Bronchial Symptoms Research Articles

Eosinophil cationic protein in nasal secretion and in serum and myeloperoxidase in serum in respiratory syncytial virus bronchiolitis: relation to asthma and atopy.

Eosinophil cationic protein (ECP) in nasal secretions was determined in 34 infants with respiratory syncytial virus (RSV) bronchiolitis during the acute infection stage and one and six months later. ECP in serum was determined in 19 of these children at the same time. Myeloperoxidase (MPO) was determined in the same 19 children at the acute infection stage and after one month. All children were followed prospectively for two years after the infection with regard to the development of bronchial obstructive symptoms. Asthma, defined as three or more episodes of bronchial obstruction verified by a physician, developed in 18% of children and less severe obstructive symptoms in 29%. A screening test for food IgE antibodies in serum was performed six months and a skin prick test two years after the acute infection. Nasal ECP/albumin ratios after six months were significantly higher than during the acute RSV infection. MPO, but not ECP, levels in serum were significantly elevated at the time of acute infection compared with levels after one month. Nasal ECP/albumin ratios at the acute infection were compared to a control group of 27 infants with non-RSV upper respiratory tract infections and did not differ. It was not possible to predict, either from ECP/albumin ratios in nasal secretion or from ECP and MPO in serum, which children would develop asthma, other bronchial obstructive symptoms or positive IgE tests.

From allergen sources to reduction of allergen exposure

Allergen exposure plays a major role in the development of sensitization, inflammation and symptomatic asthma. The development of new means of detecting allergens has enabled the evaluation of the effect of a reduction in allergen exposure to be better assessed. In order to prevent allergen exposure it is necessary to determine the allergen sources and reservoirs to which avoidance measures should be directed. The allergen sources and reservoirs of mite, cat, dog, cockroach, rodent, mould and pollen allergens are briefly reviewed. The relationships between allergen exposure, sensitization, nonspecific bronchial hyperreactivity and asthma symptoms are discussed. Recognition of the risks, environmental control, and reduction in allergen loads should be among the objectives of asthma management.

Clinical and symptom measures.

We present a review of specific health status measures, including symptoms, physical examination, and laboratory tests (exclusive of lung function tests), in terms of their suitability for assessing the presence and severity of asthma in epidemiologic and clinical research. We focus on the validity, reliability, and responsiveness to clinical intervention of these measures. Several adult questionnaires designed for epidemiologic research include questions on asthma and wheezing that have demonstrated repeatability and validity against concurrent measurements of nonspecific airway responsiveness. The International Union Against Tuberculosis Bronchial Symptoms Questionnaire was designed specifically to detect asthma and airway hyperresponsiveness in adult populations, and its reliability and validity have been well documented. A childhood questionnaire developed by Australian investigators has been demonstrated to provide information on asthma and wheezing that is reliable and valid against the criterion of concurrently measured nonspecific airway responsiveness. Although suitable for epidemiologic research, these questionnaires do not provide sufficient data on the severity of current asthma symptoms (aspects of which include intensity, duration, and frequency of symptoms) to be useful for clinical research involving subjects with established asthma. Many different methods of obtaining and analyzing symptom data have been used in clinical trials, but these have not received the methodologic scrutiny that allow the recommendation of a "best" approach for evaluating symptoms in clinical trials of interventions for asthma. The use of daily symptom diaries in short-term drug trials is common, but the optimal symptom-reporting interval for such studies has not been established. Similarly, a particular approach to integrating different symptoms (wheeze, dyspnea, cough, sputum) and the different aspects of these symptoms (intensity, duration, frequency) cannot be recommended on the basis of available data. Physical examination findings have little utility as asthma outcome measures because they may be normal between symptom episodes, they have relatively poor interobserver reliability, and they are relatively poor predictors of the outcome of emergency room visits for asthma. The finding of an elevated arterial PCO2 has utility as an indicator of a severe asthma attack, but arterial blood gas measurements have little other utility as asthma outcome measures. The chest radiograph is generally normal in patients with asthma and therefore not useful as an asthma outcome measure.(ABSTRACT TRUNCATED AT 400 WORDS)

Bronchial symptoms and respiratory function in workers exposed to methylmethacrylate.

This study aimed to investigate the pulmonary effects of methylmethacrylate (MMA) in a group of occupationally exposed workers. In the exposed group 20% had chronic cough compared with 1% in controls. Spirometric values at the beginning of the workshift were similar in both groups, but a mild airways obstruction appeared during the workshift. The maximum expiratory flow when 50% of the forced vital capacity remained to be exhaled (MEF50) and the ratio of MEF50 to maximal expiratory flow (MEF50/MEF) decreased significantly during the workshift among exposed workers v controls (p = 0.04 and 0.01 respectively). Results remained unaffected after adjustment for smoking. Exposure to MMA seems to be responsible for a mild airways obstruction but further study on a larger population would be useful.

Relationships among numbers of bronchoalveolar lavage cells expressing messenger ribonucleic acid for cytokines, asthma symptoms, and airway methacholine responsiveness in atopic asthma

Background: We recently demonstrated that T lymphocytes in bronchoalveolar lavage (BAL) fluid from atopic asthmatic patients were activated and expressed increased cytokine messenger ribonucleic acid (mRNA) for “T H2-type” cytokines, particularly IL-4 and IL-5, when compared with those in normal control subjects. This pattern of cytokines may determine the nature of the cellular infiltrate in the bronchial mucosa in asthma and hence the bronchial hyperresponsiveness (BHR) and symptoms that characterize this condition. Methods: To examine the association between these cytokines and clinical measures of asthma severity we have extended our studies of BAL cells from subjects with atopic asthma. Numbers of BAL cells with positive in situ hybridization signals for IL-2, IL-3, IL-4, IL-5, granulocyte macrophage colony-stimulating factor (GM-CSF), and Interferon-γ were counted on cytocentrifuge preparations. Results were compared between patients with symptomatic ( n = 19) and asymptomatic asthma ( n = 10), and associations were sought with airway methacholine responsiveness, resting airway caliber, and asthma symptom scores. Results: There were increased proportions of cells positive for IL-3 ( p < 0.05), IL-4 ( p < 0.005), IL-5 ( p < 0.005), and GM-CSF ( p < 0.005) mRNA in BAL fluid from patients with symptomatic asthma when compared with that from subjects free of symptoms, but no difference between the groups in numbers of cells expressing IL-2 and interferon-γ mRNA. There were significant associations among numbers of cells expressing mRNA for IL-4, IL-5, and GM-CSF, and airflow restriction, BHR, and Aas asthma score. Conclusions: These findings support the hypothesis that cytokines contribute to airway events that determine asthma symptoms and BHR.

Allergenic pollen and pollinosis in Warsaw

Our study of fifty two hay fever patients included twenty six solely allergic to grass pollen and twenty six exhibiting allergy to various pollen species, such as hazel, birch, oak, poplar, andArtemisia. Their total and specific IgE response was evalutated by the immunoenzymatic method, while clinical reactivity was assessed by recording nasal and bronchial symptom scores between mid-March and mid-July. Simultaneously pollen counts were made. Polysensitized patients showed significantly higher levels of both total and specific IgE, which testifies to the enhanced quantitative and qualitative IgE. Multisensitized patients reacted earlier than patients sensitized to grass pollen only, which confirms that non-grass plants flowering only in the spring cause the priming effect on the nasal and bronchial mucosa. The early symptoms may be attributable to tree pollen sensitivity or may refletct higher grass pollen IgE levels in the polysensitized group. Characteristically, nasal symptoms preceded bronchial symptoms of several weeks.

Relationships Between Characteristics of Exposure to Pigeon Antigens: Clinical Manifestations and Humoral Immune Response

An extensive clinical study has been performed on pigeon breeders in the Canary Islands. Three hundred forty-three subjects have participated in this study through the filling of a clinical and epidemiologic questionnaire. A venous blood sample was also taken from each fancier for a further serologic analysis. Detection of specific IgG antibodies was made by an indirect enzyme-linked immunosorbent assay (ELISA) using pigeon serum as antigenic material. Twenty-nine (8 percent) breeders fulfilled the "classic" pigeon breeders' disease (PBD) criteria. One hundred six (31 percent) had rhinitis, 62 (19 percent) had immediate bronchial symptoms, and 51 (15 percent) suffered from chronic bronchitis. A significant level of specific IgG was detected in 139 (40 percent) cases. Rates were correlated with pneumonitis symptomatology (p < 0.001) and with chronic bronchitis (p < 0.05). There was a significant association between the number of pigeons and the level of sensitization (p < 0.001). Finally, a statistical relationship between the intensity of exposure and specific IgG response was also found (p < 0.001). Titers of specific IgE could not be related either to the reported symptomatology in the questionnaire or to any of the exposure parameters analyzed.

Respiratory symptoms and bronchial responsiveness are related to dietary salt intake and urinary potassium excretion in male children

To investigate whether dietary salt intake and urinary sodium and potassium levels are related to respiratory symptoms and bronchial responsiveness, a cross-sectional study among 2593 subjects aged 9 to 16 was conducted in four communities of the Latium region (Italy). Questionnaires were administered to the parents, urine samples were collected, lung function, methacholine challenge tests and prick tests were performed. Information about familial and personal dietary salt use and respiratory health was collected from the parents of 2439 (94%) subjects. A total of 2020 methacholine challenge tests and 916 urinary sodium and potassium levels were available for analysis. Personal table salt use was strongly related to cough and phlegm apart from colds (adjusted odds ratios, OR, 1.87, 95% confidence intervals, CI, 1.20-2.90), wheezing apart from colds (OR, 2.19, 95% CI, 1.27-3.77), wheezing with dyspnoea (OR, 1.45, 95% CI, 0.98-2.12) and wheezing after exercise (OR, 2.16, 95% CI, 1.35-3.44). These associations were mainly found in boys. Use of familial table salt and canned food showed no relation to respiratory symptoms. Increased bronchial responsiveness was associated with a higher urinary potassium excretion in boys, but not with urinary sodium. In conclusion, personal table salt use is related to an increased prevalence of bronchial symptoms; an increase in bronchial responsiveness among those with higher potassium excretion also seems to be implied. Although it is difficult to interpret the results of this study in causal terms, the findings might be relevant to the distribution of bronchial symptoms and diseases in the population.

Respiratory symptoms questionnaire for asthma epidemiology: validity and reproducibility.

There is a need for a new respiratory symptoms questionnaire for use in epidemiological research in asthma. A questionnaire was designed following a pilot study in 78 subjects. It contains nine questions on symptoms such as wheeze and difficulty with breathing in defined circumstances such as exercise and sleep. It was completed by 211 adults and validated by comparison with a self reported history of asthma and with bronchial hyperresponsiveness to histamine. Its short term reproducibility was measured by three repeat administrations over two weeks. Subjects with asthma (n = 33), particularly those having had an asthma attack in the last year (n = 23), were more likely to report any symptom and to report a greater number of symptoms than those without asthma. The same relationship was found for bronchial hyperresponsiveness and symptoms. Either two or more, or three or more, symptoms appeared to be good indices of self reported asthma and bronchial hyperresponsiveness, or both, with a high sensitivity (65-91%) and specificity (85-96%). Reproducibility was good, with few subjects changing the number of symptoms reported by more than one symptom and none by more than four symptoms. The results compared favourably with those from questions on phlegm production from the MRC questionnaire and were better than those reported for the MRC wheeze questions. The questionnaire will be useful for epidemiological research on asthma and could form part of a new standardised questionnaire with wide applications.

慢性副鼻腔炎における肺機能 副鼻腔気管支症候群との関連

Sinobronchial syndrome (SBS) is a clinical entity which combines chronic sinusitis (CS) and various bronchial disorders: bronchiectasis, chronic bronchitis and diffuse panbronchiolitis.In the past, CS was said to be the cause of bronchial involvement, because nasal symptoms begin earlier than bronchial symptoms in most patients with SBS. In order to determine whether or not the bronchial involvements are the result of nasal disease, we examined the pulmonary function of patients with CS and SBS.We tested the pulmonary function, vital capacity (VC), forced expiratory volume in 1 sec (FEV10), and corrected values of maximum flows on the flow volume curve at 50% and 25% of the vital capacity (%V50, %V25) of 66 patients with CS without bronchial involvement, or 21 patients with SBS. We also evaluated the pulmonary function of 65 volunteers as a control group. None of them had a history of smoking.VC and FEV1.0 were not decreased in patients with CS. The %V50 and %V25 of those with CS were significantly lower than in the control group (p<0.01) and significantly lower in those with SBS than in those with CS (p<0.01).No positive correlation was found between the duration and severity of CS and the decrease in the level of %V50 and %V25. Some patients had occult peripheral airway dysfunction in the early stage of CS. These findings suggest that CS is not the cause of bronchial involvement and that CS and peripheral airway disorder develop at the same time in some patients, who may later develop SBS.

Relation of Dose-response Slope to Respiratory Symptoms in a Population of Australian Schoolchildren

To describe bronchial responsiveness in populations, the dose-response slope (DRS), which is the linear slope of the dose-response curve, may be a more useful measure of severity than the provoking dose that causes a 20% fall in FEV1 (PD20 FEV1). To examine the distribution of DRS measurements and their relation to respiratory symptoms in children, we have analyzed data collected during a population study designed to measure the prevalence of bronchial hyper-responsiveness and respiratory symptoms. In this study, respiratory symptom history was measured by a self-administered questionnaire to parents and bronchial responsiveness was measured using the rapid inhalation method. Of 1,217 children studied, DRS values were obtained for 1,203 children who had technically satisfactory bronchial challenge data. In asymptomatic children, DRS values were distributed symmetrically on a logarithmic scale. The geometric mean DRS was reliable measure of the central position of the curve, and 1.96 standard deviations only slightly underestimated the 95% interval. In children with recent wheeze, the distribution was skewed toward larger DRS values. Mean DRS values were significantly different between groups determined according to symptom frequency. It appears that DRS values are more useful than PD20 FEV1 values in epidemiologic studies of respiratory illness in children because a value that relates well to symptom history can be calculated for the entire sample. The major advantages are that the measurement more clearly discriminates between symptom severity groups and that a value that represents abnormal responsiveness can be calculated.

Clinical and immunologic reactivity of patients allergic to grass pollens and to multiple pollen species: I. Clinical and immunologic characteristics

The heterogeneity of pollen-allergic individuals is well-known but poorly characterized. Twenty-six patients were studied to characterize their immunologic and clinical patterns. Thirteen patients were allergic only to grass pollens, and 13 other patients were allergic to grass-pollen and other pollen species, including Cupressaceae, plane tree, olive, and Parietaria. The IgE response was assessed by the titration of serum total IgE and orchard grass-specific IgE, as well as by IgE immunoblots to orchard-grass pollens. Clinical reactivity was assessed by nasal challenge with orchard-grass pollens before the pollen season and nasal and bronchial symptom-medication scores between April 1 and June 15. Pollen counts were obtained during this period of survey. Polysensitized patients had significantly increased levels of serum total and specific IgE and a greater heterogeneity of IgE immunoblots, suggesting an enhanced qualitative and quantitative IgE immune response. Polysensitized patients had nasal and bronchial symptoms occurring earlier than grass pollen-allergic individuals, confirming the priming effect caused by other plans flowering with an earlier season for both nasal and bronchial mucosa. Alternatively, the early symptoms may be attributable to the tree pollens or might reflect the higher grass-pollen IgE level in the polysensitized group. Bronchial symptoms appeared a few weeks after nasal symptoms. Nasal challenges were similar in both groups, and the severity of nasal symptoms during the season was not significantly different in both groups, suggesting that the intensity of symptoms is not related to the sensitization nor to the IgE immune response of the subjects.

Grass-pollen allergen carried by the smaller micronic aerosol fraction

Abstract Aerodynamically, grass-pollen grains should be filtered from the inhaled air in the nose. They should not penetrate into the deeper airways (bronchi, bronchioles). Yet, bronchial symptoms are not seldom seen in patients suffering from pollinosis. Therefore, the grass-pollen allergenic activity of the smaller, paucimicronic atmospheric aerosol fraction was studied. Outdoor airborne particulate matter was collected and separated into fractions according to aerodynamic sizes (> 10; 4.9–10; 2.7–4.9; 1.3–2.7; 0.6–1.3; < 0.6 μm), with a Cascade Impactor mounted on top of a high volume sampler. The different fractions were tested for the presence of grass-pollen allergenic activity using a RAST-inhibition assay. The results show that on days with a relatively high grass-pollen count, a considerable amount of allergen was present in all the smaller micronic aerosol fractions.

Evaluation of a New Asthma Questionnaire

The new International Union Against Tuberculosis (IUAT) bronchial symptoms questionnaire was completed by 827 subjects participating in a prospective study of respiratory symptoms and lung function in aluminum smelter workers. A modified Medical Research Council (MRC) questionnaire was also administered. Bronchial reactivity (BR) was measured in 809 subjects by methacholine challenge using a rapid method. Factor analysis demonstrated sensible clustering of responses to items unique to the new questionnaire such as nocturnal, spontaneous, and postexertional dyspnea, dust-induced dyspnea and tightness, and breathing difficulty. Responses to IUAT questions concerning past asthma, wheeze, chest tightness, morning cough and sputum, and asthma medication agreed well with corresponding items from the MRC questionnaire. Questions concerning asthma, medication, dust-induced, nocturnal, and spontaneous dyspnea, chest tightness, wheeze, nocturnal cough, postexertional dyspnea and breathing difficulty also had high validity against the criterion of concurrently measured bronchial reactivity. It is concluded that the IUAT questionnaire is a valid asthma questionnaire.

Salicylate pre‐treatment attenuates intensity of bronchial and nasal symptoms precipitated by aspirin in aspirin‐intolerant patients

Aspirin (ASA) and other non-steroidal anti-inflammatory drugs, which are cyclooxygenase (COX) inhibitors, precipitate asthmatic attacks in ASA-intolerant patients, while sodium salicylate, hardly active on COX by itself, is well tolerated by these patients. However, salicylate moiety appears to interfere with aspirin inhibitory action on platelets and vascular COX. Such interaction, if present at the level of respiratory tract, may be of interest to pathogenesis of ASA-induced asthma. We performed a double-blind, placebo-controlled, randomized cross-over study on the effect of choline magnesium trisalicylate (CMT, trilisate) pre-treatment on ASA-induced adverse reactions in nine patients. Pulmonary function tests, nasal symptoms score, PNIF and serum salicylate levels were monitored following challenges with threshold doses of ASA. Trilisate administered at a dose of 3000 mg daily for 3 days, offered a moderate protection against ASA-induced symptoms; it diminished the severity and/or delayed the appearance of FEV1 fall. Maximal decreases in FEV1 as well as reaction intensity indexes were significantly lower (P less than 0.02 and P less than 0.002, respectively) after trilisate pre-treatment as compared to placebo. Trilisate also attenuated nasal symptoms in three out of five patients. Although the precise mechanism of the protective action of trilisate is unknown, our data support the possibility of interaction between salicylate and ASA on cyclo-oxygenase locus in the respiratory tract in ASA-intolerant patients.

Reactive Airway Dysfunction Syndrome in Three Police Officers following a Roadside Chemical Spill

The reactive airway dysfunction syndrome (RADS) is a recently described syndrome in which bronchial hyperreactivity and asthmatic symptoms develop in previously healthy individuals after a single large exposure to an irritating gas, fume, or vapor. We report a cluster of three Philadelphia police officers who developed RADS after a common exposure to toxic fumes from a roadside truck accident. Results of initial pulmonary function testing were normal in all three, and methacholine challenge was required for diagnosis in two out of the three. This syndrome needs to be recognized by physicians dealing with environmental or industrial medicine as a potential cause of loss of work or inability to perform on the job. Also, there is a potential for multiple individuals to develop this syndrome from a single incident.

Nasal inhalation of the glucocorticoid budesonide from a spacer for the treatment of patients with pollen rhinitis and asthma

Glucocorticoid sprays are increasingly used for the treatment of allergic rhinitis and asthma. This therapy is highly effective, and side effects are few and mild. It was the aim of the present study to evaluate a physiological nasal inhalation technique, which results in airway deposition of the steroid molecule similar to that of inhaled allergen particles. Thirty adults with grass pollen-induced rhinitis and asthma inhaled the steroid molecule budesonide through the nose from a pressurized aerosol attached to a spacer device. Compared with inhalation of placebo, the treatment resulted in a significant reduction of nasal symptoms (P = 0.005), of bronchial symptoms (P = 0.005), but not of eye symptoms. In addition, nasal peak inspiratory flow (P = 0.0003) and oral peak expiratory flow (P = 0.02) increased. There was no difference between budesonide and placebo with regard to local side effects, such as nose bleeding, hoarseness, and irritation in mouth and throat. It is concluded that nasal inhalation of a steroid from a spacer offers effective therapy of pollen rhinitis and asthma without significant local side effects. This therapeutic modality may have advantages over the ordinarily used nasal and bronchial spray treatment in patients with both rhinitis and asthma, especially when conventional spray therapy is associated with local side effects.

Sinobronchial Syndrome in Japanese People

Sinobronchial syndrome (SBS) involves the coexistence of chronic rhinosinusitis and chronic lower airway inflammation. In Japanese patients, the lower airway lesions may be diffuse panbronchiolitis (DPB), chronic bronchitis, or chronic bronchiectasis. DPB is chronic inflammation of the region around the bronchioles, particularly the respiratory bronchioles, and seems to occur mostly in Japanese. The frequency of occurrence of SBS was 32 (10.4%) in 307 patients seen for chronic rhinosinusitis and 41 (55.4%) in 74 patients seen for chronic lower airway inflammatory disease. In many patients with SBS, the nasal symptoms appeared in childhood and the bronchial symptoms (coughing and expectoration) appeared in or after adolescence. Long-term follow-up of patients who underwent sinus surgery after the onset of SBS showed poor postoperative improvement of the lower airway symptoms. Correlation was strong between SBS and HLA-Bw54, an antigen found specifically in Mongoloids (corrected p value (pc), 3.88 × 10–7; relative risk (KR), 7.03). Correlation of HLA-Bw54 with DPB was stronger than with SBS as a whole (pc, 2.23 × 10–6; RR, 11.00). These results suggested that SBS, and particularly DPB, is a disease strongly dependent on a genetic diathesis in Japanese people.

Evidence of grass‐pollen allergenic activity in the smaller micronic atmospheric aerosol fraction

In June 1988, during the grass-pollen season in Leiden, The Netherlands, outdoor airborne particulate matter was collected and separated into fractions according to aerodynamic sizes (greater than or equal to 10 microns, 4.9-10 microns, 2.7-4.9 microns, 1.3-2.7 microns, 0.6-1.3 microns, less than or equal to 0.6 microns), with a cascade impactor mounted on top of a high volume sampler. The different fractions were tested for the presence of grass-pollen allergenic activity using a RAST-inhibition assay: specific IgE-antibody-containing patient serum was applied on the particle-loaded impaction strips, and the serum was recovered by descending elution for further analysis in the RAST. Simultaneously, continuous measurements were made of the airborne grass-pollen concentration using a volumetric pollen trap. Sampling observations lasting 7-9 hr during a period with relatively high airborne grass-pollen concentrations showed reliably detectable amounts of grass-pollen allergen, not only in the first impaction stage where intact pollen were collected, but also in the lower stages collecting the smaller, paucimicronic and submicron atmospheric aerosol fraction. It is evident that this result has serious implications for the understanding of the bronchial symptoms frequently seen in hay fever patients on days with high pollen concentrations in the air.

Double-blind, placebo-controlled immunotherapy with mixed grass-pollen allergoids: IV. Comparison of the safety and efficacy of two dosages of a high-molecular-weight allergoid

Specific immunotherapy is still widely used in grass-pollen allergy, but its side effects may limit its use. We tested the safety and efficacy of a formalinized high-molecular-weight allergoid prepared from a mixed grass-pollen extract with two injection schedules in a double-blind, placebo-controlled study. Eighteen patients received placebo, 19 received the low-dose schedule (maximal dose: 2000 PNU) and 20 received the high-dose schedule (maximal dose: 10,000 PNU). Only one patient presented a systemic reaction of moderate severity for a dose of 1200 PNU. Before the onset of the pollen season, patients had a nasal challenge with orchard grass-pollen grains, a skin test titration, and the titration of serum-specific IgG. Both groups of patients presented a significant reduction in nasal and skin sensitivities and a significant increase in IgG compared to placebo. Symptoms and medications for rhinitis and asthma were studied during the season, and both groups receiving allergoids had a significant reduction of symptom-medication scores for nasal and bronchial symptoms. There was a highly significant correlation between nasal symptom-medication scores during the season and the results of nasal challenges. High-molecular-weight allergoids are safe and effective.