Association of lower airway inflammation with physiologic findings in young children with cystic fibrosis.

BACKGROUND: The relationship between lower airway markers of inflammation and infection with physiologic findings is poorly understood in young children with cystic fibrosis (CF). The goal of this study was to evaluate the association of bronchoalveolar lavage fluid (BALF) markers of infection and inflammation, including mediators linked to airway remodeling, to infant lung function values in young children with CF undergoing clinically indicated bronchoscopy. METHODS: Plethysmography and the raised volume rapid thoracoabdominal compression (RVRTC) technique were performed in 16 sedated infants and young children with CF prior to bronchoscopy. BALF was collected and analyzed for pathogen density, cell count, % neutrophils, transforming growth factor beta 1 (TGF-beta(1)), matrix metalloproteinases (MMP), and interleukin-8 (IL-8). RESULTS: There was a significant direct correlation between functional residual capacity (FRC), the ratio of residual volume to total lung capacity (RV/TLC) and FRC/TLC with % neutrophils (P < 0.05). Forced expiratory flows were inversely correlated to % neutrophils (P < 0.01). Lung function parameters did not differentiate those with and without lower airway infection; however, pathogen density directly correlated with FRC and inversely correlated with flows (P < 0.05). In a subset of the population, MMP-2 directly correlated with RV/TLC and inversely correlated with flows (P < 0.05) and TGF-beta(1) directly correlated with FRC (P < 0.05). CONCLUSIONS: Results from this study suggest that lower airway inflammation as well as mediators linked to airway remodeling play an active role in pulmonary deterioration in CF infants and young children undergoing clinically indicated bronchoscopy.

Strongyloides stercoralys: una peculiar forma de exacerbación en la EPOC / Strongyloides stercoralys as an unusual cause of COPD exacerbation

Strongyloides es un nematodo que puede persistir en el organismo durante largos períodos y tener como única manifestación eosinofilia asintomática. La enfermedad pulmonar obstructiva crónica (EPOC) puede ser una afección asociada a esta infección. La presencia de una alteración en la inmunidad celular o el uso de esteroides, frecuentes en el tratamiento de la exacerbación de la EPOC, podría provocar una hiperinfección de la larva, arrastrando en su paso al torrente sanguíneo bacterias entéricas. Así pues, la presencia no esperada de bacterias entéricas en la exacerbación de un caso de EPOC no grave con eosinofilia crónica sin filiar debería orientarnos a la búsqueda activa de larvas rabditiformes en las heces (AU)

The nematode of the genus Strongyloides can persist in the body for long periods with asymptomatic eosinophilia as its only manifestation. If patients with chronic obstructive pulmonary disease (COPD) are also infected by this organism, altered cellular immunity or therapy with corticosteroids, which are commonly used to treat COPD exacerbations, could lead to hyperinfection and dissemination of the larvae from the gastrointestinal tract to the bloodstream. Thus, the unexpected presence of enteric bacteria in the context of a nonsevere COPD exacerbation with unexplained chronic eosinophilia should lead us to search for rhabditiform larvae in stool (AU)

Relationship of skin-prick reactivity to aeroallergens and hyperresponsiveness to challenges with methacholine and adenosine monophosphate.

BACKGROUND: Clarification of the relationship between atopy and bronchial hyperresponsiveness (BHR), both key features of asthma, is critical to our understanding of the disease. We therefore investigated the putative relationship between skin-prick reactivity to aeroallergens and BHR to direct and indirect stimuli. METHODS: We performed a retrospective analysis of data from 332 patients presenting with a diagnosis of asthma. Patients were characterized by skin prick tests (SPT), spirometry and bronchial challenge with methacholine and adenosine monophosphate (AMP). RESULTS: For patients who had BHR to methacholine but not AMP, the presence of atopy was associated with a lower PD20 (the provocative dose of methacholine producing a fall in FEV1 of 20%), amounting to a geometric mean (95% confidence interval (CI)) of 2.3-fold (1.4-4.0) difference. Furthermore, the number of skin-prick positive (SPP) responses was related to methacholine reactivity: 0-1 SPP, PD20 = 69.9 micro g; 2-4 SPP, PD20 = 47.8 micro g; 5-8 SPP, PD20 = 35.6 micro g. There was a 2.0- fold (1.1-3.6) difference between the groups with a low (0-1 SPP) and high (5-8 SPP) degree of skin-prick reactivity. A similar pattern was seen when data were analyzed including only perennial allergens. Spirometry was unrelated to the degree of skin-prick reactivity. DISCUSSION: These results suggest that skin-prick reactivity to aeroallergens is associated with BHR to methacholine.