ABSTRACT
In order to investigate the relationship between airways inflammation and disease severity, and improve the understanding of persistent asthma, 74 asthmatics, with disease severity ranging from intermittent, to mild to moderate and severe persistent (classified according to the Global Initiative for Asthma [GINA] guidelines), and 22 nonatopic control subjects were studied using the method of induced sputum. Sputum was analyzed for total and differential cell counts concentrations of albumin, and levels of eosinophil cationic protein (ECP), myeloperoxidase (MPO), and tryptase, inflammatory mediators reflecting eosinophil, neutrophil, and mast cell activation. Asthma severity (assessed by FEV(1), peak expiratory flow [PEF] variability, and daily symptom scores) and methacholine airways responsiveness were related to sputum eosinophilia and ECP. In addition, sputum neutrophilia and MPO levels correlated, albeit weakly, with PEF variability and symptom scores, respectively. Tryptase concentrations were raised in mild to moderate asthmatics. Albumin concentrations were significantly raised across the spectrum of asthma severity and correlated with those of tryptase and ECP. Despite treatment with either high doses of inhaled corticosteroids or oral corticosteroids, prominent eosinophilic inflammation with raised ECP was noted. This study points to persistent, disease severity-related airways inflammation in asthma, involving eosinophils, mast cells, and neutrophils, which is evident despite treatment with corticosteroids.
Subject(s)
Asthma/physiopathology , Bronchial Hyperreactivity/physiopathology , Ribonucleases , Adult , Albumins/metabolism , Asthma/drug therapy , Asthma/metabolism , Biomarkers , Blood Proteins/metabolism , Bronchial Hyperreactivity/drug therapy , Bronchial Hyperreactivity/metabolism , Chymases , Eosinophil Granule Proteins , Eosinophils/metabolism , Eosinophils/pathology , Female , Glucocorticoids/therapeutic use , Humans , Male , Mast Cells/enzymology , Mast Cells/pathology , Methacholine Compounds , Neutrophils/enzymology , Neutrophils/pathology , Peroxidase/metabolism , Respiratory Function Tests , Serine Endopeptidases/metabolism , Severity of Illness Index , Sputum/cytology , Sputum/metabolism , TryptasesABSTRACT
We present the case of a 25 year old woman who, 3 yrs after resection of a vascular ring, had persisting complaints of episodic dyspnoea. This was caused by compression of the distal trachea and ostium of the right main bronchus by the descending part of the remaining right-sided aorta. Probable mechanisms are discussed.
Subject(s)
Aorta, Thoracic/abnormalities , Bronchial Diseases/etiology , Dyspnea/etiology , Postoperative Complications/etiology , Tracheal Stenosis/etiology , Adult , Bronchial Diseases/surgery , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Female , Humans , Reoperation , Tracheal Stenosis/surgeryABSTRACT
Nocturnal symptoms are common in asthma, even when patients are regularly seen at an outpatient clinic. Inflammation is generally accepted as a general feature of asthma and the severity of this basic inflammatory process can be increased by exogenous triggers such as exposure to allergens and nonallergic stimuli. Superimposed endogenous circadian rhythms may play a more important and intricate role in the circadian modulation of the inflammatory process by changing the number of cells, their release of mediators and/or the susceptibility of airway smooth muscle and vasculature. For instance, an increase in vagal tone may induce nocturnal bronchoconstriction which is further enhanced by falling catecholamine levels. Together, the reduced nocturnal catecholamine levels and the diminished bronchodilating capacity of the NANC system and the low cortisol levels oppose possible protection against inflammatory processes leading to nocturnal airflow obstruction.