Abstract
Background . Neutrophils can play a significant role in the formation of bronchial inflammation in asthma exacerbation in patients with cold-induced airway hyperresponsiveness (CIAHR). Aim. To evaluate the role of neutrophils in the dynamics of the inflammatory pattern of bronchi in the exacerbation of asthma in patients with CIAHR. Materials and methods. In 31 patients (average age (37.2 ± 2.7) years) with persistent bronchial asthma (BA) with moderate exacerbation and previously established cold-induced airway hyperresponsiveness during cold air isocapnic hyperventilation (– 20 ºC, 3 min) (CAIH), the level of asthma control (Asthma Control Test (ACT), score) and external respiration (forced expiratory volume in the first second (FEV 1 ), forced expiratory flow between 25% and 75% of the vital capacity (FEF 25–75 )) were assessed; induced sputum (IS) was examined initially and after 24 weeks of follow-up. At the time of the examination, the patients were additionally prescribed prednisone orally (at a maximum dose of 30 mg) for the first 10 days in order to stop the exacerbation, and then they continued treatment with a combination of budesonide / formoterol (640 / 18 μg per day) for 24 weeks. Results. At the time of the initial examination, the ACT score was 17.0 (13.0; 19.5), FEV 1 was 89.1 ± 3.9%, and the number of neutrophils in the sputum was 55.9 ± 5.6%. At the end of treatment, the ACT score was 22.0 (17.0; 24.5) ( p = 0.037), FEV 1 was 96.2 ± 2.9% ( p = 0.038), the number of neutrophils in IS decreased, but remained high enough (40.0 ± 5.5%; p = 0.048); and the number of eosinophils did not change. A linear regression equation was made reflecting the relationship between the initially high number of neutrophils in the sputum, other cellular elements in the sputum, the level of asthma control, and the degree of severity of the bronchial response after a bronchoprovocation test with CAIH. Conclusion . Asthma exacerbation in patients with CIAHR is associated with an increase in the neutrophil pool of the bronchial inflammatory infiltrate and correlates with the degree of severity of the airway reaction to cold bronchoprovocation and the level of asthma control.
Highlights
Neutrophils can play a significant role in the formation of bronchial inflammation in asthma exacerbation in patients with cold-induced airway hyperresponsiveness (CIAHR)
Статистически значимое улучшение вентиляционной функции легких с уменьшением реакции при бронходилатационной пробе наступало к 3-му визиту, при длительном регулярном применении в стабильной дозе ингаляционных глюкокортикостероидов (ИГКС)/ДДБА
РАН, руководитель лаборатории функциональных методов исследования дыхательной системы, Дальневосточный научный центр физиологии и патологии дыхания (ДНЦ ФПД), г
Summary
Нейтрофилы могут играть значительную роль в формировании бронхиального воспаления при обострении бронхиальной астмы (БА) у больных с холодовой гиперреактивностью дыхательных путей (ХГДП). В конце лечения уровень контроля над астмой составил 22,0 (17,0; 24,5) (р = 0,037), ОФВ1 96,2 ± 2,9% (р = 0,038), количество нейтрофилов в ИМ снижалось, но оставалось достаточно высоким (40,0 ± 5,5%; р = 0,048); число эозинофилов не изменялось. Показавшее зависимость между исходно высоким количеством нейтрофилов в мокроте, другими клеточными элементами мокроты, уровнем контроля над болезнью и степенью выраженности реакции бронхов после проведения острой бронхопровокационной пробы ИГХВ. Обострение у больных бронхиальной астмой с холодовой гиперреактивностью дыхательных путей ассоциируется с увеличением нейтрофильного пула бронхиального воспалительного инфильтрата и коррелирует со степенью выраженности реакции на холодовую бронхопровокацию и уровнем контроля над заболеванием. Пирогов А.Б., Приходько А.Г., Афанасьева Е.Ю. и др
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