Elevated Complement C3a in Plasma from Patients with Severe Acute Asthma

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<h2>Abstract</h2><h3>Background</h3> Complement component C3a, an anaphylatoxin, provokes acute inflammatory responses, including smooth muscle contraction, mucus hypersecretion, increase in vascular permeability, and recruitment of inflammatory cells. Thus C3a may be related to airway inflammation and bronchoconstriction in acute asthma exacerbation. <h3>Objective</h3> We sought to determine whether plasma C3a is elevated in patients presenting for emergency treatment of acute asthma exacerbations and to correlate C3a concentrations with response to therapy. <h3>Methods</h3> Plasma C3a and serum eosinophil cationic protein were measured in 52 patients with acute asthma with peak expiratory flow of ≤50% the predicted value. Control subjects were 42 patients with stable chronic asthma. Patients with severe acute asthma were classified into 2 groups (admitted and discharged), according to how effective inhaled bronchodilators and systemic corticosteroids were in the first 2 hours of treatment. <h3>Results</h3> Concentrations of C3a in plasma from subjects in the admitted group (median, 256 ng/mL; range, 94 to 454) were significantly higher than those in the discharged group (197 ng/mL; 72 to 300) or those in patients with stable chronic asthma (166 ng/mL; 89 to 254; <i>P</i> < .0001). Elevated plasma C3a concentrations in admitted asthmatic patients decreased significantly by 7 days after admission (<i>P</i> = .0005). No significant difference was evident in serum eosinophil cationic protein concentration between the admitted group (33.1 μg/L; 6.3 to 143) and the discharged group (32.7 μg/L; 14.6 to 160; <i>P</i> = .99). <h3>Conclusions</h3> Concentrations of C3a, which can induce airway inflammation and bronchoconstriction, were associated with differences in response to emergency treatment of severe asthma exacerbation.