Thymomodulin increases the depressed production of superoxide anion by alveolar macrophages in patients with chronic bronchitis.

Thymomodulin is an immunomodulating agent which is derived from calf thymus by partial acid lysis. It promotes T-cell maturation, enhances antibody synthesis and improves the phagocytic response of neutrophils. Clinical trials have revealed the effectiveness of this thymic derivative in the prevention of recurrent respiratory infections (RRI) in children and in adults; 11 patients (8 males and 3 females; age range 18-76 years) with chronic bronchitis dominated by recurrent respiratory infections were studied. They were treated orally for 6 months during the winter season with 120 mg/day of thymomodulin. All the subjects were asked to keep a diary recording the intensity of their symptoms, the number of working days lost (days of illness) and the use of antibiotic and/or mucolytic drugs. At the beginning and at the end of the trial each patient was subjected to a control with a flexible fibreoptic bronchoscope with bronchoalveolar lavage to evaluate the phagocytic response of alveolar macrophages. At the end of therapy a significant improvement of the clinical status, evaluated by the above-mentioned parameters, of the bronchial mucosa aspect and an increase in alveolar macrophage superoxide production was noticed (from 0.1 +/- 0.09 and 0.8 +/- 0.5 nmol to 1.6 +/- 0.8 and 4.1 +/- 2.2 nmol with PMA or zymosan particles respectively; p less than 0.001). During thymomodulin treatment no side-effects were recorded.

[Asthma improved by acetylsalicylic acid]. / Asthme amélioré avec l'acide acétylsalicilique.

It is known that in some asthmatic subjects the administration of acetylsalicylic acid (ASA) and non-steroid anti-inflammatory drugs (NSAID) results in bronchodilatation. We have administered 750 mg of ASA intravenously to 100 asthmatic patients who were without history of ASA intolerance. Functional assessment (FEV) was performed under basal conditions and after 5, 10, 15, 30, 60, 90, 120, 150 and 180 minutes after the administration of ASA. 64 patients had no functional variations, 14 showed a percentage variation of less than 20% in FEV and 14 had a doubtful bronchodilatation (FEV 15-20%). The test was repeated after an interval of 1 week in those patients who showed an increase of 20% in FEV and only 2 confirmed the bronchodilatation. The pathogenesis of asthma that is improved by ASA is not entirely clear, but it is an extremely interesting model for study of the role of different mediators in the asthma syndrome.

Protective effect of Duovent on bronchospasm induced by carbachol in comparison with each of its components.

The protective effect on bronchospasm, induced by carbachol, of 2 puffs of fenoterol (200 micrograms), ipratropium bromide (80 micrograms) and Duovent (200 micrograms fenoterol + 80 micrograms ipratropium bromide) was compared in a group of 12 asthmatic patients. The double-blind study was always performed at the same time of day, 2 and 5 h after premedication, on 4 consecutive days. After the 1st day, when placebo was given, the drugs were administered randomly. As regards PD20 FEV1 (dose of carbachol necessary to determine a 20% decrease in FEV1), Duovent was found to be the most active drug. A very clear difference was seen 2 h later, not only compared to fenoterol (PD20 placebo, means +/- SD: 90.8 +/- 93.2 micrograms; PD20 Duovent: 1,876.5 +/- 1,103.5 micrograms; PD20 fenoterol: 324.3 +/- 220.7 micrograms) but also with ipratropium bromide (PD20: 1,215.8 +/- 950 micrograms). After 5 h, the three treatments maintained a significant action, but the efficacy of Duovent, while significantly greater than that of fenoterol, was very similar to that of ipratropium (PD20 placebo: 78.4 +/- 92.6 micrograms; PD20 fenoterol: 134.6 +/- 138.2 micrograms; PD20 ipratropium bromide: 295.4 +/- 337 micrograms; PD20 Duovent: 286.7 +/- 181.2 micrograms).

Lysozyme activity in bronchial and broncho-alveolar fluids.

Patients affected by different diseases were submitted to bronchial and bronchoalveolar lavage, performed by fiberoptic bronchoscopy under xylocaine anesthesia. Bronchial lavage levels of lysozyme are very high and depend on the secretory rate of the mucosa, although further amounts can be derived from bronchial washings during inflammatory processes by neutrophils. Broncho-alveolar levels are mainly a function of macrophage secretion and dosages may provide an insight to the dynamic behaviour of macrophages in their response to foreign stimuli. Alveoli and blood levels reach an equilibrium, as assessed by mixed venous and arterial blood samples. Administration of exogenous lysozyme is able to increase bronchial IgA and sIGA. Serum immunoglobulins are higher as well, because of the polyclonal stimulation of the lymphocytes. Antiinflammatory properties and modulation of PMN arrival to inflammatory sites play a role in diminishing the enzymatic load to the lung and bronchi.