Abstract
Uncontrolled asthma is a risk factor for pregnancy-related complications. Hyaluronic acid (HA), a potential peripheral blood marker of tissue fibrosis in various diseases, promotes eosinophil survival and plays a role in asthmatic airway inflammation as well as in physiological processes necessary to maintain normal pregnancy; however the level of circulating HA in asthma and asthmatic pregnancy is unknown. We investigated HA levels in asthmatic patients (N = 52; asthmatic pregnant (AP) N = 16; asthmatic non-pregnant (ANP) N = 36) and tested their relationship to asthma control. Serum HA level was lower in AP than in ANP patients (27 [24.7–31.55] vs. 37.4 [30.1–66.55] ng/mL, p = 0.006); the difference attenuated to a trend after its adjustment for patients’ age (p = 0.056). HA levels and airway resistance were positively (r = 0.467, p = 0.004), HA levels and Asthma Control Test (ACT) total score inversely (r = −0.437, p = 0.01) associated in ANP patients; these relationships remained significant even after their adjustments for age. The potential value of HA in the determination of asthma control was analyzed using ROC analysis which revealed that HA values discriminate patients with ACT total score ≥20 (controlled patients) and <20 (uncontrolled patients) with a 0.826 efficacy (AUC, 95% CI: 0.69–0.97, p = 0.001) when 37.4 ng/mL is used as cut-off value in ANP group, and with 0.78 efficacy (AUC, 95% CI: 0.65–0.92, p = 0.0009) in the whole asthmatic cohort. In conclusion circulating HA might be a marker of asthma control, as it correlates with airway resistance and has good sensitivity in the detection of impaired asthma control. Decrease of HA level in pregnancy may be the consequence of pregnancy induced immune tolerance.
Highlights
Asthma is a chronic inflammatory disease of the airways characterized by variable and recurring symptoms, local inflammation, reversible airflow obstruction, and bronchospasm [1]
The normal circulating concentration of Hyaluronic acid (HA) may vary from 10 to 100 mg/L [27], and it correlates with age; the average level of middle aged persons is between 30–40 mg/L [39]
Lower level of circulating HA was found in asthmatic pregnant women compared to asthmatic non-pregnant patients in this study
Summary
Asthma is a chronic inflammatory disease of the airways characterized by variable and recurring symptoms, local inflammation, reversible airflow obstruction, and bronchospasm [1]. Asthma is a prevalent chronic disease which is not optimally controlled in about 50% of cases even in developed countries. It has a high burden of morbidity especially if not controlled [2]; objective serum markers reflecting asthma control are not known. A number of studies investigated the sensitivity of circulating inflammatory markers in the evaluation of asthma control. In our recent study another inflammatory biomarker, serum soluble urokinase plasminogen activator receptor (suPAR) was shown to correlate with airway resistance having a good sensitivity in the detection of impaired asthma control [12]
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