≥80%, 79% reached ≥90% and 62% reached ≥100% of target ventilation in EVH testing; of children with a history of exercise-induced dyspnoea, the decline percentages were as follows: 24% (≥8% fall), 17% (≥10% fall), 10% (≥12% fall), 6% (≥15% fall) and 5% (≥20% fall) in FEV1, compared to 11%, 4%, 3%, 1% and 0% among the healthy controls, respectively. Healthy controls and boys performed testing at higher ventilation rates (p < .05). CONCLUSION Eucapnic voluntary hyperventilation testing is feasible among children aged 10-16 years and has diagnostic value in evaluating exercise-induced dyspnoea among children. A minimum 10% fall in FEV1 is a good diagnostic cut-off value. Disease status appears to be important covariates.
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Affiliation(s)
- Janne Burman
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Varpu Elenius
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Heikki Lukkarinen
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Tom Kuusela
- Department of Physics and AstronomyUniversity of TurkuTurkuFinland
| | - Mika J. Mäkelä
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Olli Kesti
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Katri Väätäinen
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Maria Maunula
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Sami Remes
- Department of PediatricsKuopio University HospitalKuopioFinland
| | - Tuomas Jartti
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
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Wallace E, Guiu Hernandez E, Epton M, Ploen L, Huckabee ML, Macrae P. A Sensory Stimulation Protocol to Modulate Cough Sensitivity: A Randomized Controlled Trial Safety Study. Am J Speech Lang Pathol 2020; 29:1423-1433. [PMID: 32379483 DOI: 10.1044/2020_ajslp-19-00180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This study evaluated the safety and efficacy of a sensory stimulation protocol that was designed to modulate citric acid cough thresholds as a potential treatment for silent aspiration. Method Healthy adults (n = 24) were randomly assigned to one of three sensory stimulation groups: (a) high-intensity ultrasonically nebulized distilled water (UNDW) inhalations (1.6 ml/min); (b) low-intensity UNDW inhalations (0.5 ml/min); and (3) control, 0.9% saline inhalations (1.6 ml/min). Sensory stimulation was delivered once a day, for 4 consecutive days. Citric acid cough thresholds were determined at baseline, Day 3, and Day 5 to evaluate changes in cough sensitivity. Spirometry was undertaken before, during, and after each sensory stimulation session to monitor for bronchoconstriction. Results No participant showed evidence of bronchoconstriction during the sensory stimulation protocol. There was an interaction effect between day and group on suppressed cough thresholds, χ2(4) = 11.32, p = .02. When compared to the control group, there was a decrease in citric acid cough thresholds across Days 1-5 in the high-intensity (-1.8 doubling concentrations, 95% confidence interval [-2.88, -0.72], p = .01) and low-intensity (-1.3 doubling concentrations, 95% confidence interval [-2.4, -0.2], p = .03) UNDW inhalation groups, representing a sensitization effect of UNDW inhalations on cough sensitivity. Conclusions The UNDW sensory stimulation protocol was safe in healthy adults. The findings provide preliminary evidence that UNDW inhalations sensitize laryngeal afferents related to citric acid-induced cough induction. The therapeutic potential of the UNDW sensory stimulation protocol will be explored in patients with reduced cough sensitivity who are at risk of silent aspiration and aspiration pneumonia. Plain Language Summary This study explored the safety and efficacy of a sensory stimulation protocol that was designed to modulate cough sensitivity as a potential treatment for silent aspiration. The study revealed that inhalations of nebulized distilled water were safe and increased cough sensitivity, when compared to control saline inhalations.
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Affiliation(s)
- Emma Wallace
- Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand
| | - Esther Guiu Hernandez
- Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand
| | - Michael Epton
- Canterbury Respiratory Research Group, Christchurch Hospital, New Zealand
| | - Laura Ploen
- Respiratory Physiology Laboratory, Christchurch Hospital, New Zealand
| | - Maggie-Lee Huckabee
- Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand
| | - Phoebe Macrae
- Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand
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30
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Tommola M, Won HK, Ilmarinen P, Jung H, Tuomisto LE, Lehtimäki L, Niemelä O, Kim TB, Kankaanranta H. Relationship between age and bronchodilator response at diagnosis in adult-onset asthma. Respir Res 2020; 21:179. [PMID: 32660470 PMCID: PMC7359254 DOI: 10.1186/s12931-020-01441-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Possible variation in bronchodilator response (BDR) according to age at the diagnosis of adult-onset asthma is unknown. Our aim was to assess if BDR in FEV1 is related to age at diagnosis of adult-onset asthma and how many subjects fulfill the 400 mL criterion of BDR, the suggested cut-off for asthma-like reversibility in asthma-COPD overlap (ACO). METHODS A total of 1030 patients with adult-onset asthma were included; 245 from SAAS (Seinäjoki Adult Asthma Study, Finland) and 785 from COREA (Cohort for Reality and Evolution of Adult Asthma in Korea) cohorts. BDR in FEV1 at the diagnosis of asthma was assessed. Patients were divided into groups based on age at asthma diagnosis: < 40, 40-59.9, and ≥ 60 years. The cohorts were analyzed separately. RESULTS BDR % in FEV1 did not differ between the groups of different age at asthma diagnosis and no correlation between BDR and age was found. Of patients aged ≥40 years, only 18% (SAAS-cohort) and 5% (COREA-cohort) reached the 400 mL BDR in FEV1. After exclusion of possible ACO patients, the results remained similar. CONCLUSION By using two large cohorts of steroid-naive patients with asthma, we have shown that BDR at diagnosis of asthma is constant over large age span range, and the limit of 400 mL in BDR in FEV1 is rarely reached. TRIAL REGISTRATION Seinäjoki Adult Asthma Study is registered at ClinicalTrials.gov with identifier number NCT02733016 .
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Affiliation(s)
- Minna Tommola
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Ha-Kyeong Won
- Department of Internal Medicine, VHS Medical Center, Seoul, South Korea
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Heewon Jung
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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31
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dos Santos JDMB, Bachi ALL, Luna Junior LA, Foster R, Sierra APR, Benetti M, Araújo JR, Ghorayeb N, Kiss MAPD, Vieira RP, Bullens DMA, Vaisberg M. The Relationship of IL-8 and IL-10 Myokines and Performance in Male Marathon Runners Presenting Exercise-Induced Bronchoconstriction. Int J Environ Res Public Health 2020; 17:ijerph17082622. [PMID: 32290385 PMCID: PMC7215610 DOI: 10.3390/ijerph17082622] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 12/25/2022]
Abstract
At present, it is unclear which exercise-induced factors, such as myokines, could diminish the negative impact of the reduction in pulmonary function imposed by the exercise in question. In this study, we aim to evaluate the prevalence of exercise-induced bronchoconstriction (EIB) and also to investigate the effect of myokines in the performance of marathon runners presenting EIB or not. Thirty-eight male recreational marathon runners (age 38.8 [33-44], height 175.7 [172.0-180.3]; weight 74.7 [69.3-81.6]) participated in this study, and through spirometry tests, a prevalence of 23.6% of EIB was found, which is in agreement with the literature. The volunteers who tested positive to EIB (EIB+) presented lower maximum aerobic capacity compared to those who tested negative (EIB-) (EIB+ 44.02 [39.56-47.02] and EIB- 47.62 [44.11-51.18] p = 0.03). The comparison of plasma levels of IL-1β (EIB+ p = 0.296, EIB- p = 0.176, EIB+ vs. EIB- baseline p = 0.190 immediately after p = 0.106), IL-4 (undetectable), IL-6 (EIB+ p = 0.003, EIB- p ≤ 0.001, EIB+ vs. EIB- baseline p = 0.301 immediately after p = 0.614), IL-8 (EIB+ p = 0.003, EIB- p ≤ 0.001, EIB+ vs. EIB- baseline p = 0.110 immediately after p = 0.453), IL-10 (EIB+ p = 0.003, EIB- p ≤ 0.001, EIB+ vs. EIB- baseline p = 0.424 immediately after p = 0.876) and TNF-α (EIB+ p = 0.003, EIB- p ≤ 0.001, EIB+ vs. EIB- baseline p = 0.141 immediately after p = 0.898) were similar in both groups 24 h before and immediately after the marathon. However, negative correlations were found between the marathon finishing time and the levels of IL-8 (r = -0.81, p = 0.022), and IL-10 (r = -0.97, p ≤ 0.001) immediately after completing the marathon. In conclusion, for the first time, it is shown that the myokines IL-8 and IL-10 are related to improvement of the performance of marathon runners presenting EIB.
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Affiliation(s)
- Juliana de Melo Batista dos Santos
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04025-002, Brazil; (A.L.L.B.); (L.A.L.J.); (R.F.); (M.V.)
- Correspondence: ; Tel.: +55-11-5576-4848
| | - André Luis Lacerda Bachi
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04025-002, Brazil; (A.L.L.B.); (L.A.L.J.); (R.F.); (M.V.)
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, Brazil
| | - Luiz Antonio Luna Junior
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04025-002, Brazil; (A.L.L.B.); (L.A.L.J.); (R.F.); (M.V.)
| | - Roberta Foster
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04025-002, Brazil; (A.L.L.B.); (L.A.L.J.); (R.F.); (M.V.)
- Method Faculty of Sao Paulo (FAMESP), São Paulo 04046-200, Brazil
| | - Ana Paula Renno Sierra
- School of Physical Education and Sport, University of São Paulo (USP), São Paulo 05508-030, Brazil; (A.P.R.S.); (M.B.); (M.A.P.D.K.)
| | - Marino Benetti
- School of Physical Education and Sport, University of São Paulo (USP), São Paulo 05508-030, Brazil; (A.P.R.S.); (M.B.); (M.A.P.D.K.)
| | - José Roberto Araújo
- Department of Morphology and Genetics, Federal University of Sao Paulo (UNIFESP), São Paulo 04023-900, Brazil;
| | - Nabil Ghorayeb
- Sports Cardiology Department, Dante Pazzanese Institute of Cardiology, São Paulo 04012-909, Brazil;
| | | | - Rodolfo P. Vieira
- Post-Graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos 11060-001, Brazil;
- Post-Graduation Program in Bioengineering and Biomedical Engineering, Universidade Brasil, São Paulo 08230-030, Brazil
- School of Medicine, Anhembi Morumbi University, São José dos Campos 04705-000, Brazil
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos 12245-520, Brazil
| | - Dominique M. A. Bullens
- Clinical Division of Pediatrics, UZ Leuven, 3000 Leuven, Belgium;
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Mauro Vaisberg
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04025-002, Brazil; (A.L.L.B.); (L.A.L.J.); (R.F.); (M.V.)
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Yamamura K, Hara J, Sakai T, Ohkura N, Abo M, Ogawa N, Okazaki A, Sone T, Kimura H, Fujimura M, Nakao S, Kasahara K. Repeated bronchoconstriction attenuates the cough response to bronchoconstriction in naïve guinea pigs. Allergol Int 2020; 69:223-231. [PMID: 31601467 DOI: 10.1016/j.alit.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/14/2019] [Accepted: 09/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cough variant asthma (CVA) is recognized as a precursor of bronchial asthma (BA). However, the cough response to bronchoconstriction differs between these similar diseases. Repeated bronchoconstriction and the resulting imbalance of endogenous lipid mediators may impact the cough response. METHODS We investigated the influence of repeated bronchoconstriction on the cough response to bronchoconstriction using naïve guinea pigs. Bronchoconstriction was induced for 3 consecutive days and changes in the cough response and lipid mediators, such as PGE2, PGI2, and cysteinyl-LTs (Cys-LTs), in BAL fluid (BALF) were assessed. We investigated the effect of endogenous PGI2 on the cough response by employing a PGI2 receptor antagonist. In order to investigate the cough response over a longer period, we re-evaluated the cough response 2 weeks after repeated bronchoconstriction. RESULTS The number of coughs induced by bronchoconstriction were significantly decreased by repeated bronchoconstriction. The levels of PGE2, PGI2, and Cys-LTs, and the ratio of PGI2/PGE2 were significantly increased, following repeated bronchoconstriction. This decrease in the cough response was suppressed by pretreatment with a PGI2 receptor antagonist. Two weeks after repeated bronchoconstriction, the cough response returned to the same level as before repeated bronchoconstriction along with a concomitant return of lipid mediators, such as PGE2, PGI2, and Cys-LTs and the ratio of PGI2/PGE2. CONCLUSIONS Our results suggest that repeated bronchoconstriction and the resulting imbalance of endogenous lipid mediators contribute to the difference in cough responses to bronchoconstriction in CVA and BA.
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Affiliation(s)
- Kenta Yamamura
- Department of Respiratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
| | - Johsuke Hara
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Tamami Sakai
- Department of Respiratory Medicine, Division of Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Noriyuki Ohkura
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Miki Abo
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Naohiko Ogawa
- Department of Respiratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Akihito Okazaki
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Takashi Sone
- Department of Regional Respiratory Symptomatology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hideharu Kimura
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | | | - Shinji Nakao
- Department of Hematology Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
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33
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Backer V. Reply. J Allergy Clin Immunol 2020; 145:1480. [PMID: 32127190 DOI: 10.1016/j.jaci.2020.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Nie Z, Maung JN, Jacoby DB, Fryer AD. Lung eosinophils increase vagus nerve-mediated airway reflex bronchoconstriction in mice. Am J Physiol Lung Cell Mol Physiol 2020; 318:L242-L251. [PMID: 31746625 PMCID: PMC7052679 DOI: 10.1152/ajplung.00040.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 01/07/2023] Open
Abstract
Eosinophils mediate airway hyperresponsiveness by increasing vagally mediated reflex bronchoconstriction. Here, we tested whether circulating or airway eosinophils change nerve function. Airway resistance in response to aerosolized 5-hydroxytryptamine (5-HT, 10-300 mM) was measured in wild-type mice or transgenic mice that overexpress IL5 in T cells (+IL5T), overexpress IL5 in airway epithelium (+IL5AE), or overexpress IL5 but are devoid of eosinophils (+IL5AE/-Eos). Inflammatory cells in bronchoalveolar lavage (BAL), blood, and bone marrow were quantified. Blood eosinophils were increased in +IL5T and +IL5AE mice compared with wild-type mice. +IL5T mice had increased eosinophils in bone marrow while +IL5AE mice had increased eosinophils in BAL. Eosinophils surrounding large airways were significantly increased only in +IL5AE mice. With intact vagal innervation, aerosolized 5-HT significantly increased airway resistance in +IL5AE mice. 5-HT-induced bronchoconstriction was blocked by vagotomy or atropine, demonstrating that it was mediated via a vagal reflex. Airway resistance was not increased in +IL5AE/-Eos mice, demonstrating that it required lung eosinophils, but was not affected by increased bone marrow or blood eosinophils or by increased IL5 in the absence of eosinophils. Eosinophils did not change M3 function on airway smooth muscle, since airway responses to methacholine in vagotomized mice were not different among strains. Eosinophils surrounding large airways were sufficient, even in the absence of increased IL5 or external insult, to increase vagally mediated reflex bronchoconstriction. Specifically blocking or reducing eosinophils surrounding large airways may effectively inhibit reflex hyperresponsiveness mediated by vagus nerves in eosinophilic asthma.
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Affiliation(s)
- Zhenying Nie
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jessica N Maung
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
| | - David B Jacoby
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
| | - Allison D Fryer
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
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35
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Alving K. FeNO and the Prediction of Exercise-Induced Bronchoconstriction. J Allergy Clin Immunol Pract 2019; 6:863-864. [PMID: 29747989 DOI: 10.1016/j.jaip.2017.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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36
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Saubade M, Chiari M, Guinchard AC, Rochat I. [Exercise induced dyspnea in adolescents]. Rev Med Suisse 2019; 15:1310-1317. [PMID: 31290625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Exercise induced dyspnea is a common complaint among adolescents, whether sedentary or competitive athletes. This complaint may be associated with reduced athletic performance and general fatigue. It can be caused by various etiologies, sometimes concomitant. It is important for clinicians to obtain a specific history and then perform the appropriate additional tests. The three most common diagnostic entities are exercise-induced asthma/bronchoconstriction, exercise-induced laryngeal obstruction, and physical deconditioning, each with distinctive characteristics. Therapeutic management, including environmental measures and appropriate drug treatment, must be individualized and depends on the etiology.
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Affiliation(s)
- Mathieu Saubade
- Swiss Olympic Medical Center, division de médecine physique et réadaptation, CHUV, 1011 Lausanne
- Département de promotion de la santé et prévention, Centre universitaire de médecine générale et santé publique - Unisanté, 1011 Lausanne
| | - Mike Chiari
- Département de promotion de la santé et prévention, Centre universitaire de médecine générale et santé publique - Unisanté, 1011 Lausanne
| | | | - Isabelle Rochat
- Unité de pneumologie pédiatrique, Service de pédiatrie, Département Femme-Mère-Enfants, CHUV et Université de Lausanne, 1011 Lausanne
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Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) is an angiogenic, heparin-binding glycoprotein playing an important role in the pathogenesis of many diseases and disorders, including asthma. It has been reported that increased VEGF serum concentration is a biomarker of neovascularization, which could suggest that higher VEGF expression may be relevant to asthmatics with airway remodeling and irreversible bronchoconstriction. OBJECTIVES The aim of this study was to assess the possible association between VEGF serum concentration and irreversible bronchoconstriction in adult patients with a diagnosis of asthma. MATERIAL AND METHODS This study involved 82 adult patients with asthma (42 persons with and 40 persons without irreversible bronchoconstriction) and 40 healthy adult controls. Vascular endothelial growth factor serum concentration was analyzed using enzyme-linked immunosorbent assay (ELISA). RESULTS Vascular endothelial growth factor serum concentration in patients with asthma was higher than in healthy controls (p = 0.0131), particularly in those from the subgroup of irreversible bronchoconstriction (p = 0.0133). The rising tendency was confirmed using the Kruskal–Wallis rank sum test that showed a significant difference (p = 0.0374) in VEGF values among the 3 groups examined: healthy controls (Me = 246.6 pg/mL), asthmatics with reversible bronchoconstriction (Me = 288.6 pg/mL) and asthmatics with irreversible bronchoconstriction (Me = 340.6 pg/mL). However, the direct comparison between the 2 asthmatics groups (reversible vs irreversible bronchoconstriction) did not show a statistically significant difference (p = 0.5521). CONCLUSIONS Increased VEGF serum concentration is characteristic of patients with asthma, especially those with irreversible bronchoconstriction.
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Affiliation(s)
- Krzysztof Gomułka
- Department of Internal Medicine and Allergology, Wroclaw Medical University, Poland
| | - Jerzy Liebhart
- Department of Internal Medicine and Allergology, Wroclaw Medical University, Poland
| | | | - Wojciech Mędrala
- Department of Internal Medicine and Allergology, Wroclaw Medical University, Poland
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Toledo-Pons N, van Boven JFM, Román-Rodríguez M, Pérez N, Valera Felices JL, Soriano JB, Cosío BG. ACO: Time to move from the description of different phenotypes to the treatable traits. PLoS One 2019; 14:e0210915. [PMID: 30677059 PMCID: PMC6345463 DOI: 10.1371/journal.pone.0210915] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/03/2019] [Indexed: 12/25/2022] Open
Abstract
Background Asthma-COPD overlap (ACO) is a term that encompasses patients with characteristics of two conditions, smoking asthmatics or COPD patients with asthma-like features such as high bronchodilator response or blood eosinophil count ≥300 cells/μL. The aim of this study was to compare the different phenotypes inside the ACO definition in a real-life population cohort. Methods We analyzed patients from the MAJORICA cohort who had a diagnosis of asthma and/or COPD based on current guidelines, laboratory data in 2014 and follow-up until 2015. Prevalence of ACO according to the different criteria, demographic, clinical and functional characteristics, prescriptions and use of health resources data were compared between three groups. Results We included 603 patients. Prevalence of smoking asthmatics was 14%, COPD patients with high bronchodilator response 1.5% and eosinophilic COPD patients 12%. Smoking asthmatics were younger and used more rescue inhalers, corticosteroids and health resources. Conversely, eosinophilic COPD patients were older than the other groups, often treated with corticosteroids and had lower use of health resources. Most of the COPD patients with high bronchodilator response were included in the eosinophilic COPD group. Conclusions ACO includes two conditions (smoking asthmatics and eosinophilic COPD patients) with different medication requirement and prognosis that should not be pooled together. Use of ≥300 blood eosinophils/μL as a treatable trait should be recommended.
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Affiliation(s)
- Nuria Toledo-Pons
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitari Son Espases-IdISBa, Mallorca, Spain
| | - Job F. M. van Boven
- Department of General Practice & Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Miguel Román-Rodríguez
- Primary Care respiratory research unit, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Mallorca, Spain
| | - Noemí Pérez
- Gabinete Técnico Servicios Centrales, Servicio de Salud de las Islas Baleares, Mallorca, Spain
| | | | - Joan B. Soriano
- Hopital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Consultor de Metodología e Investigación de SEPAR, Barcelona, Spain
| | - Borja G. Cosío
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitari Son Espases-IdISBa, Mallorca, Spain
- * E-mail:
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Colombo R, da Silva Rosario S, Nesello PFT, Angeletti MG, Ramos MB, Brugger AM, Gerhardt GJL. Effect of airway narrowing in asthma: active learning through a simple and didactic model. Adv Physiol Educ 2018; 42:473-476. [PMID: 29972060 DOI: 10.1152/advan.00053.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Rafael Colombo
- University of Caxias do Sul , Caxias do Sul, Rio Grande do Sul , Brazil
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40
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Foy BH, Gonem S, Brightling C, Siddiqui S, Kay D. Modelling the effect of gravity on inert-gas washout outputs. Physiol Rep 2018; 6:e13709. [PMID: 29845761 PMCID: PMC5974727 DOI: 10.14814/phy2.13709] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/11/2018] [Accepted: 04/15/2018] [Indexed: 11/24/2022] Open
Abstract
Multiple-breath washout (MBW) is a pulmonary function test (PFT) that is used to infer lung function through measurement of ventilation heterogeneity (VH). However, the body position that a test is taken in may also influence VH, due to the "Slinky" effect of gravity on the lungs. In healthy subjects this has minimal effect, but in unhealthy groups, PFT outputs have been seen to change drastically with body position. In this study, we used a combined computational and clinical approach to better understand the response of outputs from the MBW to body position. A patient-specific model of the MBW was developed, then validated against clinically measured washout data, as well as broader results in the literature. This model was then used to compare changes in MBW outputs with respect to body position, showing that output changes sensitively predict regional airway size differences between lobes. We then highlight cases in which body position effects may bias MBW outputs, leading to elevated or masked responses to bronchoconstriction. We close by placing this result in context with broader clinical practice, and showing how it can help improve interpretation of test outputs.
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Affiliation(s)
- Brody H. Foy
- Department of Computer ScienceUniversity of OxfordOxfordOxfordshireUnited Kingdom
| | - Sherif Gonem
- Respiratory Biomedical Research CentreUniversity of Leicester/National Institute of Health ResearchLeicesterLeicestershireUnited Kingdom
| | - Chris Brightling
- Respiratory Biomedical Research CentreUniversity of Leicester/National Institute of Health ResearchLeicesterLeicestershireUnited Kingdom
| | - Salman Siddiqui
- Respiratory Biomedical Research CentreUniversity of Leicester/National Institute of Health ResearchLeicesterLeicestershireUnited Kingdom
| | - David Kay
- Department of Computer ScienceUniversity of OxfordOxfordOxfordshireUnited Kingdom
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Han L, Limjunyawong N, Ru F, Li Z, Hall OJ, Steele H, Zhu Y, Wilson J, Mitzner W, Kollarik M, Undem BJ, Canning BJ, Dong X. Mrgprs on vagal sensory neurons contribute to bronchoconstriction and airway hyper-responsiveness. Nat Neurosci 2018; 21:324-328. [PMID: 29403029 PMCID: PMC5857222 DOI: 10.1038/s41593-018-0074-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/04/2017] [Indexed: 01/28/2023]
Abstract
Asthma, accompanied by lung inflammation, bronchoconstriction and airway hyper-responsiveness, is a significant public health burden. Here we report that Mas-related G protein-coupled receptors (Mrgprs) are expressed in a subset of vagal sensory neurons innervating the airway and mediates cholinergic bronchoconstriction and airway hyper-responsiveness. These findings provide insights into the neural mechanisms underlying the pathogenesis of asthma.
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Affiliation(s)
- Liang Han
- The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Nathachit Limjunyawong
- The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Fei Ru
- Department of Medicine, Division of Allergy and Clinical Immunology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Zhe Li
- The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Olivia J Hall
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Haley Steele
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yuyan Zhu
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Julie Wilson
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wayne Mitzner
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Marian Kollarik
- Department of Medicine, Division of Allergy and Clinical Immunology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bradley J Undem
- Department of Medicine, Division of Allergy and Clinical Immunology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brendan J Canning
- Department of Medicine, Division of Allergy and Clinical Immunology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Xinzhong Dong
- The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Howard Hughes Medical Institute, Johns Hopkins University, Baltimore, MD, USA.
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David MMC, Gomes ELDFD, Mello MC, Costa D. Noninvasive ventilation and respiratory physical therapy reduce exercise-induced bronchospasm and pulmonary inflammation in children with asthma: randomized clinical trial. Ther Adv Respir Dis 2018; 12:1753466618777723. [PMID: 29865929 PMCID: PMC5990882 DOI: 10.1177/1753466618777723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/27/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Asthma is characterized by hyperresponsiveness of the airways, and exercise-induced bronchospasm (EIB) is a symptom that limits a large proportion of asthmatic patients, especially children. Continuous positive airway pressure (CPAP) leads to a reduction in the reactivity of the airways. The aim of this study was to evaluate the effect of outpatient treatment with CPAP and bilevel pressure combined with respiratory physical therapy for children and adolescents with asthma following bronchial hyperresponsiveness caused by an exercise bronchoprovocation test. METHODS A randomized, controlled, blind, clinical trial was conducted involving 68 asthmatic children and adolescents aged 4 to 16 years divided into three groups: G1, treated with bilevel pressure (inspiratory positive airway pressure: 12 cm H2O; expiratory positive airway pressure: 8 cm H2O), G2, treated with CPAP (8 cm H2O) and G3, treated with respiratory muscle training (RMT), considered as the control group. All groups were treated at an outpatient clinic and submitted to 10 1-hour sessions, each of which also included respiratory exercises. Evaluations were performed before and after treatment and involved spirometry, an exercise bronchoprovocation test, respiratory pressures, fraction of nitric oxide (FeNO), the Asthma Control Questionnaire (ACQ6) and anthropometric variables. This study received approval from the local ethics committee (certificate number: 1487225/2016) and is registered with ClinicalTrials [ ClinicalTrials.gov identifier: NCT02939625]. RESULTS A total of 64 patients concluded the protocol; the mean age of the patients was 10 years. All were in the ideal weight range and had adequate height ( z score: -2 to +2). The three groups demonstrated improved asthma control after the treatments, going from partial to complete control. A significant increase in maximal inspiratory pressure occurred in the three groups, with the greatest increase in the RMT group. A reduction in FeNO in the order of 17.4 parts per billion (effect size: 2.43) and a reduction in bronchial responsiveness on the exercise bronchoprovocation test occurred in the bilevel group. An improvement in FeNO on the order of 15.7 parts per billion (effect size: 2.46) and a reduction in bronchial responsiveness occurred in the CPAP group. No changes in lung function or responsiveness occurred in the RMT group. CONCLUSION Positive pressure and respiratory exercises were effective in reducing pulmonary inflammation, exercise-innduced bronchoespasm (EIB), and increased the clinical control of asthma, as well as RMT, which also resulted in improved clinical control.
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Affiliation(s)
| | | | - Maryjose Carvalho Mello
- Nove de Julho University, Rua Vergueiro, 235/249 - Liberdade, São Paulo - SP, Brazil 01504-000
| | - Dirceu Costa
- Nove de Julho University, Rua Vergueiro, 235/249 - Liberdade, São Paulo - SP, Brazil 01504-000
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Martinez-Moragon E, Plaza V, Torres I, Rosado A, Urrutia I, Casas X, Hinojosa B, Blanco-Aparicio M, Delgado J, Quirce S, Sabadell C, Cebollero P, Muñoz-Fernández A. Fibromyalgia as a cause of uncontrolled asthma: a case-control multicenter study. Curr Med Res Opin 2017; 33:2181-2186. [PMID: 28699806 DOI: 10.1080/03007995.2017.1354828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fibromyalgia can affect the control of asthma when both diseases are present in a single patient. OBJECTIVES To characterize asthma in patients with concomitant fibromyalgia to assess whether fibromyalgia is an independent factor of asthma severity that influences poor asthma control. We also evaluated how dyspnea is perceived by patients in order to demonstrate that alterations in the perception of airway obstruction may be responsible for poor asthma control. METHODS This was a cross-sectional case-control multicenter study, in which 56 patients in the asthma and fibromyalgia group were matched to 36 asthmatics by sex, approximate age, and asthma severity level. All patients were women. Study variables included the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the Nijmegen hyperventilation syndrome questionnaire, the Hospital Anxiety and Depression Scale, and perception of dyspnea after acute bronchoconstriction. RESULTS Although patients in both study groups showed similar asthma severity and use of anti-asthmatic drugs, patients in the asthma and fibromyalgia group showed lower scores on the ACT and MiniAQLQ questionnaires, and higher scores of anxiety and depression as well as hyperventilation compared to asthma patients without fibromyalgia. All these differences were statistically significant. CONCLUSIONS Fibromyalgia in patients with asthma influences poor control of the respiratory disease and is associated with altered perception of dyspnea, hyperventilation syndrome, high prevalence of depression and anxiety, and impaired quality of life. CLINICAL IMPLICATIONS Fibromyalgia may be considered a risk factor for uncontrolled asthma in patients suffering from asthma and fibromyalgia concomitantly.
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Affiliation(s)
| | - Vicente Plaza
- b Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | | | - Ana Rosado
- d Hospital Universitario Fundacion Alcorcon , Alcorcon , Spain
| | | | - Xavier Casas
- f Parc Sanitari Sant Joan de Deu , Sant Boi de Llobregat , Spain
| | - Belen Hinojosa
- g Complejo Hospital Universitario de Huelva , Municipio de Huelva , Spain
| | | | - Julio Delgado
- i Hospital Universitario Virgen Macarena , Sevilla , Spain
| | - Santiago Quirce
- j Hospital La Paz Institute for Health Research , Paseo de la Castellana , Spain
| | | | - Pilar Cebollero
- l Hospital Universitario Virgen del Camino , Pamplona , Spain
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44
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Reinhard-Groebli F, Nicod LP. [Exercise-induced bronchoconstriction: epidemiology, physiopathology and management]. Rev Med Suisse 2017; 13:1985-1989. [PMID: 29143502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Exercise-induced bronchoconstriction, associated or not with asthma, describes a transient limitation of airflow in the airways occurring during or after physical activity, regardless of age or training. Bronchoconstriction on exertion is principally induced by thermal and fluid losses of the bronchial mucosa by hyperventilation of large air volumes. Respiratory symptoms are variable and not specific. Among bronchial provocation test, eucapnic voluntary hyperventilation owns the best sensitivity and specificity in the diagnosis of exercise-induced bronchoconstriction. Therapeutic management consists in an adjustment of the environment and training, as well as bronchodilators.
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Affiliation(s)
| | - Laurent P Nicod
- Service de pneumologie, Département de médecine interne, CHUV, 1011 Lausanne
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45
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Henry B, Royston TJ. A multiscale analytical model of bronchial airway acoustics. J Acoust Soc Am 2017; 142:1774. [PMID: 29092575 PMCID: PMC5626572 DOI: 10.1121/1.5005497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/09/2017] [Accepted: 09/11/2017] [Indexed: 05/28/2023]
Abstract
Sound transmission and resulting airway wall vibration in a complex multiscale viscoelastic model of the subglottal bronchial tree was calculated using a modified one-dimensional (1D) branching acoustic waveguide approach. This is an extension of previous work to enable use of complex airway trees that are partially derived from subject-specific medical images, without the need for self-similarity in the geometric structure. The approach was validated numerically for simplified airway geometries, as well as experimentally by comparison to previous studies. A comprehensive conducting airway tree with about 60 000 branches was then modified to create fibrotic, bronchoconstrictive, and pulmonary infiltrate conditions. The fibrotic case-systemic increase in soft tissue stiffness-increased the Helmholtz resonance frequency due to the increased acoustic impedance. Bronchoconstriction, with geometric changes in small conducting airways, decreased acoustic energy transmission to the peripheral airways due in part to the increased impedance mismatch between airway orders. Pulmonary infiltrate significantly altered the local acoustic field in the affected lobe. Calculation of acoustic differences between healthy versus pathologic cases can be used to enhance the understanding of vibro-acoustic changes correlated to pathology, and potentially provide improved tools for the diagnosis of pulmonary diseases that uniquely alter the acoustics of the airways.
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Affiliation(s)
- Brian Henry
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, 851 South Morgan Street, MC 063, Chicago, Illinois 60607, USA
| | - Thomas J Royston
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, 851 South Morgan Street, MC 063, Chicago, Illinois 60607, USA
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46
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Yoshikawa T. [Exercise-induced bronchoconstriction (EIB)]. Nihon Rinsho 2016; 74:1688-1692. [PMID: 30551281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Exercise-induced bronchoconstriction(EIB) is defined as a transient airway obstruction that follows a modest period of high intensity exercise. Accumulating evidence demonstrated that EIB is reported not only among patients with asthma (EIBA), but also observed in a signifi- cant number of individuals without a known diagnosis of asthma (EIBWA). Accordingly, most recent guidelines have been largely revised. Since EIBA have different pathological back- ground from that in EIBwA, EIBA and EIBwa might have distinct responses to treatment and prevention despite using similar therapeutic strategies. This article aims to present a brief review on the current understandings of clinical features, pathogenesis, and management of both types of EIB.
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Weiler JM, Brannan JD, Randolph CC, Hallstrand TS, Parsons J, Silvers W, Storms W, Zeiger J, Bernstein DI, Blessing-Moore J, Greenhawt M, Khan D, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Tilles SA, Wallace D. Exercise-induced bronchoconstriction update-2016. J Allergy Clin Immunol 2016; 138:1292-1295.e36. [PMID: 27665489 DOI: 10.1016/j.jaci.2016.05.029] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/13/2016] [Accepted: 05/25/2016] [Indexed: 12/26/2022]
Abstract
The first practice parameter on exercise-induced bronchoconstriction (EIB) was published in 2010. This updated practice parameter was prepared 5 years later. In the ensuing years, there has been increased understanding of the pathogenesis of EIB and improved diagnosis of this disorder by using objective testing. At the time of this publication, observations included the following: dry powder mannitol for inhalation as a bronchial provocation test is FDA approved however not currently available in the United States; if baseline pulmonary function test results are normal to near normal (before and after bronchodilator) in a person with suspected EIB, then further testing should be performed by using standardized exercise challenge or eucapnic voluntary hyperpnea (EVH); and the efficacy of nonpharmaceutical interventions (omega-3 fatty acids) has been challenged. The workgroup preparing this practice parameter updated contemporary practice guidelines based on a current systematic literature review. The group obtained supplementary literature and consensus expert opinions when the published literature was insufficient. A search of the medical literature on PubMed was conducted, and search terms included pathogenesis, diagnosis, differential diagnosis, and therapy (both pharmaceutical and nonpharmaceutical) of exercise-induced bronchoconstriction or exercise-induced asthma (which is no longer a preferred term); asthma; and exercise and asthma. References assessed as relevant to the topic were evaluated to search for additional relevant references. Published clinical studies were appraised by category of evidence and used to document the strength of the recommendation. The parameter was then evaluated by Joint Task Force reviewers and then by reviewers assigned by the parent organizations, as well as the general membership. Based on this process, the parameter can be characterized as an evidence- and consensus-based document.
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48
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Rao Bondugulapati LN, Rees DA. Inhaled corticosteroids and HPA axis suppression: how important is it and how should it be managed? Clin Endocrinol (Oxf) 2016; 85:165-9. [PMID: 27038017 DOI: 10.1111/cen.13073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/19/2016] [Accepted: 03/29/2016] [Indexed: 12/12/2022]
Abstract
Inhaled corticosteroids (ICS) are established as a cornerstone of management for patients with bronchoconstrictive lung disease. However, systemic absorption may lead to suppression of the hypothalamic-pituitary-adrenal (HPA) axis in a significant minority of patients. This is more likely in 'higher risk' patients exposed to high cumulative ICS doses, and in those treated with frequent oral corticosteroids or drugs which inhibit cytochrome p450 3A4. Hypothalamic-pituitary-adrenal axis suppression is frequently unrecognized, such that some patients, notably children, only come to light when an adrenal crisis is precipitated by physical stress. To minimize this risk, 'higher risk' patients and those with previously identified suppressed cortisol responses to Synacthen testing should undergo an education programme to inform them about sick day rules. A review of ICS therapy should also be undertaken to ensure that the dose administered is the minimum required to control symptoms.
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Affiliation(s)
| | - D A Rees
- Neurosciences and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
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Belanger KK, Ameredes BT, Boldogh I, Aguilera-Aguirre L. The Potential Role of 8-Oxoguanine DNA Glycosylase-Driven DNA Base Excision Repair in Exercise-Induced Asthma. Mediators Inflamm 2016; 2016:3762561. [PMID: 27524866 PMCID: PMC4976190 DOI: 10.1155/2016/3762561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/13/2016] [Indexed: 12/20/2022] Open
Abstract
Asthma is characterized by reversible airway narrowing, shortness of breath, wheezing, coughing, and other symptoms driven by chronic inflammatory processes, commonly triggered by allergens. In 90% of asthmatics, most of these symptoms can also be triggered by intense physical activities and severely exacerbated by environmental factors. This condition is known as exercise-induced asthma (EIA). Current theories explaining EIA pathogenesis involve osmotic and/or thermal alterations in the airways caused by changes in respiratory airflow during exercise. These changes, along with existing airway inflammatory conditions, are associated with increased cellular levels of reactive oxygen species (ROS) affecting important biomolecules including DNA, although the underlying molecular mechanisms have not been completely elucidated. One of the most abundant oxidative DNA lesions is 8-oxoguanine (8-oxoG), which is repaired by 8-oxoguanine DNA glycosylase 1 (OGG1) during the base excision repair (BER) pathway. Whole-genome expression analyses suggest a cellular response to OGG1-BER, involving genes that may have a role in the pathophysiology of EIA leading to mast cell degranulation, airway hyperresponsiveness, and bronchoconstriction. Accordingly, this review discusses a potential new hypothesis in which OGG1-BER-induced gene expression is associated with EIA symptoms.
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Affiliation(s)
- KarryAnne K. Belanger
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Bill T. Ameredes
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
- Sealy Center for Molecular Medicine, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
- Sealy Center for Environmental Health and Medicine, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Istvan Boldogh
- Sealy Center for Molecular Medicine, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
- Sealy Center for Environmental Health and Medicine, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Leopoldo Aguilera-Aguirre
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA
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50
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Hedges KL, Tawhai MH. Simulation of Forced Expiration in a Biophysical Model, With Homogeneous and Clustered Bronchoconstriction. J Biomech Eng 2016; 138:061008. [PMID: 27109169 PMCID: PMC4867021 DOI: 10.1115/1.4033475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 04/06/2016] [Indexed: 11/08/2022]
Abstract
One limitation of forced spirometry is that it integrates the contribution of the complex and dynamic behavior of all of the airways and tissue of the lung into a single exhaling unit, hence, it is not clear how spirometric measures are affected by local changes to the airways or tissue such as the presence of "ventilation defects." Here, we adapt a wave-speed limitation model to a spatially distributed and anatomically based airway tree that is embedded within a deformable parenchyma, to simulate forced expiration in 1 s (FEV1). This provides a model that can be used to assess the consequence of imposed constrictions on FEV1. We first show how the model can be parameterized to represent imaging and forced spirometry data from nonasthmatic healthy young adults. We then compare the effect of homogeneous and clustered bronchoconstriction on FEV1 in six subject-specific models (three male and three female). The model highlights potential sources of normal subject variability in response to agonist challenge, including the interaction between sites of airway constriction and sites of flow limitation at baseline. The results support earlier studies which proposed that the significant constriction of nondefect airways must be present in order to match to clinical measurements of lung function.
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Affiliation(s)
- Kerry L. Hedges
- Auckland Bioengineering Institute,
University of Auckland,
Private Bag 92019,
Auckland 1142,
New Zealand
e-mail:
| | - Merryn H. Tawhai
- Auckland Bioengineering Institute,
University of Auckland,
Private Bag 92019,
Auckland 1142,
New Zealand
e-mail:
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