Enhancing indoor air quality -The air filter advantage.

Air pollution has become the world's single biggest environmental health risk, linked to around 7 million deaths in 2012 according to a recent World Health Organisation (WHO) report. The new data further reveals a stronger link between, indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischemic heart disease, as well as between air pollution and cancer. The role of air pollution in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases, is well known. While both indoor and outdoor pollution affect health, recent statistics on the impact of household indoor pollutants (HAP) is alarming. The WHO factsheet on HAP and health states that 3.8 million premature deaths annually - including stroke, ischemic heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer are attributed to exposure to household air pollution. Use of air cleaners and filters are one of the suggested strategies to improve indoor air quality. This review discusses the impact of air pollutants with special focus on indoor air pollutants and the benefits of air filters in improving indoor air quality.

Identification of Aspergillus (A. flavus and A. niger) Allergens and Heterogeneity of Allergic Patients' IgE Response.

Aspergillus species (A. flavus and A. niger) are important sources of inhalant allergens. Current diagnostic modalities employ crude Aspergillus extracts which only indicate the source to which the patient has been sensitized, without identifying the number and type of allergens in crude extracts. We report a study on the identification of major and minor allergens of the two common airborne Aspergillus species and heterogeneity of patients' IgE response to them. Skin prick tests were performed on 300 patients of bronchial asthma and/or allergic rhinitis and 20 healthy volunteers. Allergen specific IgE in patients' sera was estimated by enzyme allergosorbent test (EAST). Immunoblots were performed to identify major/minor allergens of Aspergillus extracts and to study heterogeneity of patients'IgE response to them. Positive cutaneous responses were observed in 17% and 14.7% of patients with A. flavus and A. niger extracts, respectively. Corresponding EAST positivity was 69.2% and 68.7%. In immunoblots, 5 allergenic proteins were identified in A. niger extract, major allergens being 49, 55.4 and 81.5 kDa. Twelve proteins bound patients' IgE in A. flavus extract, three being major allergens (13.3, 34 and 37 kDa). The position and slopes of EAST binding and inhibition curves obtained with individual sera varied from patient to patient. The number and molecular weight of IgE-binding proteins in both the Aspergillus extracts varied among patients. These results gave evidence of heterogeneity of patients' IgE response to major/minor Aspergillus allergens. This approach will be helpful to identify disease eliciting molecules in the individual patients (component resolved diagnosis) and may improve allergen-specific immunotherapy.

Morbidities associated with obstructive sleep apnea.

Obstructive sleep apnea (OSA)-induced biological changes include intermittent hypoxia, intermittent hypercapnia, intrathoracic pressure changes, sympathetic activation and sleep fragmentation. OSA can cause metabolic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress and hypercoagulation, and neurohumoral changes. There is evidence suggesting that OSA is independently associated with metabolic syndrome. OSA has been shown to increase the risk for systemic hypertension, pulmonary vascular disease, ischemic heart disease, cerebral vascular disease, congestive heart failure and arrhythmias. Although there are evidences accumulating that there may be a causal relationship between OSA and cardiovascular disorders, there is a need for more data from randomized controlled intervention trials to confirm this relationship. Many risk factors of OSA (age, male gender and obesity) are also known risk factors for cardiovascular disease. Severe OSA-hypopnea significantly increases the risk of fatal and nonfatal cardiovascular events in both men and women, and continuous positive airway pressure treatment reduces this risk in both. Neurocognitive consequences of OSA include daytime sleepiness, loss of alertness, memory deficit, reduced vigilance, impaired executive function, increased risk for automobile and occupational accidents, and decreased quality of life.

Lipids of erythrocyte membranes of COPD patients: a quantitative and qualitative study.

Chronic obstructive pulmonary disease (COPD) is characterized by inflammation of lung parenchyma and pulmonary hypoxemia with a proven systemic component. Tobacco smoke is the most important risk factor and plasma membrane plays a major role in the disease pathology and progression. The properties of biological membranes are a function of their lipid composition. Any change in its composition may lead to the pathophysiology. In COPD research, erythrocytes are emerging as a new therapeutic venture, as their shape and properties change in the disease. Therefore we studied the lipid composition of the erythrocyte membranes of COPD patients. The study included 30 patients having COPD, 10 healthy smokers and 10 non-smokers. Erythrocytes were separated from peripheral blood and their membranes prepared, followed by estimation of proteins, cholesterol and phospholipids. Individual phospholipids were identified and separated by TLC and fatty acid composition determined by gas chromatography. The data were analyzed statistically and P < 0.05 was considered significant. Our results demonstrate that in very severe COPD, proteins decrease, whereas phospholipids and cholesterol contents increase significantly, which showed a consistent negative correlation with FEV1%. The fatty acid analysis showed preponderance towards saturated fatty acids mainly arachidic and behenic acid, suggesting a decrease in membrane fluidity or a closer packing of lipid rafts. We are the first to report about preponderance of saturated fatty acids in plasma membrane of erythrocytes of COPD patients which may decrease the membrane fluidity and possibly impair the functions of the plasma membrane in the disease.

Changes in protein profile of erythrocyte membrane in bronchial asthma.

OBJECTIVES: Erythrocyte membrane proteins reflect the prototype of multifunctional proteins of various erythroid and non-erythroid cells, which demonstrate various cellular functions. The protein profile of cells changes in various diseases. Therefore, the objective of this study was to understand the changes in protein profile of erythrocyte membranes in bronchial asthma. METHODS: The study included 20 patients of bronchial asthma and 20 healthy subjects. Erythrocytes were isolated from peripheral blood, membranes were prepared followed by the determination of protein contents, and protein profile was assessed using SDS-PAGE. RESULTS: In bronchial asthma, the protein contents of erythrocyte membranes in asthmatic patients were significantly higher (p < .005) than in healthy controls. Analysis of protein profile showed absence of the proteins, namely, band 4.2 and adducin subunit-II, and appearance of protein bands of molecular weights corresponding to galectin-3, glyceraldehyde 3-phosphate dehydrogenase, ß-actin, dematin, band 4.1, and adducin (subunit-I) in asthmatic patients when compared with healthy controls. CONCLUSIONS: In asthma, there are quantitative and qualitative changes in proteins of erythrocyte membranes. The absence of band 4.2 protein may cause impairment of the erythrocyte membrane integrity, and presence of galectin-3 may lead to the activation of various inflammatory cells. The altered protein profile may possibly lead to altered response of the inflammatory cells to the asthmogenic stimuli, which may be responsible for pathophysiology and manifestation of the symptoms of bronchial asthma.

Sphingomyelin metabolism in erythrocyte membrane in asthma.

BACKGROUND: Sphingomyelin (SM), a major lipid constituent of outer leaflet of plasma membranes, with cholesterol, constitutes microdomains, which are termed as lipid rafts. These rafts provide support to proteins, receptors, enzymes, and so on and organize and orient them to conduct cellular functions including transmembrane signaling to substances in external milieu. The SM contents are regulated by its metabolism, changes in which may affect the composition of lipid rafts and cell response to the triggers of asthma which may lead to the pathophysiology. For studying changes in membranes, erythrocytes, which contain lipid rafts, are considered to be the best cell type. Hence, this study was conducted on plasma membrane of erythrocytes of asthmatic patients. OBJECTIVE: The objective is to understand the changes in SM metabolism in asthma. METHODS: The study included 50 subjects (25 asthmatics and 25 healthy subjects). Erythrocytes were isolated from the peripheral blood and membrane prepared. This was followed by determination of total cholesterol, phospholipids, SM, and sphingomyelinase activity. P < .05 was considered significant. RESULTS AND CONCLUSIONS: In asthmatics, there was a significant decrease in cholesterol contents (p < .05), decrease in total phospholipid contents (p < .005), increase in SM (p < .01), decrease in cholesterol: SM ratio (p < .001) and increase in sphingomyelinase activity (p < .001) in erythrocyte membranes. We conclude that in asthma, the increase in SM contents is associated with increased sphingomyelinase activity which shows an imbalance in SM metabolism, directed toward its accumulation. The ratio of cholesterol to SM, critical for maintenance of lipid rafts, was significantly lower in asthmatics. This indicates changes in structure of lipid rafts which may lead to the pathophysiology and development of asthma. Regulation of SM metabolism may help in disease regulation and its control.

Emerging and established parasitic lung infestations.

Many lung infestations from established and newly emerging parasites have been reported as a result of the emergence of HIV/AIDS, the increasing use of immunosuppressive drugs, increasing organ transplantations, the increase in global travel, and climate change. A renewed interest in parasitic lung infections has been observed recently because many protozoal and helminthic parasites cause clinically significant lung diseases. The diseases caused by these parasites may mimic common and complicated lung diseases ranging from asymptomatic disease to acute respiratory distress syndrome requiring critical care management. The availability of new molecular diagnostic methods and antiparasitic drugs enables early diagnosis and prompt treatment to avoid the morbidity and mortality associated with these infestations. Good hygiene practices, improvement in socioeconomic conditions, vector control measures, and consumption of hygienically prepared and properly cooked food are essential to reduce the occurrence of parasitic infestations.

Parasitic lung infections.

PURPOSE OF REVIEW: Global climate change and population explosion leading to changes in natural ecosystem and travel across the continents have resulted in an increase in the transmission of parasites to human beings. This review focuses on recent advancements in parasitic lung infections. RECENT FINDINGS: Invasive parasitic diseases including lung infections are increasingly being reported in patients with immunodeficiency syndromes. A recombinant kinesin-related antigen of Leishmania donovani has been validated with ELISA using urine samples for the diagnosis of visceral leishmaniasis. Pyruvate kinase deficiency has been shown to provide protection against Plasmodium falciparum infection. Intravenous artesunate is an alternative drug for the treatment of severe malaria. The best way to protect from malaria is the use of long-lasting insecticide-treated bednets. Biennial treatment with praziquantel has been found to be cost-effective treatment for control of infection with Schistosoma haematobium. Pulmonary paragonimiasis can be diagnosed by fine needle aspiration biopsy of pulmonary nodules. Strongyloides stercoralis hyperinfection can mimic accelerated idiopathic pulmonary fibrosis. Migratory nodular shadows with halos are important chest computed tomographic findings in human toxocariasis. SUMMARY: Patients with immunodeficiency syndromes (HIV infection, organ transplantation and immunosuppressive drugs, including corticosteroids) should be evaluated for early detection of parasitic lung infections.

Serum interleukin-1beta as a marker for differentiation of asthma and chronic obstructive pulmonary disease.

Asthma and chronic obstructive pulmonary disease (COPD) are diseases of airway inflammation with clinical and physiological similarities, making their differentiation difficult. Airway inflammatory changes are associated with systemic changes. However, no serum marker is known for their differentiation. Therefore, serum interleukin (IL)-1beta levels were determined. Out of a total of 1023 patients screened, we included in the study ten patients each with atopic asthma, non-atopic asthma and COPD and ten healthy subjects. Skin prick tests with 14 inhalant allergens were performed on each patient. Blood was collected in the symptomatic and asymptomatic phases of the diseases and serum IL-1beta and IgE levels were determined. Our results showed that in the symptomatic phase in asthmatics, serum IL-1beta levels were higher (P<0.05) than in patients with COPD. Serum IgE levels were higher (P<0.05) in atopic asthmatics than in non-atopic asthmatics and in COPD patients. We conclude that serum IL-1beta level determination during the symptomatic phase of the diseases may help to differentiate asthmatics from patients with COPD. Serum IgE levels may differentiate atopic asthmatics from non-atopic asthmatics and COPD patients.

Tropical pulmonary eosinophilia: pathogenesis, diagnosis and management.

PURPOSE OF REVIEW: Tropical pulmonary eosinophilia is predominantly seen in the tropical and subtropical regions of the world. It is being increasingly reported from other parts of world, however, due to increases in global travel and migration. This review focuses attention on recent developments. RECENT FINDINGS: Tropical pulmonary eosinophilia is an occult form of human filariasis. The gamma-glutaryl transpeptidase found in the infective L3 stage larvae of Brugia malayi has been found to have similarities with the gamma-glutaryl transpeptidase present on the surface of human pulmonary epithelium. It has, therefore, been proposed that filarial gamma-glutaryl transpeptidase may play an important role in the pathogenesis of tropical eosinophilia. Airway hyperresponsiveness, manifesting as asthma-like syndrome, has been reported in tropical pulmonary eosinophilia and it has been suggested that interleukin-4 induces and interferon-gamma suppresses filarial-induced airway hyperresponsiveness. The intense eosinophilic alveolitis seen in acute tropical pulmonary eosinophilia is suppressed by 3 weeks of treatment with diethylcarbamazine citrate. A mild eosinophilic alveolitis along with radiological, physiological and hematological abnormalities, though with reduced intensity, persists in some patients however. SUMMARY: A chronic mild interstitial lung disease has been found to persist in tropical pulmonary eosinophilia despite treatment.

How to diagnose and manage common parasitic pneumonias.

PURPOSE OF REVIEW: Parasitic pneumonia is being increasingly reported from many parts of the world due to globalization and travel across the continents. This review outlines the recent developments in the diagnosis and management of parasitic pneumonias. RECENT FINDINGS: A polymerase chain reaction that can differentiate pathogenic Entamoeba histolytica from nonpathogenic species has been reported. It has been observed that pulmonary infection with Leishmania donovani can occur in immunodeficient and lung transplant patients. Acute respiratory distress syndrome, seen in severe falciparum malaria, has also been observed in vivax malaria. A study has demonstrated the return of chloroquine-sensitive falciparum malaria several years after chloroquine treatment was discontinued. Pulmonary hypertension has been reported in Schistosoma hematobium, S. mansoni and S. japonicum infections. Strongyloides hyperinfection and disseminated disease are frequently reported in immunocompromised individuals. Parenteral ivermectin is found to be useful in the treatment of disseminated strongyloidiasis. A chronic mild interstitial lung disease has been found to persist in tropical pulmonary eosinophilia despite treatment. Studies are in progress to develop vaccines against amoebiasis, malaria and hookworm infections. SUMMARY: Parasitic pneumonia can sometimes be life threatening. If proper diagnosis is made early, the pneumonia can be treated successfully with currently available drugs.