Eosinophils, bronchial hyperreactivity and late-phase asthmatic reactions

We have measured airways reactivity (methacholine PC20) and blood eosinophils in eleven asthmatics with allergen-induced late-phase reactions. Before challenge there was a significant (P less than 0.05) inverse correlation between blood eosinophils and the methacholine PC20. After allergen inhalation eosinophil counts were significantly (P less than 0.01) elevated at 24 hr. These increases in blood eosinophil counts were not observed in patients who developed single early responses. The magnitude of the changes in eosinophil counts (24 hr minus pre-challenge values) also correlated with the baseline methacholine PC20 (P less than 0.01) in the late-phase responders. These observations suggest that there may be a direct association between eosinophils and airway reactivity in subjects who develop late-phase asthmatic reactions.     

Rhinovirus respiratory infections and asthma

Viral infections, particularly respiratory illnesses caused by rhinovirus, are the most common cause of asthma exacerbations in children and contribute in large part to asthma morbidity in adults. Epidemiologic studies and increasingly sophisticated viral detection methodologies have helped to define the role of rhinovirus as a potential causative agent in asthma exacerbations. Rhinovirus-induced lung disease is multifaceted and can be characterized in terms of a variety of physiologic, immunologic, and viral processes. The precise direct and indirect mechanisms of viral contribution to exacerbations must still be elucidated. Understanding them will have an impact on the design of future treatment modalities.     

Immunoglobulin E-independent major histocompatibility complex-restricted T cell peptide epitope-induced late asthmatic reactions.

Intradermal administration of short overlapping peptides derived from chain 1 of the cat allergen Fel d 1 (FC1P) that did not cross-link IgE, elicited isolated late asthmatic reactions with no visible early or late cutaneous response in 9/40 cat-allergic asthmatics. Four of the nine were human histocompatibility leukocyte antigen DR13-positive, as compared with only 1/31 nonreactors. The other five reactors expressed either DR1 or DR4. To confirm major histocompatibility complex restriction, fibroblast cell lines transfected with HLA-DR molecules were used to present FC1Ps to cat allergen-specific T cell lines derived from subjects before peptide injection. FC1P3 (peptide 28-44 of Fel d 1 chain 1) was recognized in the context of DR13 alleles (DRB1*1301, 1302) and induced specific T cell proliferation and IL-5 production. T cells from a DR1(+) responder proliferated and produced IL-5 in the presence of FC1P3 and DR1 (DRB1*0101) fibroblast cell lines, whereas T cells from a DR4(+) subject recognized FC1P2 (peptide 22-37) when presented by DRB1*0405. We conclude that short, allergen-derived peptides can directly initiate a major histocompatibility complex-restricted, T cell-dependent late asthmatic reaction, without the requirement for an early IgE/mast cell-dependent response, in sensitized asthmatic subjects.     

Topical upper airway anaesthesia with lidocaine increases airway resistance by impairing glottic function

Objective To assess if two different forms of upper airway topical anaesthesia induce similar changes in airway flow resistance (Rrs).Design Serial measurements of Rrs before and after topical anaesthesia with acqueous or paste lidocaine.Setting Lung function test laboratory.Participants 9 normal men with documented normal lung function tests.Interventions 2 different session of topical upper airway anaesthesia with 100 mg of liquid 5% lidocaine and 100 mg of 2% lidocaine paste, respectively.Measurements and results Rrs was measured by the random noise forced oscillation technique. Fiberoptic upper airway examination was performed in two subjects. Rrs increased on average by 81% after lidocaine spray and by 68% after lidocaine paste (p<0.005, respectively) with no difference in the magnitude of Rrs increase between the two modes of anaesthesia studied. This increase lasted 13±3 min (spray) and 12±3 min (paste), respectively (p=ns). Fiberoptic examination of the two most responders showed inspiratory laryngeal collapse.Conclusions Topical upper airway anaesthesia transiently increases Rrs with no specific effects regarding the drug presentation. Laryngeal dysfunction may be one mechanisms involved in Rrs increase following upper airway topical anaesthesia. Such findings may explain some poor respiratory tolerance reported during endoscopy.     

Managing upper airway obstruction.

A complete respiratory obstruction can lead to death in 3 minutes. The first and constant duty of the nurse aider is to check that the person is breathing by looking, listening and feeling. Partial obstruction is no less serious than complete obstruction. The nurse aider, in any situation, should assess the problem and attempt to overcome the airway obstruction using the measures described.     

精神科病房上呼吸道感染的调查及管理

Background: It is paid attention to infection of psychotic by medical staff, because of the special of department of psychiatry ,the inpatient has own characteristics.     

Use of Echinacea in upper respiratory tract infection

The significant burden of upper respiratory tract infection in adults and children, coupled with a lack of specific treatment options, invites the use of alternative therapies. Echinacea is an herb widely used for the prevention or treatment of upper respiratory tract infection. This review article examines the mechanism of action, dose, and types of Echinacea used for these purposes. The principal mode of action of Echinacea is through immunostimulation. Most Echinacea studies were done in Germany, but their results are difficult to interpret because of variability of experimental parameters. Types of Echinacea commonly used are Echinacea purpurea, E pallida, and E angustifolia. Both the plant's upper parts and roots are used. For oral administration, tablets, extracts, fresh pressed juice, teas, and tinctures have been used. Though studies show a beneficial effect, clear conclusions and recommendations of Echinacea use cannot be made due to a lack of standard product, variability in dose, and variability in outcome measures. Therefore, well-designed studies with consistent standardized measures are required.     

Influenza infection in suckling mice expands an NKT cell subset that protects against airway hyperreactivity

Infection with influenza A virus represents a major public health threat worldwide, particularly in patients with asthma. However, immunity induced by influenza A virus may have beneficial effects, particularly in young children, that might protect against the later development of asthma, as suggested by the hygiene hypothesis. Herein, we show that infection of suckling mice with influenza A virus protected the mice as adults against allergen-induced airway hyperreactivity (AHR), a cardinal feature of asthma. The protective effect was associated with the preferential expansion of CD4-CD8-, but not CD4+, NKT cells and required T-bet and TLR7. Adoptive transfer of this cell population into allergen-sensitized adult mice suppressed the development of allergen-induced AHR, an effect associated with expansion of the allergen-specific forkhead box p3+ (Foxp3+) Treg cell population. Influenza-induced protection was mimicked by treating suckling mice with a glycolipid derived from Helicobacter pylori (a bacterium associated with protection against asthma) that activated NKT cells in a CD1d-restricted fashion. These findings suggest what we believe to be a novel pathway that can regulate AHR, and a new therapeutic strategy (treatment with glycolipid activators of this NKT cell population) for asthma.     

A prospective study of respiratory infection in asthmatic patients treated with beclomethasone dipropionate and sodium cromoglycate.

A prospective study of forty adult asthmatic patients attending two chest clinics in the City of Liverpool was undertaken. All patients had reversible airways obstruction and were under treatment with either beclomethasone dipropionate or sodium cromoglycate. Satisfactory symptomatic control was achieved in both groups of patients on a subjective basis, but there was a statistically significant (P less than 0-001) reduction in the number of admissions to hospital in the treatment year compared to the preceding 12 months in the beclomethasone aerosol group. No increased incidence of lower respiratory tract infections or non-specific sore throats was found in either group studied. No cases of clinical oral Candida infection occurred in the beclomethasone aerosol treated patients. It is concluded that beclomethasone dipropionate in aerosol form is not only a safe and effective method for symptomatic control of adult bronchial asthma but is also economically worthwhile as a means of reducing hospital admissions in this vulnerable group of patients.     

Management of upper respiratory tract infection by family doctors

The prescribing behaviour of family doctors in Hong Kong towards upper respiratory tract infections (URTIs) and the factors that might affect such behaviour were studied. All 1016 members of the Hong Kong College of Family Physicians were sent a postal questionnaire. A total of 730 family doctors completed the questionnaire, with an overall response rate of 71.8%. Doctors who were older, more senior, or in private practice were more likely to think antibiotics were useful for URTIs and to prescribe them. These doctors were also more likely to think their patients would expect antibiotics from them. Postgraduate vocational training in general practice/family medicine helped make family doctors think fewer patients would expect antibiotics from them but did not affect their perception of the usefulness of antibiotics for URTIs. Our results showed that doctors with certain characteristics were more likely to prescribe antibiotics for URTIs and these doctors may be targeted for continued medical education.     

Study of upper respiratory tract bacterial flora: first report. Variations in upper respiratory tract bacterial flora in patients with acute upper respiratory tract infection and healthy subjects and variations by subject age

With the appearance of penicillin-resistant Streptococcus pneumoniae, there has been increasing debate concerning antimicrobial treatments for acute upper respiratory tract infection (AURTI) and acute otitis media in children. This study compares the nasopharyngeal bacterial flora in patients with AURTI (AURTI group; 710 subjects) and healthy subjects (HS group; 380 subjects). The comparisons were made between subjects aged 6 years or younger (0–6 subgroup: 330 subjects), between 7 and 74 years (7–74 subgroup: 668 subjects), and 75 years and older (92 subjects), because the subjects were subgrouped as described above dependent on the maturity of the protective immunity. In the HS group 7–74 subgroup, viridans group streptococci, Staphylococcus aureus, coagulase-negative staphylococci, and Corynebacterium sp. with a detection rate of 10% or more were classified as normal nasal flora (NNF), and Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were classified as drum cavity pathogens (DCP). In the 0–6 subgroup, although the detection rate for DCP bacteria in the AURTI group tended to be high, it did not reach a significant difference, whereas the detection rate for NNF bacteria was significantly lower. This trend was also observed to some degree in the other age subgroup. In the 0–6 subgroup, leukocyte infiltration observed with a microscope indicated the closest relationship between S. pneumoniae detection rate and detection quantity. These results suggest that in the 0–6 subgroup the tendency for patients with AURTI to have NNF bacteria as well as DCP bacteria should be taken into consideration.     

Diagnosis of anesthetic-induced upper airway obstruction in children using respiratory inductance plethysmography

Objective.Upper airway obstruction is the most rapid and clinically relevant cause of hypoxia during sedation and anesthesia. This study was designed to determine if respiratory inductance plethysmography (RIP) could quantify the degree of upper airway obstruction caused by induction of general anesthesia. Methods.RIP tracings were obtained during induction of general anesthesia in healthy children. Three sets of measurements were obtained during: (1) a 3 minute control period without anesthetics, (2) 3 minutes of 50% nitrous oxide, and (3) halothane administration to complete the induction of general anesthesia. Clinical impression of upper airway obstruction (none, partial, or complete) was correlated with two separate RIP analysis techniques. Results.Three hundred ninety-five breathing epochs from 20 children (ages 3–10 years) were analyzed by both phase shift and phase inversion techniques. Although both techniques had good general correlation with severity of airway obstruction, neither was sufficiently reliable for accurate prediction of severity of airway obstruction. Conclusions.We investigated two methods for analyzing RIP tracings during varying degrees of upper airway obstruction in anesthetized children. We found that neither technique was sufficiently accurate for predicting the severity of upper airway obstruction and would not be useful as a predictor of upper airway obstruction in the clinical or research settings.