高渗盐水与组胺支气管激发试验在咳嗽变异性哮喘相关性的研究

目的研究探讨高渗盐水与组织胺支气管激发试验在咳嗽变异性哮喘患者中相关性。方法将12名咳嗽变异性哮喘患者分别行组织胺和高渗盐水支气管激发试验,两次试验间隔一周,记录组胺和高渗盐水的累计激发量（PD20）,对其行相关性分析研究。结果两者之间相关系数为0．794,有显著性统计学意义（P〈0．05）。结论两者在咳嗽变异性哮喘中有较强的相关性。     

血小板平均体积在支气管哮喘急性发作期的变化

目的观察血小板平均体积(MPV)在支气管哮喘急性发作期患者血清中的变化,探讨血小板平均体积与支气管哮喘急性发作期的关系。方法支气管哮喘急性发作期患者40例,支气管哮喘慢性持续期患者40例,健康对照组40例,分别检测三组血清中血小板平均体积,采用单因素方差分析,比较三组之间血小板平均体积的变化。结果支气管哮喘急性发作期患者血小板平均体积为(10.69±0.96)fl,支气管哮喘慢性持续期为(10.59±0.75)fl,健康对照组为(10.46±0.66)fl,三组两两比较均P0.05,差别有统计学意义。结论支气管哮喘急性发作期患者血清中血小板平均体积较慢性持续期和健康对照组明显升高,可能与支气管哮喘急性发作期的发病及严重程度有关。     

Respiratory impedance response to a deep inhalation in children with history of cough or asthma

The aim of this study was to describe the change in respiratory impedance induced by a deep inhalation (DI) in children who developed a positive response to inhalation of methacholine (Mch). Eighteen children aged 4.5-12.5 years, presenting with chronic cough or doctor-diagnosed asthma, were studied at baseline after inhalation of Mch and after inhalation of a bronchodilator. Respiratory resistance (Rrs) and reactance (Xrs) were measured by the forced oscillation technique, varying transrespiratory pressure at 12 Hz around the head. The tidal flow (V') and volume (V) dependence of Rrs before and after the DI was characterized according to the equation Rrs = K1 + K2 x /V'/ + K3 x V. DI induced no significant change at baseline or after inhalation of a bonchodilator. During Mch challenge, Rrs and K1 were significantly lower, and K3 and Xrs significantly less negative after DI than before, during both inspiration and expiration; there was no change in K2.We conclude that DI results in a decrease in Rrs in children with induced bronchoconstriction. The associated changes in Xrs, K1, and K3, and lack of decrease in K2, suggest that dilatation of airways occurs at the bronchial level, with little contribution of the upper airways or of a change in breathing patterns.     

Characteristic modifications of the peripheral airways in patients with bronchial asthma in areas with air pollution

OBJECTIVE: Changes in the peripheral airways in patients with bronchial asthma who were living in the Kawasaki industrial zone, region with severe air pollution, were morphologically investigated in order to determine the pathological conditions of such bronchial asthma, in particular ascertaining the effect of air pollution. METHODOLOGY: Studies were made of the morphological characteristics of the peripheral airways in patients with bronchial asthma who had resided for long periods in an area near Tokyo affected by air pollution. RESULTS: The endoscopic findings of the peripheral airways were distinct, consisting of reddening, stenosis, pigmentation, pallor, lustrelessness and hypersecretion. The histological findings also differed from those in usual forms of asthma. CONCLUSIONS: The bronchial asthma in the present patients appeared to be a totally different form from a morphological viewpoint, although it was quite similar to known types in its clinicophysiological features.     

Effects of thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis on bronchial responsiveness to histamine: Implications on the autonomic imbalance theory of asthma

Abstract Autonomic nervous system abnormalities in airway control may contribute to the symptoms of asthma, and even to the pathogenesis of bronchial hyperresponsiveness (BHR). Partial pulmonary sympathetic denervation by means of bilateral upper dorsal thoracoscopic D₂–D₃ sympathicolysis (TS) is an accepted treatment in severe essential hyperhidrosis (EH). The effects of this intervention on BHR are unknown. The objective of this study was to evaluate whether partial pulmonary sympathetic denervation by means of TS has an effect on BHR. Bronchial challenge tests with histamine, enabling the calculation of the provocative dose causing a 20% reduction in FEV₁ (PD_{20 His}) were performed 1 day before, and 6 weeks and 6 months after TS in 35 patients with severe EH. In nine patients (including three patients with a previous history of asthma) with pre-operative BHR (defined as PD_{20 His} < 2 mg), mean PD_{20 His} did not change significantly at 6 weeks, nor at 6 months after TS (0.62 ± 0.33, 0.71 ± 0.42 and 0.93 ± 0.65 mg, respectively) although there was a non-significant trend towards an increase in PD_{20 His} at 6 months. Three of the 26 patients (12%) without pre-operative BHR became hyperresponsive after TS, whereas 1 of the 9 patients with pre-operative BHR lost hyperresponsiveness. No patient developed asthma symptoms after TS. Upper dorsal thoracoscopic D₂–D₃ sympathicolysis performed for the treatment of EH has no significant effects on mean PD_{20 His} and individual loss (11%) or development (12%) of BHR occurs only in a minority of patients.     

MMEF/FVC及其下降值与支气管激发试验阳性率的关系探讨

目的探讨MMEF/FVC及其下降值与支气管激发试验阳性率的关系。方法235例慢性咳嗽、胸闷、喘息的患者进行组织胺支气管激发试验,并分析支气管激发试验结果阳性率与患者基础肺功能MMEF/FVC及其下降值的关系。结果在支气管激发试验阳性组MMEF/FVC比值明显低于阴性组(0.87+0.76,1.01+0.28;P0.001),差异有统计学意义,并且MMEF/FVC比值在不同激发程度的下降值同样具有统计学意义(P0.05),ROC曲线下面积为72%(标准误为0.033,P0.001),MMEF/FVC比值的最佳截点为0.85,灵敏度67%(75/112),特异度70%(86/123),,准确率为68.5%(161/235),阳性预测值为67%,阴性预测值为70%。结论支气管激发试验阳性率与MMEF/FVC比值及其下降有关,并且此比值可用于预测支气管激发试验阳性率。     

Sputum eosinophilia and bronchial responsiveness in patients with chronic non-productive cough responsive to anti-asthma therapy

OBJECTIVE: We aimed to examine airway inflammation and bronchial responsiveness in patients with chronic non-productive cough responsive to anti-asthma therapy. METHODOLOGY: Bronchial responsiveness to methacholine as well as the number of inflammatory cells and concentration of eosinophil cationic protein (ECP) in induced sputum were measured in 42 patients with chronic non-productive cough of unknown origin. Their response to bronchodilator, antiallergic and inhaled or oral glucocorticoid therapy was subsequently assessed. RESULTS: Complete remission of coughing was attained with anti-asthma therapies in 34 patients (responder group), while eight patients did not respond (non-responder group). Twenty patients in the responder group and three in the non-responder group showed bronchial hyperresponsiveness (BHR). The number of eosinophils and ECP levels in the sputum from responders with BHR were significantly increased when compared with those from non-responders and healthy subjects. These sputum measures were also significantly increased in responders without BHR when compared with healthy subjects. However, there were no significant differences in these inflammatory markers between the responders with and without BHR. The neutrophil numbers in the sputum from non-responders and responders both with and without BHR were also significantly higher than in control subjects, but there were no significant differences. CONCLUSIONS: These findings suggest that patients with chronic non-productive cough responsive to anti-asthma therapy characteristically have eosinophilic airway inflammation, which may play an important role in the development of chronic cough. Furthermore, the evaluation of not only bronchial responsiveness but also airway inflammation by examination of induced sputum may be useful for diagnosis and deciding on therapeutic strategies.     

Comparative effects of volume history on bronchoconstriction induced by hyperventilation and methacholine in asthmatic subjects

The aim of this study was to find out if bronchodilatation following deep inspiration can be induced by the inhalation of a "natural" stimulus (hyperventilation of cold dry air), and if the effect is similar to that induced by methacholine. After baseline assessment of lung resistance (RL), 10 asthmatic subjects were asked to inhale cold dry air for 3 min. RL was monitored continuously for 3-4 min, at which time subjects were asked to take a fast deep inspiration. After recovery, the manoeuvre was repeated and RL was reassessed. The manoeuvre was then repeated a third time. After functional recovery, progressive doses of methacholine were inhaled until the increase in RL was comparable to that obtained after hyperventilation (56 +/- 16% and 65 +/- 24%, respectively, mean +/- SD, NS). The same deep inspiration manoeuvre was repeated three times with recovery as after hyperventilation of cold dry air. Maximum changes in RL were not significantly different after each of the three manoeuvres for either type of bronchoconstriction. The mean fall in RL was 14.2 +/- 9.9% after hyperventilation and 16.4 +/- 10.5% after methacholine. There was a satisfactory correlation (r = 0.80, p less than 0.01) between the bronchodilatation after deep inspiration for both types of stimuli. We conclude that the bronchodilator effect of deep inspiration is no different using either a pharmacological stimulus (methacholine) or a "natural" stimulus (hyperventilation of unconditioned air). These results show that assessing the response to hyperventilation with manoeuvres requiring deep inspiration, forced expiratory volume in one second (FEV1) may alter airway tone in a way similar to pharmacological stimuli.     

Effect of fluticasone on markers of inflammation and quality of life in steroid‐naive patients with mild asthma

Background and Aims: Patients with mild asthma may adapt to symptoms that may be neglected at a medical consultation. Despite active airway inflammation, indicating need for treatment symptoms may be poorly perceived and influence on quality of life. The aim was to find out if markers of asthma activity and quality of life are influenced by inhaled steroids in patients who regard themselves as free of symptoms. Methods: Seventy steroid‐free patients with mild asthma were treated with inhaled fluticasone (250 µg twice daily) or placebo for 3 months in a randomised, double‐blind, study. Spirometry with reversibility test, exhaled nitric oxide (NO), bronchial responsiveness to methacholine and eucapnic dry air hyperventilation and quality of life [(Asthma Quality of Life Questionnaire (AQLQ)] were assessed before and after treatment. Results: Fluticasone, but not placebo, decreased methacholine responsiveness. Bronchial responsiveness to dry air and exhaled NO levels was significantly lowered by fluticasone compared with placebo. Quality‐of‐life scores were high already before treatment and were not significantly altered by treatment. Conclusion: Treatment with an inhaled steroid in mild asthmatics altered bronchial responsiveness and exhaled NO levels but did not improve quality of life. In mild asthma, there is thus a space for improvement with regard to inflammatory parameters in patients who have only minor symptoms that are not influenced by treatment. In a long‐term perspective, the indication for treatment of surrogate markers remains, however, unclear. Please cite this paper as: Ehrs P‐O, Sundblad B‐M and Larsson K. Effect of fluticasone on markers of inflammation and quality of life in steroid‐naive patients with mild asthma. The Clinical Respiratory Journal 2009; DOI:10.1111/j.1752‐699X.2009.00145.x.     

FeNO在支气管哮喘患者中的应用价值

目的探讨呼出气一氧化氮(FeNO)测定在支气管哮喘患者中的应用价值。方法对哮喘患者治疗前、治疗后及健康对照组采用FeNO分析仪和肺功能仪测定FeNO及FEV_1%的水平,同时分析FeNO与FEV1%的相关性。结果哮喘患者治疗前FeNO为(69.35±26.51)ppb;吸入信必可治疗4周后FeNO为(34.01±21.49)ppb;健康对照组FeNO为(16.28±8.80)ppb。哮喘组治疗前、后的FeNO指标显著高于健康对照组(P0.05),且治疗前指标高于治疗后(P0.05);治疗前FEV_1%的水平显著低于治疗后及对照组(P0.05);FeNO与FEV1%无直线相关性。结论 FeNO的水平能够反映哮喘患者慢性气道炎症,并且在评估哮喘控制水平方面可能发挥作用。     

嗜酸细胞趋化因子在哮喘、嗜酸细胞性支气管炎患者诱导痰中的表达及其与气道炎症的关系

目的探讨嗜酸细胞趋化因子（eotaxin）在支气管哮喘、嗜酸细胞性支气管炎患者气道炎症发生中的作用以及在两者间的区别。方法分别收集支气管哮喘（A组）、嗜酸细胞性支气管炎（EB组）、单纯慢性支气管炎（CB组）缓解期/稳定期患者13例、11例、12例和健康对照者（C组）9例。诱导痰并经处理后进行分类细胞记数,并用夹心法酶联免疫吸附测定（ELISA）其诱导痰上清液中eotaxin浓度。结果诱导痰嗜酸细胞占白细胞百分比（Eos/Leu%）、eotaxin浓度A组[（19.2±9.7）%;（0.251±0.118）g/L]、EB组[（11.4±6.1）%;（0.146±0.079）g/L]分别与CB组[（0.9±0.6）%;（0.043±0.036）g/L]、C组[（0.8±0.4）%;（0.031±0.013）g/L]比较,差异有显著性（P均〈0.05）;A组Eos/Leu%、eotaxin浓度与EB组比较,差异也有显著性（P均〈0.05）。结论 eotaxin可能通过对Eos的选择性趋化作用参与了支气管哮喘和嗜酸细胞性支气管炎患者气道炎症的发生机制,这种作用机制对于支气管哮喘和嗜酸细胞性支气管炎在程度上可能是不同的。     

Diurnal variation in bronchial responsiveness in asthmatic children

To establish the presence of a diurnal variation in bronchial responsiveness in asthmatic children, the increase of peak expiratory flow rate (PEFR) followins sympathomimetic inhalation and the response to bronchial provocation with histamine and hyperventilation of cold dry air (HVCDA) were studied. Twenty-nine patients (20 boys, nine girls, aged 9.3 to 17.8 years) measured PEFR before and after sympathomimetic inhalation three times a day for four weeks. A further 15 patients (eight boys, seven girls, aged 6.9 to 18.0 years) underwent bronchial provocation testing every six hours for 24 hours. A diurnal variation in bronchodilator responsiveness was demonstrated in 55% of the first group. Mean amplitude was 60.8% of patients' mean increase in PEFR following bronchodilators. On grouped data, bronchodilation was greater in the morning than in the afternoon (p < 0.0005) or in the evening (p < 0.0005). A diurnal variation in the response to bronchial provocation was also found in the second group, but the timing of the rhythm depended on the stimulus used. On grouped data, airways were most sensitive to histamine at 0400 hours and most sensitive to HVCDA at 1600 hours. The diurnal variation demonstrated in bronchial responsiveness could not be attributed to changes in baseline airway caliber and was present despite the patients' taking sufficient medication to control their asthmatic symptoms.     

Childhood asthma following hospitalization with acute viral bronchiolitis in infancy

A prospective follow-up of 48 infants hospitalized with respiratory syncytial virus bronchiolitis in the first year of life revealed that 44 of these infants had symptoms suggestive of asthma in the 5 years following their initial illness (cumulative prevalence 92%). Symptoms became less frequent and less troublesome during the follow-up period. Thirty-five of these children visited the laboratory for clinical examination, pulmonary function testing, and histamine challenge. Twenty-five children were believed to have clinical evidence of asthma at the time of the laboratory visit (point prevalence 71%). Five children were unable to perform pulmonary function tests; 25 of the remaining 30 (67%) had a positive histamine challenge test. No relationship could be demonstrated between a clinical diagnosis of asthma, a family history of atopy, and the results of histamine challenge testing. These results question the relationship between the results of bronchial provocation tests and clinical asthma in this age group.     

Airway cough sensitivity to inhaled capsaicin and bronchial responsiveness to methacholine in asthmatic and bronchitic subjects

The objective of this study was to evaluate the effect of chronic airway inflammation on airway cough sensitivity and non-specific bronchial responsiveness, and the relationship between them. The capsaicin cough threshold, defined as the lowest concentration of capsaicin causing five or more coughs, and non-specific bronchial responsiveness, defined as the methacholine concentration causing a 20% fall in forced expiratory volume in 1 s (FEV1) (PC20-FEV1), were measured in 18 asthmatic, 13 bronchitic (sinobronchial syndrome) and 28 healthy non-atopic subjects. All subjects were non-smoking men. The geometric mean values (mumol) of the cough threshold were 18.9 (GSEM 1.29), 8.69 (GSEM 1.29) and 27.6 (GSEM 1.31) in asthmatic, bronchitic and normal subjects, respectively. The value in bronchitic subjects was significantly lower (P < 0.02) than that in normal subjects. The geometric mean value of PC20-FEV1 in asthmatic subjects (0.48 mg/ml (GSEM 1.38)) was significantly lower than that in bronchitic subjects (18.5 mg/ml (GSEM 1.75)) (P < 0.001). There was no correlation between cough threshold and PC20-FEV1 values (correlation coefficient (r) = 0.155). These results indicate that cough sensitivity is potentiated by chronic airway inflammation in bronchitis but not in asthma, and suggest that cough sensitivity and bronchial responsiveness may be independently potentiated by different mechanisms resulting from chronic airway inflammation.     

Selective histamine blockade in childhood asthma; the effect of terfenadine on resting bronchial tone and exercise induced bronchoconstriction

The orally active histamine H1 blocker terfenadine was investigated for its effect on resting bronchial tone and exercise induced bronchoconstriction in 20 asthmatic children by a double blind placebo controlled study. Terfenadine produced acute broncholidation with an average 32% improvement in FEV1 by 3 h. After exercise challenge terfenadine partially inhibited exercise induced bronchoconstriction. The maximum fall in PEFR after exercise was reduced from 32% after placebo to 21.5% after terfenadine. These results suggest that asthmatic children have background resting 'histamine tone' that is reversible by histamine H1 blockage.     

支气管哮喘患儿血清miR-34、Notch1水平与气道炎症的相关性分析

目的探究微小RNA-34(miR-34)、Notch1在支气管哮喘(BA)患儿血清中的表达水平及其与气道炎症的关系。方法选取2018年10月~2020年5月本院收治的94例BA患儿为BA组,并选取同期90例体检健康儿童为健康组。比较两组一般资料;采用实时荧光定量PCR(qRT-PCR)法检测血清miR-34、Notch1 mRNA表达水平;酶联免疫吸附法(ELISA)检测血清白介素-17(IL-17)、白介素-10(IL-10)水平;采用血细胞分析仪检测嗜酸性粒细胞(EOS)水平;Pearson法分析BA患儿血清miR-34、Notch1 mRNA表达水平与IL-17、IL-10、EOS,及miR-34表达水平与Notch1 mRNA的相关性;Logistic回归分析发生BA的影响因素。结果BA组患儿血清miR-34及IL-10水平,均明显低于健康组(P<0.05),Notch1 mRNA、IL-17、EOS水平、家族哮喘史、个人过敏史、家族过敏史均明显高于健康组(P<0.05);BA患儿血清miR-34表达水平与IL-17、EOS、Notch1 mRNA呈负相关(P<0.05),与IL-10呈正相关(P<0.05);血清Notch1 mRNA表达水平与IL-17、EOS呈正相关(P<0.05),与IL-10呈负相关(P<0.05);miR-34是影响BA发生的独立保护因素(P<0.05),Notch1、IL-17、家族哮喘史、个人过敏史、家族过敏史是影响BA发生的独立危险因素(P<0.05)。结论BA患儿血清miR-34表达水平降低,Notch1表达水平升高,两者呈负相关,且均与气道炎症显著相关,检测血清miR-34、Notch1表达水平,均有助于辅助诊断BA,两者联合可提高对BA的诊断价值。     

支气管哮喘患儿血清miR-34、Notch1水平与气道炎症的相关性分析

目的探究微小RNA-34(miR-34)、Notch1在支气管哮喘(BA)患儿血清中的表达水平及其与气道炎症的关系。方法选取2018年10月~2020年5月本院收治的94例BA患儿为BA组,并选取同期90例体检健康儿童为健康组。比较两组一般资料;采用实时荧光定量PCR(qRT-PCR)法检测血清miR-34、Notch1 mRNA表达水平;酶联免疫吸附法(ELISA)检测血清白介素-17(IL-17)、白介素-10(IL-10)水平;采用血细胞分析仪检测嗜酸性粒细胞(EOS)水平;Pearson法分析BA患儿血清miR-34、Notch1 mRNA表达水平与IL-17、IL-10、EOS,及miR-34表达水平与Notch1 mRNA的相关性;Logistic回归分析发生BA的影响因素。结果BA组患儿血清miR-34及IL-10水平,均明显低于健康组(P<0.05),Notch1 mRNA、IL-17、EOS水平、家族哮喘史、个人过敏史、家族过敏史均明显高于健康组(P<0.05);BA患儿血清miR-34表达水平与IL-17、EOS、Notch1 mRNA呈负相关(P<0.05),与IL-10呈正相关(P<0.05);血清Notch1 mRNA表达水平与IL-17、EOS呈正相关(P<0.05),与IL-10呈负相关(P<0.05);miR-34是影响BA发生的独立保护因素(P<0.05),Notch1、IL-17、家族哮喘史、个人过敏史、家族过敏史是影响BA发生的独立危险因素(P<0.05)。结论BA患儿血清miR-34表达水平降低,Notch1表达水平升高,两者呈负相关,且均与气道炎症显著相关,检测血清miR-34、Notch1表达水平,均有助于辅助诊断BA,两者联合可提高对BA的诊断价值。     

Inhibition of exercise-induced bronchoconstriction by nebulised sodium cromoglycate in patients with bronchial asthma.

In this double blind study, 10 patients with bronchial asthma underwent exercise challenge on five occasions. The first of these was a control test carried out without prior drug administration; the other tests were preceded by the administration, in random order, of a sodium cromoglycate (SCG) capsule, a placebo capsule, an ampoule of sodium cromoglycate solution, and a placebo ampoule. Comparisons of the largest falls in PEFR after exercise showed statistically significant inhibition of exercise-induced bronchospasm, compared with control, with both SCG inhalation solution (P less than 0.01) and SCG powder (P less than 0.01). SCG powder was more active, but the difference was not significant. A significant difference in protection was found between SCG powder and its placebo (P less than 0.01). SCG inhalation solution was also more effective than its placebo, but the difference did not reach significance, since the latter conferred some protection.     

Does nifedipine affect the diurnal variation of asthma in children?

Diurnal variations in airway caliber and in bronchial reactivity have been described. The mechanisms underlying these variations are not known. The hypothesis that these variations can be diminished by calcium channel blockers was tested by giving 22 asthmatic children 10 mg of nifedipine or identical placebo three times a day for 4 weeks in a double-blind, randomized, crossover-designed study. Treatment with nifedipine did not diminish the diurnal variations in airway caliber, judged from peak expiratory flow rates, or in bronchial reactivity, judged from bronchodilator responsiveness. Group mean amplitude of the diurnal variation in airway caliber was 10.5% on nifedipine and 10.6% on placebo. Group mean amplitude of the diurnal variation in bronchodilator responsiveness was 75.4% on nifedipine and 69.5% on placebo. There were no differences in mean peak expiratory flow rate between nifedipine and placebo periods. This study did not find any evidence to support the hypothesis that the diurnal variations in airway caliber and in bronchial reactivity can be diminished by calcium channel blockers.