Stable Asthmatic Patients Research Articles

Study of voice disorders in patients with bronchial asthma and chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) and bronchial asthma are known to cause adverse effects on voice, which might affect the quality of life of an individual.AimThe study was designed to study the voice disorders in patients with COPD and bronchial asthma and its relation to disease severity and medication.Patients and methodsTotally, 60 patients were recruited: 30 stable bronchial asthma patients and 30 stable COPD patients. All participants underwent spirometry and study of voice parameters using auditory perceptual assessment, videolaryngostroboscopy system, voice recording, and acoustic analysis.ResultsImpaired voice quality and various grades of dysphonia were detected in the COPD group in 30% by means of auditory perceptual assessment; structural changes in the vocal folds (diffuse congestion, unhealthy mucosa, and edema) were detected in 36.6%. In the bronchial asthma group, impaired voice quality and various grades of dysphonia were detected in 16.7% and structural changes were detected in 20% of them, whereas acoustic analysis showed a highly significant increase in jitter and shimmer and decreased harmonic-to-noise ratio in 100% of patients of both groups. These changes were greater in metered dose inhaler users than in dry-powder inhaler users. In the bronchial asthma group, fluticasone propionate users had a significantly decreased harmonic-to-noise ratio compared with beclomethasone dipropionate and budesonide users, as well as the least pitch and highest shimmer and jitter. A significant statistical correlation was found between ipratropium inhalation usage and increased shimmer in the COPD group. There was a highly significant correlation between spirometric severity and both grade of dysphonia and character of voice in bronchial asthma patients.ConclusionAll COPD and bronchial asthma patients had dysphonia, either due to organic causes or due to functional causes. Voice changes were directly correlated with degree of severity and fluticasone propionate inhalation use in bronchial asthma patients, and with ipratropium bromide inhalation in the COPD group.

Evaluation of Mean Thrombocyte Volumes in Asthma Patients During Acute Exacerbations and Stable Periods

Objective: Asthma is a heterogeneous disease characterized by chronic airway inflammation. Mean Platelet Volume (MPV) is one of the markers of platelet activation. The disease activity has been shown to have an important role as a marker for the efficacy of anti-inflammatory therapy and inflammation. The aim of this study was to investigate the relationship between disease activity and mean platelet volume and to determine the mean platelet volume (MPV) and CRP values during asthma exacerbations and stable periods. Methods: In this study, data from 50 patients with asthma exacerbations, 50 stable asthmatic patients and 40 healthy subjects were evaluated retrospectively. Results: Even though the MPV values of patients with an asthma exacerbation was lower (9.2 ± 0.9 fL) than those of stable asthmatic patients (9.6 ± 1.3 fL), we did not find statistical differences between the groups in terms of MPV results (P = 0.374). Leukocyte, neutrophil counts and percentages and CRP levels were significantly higher in patients with an exacerbation than in stable asthmatic and control groups (p = 0.000). There was no difference in , neutrophil counts and percentages and CRP levels between stable asthmatic patients and healthy controls (p> 0.05). Conclusion: In conclusion, there was no statistically significant relationship between the MPV values and disease activity in asthmatic patients. We believe that prospective studies involving a larger number of patients are needed to determine the place of MPV in asthmatic patients, since the number of patients and controls in our study was low.

The Nasal Microbiome in Asthma

Lower respiratory tract microbiota have been associated with asthma development and severity. We hypothesized that the nasal microbiome differs between healthy and asthmatic individuals. Nasal swabs were obtained from 73 subjects recruited from the Mount Sinai Health System (New York, NY), including 22 with exacerbated asthma, 31 with stable asthma, and 20 non-asthmatic controls. The nasal microbiome was profiled by 16S rRNA sequencing and analyses were performed using QIIME (Quantitative Insights into Microbial Ecology), PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States), and STAMP (Statistical Analysis of Metagenomic Profiles). Mean age of the cohort was 35.7 years (standard deviation 15.9) with 66% female. Seventy five percent of subjects with exacerbated asthma, 45% of subjects with stable asthma, and 0% of controls had ≥1 hospitalization for asthma in the past year. Nasal bacterial compositions between the classes were significantly different (PERMANOVA η2=5%; P=2.2x10-2). Relative to controls, the nasal microbiota of subjects with asthma were enriched with Bacteroidetes (Wilcoxon-Mann-Whitney |r|=0.33, P=5.1x10-3) and Proteobacteria (|r|=0.29; P=1.4x10-2). qPCR confirmed these findings (Prevotella buccalis fold change=130, P=2.1x10-4). Metagenomic inference revealed lower glycerolipid metabolism in exacerbated and stable asthmatic patients compared to controls (Kruskal-Wallis P=1.9x10-4). The nasal microbiome differs by asthma status, with enrichment of Proteobacteria and Bacteroidetes in subjects with asthma that is associated with lower glycerolipid metabolism. Our findings of these enriched taxa in nasal samples are consistent with lower airway findings, suggesting that microbiome profiling of easily-accessible nasal samples may be used to understand lower airway microbiota in asthma.

The application of low dose CT scan and quantitative analysis in airway remodeling and air trapping of asthma

Objective To explore airway remodeling and air trapping in asthmatic patients with low dose CT scanning and quantitative analysis. Methods 52 stable asthmatic patients in which 29 were severe and 23 were slight, and 20 healthy control cases were underwent low dose dual phase CT scanning. The LA/BSA, WA/BSA, TA/BSA, WA% and Pi10WA were analyzed as airway remolding indexes. The MLD of expiratory, VI-850 (% ) of expiratory, MLD E/I, VI-850E-I (% ) and VI-850/-950E-I (% ) were analyzed as air-trapping indexes. One-Way ANOVA or H Kruskal-Wallis was used to analyze the above indicators. Results Airway remodeling indexes and LA/BSA were (9.6 ± 2.6), (11.0 ± 3.4) and (12.6 ± 3.0)mm2/m2 in severe asthmatics group, non-severe asthmatics group and healthy control group respectively, and there was significant difference between the three groups (F=5.60, P=0.006). WA% of each group was (65.1±2.5)%, (63.3±4.4)% and (62.0±3.0)%, and there was significant difference between the three groups (F=5.53, P= 0.006). The Pi10WA was (18.4±2.6), (17.7±3.1) and (16.4±1.4) mm2 respectively with significant difference between the three groups (F=3.59, P=0.033). Air-trapping indexes, MLD of expiratory of each group was -(771±59), -(724±43) and -(676±60) HU respectively with significant difference (F=5.60, P=0.006). VI-850(%) of expiratory of each group was 30.79(30.45)%, 13.53(12.09)% and 2.85(6.87)% respectively with significant difference (H=17.20, P<0.001). Conclusions Low dose of CT scan and quantitative analysis can provide an objective and quantitative information for patients with airway disease of asthma, and both WA% and Pi10WA were objective indexes. The severe asthmatic patients were associated with obvious airway remodeling and air trapping compared with non-severe asthmatic patients. Key words: Asthma; Airway remodeling; Air trapping; Tomography, X-ray computed

The transition of sputum inflammatory cell profiles is variable in stable asthma patients.

BackgroundThe sputum inflammatory cell profile is an important indicator for classifying asthma phenotypes.ObjectiveTo investigate if sputum inflammatory cell profile remains stable and there are different characteristics between groups that show different profile over time in stable asthmatic patients.MethodsA total of 149 asthmatic patients, who were clinically stable at the time of sputum examination and had undergone sputum analysis twice, were subjected to a detailed review. Eosinophilic inflammation was diagnosed when the proportion of the sputum eosinophils was >3%. We divided the patients into 4 groups according to the transition patterns of their sputum profiles: group 1, persistent eosinophilia; group 2, eosinophilic to noneosinophilic; group 3, noneosinophilic to eosinophilic; and group 4, persistent noneosinophilia. The results of the pulmonary function tests and other clinical parameters were compared between these 4 groups.ResultsThirty-four of the initially eosinophilic asthmatic patients (39.5%; 34 of 86 patients) demonstrated noneosinophilic airway inflammation at their second sputum examination, and 24 of the initially noneosinophilic patients (38.1%; 24 of 63 patients) demonstrated eosinophilic airway inflammation at follow-up. Various clinical parameters, except the blood eosinophil count, demonstrated no significant differences between the eosinophilic and noneosinophilic asthmatic patients or among the 4 groups.ConclusionA substantial proportion of asthmatic patients who demonstrate a certain sputum inflammatory cell profile at the initial examination demonstrated profile transition in clinically stable settings over time. The clinical significance of using induced sputum analysis to phenotype stable asthmatic patients requires further evaluation.

THE FRACTION OF EXHALED NITRIC OXIDE (FENO) AND FORCED OSCILLATION TECHNIQUE (FOT) CAN PREDICT BRONCHIAL HYPERRESPONSIVENESS AGAINST ACETYLCHOLINE IN TREATED ASTHMATICS.

The bronchial hyperresponsiveness (BHR) test is useful to diagnose or evaluate effect of therapy in asthmatics, but invasive. On the other hands, the fraction of exhaled nitric oxide (FENO) is a useful noninvasive marker of eosinophilic airway inflammation in asthmatics. And also, the forced oscillation technique (FOT) is a noninvasive method that is used to measure respiratory mechanics, including respiratory resistance and reactance at multiple frequencies. To evaluate the complementary roles of FENO and FOT to predict bronchial hyperresponsiveness in adult stable asthmatic patients taking inhaled corticosteroids. From our outpatient clinic, we recruited 115 stable asthmatics that were being treated with inhaled corticosteroids at the time of the study. For each subject, we measured FENO by using an offline methods (CEIS' method); and we measured resistance at 5Hz (R5), resistance at 20Hz (R20), R5-R20, reactance at 5Hz (X5), frequency of resonance (Fres), and low-frequency reactance area (ALX), by using a MostGraph FOT machine. We also used spirometry to test BHR to acetylcholine (PC20Ach). LogPC20Ach was significantly correlated with FENO, R5, R20, R5-R20 and %FEV1. The ROC curve decided that the cutoff point of FENO was 37.8ppb (AUC=0.647, sensitivity 83.3%, specificity 55.6%, p=0.007) and that of R5 was 3.03cmH2O/L/S (AUC=0.684, sensitivity 72.2%, specificity 52.8%, p=0.001) and that of R20 was 2.77cmH2O/L/S (AUC=0.684, sensitivity 74.5%, specificity 59.4%, p=0.001). When R5 was >3.03 and FENO was >37.8ppb, 25 of 38 subjects (65.7%) had bronchial hyperresponsiveness. If R5 was <3.03 and FENO was <37.8 ppb, only 5 of 29 (17.2%) subjects had. When R20 was >2.77 and FENO was >37.8ppb, 29 of 43 subjects (67.4%) had bronchial hyperresponsiveness. If R20 was <3.03 and FENO was <37.8ppb, only 2 of 18 (11.1%) subjects had. Combining R5 or R20 and FENO can predict the level of bronchial hyperresponsiveness in adult stable asthmatics.

Correlation of total serum immunoglobulin E level, sputum, and peripheral eosinophil count in assessing the clinical severity in bronchial asthma.

Context:Asthma is a chronic inflammatory disorder of the airway with involvement of various cellular populations and release of many inflammatory mediators. Eosinophils and serum immunoglobulin E (IgE) are considered a good marker of airway inflammation in asthma. The correlation of clinical assessment with various markers of airway inflammation in asthma is not well established in the Indian population.Aims:This study aims to study the correlation of serum IgE, sputum eosinophil count, and peripheral eosinophil count with clinical severity of Asthma. Methods:This is a cross-sectional study involving 76 stable asthmatic patients of 18–60 years of age attending the pulmonary medicine OPD. Spirometry measured at baseline. Participants were categorized according to the GINA criteria based on clinical symptoms and pulmonary function test. Blood samples were collected for peripheral eosinophil count, serum IgE levels, and sputum samples for eosinophil count. All three parameters were compared with severity of asthma. The correlation of sputum eosinophil count, peripheral eosinophil count, and serum IgE with severity of asthma was analyzed by Pearson's Chi-square test, Fisher's exact test, and the correlation coefficient was reported together with standard error of the estimate.Results:The mean age of patients in our study was 37.42 years and 56.6% were male. There was a significant inverse correlation between serum IgE levels and predicted forced expiratory volume 1 s (FEV1). Sputum eosinophilia was significantly seen in severe persistent asthma patients (19.7%). There was a significant inverse correlation between sputum eosinophil count and predicted FEV1 and forced vital capacity. We also found there was a significant association between peripheral eosinophil count, sputum eosinophil count, and elevated serum IgE (g100 IU/mL) with severe persistent asthma.Conclusions:The assessment of sputum eosinophil count is simple, inexpensive, noninvasive, and direct measurement of airway inflammation. It could be the preferred method in monitoring airway inflammation and guided management in day-to-day practice.

Assessment for Efficacy of Additional Breathing Exercises Over Improvement in Health Impairment Due to Asthma Assessed using St. George's Respiratory Questionnaire.

Background:Breathing exercises have been described to be useful in asthma management by few researchers in the past.Objective:To assess the efficacy of breathing exercises (Pranayamas) added to regular optimal medications in asthma patients in improving health impairment using St. George's Respiratory Questionnaire (SGRQ).Methods:Sixty stable asthma patients (34 females) receiving optimal treatment at our institute for 3 months or more as per the Global Initiative for Asthma guidelines were included in the study. They performed seven breathing exercises under supervision at yoga center of our institute for 3 months in addition to their regular medications. SGRQ (1 month symptoms version) was used to assess the quality of life before and after breathing exercises intervention for following subsets: Symptom score, activity score, impact score, and total score to assess the efficacy of breathing exercises.Results:Of 60 asthma patients, 34 were females and 26 were males, and their mean age was 25.45 ± 5.41 years. Their baseline spirometric values were as follow: Forced expiratory volume in 1 s (FEV1) - 2.492 ± 0.358 L and peak expiratory flow rate (PEFR) - 283.82 ± 51.12 L/min. The SGRQ scores after breathing exercises intervention decreased from 45.98 ± 5.61 to 38.78 ± 4.92 for symptom subset, from 15.45 ± 3.33 to 12.34 ± 2.39 for activity subset, from 17.95 ± 4.22 to 12.12 ± 3.82 for impact subset, and from 25.83 ± 8.31 to 19.20 ± 7.09 for total scores. All these reductions were statistically highly significant (P < 0.001). Decrease in symptoms, activity, and total SGRQ scores each was significantly correlated with FEV1, FEV1/forced vital capacity (FVC) ratio, and PEFR; decrease in impact score was significantly related only with FEV1/FVC ratio.Conclusions:Breathing exercises significantly decreased all component scores of SGRQ, signifying a global improvement in health impairment due to asthma; this improvement was in addition to that was achieved with optimal asthma therapy alone.

Improvement in pulmonary functions and clinical parameters due to addition of breathing exercises in asthma patients receiving optimal treatment

Background: Breathing exercises have been described to be useful in asthma management. Objective: The aim of this study is to detect the efficacy of breathing exercises (Pranayamas) in asthma patients using spirometric indices, clinical symptoms parameters, and requirement of rescue medications. Methods: A total of 60 stable asthma patients (34 females) diagnosed and received optimal asthma treatment for 3 months or more according to the GINA guidelines were enrolled. All patients continued their respective medications and in addition performed seven breathing exercises (Surya Bhedana Pranayama, Nadi Shuddi Pranayama, Bhramari Pranayama, Surya Nadi Pranayama, Kapal Bhati, Bhastrika, and Om Chanting) under supervision at Yoga center at our Institute for 3 months after inclusion to study. Spirometry, nocturnal symptoms, and the requirement of rescue medicines were assessed before and after breathing exercise intervention. Visual analog scale (VAS) was used to assess the dyspnea and wheezing in the study participants. Results: The mean age of asthma patients was 25.45 ± 5.41 years. After breathing exercise intervention, mean forced expired volume in one second increased from 2.492 ± 0.358 L to 2.745 ± 0.343 L and mean peak expiratory flow rate increased from 283.82 ± 51.12 L/min to 336.23 ± 51.47 L/min; the increases were statistically significant. The mean nocturnal symptoms score decreased significantly from 1.416 ± 1.619 to 0.067 ± 0.362. The requirement of rescue medications decreased significantly from 6.23 ± 2.95 to 0.90 ± 1.25 puffs/week. VAS scores for breathlessness and wheezing were significantly decreased. Conclusions: Breathing exercises provided significant improvements in spirometric parameters and significant reduction in breathlessness, wheezing, and nocturnal symptoms as well as requirements of rescue medicines in asthma patients who were receiving optimal asthma treatment.

Matrix metalloproteinase (MMP)-2 -1306 C > T gene polymorphism affects circulating levels of MMP-2 in Egyptian asthmatic patients

Asthma is a common chronic inflammatory ailment affects the respiratory system leading to bronchial hyper-reactivity. Both genetic and environmental factors play a principal role in asthma pathogenesis. Matrix Metalloproteinase-2 (MMP-2) encoded by MMP-2 gene and degrades type IV collagen leading to an inflammatory response.We assessed the serum level of MMP-2 in Egyptian asthmatic patients and also we investigated the association between the functional MMP-2 -1306 C>T promoter polymorphism and bronchial asthma susceptibility and finally we explored the effect of the polymorphism on the production of MMP-2 in asthmatic patients.This study was conducted on 80 stable asthmatic patients and 80 healthy age-matched individuals. Serum MMP-2 and total IgE concentrations were measured by ELISA. Genomic DNA was extracted from whole blood and MMP-2 -1306 C>T polymorphism was genotyped by Real Time-PCR using TaqMan allele discrimination assay.Asthmatic patients had higher serum MMP-2 levels than controls. Subjects with the CT and TT genotypes had a decreased risk of asthma (OR=0.42, P=0.02, OR=0.12, P=0.04, respectively) in contrast to those with the CC genotype. A strong association was found between mutant T allele and protection against asthma (OR=0.37, P=0.002). Furthermore, serum levels of MMP-2 were significantly lower in asthmatic patients carrying CT and TT genotypes than those carrying CC genotypes.Bronchial asthma is associated with high serum levels of MMP-2, while MMP-2 -1306C>T gene polymorphism provides a significant protection against asthma manifestation through down-regulation of MMP-2 gene expression leading to lower level of circulating MMP-2.

Assessment of lung deposition and analysis of the effect of fluticasone/salmeterol hydrofluoroalkane (HFA) pressurized metered dose inhaler (pMDI) in stable persistent asthma patients using functional respiratory imaging

ABSTRACTBackground: Unambiguously for inhaled products, PK measures are best suited for ensuring that the total systemic exposure is equivalent for two products but cannot provide regional information about lung deposition and structural changes. Functional respiratory imaging (FRI) has been demonstrated to be sensitive for distinguishing small but imperative differences related to a single treatment.Methods: In this study FRI is used in 16 asthmatic patients to assess equivalence in regional deposition for two products (fluticasone/salmeterol, test and reference) by directly measuring regional functional and structural changes within the lungs following its administration.Results: No differences were observed between the lung deposition patterns and the effects on lung structure and function of two products, having the same formulation and manufactured by different organizations using FRI.Conclusions: Results using FRI complement PK assessments. The added value of this approach to the conventional clinical methods could be significant.

Clinical significance of serum vascular endothelial growth factor in young male asthma patients.

Background/AimsVascular endothelial growth factor (VEGF) is an important mediator of angiogenesis. However, little is known about the potential use of serum levels of VEGF as a biomarker for asthma. We investigated the differences in VEGF levels among normal controls, stable asthma patients, and those with exacerbation of acute asthma. All subjects were young males.MethodsWe measured VEGF levels in each patient group, and examined any serial changes in those with acute exacerbation.ResultsVEGF levels were significantly higher in stable asthmatic patients and even more so in acute asthmatic patients, compared to healthy controls. However, there was no correlation between VEGF levels and forced expiratory volume in 1 second in patients with stable asthma. In addition, there were no correlations between VEGF levels and asthma control test scores. In patients with acute exacerbation, VEGF levels significantly increased during the acute period; their levels decreased gradually at 7 and 14 days after treatment.ConclusionsCompared to normal control patients, the serum levels of VEGF were elevated in stable asthma patients and even more elevated in patients with acute exacerbation. However, the role of VEGF as a biomarker in stable asthma is limited. In patients with acute exacerbation, VEGF levels were associated with clinical improvements.

A comparison of the efficacy and safety of daily inhaled budesonide/formoterol and as and when needed inhaled budesonide/formoterol combination in moderate persistent asthma

Background: To evaluate efficacy and safety of a fixed dose combination of budesonide/formoterol inhaler, when used as and when needed treatment approach in comparison with similar regimen daily. Methods: A prospective, open label, parallel group study design, in which, screened patients, having moderate persistent asthma, underwent a 2 week of run in period, underwent randomization in two treatment groups, in one group daily treatment with fixed dose combination of budesonide/formoterol inhaler and in another group as and when needed treatment with similar medication. The assessments after baseline were done at 2, 4 and 6 weeks. The primary outcomes were Asthma Control Questionnaire Score (ACQS), asthma free days, exacerbation frequency and severity. Other outcomes were, lung functions, need for rescue medication, Modified Borg dyspnea score and patient preference on VAS. Results: The mean age of 50 patients included in study was 40.24±2.38 years in group I, and 39.24±1.81 years in group II. Patients were followed up for 6 weeks after 2 weeks of run in period. Improvement of ACQS, exacerbation prevention and number of asthma free days were same with both the regimens. Though the drugs taken in as and when needed treatment group was almost half of daily regimen group. Adverse drug reactions (ADRs) were not found in any group. No association between adverse effects and dose was established. Conclusions: Both the treatment regimens improve the asthma control parameters, prevent exacerbations and prevent the decline in lung functions with the similar efficacy and safety. So as and when needed treatment approach can be an alternative to daily regimen for stable moderate persistent asthma patients.

The importance of bacterial and viral infections associated with adult asthma exacerbations in clinical practice.

BackgroundViral infection is one of the risk factors for asthma exacerbation. However, which pathogens are related to asthma exacerbation in adults remains unclear.ObjectiveThe relation between various infections and adult asthma exacerbations was investigated in clinical practice.MethodsThe study subjects included 50 adult inpatients due to asthma exacerbations and 20 stable outpatients for comparison. The pathogens from a nasopharyngeal swab were measured by multiplex PCR analysis.ResultsAsthma exacerbations occurred after a common cold in 48 inpatients. The numbers of patients with viral, bacterial, or both infections were 16, 9, and 9, respectively. The dominant viruses were rhinoviruses, respiratory syncytial virus, influenza virus, and metapneumovirus. The major bacteria were S. pneumoniae and H. influenzae. Compared to pathogen-free patients, the patients with pathogens were older and non-atopic and had later onset of disease, lower FeNO levels, lower IgE titers, and a higher incidence of comorbid sinusitis, COPD, or pneumonia. Compared to stable outpatients, asthma exacerbation inpatients had a higher incidence of smoking and comorbid sinusitis, COPD, or pneumonia. Viruses were detected in 50% of stable outpatients, but a higher incidence of rhinovirus, respiratory syncytial virus, and metapneumovirus infections was observed in asthma exacerbation inpatients. H. influenzae was observed in stable asthmatic patients. Other bacteria, especially S. pneumoniae, were important in asthma exacerbation inpatients.ConclusionViral or bacterial infections were observed in 70% of inpatients with an asthma exacerbation in clinical practice. Infection with S. pneumoniae was related to adult asthma exacerbation.

The Interpretation of Dyspnea in the Patient with Asthma.

Physicians have noted dyspnea in severely ill asthmatic patients to be associated with fright or panic; in more stable patients dyspnea may reflect characteristics including lung function, personality and behavioral traits. This study evaluates the symptom of dyspnea in 32 asthmatic patients twice: first when acutely ill and again after an initial response to therapy. Spirometry was performed, dyspnea quantified (Borg scale), and panic assessed with a specialized measure of acute panic (the acute panic inventory (API)) in the 32 patients before and again after treatment. After treatment, questionnaires to evaluate somatization and panic disorder were also administered. When acutely ill, both the API and all spirometric measures (PEFR; FEV1; IC) correlated with dyspnea. Multiple linear regression showed that measures of the API, the peak expiratory flow rate, and female sex taken together accounted for 41% of dyspnea in acute asthma. After treatment, the API again predicted dyspnea while spirometric data did not. Those subjects who described themselves as having chronic panic disorder reported high grades of dyspnea after treatment also. We conclude that interpretations of the self-report of asthma differ between acutely ill and stable asthmatic patients.

To study the efficacy and safety of doxophylline and theophylline in bronchial asthma.

Asthma is a non communicable chronic disease prevalent all over the world. Two commonly used methylxanthines, theophylline and doxofylline were compared in the study in stable asthmatic patients at recommended doses by various spirometric lung function tests with forced expiratory volume at second one (FEVI) between 50 to 80% of predicted FEVI. A total of 100 patients were divided in two groups. Group I was administered 300 mg theophylline twice a day and Group II was administered doxofylline 400 mg twice a day orally for six weeks. Spirometric variables symptom score, and adverse effects were recorded at the baseline level and after six weeks of therapy. Data was compared and analysed statistically. The spirometric values of forced expiratory volume in 1 second (FEVI), forced vital capacity (FVC), and FEV1/FVC showed a statistically significant improvement over base line with the use of both theophylline as well as doxophylline, but were not statistically different from each other. There was a statistically significant improvement in peak expiratory flow rate (PEFR) after six weeks of treatment with doxophylline compared to theophylline. It was found that the doxophylline has a better safety profile as compared to theophylline. Adverse events occurred in a greater proportion of patients in the theophylline group. In the study it was concluded that both theophylline and doxofylline improved the lung function tests and symptoms in patients of mild Bronchial Asthma, but doxofylline has a better profile in terms of safety.

Abnormal Chemokine Receptor Profile on Circulating T Lymphocytes from Nonallergic Asthma Patients

Background: T lymphocytes are involved in the pathogenesis of nonallergic asthma. The objective of this study was to characterize the subset distribution and pattern of chemokine receptor expression in circulating T lymphocyte subsets from nonallergic asthma patients. Methods: Forty stable nonallergic asthma patients and 16 sex- and age-matched healthy donors were studied. Twelve patients did not receive inhaled steroids (untreated patients), 16 received 50-500 μg b.i.d. of inhaled fluticasone propionate (FP) (standard-dose patients), and 12 received over 500 μg b.i.d. of inhaled FP (high-dose patients) for at least 12 months prior to the beginning of this study and were clinically well controlled. Flow cytometry was performed using a panel of monoclonal antibodies (4 colors). Results: Nonallergic asthma patients treated with high doses of inhaled FP showed a significant reduction in the percentages of CD3+ T lymphocytes compared to healthy controls. Untreated patients showed a significant increase in CCR6 expression in CD8+CD25+ and CD8+CD25+bright T cells compared to healthy controls. The results were similar for CXCR3 and CCR5 expression. In patients treated with standard doses of FP, CCR5 expression was significantly increased in CD3+ T lymphocytes relative to healthy controls. Conclusions: The different groups of clinically stable nonallergic asthmatic patients showed distinct patterns of alterations in subset distribution as well as CCR6, CXCR3, and CCR5 expression on circulating T lymphocytes.

Irreversible acinar airway abnormality in well controlled asthma

Even in stable asthma patients, acinar ventilation distribution can be abnormal, and we aimed to specifically maximize its reversibility by switching patients from a standard inhaled corticosteroid (iCS) to a fine particle iCS formulation. For this prospective double-blind double-dummy randomized study, 66 stable asthma patients under maintenance iCS (equivalent budesonide ≤ 800 μg/day) were screened for abnormal baseline acinar ventilation heterogeneity (Sacin). After a 3-week run-in period, 35 eligible patients were randomized to fine particle beclomethasone (HFA-BDP; Qvar Autohaler) or to budesonide (DPI-BUD; Pulmicort Turbohaler). Asthma Control Test (ACT) score and various lung function indices reflecting the small airways were obtained at baseline, after 6 and 12 weeks. Thirty one patients [age:52 ± 17(SD) years; FEV1:76 ± 19(SD)%pred] completed the study (DPI-BUD:n = 16; HFA-BDP:n = 15). After 6 and 12 weeks, there were no significant changes in acinar or conductive ventilation heterogeneity, nor in mid-expiratory flow, RV/TLC, closing capacity, impulse oscillometry indices (resistance, reactance), bronchial NO production or alveolar NO, in either treatment arm. Asthma control was maintained in both arms. In stable asthma patients with small airways dysfunction under maintenance therapy, there is a residual functional abnormality in the lung periphery which is probably not eosinophilic in origin and cannot be normalized with the iCS formulations under study. ISRCTN17195095.

Clinical application of inert gas Multiple Breath Washout in children and adolescents with asthma

Children with asthma often have normal spirometry despite significant disease. The pathology of the small airways in asthma may be assessed using Multiple Breath Washout (MBW) and calculating the Lung Clearance Index (LCI). There are only few studies using MBW in children with asthma and existing data regarding bronchodilator effect are contradictory. The aim of the present pilot study was to compare LCI in asthma and controls and assess the effect of salbutamol in children with asthma on the LCI. Unselected patients with a diagnosis of asthma visiting the outpatient department of our hospital between 04-2010 and 03-2011 were recruited and compared to a healthy control group. MBW was performed as inert gas MBW using sulfurhexafluorid (SF6) as the tracer gas. Clinical data were documented and spirometry and MBW (EasyOne Pro, MBW module, NDD Switzerland) were performed before and after the use of salbutamol (200-400μg). Healthy controls performed baseline MBW only. 32 children diagnosed with asthma (4.7-17.4 years) and 42 controls (5.3-20.8) were included in the analysis. LCI differed between patients and controls, with a mean LCI (SD) of 6.48 (0.48) and 6.21 (0.38) (P=0.008). Use of salbutamol had no significant effect on LCI for the group. These pilot data show that clinically stable asthma patients and controls both have a LCI in the normal range. However, in patients the LCI is significantly higher indicating that MBW may have a role in assessing small airways disease in asthma.

A Decreased Mean Platelet Volume Is Associated with Stable and Exacerbated Asthma

Background: Systemic inflammation is related to disease progression in asthma. Activated platelets play a critical role in atherogenesis, inflammation, and atherothrombosis. The mean platelet volume (MPV) is an early marker of platelet activation. Objectives: The aim of this study is to clarify the relevance of MPV levels in patients with stable and exacerbated asthma. Methods: We investigated the peripheral blood cell count parameters, C-reactive protein (CRP), lung function parameters, and arterial blood gas in patients with asthma and control subjects. Eighty-five stable asthma patients and 85 asthmatics with exacerbations were investigated. Eighty-five controls matched for age, gender, body mass index (BMI), and smoking status were recruited. Results: Patients with exacerbated asthma had lower MPV and higher CRP levels and white blood cell (WBC) counts compared to patients with stable asthma and control subjects. Furthermore, the MPV was reduced in patients with stable asthma compared to control subjects. Negative correlations between MPV and CRP were present in stable and exacerbated asthma. Although there was no relationship between MPV and WBC count in stable asthma, there was an inverse relationship between MPV and WBC count in exacerbated asthma. Conclusions: These findings show that patients with stable asthma had a lower MPV compared to controls and the MPV levels in asthmatic patients with exacerbations were lower compared to those in patients with stable asthma. Further investigations regarding the role of MPV in asthma may be beneficial in the search for therapeutic targets.