The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study / Efeito de diferentes soluções para irrigação nasal após septoplastia e radiofrequência das conchas nasais: estudo prospectivo e randomizado

Abstract Introduction Nasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing. Objective The aim of the present study was to compare the effects of nasal irrigation solutions with different contents following septoplasty and concha radiofrequency. Methods The present study was a prospective, randomized, controlled simple blind study of 120 patients who underwent septoplasty and bilateral concha radiofrequency. Patients were divided into four groups according to the nasal irrigation solution used: tap water, buffered isotonic saline, saline with xylitol, and hypertonic sea water. Patients were examined on the 7th and 15th postoperative days. A saccharine test was applied to determine mucociliary activity preoperatively and on the 7th and 15th postoperative days. Patients were asked about drying and obstruction using a 10 cm visual analog scale. In addition, patients were examined to determine the crusting score. Results There was no significant difference found in the preoperative and 7th and 15th postoperative days' mucociliary clearance times among the four groups. The crusting score was found to be significantly lower in the hypertonic sea water group (p < 0.001). Drying and obstruction on the 7th and 15th postoperative days were found to be significantly more comfortable in the hypertonic sea water group (p < 0.001). Conclusion Hypertonic sea water is the recommended irrigation solution, as it is associated with less crusting, drying, and obstruction in the nose for the postoperative period following septoplasty and concha radiofrequency.

Resumo Introdução Soluções para irrigação nasal são amplamente usadas após cirurgias endonasais. Essas soluções removem os resíduos e crostas, reduzem a probabilidade de formação de sinéquias e aceleram a cicatrização da mucosa. Objetivo O objetivo do presente estudo foi comparar os efeitos das soluçoes para irrigaçao nasal com diferentes conteudos apos septoplastia e turbinoplastia com radiofrequencia. Método O presente estudo foi um estudo cego simples, randomizado, controlado e prospectivo de 120 pacientes submetidos a septoplastia e turbinoplastia bilateral com radiofrequencia. Os pacientes foram divididos em quatro grupos de acordo com a soluçao nasal utilizada: agua da torneira, soluçao salina isotonica tamponada, soluçao salina com xilitol e agua do mar hipertonica. Os pacientes foram examinados no 7° e 15° dias do pos-operatorio. O teste de sacarina foi utilizado para determinar a atividade mucociliar pre-operatoria e no 7° e 15° dias do pos-operatorio. Os pacientes foram questionados sobre a sensaçao de secura e obstruçao nasais utilizando uma escala visual analógica de 10 cm. Alem disso, os pacientes foram examinados para determinar o escore em relaçao a crostas. Resultados Não houve diferença significativa entre o pré-operatório e o sétimo e 15° dias do pós-operatório dos tempos de clearance mucociliar entre os quatro grupos. Verificou-se que o escore em relação a crostas foi significativamente menor no grupo que usou água do mar hipertônica (p < 0,001). As sensações de secura e obstrução nasais no sétimo e 15° dias do pós-operatório mostraram-se significativamente mais confortáveis no grupo água do mar hipertônica (p < 0,001). Conclusão A água de mar hipertônica é a solução de irrigação recomendada, pois está associada a menor incidência de crostas, secura e obstrução nasais no pós-operatório de cirurgia de septoplastia e das conchas nasais com radiofrequência.

Review of Mesna (Mistabron) as a Mucolytic for Preventing Plumonary complications in Intensive Care Setting.

Impaired mucus clearance or mucus hypersecretion are important feature of many pathological respiratory conditions and in ICU patients. Mesna is a potent mucolytic available as 200 mg/ml solution for neublization and endotracheopulmonary instillation. As effective “mucus clearance” is critical in managing post-operative and other ICU conditions to prevent complications like atelectasis and hypoxia, there is a need to review the clinical results of mucolytic agent Mesna, and its role in mucociliary clearance in critical care patients and in other respiratory conditions.

The impact of topically applied preservation solutions on the respiratory epithelium of tracheal grafts submitted to cold ischemia: functional and morphological analysis

OBJECTIVE: Advances in graft reepithelialization and revascularization have renewed interest in airway transplantation. This study aims to determine whether topically applied preservation solutions can ameliorate ischemic injury to tracheal grafts. We analyzed 1) the effects of cold ischemia on the mucociliary clearance of tracheal grafts and 2) the impact of topically applied preservation solutions on the effects of cold ischemia on mucociliary clearance. METHOD: Tracheal segments (n=217) from 109 male Wistar rats were harvested, submerged in low-potassium-dextran-glucose, histidine-tryptophan-ketoglutarate, or saline solution (saline group), and stored at 4°C for 6, 10, 16, or 24 hours. A control group (not submerged) was analyzed immediately after harvesting. In situ mucociliary transport and ciliary beating frequency were measured using a stroboscope. Epithelial integrity, cellular infiltration, and mucus storage were quantified by light microscopy and image analysis software, along with transmission electron microscopy. RESULTS: 1) The effects of cold ischemia: in situ mucociliary transport and ciliary beating frequency were greater in the control group than after cold ischemia. Microscopic analysis results were similar between groups. 2) The effects of preservation solutions: there was no difference between the low-potassium-dextran-glucose, histidine-tryptophan-ketoglutarate, and saline groups in functional or light microscopy analysis. The saline group presented stronger signs of ischemic injury with transmission electron microscopy. CONCLUSIONS: Cold ischemia diminished the mucociliary clearance of the tracheal respiratory epithelium. Topically applied preservation solutions did not ameliorate the injury caused by cold ischemia to the tracheal respiratory epithelium. .

[Comparative evaluation of the effect of Malva sylvestris and bromhexine on mucociliary system of trachea in chicken]

Malva sylvestris [M.S] with various drug effects, especially on mucociliary system as dilutor drug and sputum collection is known. This study examined the effects of M.S and Bromhexine HCL [B.H] in mucociliary system of trachea chicken. In this experimental study five groups of Leghorn chickens were studied under identical conditions. Four groups received oral B.H and oral M.S extract and nebulas normal saline and nebulas M.S extract during 12 days, respectively and one group was considered as control. After 12 days the chicks were killed and the biopsy samples from the middle tracheal were taken for histopathology study using PAS and H and E methods under light microscopy. Finally Image tools II Software were used for counting of size and number of mucous glands and cilia. Results of the analysis of data showed that nebulizing of M.S increases the number and the size of mucous glands, also the size of cilia compare to 3 groups: control, oral B.H, normal saline significantly. The oral M.S extract group showed significant differences in number of the mucous glands compared with other 3 groups. According to more mucolitic effects of M.S extract than Bromhexine HCL and side effects for drugs mucolitic is recommended to be used that respiratory and inflammatory diseases of the M.S extract

The effects on mucociliary clearance of prednisone associated with bronchial section

OBJECTIVE: Infections have been and remain the major cause of morbidity and mortality after lung transplantation. Because mucociliary clearance plays an important role in human defense mechanisms, the influence of drugs on the mucociliary epithelium of patients undergoing lung transplantation must be examined. Prednisone is the most important corticosteroid used after lung transplantation. The aim of this study was to evaluate the effects of bronchial transection and prednisone therapy on mucociliary clearance. METHODS: A total of 120 rats were assigned to 4 groups according to surgical procedure or drug therapy: prednisone therapy (1.25 mg/kg/day); bronchial section and anastomosis + prednisone therapy (1.25 mg/kg/day); bronchial section + saline solution (2 ml/day); and saline solution (2 ml/day). After 7, 15, or 30 days, the animals were sacrificed, and the lungs were removed from the thoracic cavity. The in situ mucociliary transport velocity, ciliary beat frequency and in vitro mucus transportability were evaluated. RESULTS: Animals undergoing bronchial section surgery and anastomosis had a significant decrease in the ciliary beat frequency and mucociliary transport velocity 7 and 15 days after surgery (p<0.001). These parameters were normalized 30 days after the surgical procedure. Prednisone improved mucous transportability in the animals undergoing bronchial section and anastomosis at 15 and 30 days (p<0.05). CONCLUSION: Bronchial section and anastomosis decrease mucociliary clearance in the early postoperative period. Prednisone therapy improves mucus transportability in animals undergoing bronchial section and anastomosis.

Effects of mycophenolate sodium on mucociliary clearance using a bronchial section and anastomosis rodent model

OBJECTIVE: To study the effects of mycophenolate sodium on mucociliary clearance. INTRODUCTION: Mycophenolate is one of the most commonly used immunosuppressive drugs in lung transplantation. Although its pharmacokinetic properties are well defined, its side effects on mucociliary clearance have not yet been studied. METHODS: Sixty rats were subjected to left bronchial section and anastomosis. The right bronchus was used as a control. After surgery, the rats were assigned to two groups based on whether they received saline solution (n = 30) or mycophenolate sodium (n = 30). After 7, 15, or 30 days of treatment, 10 animals from each group were sacrificed, and in vitro mucus transportability, in situ mucociliary transport velocity and ciliary beat frequency were measured. RESULTS: The analysis of mucus transportability revealed that neither mycophenolate nor bronchial section altered any transportability related property for up to 30 days of treatment after surgery (p>0.05). With regard to ciliary beat frequency, the operated left bronchi from the mycophenolate group showed a significant decrease on post-surgical day 30 (p = 0.003). In addition, we found a significant reduction in the in situ mucociliary transport velocity in the mycophenolate-treated group (p = 0.0001). DISCUSSION: These data add important information regarding mucociliary clearance dysfunction following mycophenolate therapy and suggest that mycophenolate might contribute to the high incidence of respiratory tract infections in lung transplant patients. Further studies are needed to investigate the combined action of mycophenolate with other immunosuppressive drugs and to establish methods to protect and recover mucociliary clearance, an important airway defense mechanism.

Effect of topical steroids on mucociliary clearance and nasal symptom score

Allergic rhinitis is one of the most common ENT diseases in Faisalabad. The affects of topical steroids on nasal mucosal environment has not been studied reliably. To see the affects of topical steroids on symptom score and mucociliary clearance in Allergic Rhinitis. To see whether symptom score change with change in mucociliary clearance after topical application of steroids. A quasi-experimental study. ENT Unit, Madina Teaching Hospital, Faisalabad [a tertiary care hospital]. [sample, sampling technique]: Non-probability convenience sampling. Fifty patients in total. Saccharine with dye: india ink [Indigocarmine] application on anterior end of inferior turbinate to check mucociliary clearance. [Main outcome measures]: To assess change in mucociliary clearance time and symptom score [total as well as individual] before and after application of steroid at one, three and six months in patients having allergic rhinitis. Each nasal symptom was scored as zero to 3 on a severity scale [absent-mild-moderatesevere]. Patients were tested for nasal mucociliary clearance and symptom score before and after application of steroid. The results showed statistically significant difference in these groups. 1.Topical steroids modify the nasal mucosal environment in terms of mucociliary clearance and thus affects the patients quality of life in terms of allergic rhinitis symptom score 2. More long term follow up and wider studies are required to study the definite affects of steroids on nasal mucosa

Efeito do óxido nítrico no transporte mucociliar / Effects of nitric oxide in mucociliary transport

As vias aéreas, constituídas por epitélio ciliado e secretor de muco, promovem ao trato respiratório mecanismo de defesa que livra esta superfície das partículas inaladas durante a respiração. É de fundamental importância o entendimento da fisiologia e dos mecanismos envolvidos com a atividade mucociliar. A literatura sugere que o NO, em especial o produzido pela expressão da iNOS, mantém a função mucociliar e a defesa imune da cavidade nasal. Objetivo: Avaliar o envolvimento do NO e das vias enzimáticas da produção do NO no transporte mucociliar, utilizando inibidores da NO sintase constitutiva e indutiva, L-NAME e aminoguanidina, respectivamente. Materiais e métodos: Preparações de palatos de rã foram imersos em soluções de ringer (controle), L-NAME ou aminoguanidina. Os palatos foram imersos nestas soluções por quatro períodos de 15 minutos. Medidas da velocidade do transporte mucociliar foram feitas antes e após cada exposição. Resultos: Palatos controles mantiveram estável a velocidade do transporte. O L-NAME aumentou, enquanto a aminoguanidina reduziu a velocidade de transporte do muco. Conclusão: O bloqueio inespecífico da cNOS com L-NAME e bloqueio relativamente específico da iNOS com aminoguanidina permitiu propor que dependendo da via o NO pode aumentar ou diminuir o transporte mucociliar em palatos de rã.

The airways are made up of ciliated epithelium which secretes mucous, protecting the respiratory tract from particles inhaled during breathing. Its is paramount to understand the physiology and the mechanisms involved in mucociliary activity. Literature suggests that Nitric oxide (NO), especially the one produced by iNOS expression, maintains the mucociliary function and the immune defense of the nasal cavity. AIM: to assess NO participation and the enzymatic pathways in the production of NO and mucociliary transport, using constructive and inductive NO synthetase inhibitors, L-NAME and aminoguanidine, respectively. Materials and methods: frog palates were prepared and immerse in ringer (control), L-NAME or aminoguanidine solutions. The palates were immerse in these solutions for four periods of 15 minutes. Mucociliary transport measures were carried out before and after each exposure. Results: control palates maintained stable their transportation speed. L-NAME increased, while aminoguanidine reduced mucous transportation velocity. Conclusion: unspecific cNOS block with L-NAME and relatively specific iNOS block with aminoguanidine results leads us to propose that depending on the pathway, the NO can increase or reduce mucociliary transport in frog palates.

Efeitos da azatioprina sobre a depuração mucociliar após secção e anastomose brônquica em um modelo experimental em ratos / Effects of azathioprine on mucociliary clearance after bronchial section and anastomosis in a rat experimental model

OBJETIVO: Avaliar os efeitos da azatioprina sobre o sistema mucociliar em um modelo de secção e anastomose brônquica em ratos. MÉTODOS: Trinta e seis ratos machos da raça Wistar-Furth foram submetidos à secção e anastomose brônquica esquerda e separados aleatoriamente em dois grupos para receberem solução salina ou azatioprina. Após 7, 15 e 30 dias de terapia, seis animais de cada grupo foram sacrificados, e foram realizadas as medidas da velocidade de transporte mucociliar in situ, da transportabilidade do muco in vitro e do ângulo de contato do muco nos brônquios direito (intacto) e esquerdo (seccionado). RESULTADOS: A velocidade de transporte mucociliar in situ foi significativamente menor nos brônquios seccionados do que nos brônquios intactos (p < 0,001). Houve redução da velocidade de transporte mucociliar in situ nos brônquios intactos dos animais tratados com azatioprina por 7 dias (p < 0,05), havendo completa recuperação após 30 dias de terapia. O ângulo de contato do muco foi maior nos brônquios seccionados dos animais tratados com solução salina por 30 dias (p < 0,001), estando de acordo com a redução da transportabilidade do muco in vitro observada nos mesmos animais (p < 0,001). CONCLUSÕES: Concluímos que, nos brônquios seccionados de ratos, a terapia com azatioprina causa um prejuízo apenas transitório do transporte mucociliar, enquanto a administração de solução salina prejudica o transporte mucociliar por até 30 dias. Além disso, a azatioprina contribui para prevenir alterações nas propriedades da superfície do muco.

OBJECTIVE: To evaluate the effects of azathioprine on the mucociliary system in a model of bronchial section and anastomosis in rats. METHODS: Thirty-six male Wistar-Furth rats were submitted to left bronchial section and anastomosis and divided into two groups to receive either saline solution or azathioprine. After 7, 15 and 30 days of treatment, six animals from each group were killed, after which in situ mucociliary transport velocity, in vitro mucus transportability, and contact angle of mucus in the right (intact) and left (sectioned) bronchi were measured. RESULTS: In situ mucociliary transport velocity was significantly lower in the sectioned bronchi than in the intact bronchi (p < 0.001). In situ mucociliary transport velocity was lower in the intact bronchi of the animals treated with azathioprine for 7 days (p < 0.05), and those bronchi presented full recovery after 30 days of treatment. The contact angle was higher in the mucus samples collected from the sectioned bronchi of the animals treated with saline solution for 30 days (p < 0.001), which is in accordance with the decreased in vitro mucus transportability observed in the same animals (p < 0.001). CONCLUSIONS: We conclude that, in the sectioned bronchi of rats, treatment with azathioprine causes only transitory impairment of mucociliary transport, whereas administration of saline solution impairs mucociliary transport for up to 30 days. In addition, azathioprine protects against alterations in mucus surface properties.

Influence of cyclosporine A on mucociliary system after lung transplantation in rats

PURPOSE: To investigate the function of the bronchial mucociliary system in transplanted rat lungs with and without the influence of immunosuppression. METHODS: Thirty-six rats underwent single-lung transplantation and were divided into two groups, one of which received cyclosporine treatment, and the control group which did not. Cyclosporine was administered subcutaneously in doses of 10 mg/kg daily. The rats were sacrificed 2, 15 or 30 days after transplantation. In situ bronchial mucociliary transport (MCT) and ciliary beat frequency (CBF) were determined proximal and distal to the bronchial anastomosis. RESULTS: Significant progressive improvement on MCT, proximal and distal to the anastomotic site, was also found in the cyclosporine-treated group at 15 and 30 days (p<0.01). No significant change in MCT was found in the control group. CBF behavior in the two groups. Histological analysis showed that rejection was significantly higher in the control group (p<0.05). CONCLUSION: Cyclosporine has a positive influence on bronchial mucociliary transport but not on CBF due to the effect of the rejection mechanism.

OBJETIVO: Investigar a função do sistema mucociliar em ratos transplantados sob a influência de imunossupressores. MÉTODOS: Trinta e seis ratos foram submetidos ao transplante pulmonar unilateral e divididos em dois grupos, onde um grupo foi tratado com ciclosporina e outro foi controle. Administrada ciclosporina por via subcutânea na dose de 10 mg/kg diariamente. Os ratos foram sacrificados 2, 15 e 30 dias após o transplante pulmonar. O transporte mucociliar brônquico (TMC) in situ e a freqüência de batimento ciliar (FBC) foram analisados na porção proximal e distal à anastomose brônquica. Realizada correlação dos achados com parâmetros gasométricos e histologia. RESULTADOS: Foi encontrada melhora progressiva e significante no TMC na região proximal e distal a anastomose no grupo que recebeu ciclosporina em 15 e 30 dias (p<0,01). Não houve diferença na FBC nos dois grupos estudados. A análise histológica mostrou que a rejeição foi significantemente maior no grupo controle (p<0,05). A oxigenação foi melhor nos animais que receberam a ciclosporina. CONCLUSÃO: A ciclosporina exerceu influência positiva no transporte mucociliar brônquico, provavelmente por sua ação imunossupressora.

Cyclosporin A reduces airway mucus secretion and mucociliary clearance in rats

PURPOSE: To assay the effects of cyclosporin A on mucus secretion from goblet cells and on mucociliary transport in situ in rats. METHODS: Twenty-one male Wistar rats were assigned to 3 groups: control (n = 5), saline (n = 8), and cyclosporin A (n = 8). After 30 days of drug therapy, the rats were killed, and the lungs were removed from the thoracic cavity. Mucus samples were collected, and the transport rate was evaluated in vitro using a bullfrog palate model. Mucociliary transport was timed in situ by direct view of particles trapped on the mucus moving across the respiratory tract. Finally, the amount of stored mucins in the goblet cells of the respiratory epithelium was measured. RESULTS: Drug dosage measurements showed that cyclosporine blood concentration at the moment the rats were killed was 1246.57 ± 563.88 ng/mL. The in vitro transport rate was significantly lower (P < .001) in the cyclosporin A-treated group. Also, the in-situ mucociliary transport rate was decreased in all cyclosporin A-treated animals when compared to the saline group (P = .02). Mucus quantity measurements showed a significant decrease on both acid (P = .01) and neutral (P = .02) mucus production from goblet cells in the animals submitted to cyclosporin A therapy. The correlation between the percentage of total mucus and in vitro transport rate was positive and significant (r = 0.706, P < .001), as was the correlation between the percentage of total mucus and the in situ mucociliary transport rate (r = 0.688, P = .001). CONCLUSION: This study shows that cyclosporin A plays an important role in the impairment of the mucociliary clearance in rats by reducing both acid and neutral mucus production from goblet cells and causing a decrease in the mucociliary transport velocity.

OBJETIVO: Avaliar os efeitos da ciclosporina A sobre a produção de muco das células caliciformes e sobre o transporte mucociliar in situ de ratos. MÉTODOS: Vinte e um ratos machos Wistar foram distribuídos em três grupos: Controle (n=5), Salina (n=8) e Ciclosporina A (n=8). Após 30 dias de terapia, os ratos foram mortos e os pulmões removidos da cavidade torácica. Amostras de muco foram coletadas e a medida da transportabilidade in vitro foi realizada através de um modelo de palato de rã. A velocidade do transporte mucociliar foi medida através da observação direta do deslocamento de partículas aderidas ao muco do epitélio ciliado brônquico. Por fim, efetuamos a quantificação das mucinas estocadas nas células caliciformes do epitélio respiratório. RESULTADOS: O valor médio da concentração sangüínea da ciclosporina no momento do sacrifício dos ratos foi de 1.246,57 ± 563,88 ng/ml. A transportabilidade do muco in vitro foi estatisticamente menor (p < 0.001) no grupo tratado com ciclosporina. Da mesma forma, houve um decréscimo na velocidade de transporte mucociliar nos animais imunossuprimidos em relação aos que receberam o placebo (p = 0.02). Houve diminuição significativa na quantidade de muco ácido (p = 0,01) e neutro (p = 0,02) produzidos pelas células caliciformes nos animais tratados com ciclosporina. A correlação entre a porcentagem de muco e a transportabilidade in vitro foi positiva e significante (r = 0.706, p < 0.001), assim como entre a porcentagem do muco e o transporte mucociliar in situ (r = 0.688, p = 0.001). CONCLUSÃO: O presente estudo mostra que a ciclosporina A age no sistema mucociliar causando um sério prejuízo através da redução na produção de muco ácido e neutro pelas células caliciformes como também a diminuição da velocidade de transporte mucociliar in situ e a transportabilidade do muco in vitro.

Effect of single inhalation of a salbutamol, ipratropium bromide and beclomethasone on mucociliary clearance in patients with chronic obstructive airway disease.

BACKGROUND: Chronic obstructive airway disease (COAD) is associated with hyperplasia and hypertrophy of the mucus producing glands. The beneficial effect of inhaled drug may be due to improved mucociliary function. The present study was done to evaluate the effect of salbutamol, ipratropium bromide and beclomethasone dipropionate inhalation on mucociliary clearance in patients with COAD. METHODS: Ten patients of COAD were taken up, two patients however did not complete the study. Salbutamol, ipratropium bromide, beclomethasone dipropionate and placebo inhalation were given randomly to each patient on four separate days. Radioaerosol inhalation lung cine-scintigraphy after inhalation of the different drugs was followed up to two hours and than after 24 hours. RESULTS: There was no significant visually noticeable increased mucociliary clearance on any of the days. Two patients showed definite steep slope in the time activity curves with salbutamol as compared to other drugs or placebo. All the quantitative indices analysed at the end of one hour and two hours for the three drugs were comparable to placebo. CONCLUSIONS: A single dose of inhaled salbutamol, ipratropium bromide and beclomethasone dipropionate has no appreciable effect on mucociliary clearance in patients with COAD.

Effect of inhalation of salbutamol, beclomethasone dipropionate & ipratropium bromide on mucociliary clearance in some patients with chronic stable bronchial asthma.

BACKGROUND & OBJECTIVES: Asthma is now regarded as an inflammatory disease and bronchial inflammation may disrupt mucociliary function. Inhaled drugs may act by improving mucociliary function. The aim of the study was to investigate the effect of salbutamol, ipratropium bromide and beclomethasone on mucociliary clearance in patients with chronic stable asthma and to compare the efficacy of these drugs on mucociliary clearance. METHODS: Ten patients with chronic stable asthma were enrolled in the study, but two patients did not complete the study. Patients with bronchial asthma were chosen on clinical grounds. (99m)Tc phytate radioaerosol generated through a nebulizer, was given to each patient on four days. After each administration the radioactivity over the thorax was constantly measured in sequential frame mode for 120 min. Radioactivity in the thorax was also measured after 24 h. A base-line pulmonary function test with reversibility was obtained. Salbutamol, ipratropium bromide, beclomethasone dipropionate and placebo inhalation were given randomly to each patient on four days. RESULTS: The mean age of patients (n = 8) was 36 +/- 9.3 yr and mean duration of symptoms was 5 +/- 6.6 yr. There was no visual impression that mucociliary clearance was enhanced with any of the drugs. The time activity curves did not show any visually recognisable change in slope. In only one patient the curve tended to show a steeper slope with ipratropium inhalation. In the rest of the patients the curves showed no difference at all with medication when compared with placebo. All the quantitative indices analyzed by two-way ANOVA at the end of one and two hours were comparable for the three test drugs and placebo. None of the three test drugs demonstrated statistically significant mucociliary clearance effect compared with placebo. However, the temporal difference in airways clearance efficiency (ACE) was significant with beclomethasone and ipratropium bromide. INTERPRETATION & CONCLUSION: Inhalation of any of the three drugs tested did not produce any immediate improvement in mucociliary clearance as compared to placebo in patients with stable bronchial asthma suggesting the need for further studies using higher doses of drugs for longer duration in a large sample.

Effects of formaldehyde on the frog's mucociliary epithelium as a surrogate to evaluate air pollution effects on the respiratory epithelium

The increasing use of alcohol as an alternative fuel to gasoline or diesel can increase emission of formaldehyde, an organic gas that is irritant to the mucous membranes. The respiratory system is the major target of air pollutants and its major defense mechanism depends on the continuous activity of the cilia and the resulting constant transportation of mucous secretion. The present study was designed to evaluate the effects of formaldehyde on the ciliated epithelium through a relative large dose range around the threshold limit value adopted by the Brazilian legislation, namely 1.6 ppm (1.25 to 5 ppm). For this purpose, the isolated frog palate preparation was used as the target of toxic injury. Four groups of frog palates were exposed to diluted Ringer solution (control, N = 8) and formaldehyde diluted in Ringer solution at three different concentrations (1.25, 2.5 and 5.0 ppm, N = 10 for each group). Mucociliary clearance and ciliary beat frequency decreased significantly in contact with formaldehyde at the concentrations of 2.5 and 5.0 ppm after 60 min of exposure (P<0.05). We conclude that relatively low concentrations of formaldehyde, which is even below the Brazilian threshold limit value, are sufficient to cause short-term mucociliary impairment