Mast cells: Re emergence of a pivotal role in asthma and chronic obstructive pulmonary disease [COPD]

Mast cells have long been thought to play a central role in asthma through their ability release proinflammatory mediators, but this role has been questioned by the lack of efficacy of antihistaminics and the so called mast cell stabilizing drugs. However, the evidenced increases of mast cells in the airway of asthmatics, especially the smooth muscles and the recent evidence of a more active role of smooth muscle in the pathogenesis of asthma has led to the re-emergence of mast sell as a pivotal role in asthma. This striking increase of mast cells in the airway was detected also in smokers and patients with COPD, thus drawn the attention towards the possibility of finding new treatment strategies. The aim of the current study was to investigate the presence of a relation between the number of mast sells in airway wall [smooth muscles and lamina propria] and severity of asthma and COPD. The mean number of mast cells in lamina propria and smooth muscles were higher the severer the disease, whether asthma or COPD. A positive correlation was detected between the mean number of mast cells in lamina propria and those in smooth muscles in all studied cases. Negative correlation was detected between mean number of mast cells in lamina propria and in smooth muscles and functional parameters in all studied cases.

Assessment of possible pulmonary involvement in patients with rheumatoid arthritis [RA] under methotrexate [MTX] therapy: comparison of clinical, functional, histopathological, high resolution computed tomography [HRCT] and laboratory features capability to detect pulmonary changes

Lung involvement in systemic disease may be a manifestation of the underlying pathological process, may be complication of the underlying disease or may be related to the treatment. Methotrexate [MTX], a folic acid antagonist is widely used in rheumatoid arthritis treatment; however, methotrexate-induced pulmonary drug toxicity occurs in 27% of patients. Difficulty in diagnosing these lesions had led-many researchers to assess the capability of every possible investigation [radiologic, functional, histopathologic, even 99mTc-DTPA scan] in reaching early diagnosis and differentiating it from those led by the original disease or that caused by infection, as early diagnosis and management carries good prognosis to an apparently fatal disease. Thus we compared in this study different diagnostic methods for detection of lung involvement due to MTX. We were able to detect pulmonary affection in some studies cases radiological and histopathologically, however, clinical and functional investigations lagged behind in their capabilieate the lung involvement.

Effect of long acting beta 2 agonists [LABA] on vascular remodeling in asthma

Research work studying the effect of anti-asthma drugs on indices of airway remodeling especially those concerned with the increased subepithelial airway vasculrity in asthma-emetics are still few. We studied the presence of increased vascularity and the effect of LABA on vascular remodeling on 33 asthmatics who were on inhaled steroids, however, only data of 29 patients at the end of the study period [6weeks] were available for statistical studies. We confirmed by patho- logical study of bronchoscopic biopsy that there was increased vasculrity of the airways in asthmatics, even in mild cases, and that this vascularity was higher the asthma. Moreover, there was a decrease in the number of vessels/mm2 of the lamina propria at the end of the study period in all of our patients whatever the severity of their asthma and this decrease was accompanied by functional improvement, however, more pronounced the less severe the asthma

Evaluation of different outcome measures in chronic obstructive pulmonary disease [COPD] treatment: a 9-months case of serieus study

Comparative assessment of sonic outcome measures in patients with COED receiving the recommended therapy. Twenty three COPD patients [divided into 2 groups by COPD severity] were treated and strictly supervised and followed-up for 9 months period, while variable outcome measures [physiologic, symptomatic, biological] were used to evaluate their state. Patients in both groups reported symptomatic improvement, their neutrophilic count markedly decreased, however, the pulmonary function tests were of limited values in showing patients improvement. Evidence from this study supports the idea that management of COPD require considerations of multiple outcome measures and that FEV1 is good in diagnosis and assessing disease severity but not reliable in patients follow-up

Effect of inhaled stroids in patients with stable chronic obstructive pulmonary disease [COPD] and eosinophilic bronchitis

Chronic obstructive pulmonary disease [COPD] constitutes an enormous, and growing health problem, the treatment of which has been less than satisfactory till now. Because of the chronic inflammation in the walls of large and peripheral airways as well as in the parenchyma, and as steroids are known for their anti-inflammatory effects, the latter had been investigated in more than 100 studies, however, the results are controversial. Recently, a group of COPD patients with high sputum eosinophilic count showed improvements clinically, functionally and in health status, following high dose of inhaled steroids. Thus the aim of the current study was to determine whether sputum eosinophilia [sputum eosinophils >3%]; in stable COPD patients can predict clinical benefits from treatment by high dose of inhaled steroids. Out of the 80 COPD patients who fulfilled the inclusion criteria and agreed to participate on this study, only 14 cases [Group I] showed evidence of high eosinophilic count in induced sputum, they received no oral steroids 2 months preceding the study and they had had no exacerbation one month before the study. They were given high dose of inhaled steroids [fluticasone propionate 500 microgram twice per day by Diskus] for one month. Another 14 patients [without sputum eosinophila] were also included in this study as Group II. They received inhaled steroids at a dose similar to those of group I. Patients of Group I showed decrease in sputum eosinophilia, accompanied by marked clinical improvement however, there was no detectable statistical difference in functional improvement. Those patients of Group II showed no improvement neither clinically nor functionally denoting lack of beneficial effect of inhaled steroids in COPD patients with no sputum eosinophilia.

role of eosinophilic count in induced sputum in the determination of asthma severity, control and in the adjustment of drugs dosage

Asthma is a chronic inflammatory disease of the airways, and long-term therapy for it is therefore directed towards the suppression of airway inflammation. Assessment of asthma severity and the effectiveness of therapy should be guided by the degree of airway inflammation. This is currently guided by indirect markers, such as lung function and existing asthma symptoms. Unfortunately, their uncertain relationship with the degree of airway inflammation and their temporarily improvement under bronchodilator therapy without controlling airway inflammation are considered major drawbacks. Moreover, the use of bronchoscopy for sampling of the lower airway tissue is inappropriate for clinical practice, and thus this is only reserved for research purposes. Recently, interest has been directed towards developing relatively less invasive markers for monitoring the airway inflammation more directly. These markers had proved their ability to reflect airway inflammation, moreover, their change are in agreement with the findings in airway biopsies. They are useful in monitoring treatment effectiveness and are sensitive enough to reflect worsening of airway inflammation. Among various newer methods being developed for monitoring airway inflammation, sputum induction seem to be very promising, being reproducible and less invasive, and thus could be applied for sequential measurements. Thus this study aimed at revealing the role of induced sputum [by means of the determination of sputum eosinophilic percentage] in determining asthma severity, guiding the physicians in controlling asthma, and in the adjustment of drugs dosage. This study included 27 asthmatic patients who approved to participate in this study and who fulfilled the inclusion criteria. This study showed the presence of correlation between sputum eosinophilia and asthma severity, moreover it revealed the ability of sputum eosinophilia to reveal asthma control and to help in drug adjustment

Possible role of infection with chlamydia pneumoniae in determining severity and control of chronic stable asthma and in the induction of acute exacerbations in asthmatics

Asthma is an inflammatory disease of the airways, with a worldwide unexplained increasing incidence. Multiple risk factors are discussed to contribute to the development of asthma in patients with underlying atopy. Chlamydia pneumoniae [C. pneumoniae] has been discussed as a possible cofactor causing asthma and chronic obstructive pulmonary disease. In addition, it is postulated that Chlamydia pneumoniae may play a vital role in affecting asthma severity and in inducing acute exacerbations. Thus the aim of this study was to detect whether infection with Chlamydia pneumoniae is related to asthma severity and affect the control of chronic stable asthmatics. In addition, to detect changes in clinical status and in the frequency of exacerbations on those with positive serology after the intake of specific therapy to Chlamydia. Moreover, to detect a possible role of Chlamydia pneumoniae in induction of acute exacerbations in asthmatics Ten patients with acute exacerbation of asthma and 36 cases with chronic stable asthma were serologically examined for presence of IgG antibodies against Chlamydia pneumoniae. Those with evidence of acute or chronic Chlamydia infection were treated with fluorinated 4-quinolone tablets 200mg twice daily for 2 weeks. Serological examination was then repeated and showed evidence of sero-con version. Asthma severity, clinical status and frequency of exacerbations [in the prior 3 months to this study] were determined in patients with chronic stable asthma and positive serology and compared with those with negative serology to Chlamydia pneumoniae. The same parameters in those sero-positive cases and chronic stable asthma were re-evaluated 3 months after therapy and was compared with those at baseline Forty six female asthmatics were included in this study. Ten cases suffered from acute exacerbation of asthma, three of them showed serological evidence of acute infection with Chlamydia pneumonjae. Thirty six cases had had chronic stable asthma, 19 of them showed evidence of chronic infection with Chlamydia pneumoniae. Those cases with serological evidence of chronic infection had suffered from frequent exacerbations and required higher doses of therapy than other patients in the same group. After 2 weeks of therapy with quinolones, patients showed sero-conversion, they were followed up for 3 months. Much improvement in clinical status, with decrease in drug dosage used and in the number of exacerbations were reported. Chlamydial infection in asthmatics is related to asthma severity and increase incidence of exacerbations in chronic stable asthmatics. Treatment with quinolones, by improving clinical status and decreasing frequency of exacerbations act as another evidence of these findings Moreover, Chlamydia pneumoniae plays a role in the induction of acute exacerbations in asthmatics

Effect of steroidal treatment in asthma on voice

Corticosteroids are the mainstay of treatment in bronchial asthma, unfortunately, they have systemic and local side effects, among which is dysphonia. The aim of this work was to study the effect of steroid therapy [inhaled or oral] used by asthmatics on voice. In this study 40 asthmatic patients, 20 patients were treated with steroids [inhaled or oral] and 20 patients were not treated with steroids, in addition to 20 control subjects were included. All patients were examined by laryngoscope, acoustic and aerodynamic studies. Examination revealed hazardous effects on vocal folds and subsequently on voice in patients on oral steroids. In addition, some asthmatics not receiving steroid therapy showed also ventricular hypertrophy and bilateral vocal fold nodules that led to voice changes. However, patients on inhaled steroids did not show any voice problems. Thus it is recommended a regular checking up of the vocal folds of asthmatic patients especially those on steroid therapy for early detection of any pathology even before any clinical manifestation appears