Sexuality in patients with asthma and COPD

Sexual quality of life was examined in 55 outpatients with chronic obstructive pulmonary disease (COPD) and asthma, using disease-specific questionnaires. Compared to an age- and sex-matched norm group, male patients with COPD reported a significantly lower sexual quality of life on all dimensions of the questionnaire. Female patients with COPD reported a lower frequency of sexual intimacy and lower sexual quality of life overall. Patients with asthma reported sexual quality-of-life scores that were somewhat better than COPD patients but worse than the healthy control group. Patients reported that they did not discuss sexual quality-of-life issues with their physician. Sexuality needs to be discussed by the health care provider in the consultation in order to improve quality of life of patients with chronic respiratory disorders.     

In vivo assessment of lung inflammatory cell activity in patients with COPD and asthma.

The involvement of inflammatory cells in the pathogenesis of chronic obstructive pulmonary disease (COPD) and asthma is well established. This study aimed to quantify differences in inflammatory cell function in situ in these patients as compared to normal subjects. Positron emission tomography was used to assess neutrophil activity (18F-fluorodeoxyglucose (18FDG)) and macrophage accumulation (11C-PK11195) in six patients with COPD, six chronic asthmatics and five age-matched normal control subjects. 18FDG uptake was greater in COPD than in normal subjects, with no increase in asthmatics. The mean slope of 18FDG uptake, corrected for volume of distribution, was 4.0 min(-1) in COPD patients compared with 1.5 min(-1) in control subjects and 1.7 min(-1) in asthmatics. Mean 11C-PK11195 uptake (plateau tissue:plasma) was higher in four of six COPD patients (10.8) and three of five asthmatics (11.8) than the maximum value in control subjects (6.2). From this preliminary study the authors conclude that positron emission tomography may be useful to assess polymorphonuclear neutrophil and macrophage activity in vivo in chronic obstructive pulmonary disease and asthma, and may reveal differences in cell behaviour between the study groups. In addition, positron emission tomography may provide indices of disease activity for future therapeutic studies.     

Managing asthma and COPD in patients with cardiovascular disease

Sideris et al followed 91 patients aged 25 to 82 (mean age 55) with respiratory failure due to severe asthma, emphysema, or chronic bronchitis. They found that patients with ventricular arrhythmias were significantly older than those without them. Although arrhythmias associated with myocardial infarction are managed primarily with drug therapy, those associated with acute respiratory failure respond best to adequate oxygenation and correction of metabolic and hemodynamic abnormalities.     

Improvements with tiotropium in COPD patients with concomitant asthma

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma have different diagnostic criteria and treatment paradigms. Both are common and can occur in the same patient. We sought to determine the spirometric effects of tiotropium in COPD patients with concomitant asthma. METHODS: A 12-week randomized, double-blind, placebo-controlled, parallel group trial with tiotropium 18 mcg daily was performed. Patients continued usual respiratory medications except for inhaled anticholinergics. Inclusion criteria: Physician diagnosis of COPD and asthma, age >or= 40 years, smoking >10 pack years, post-bronchodilator forced expiratory volume in 1s (FEV(1))<80% predicted, FEV(1)/forced vital capacity (FVC)<70%, >or= 12%, and >or= 200 ml increase in FEV(1) following inhaled bronchodilator, treatment with inhaled steroids >or= 1 year. Spirometry was measured serially for 6h on days 1, 29 and 85. RESULTS: Four hundred and seventy-two patients were randomized. Baseline characteristics were balanced. Mean age=59.6 years, 61.4% were men, and FEV(1)=1.55l (53.0% predicted). Improvements at 12 weeks with tiotropium were observed for the primary endpoint FEV(1) area under the curve (AUC) from 0 to 6h (difference=186+/-24 ml, p<0.001) and for morning pre-dose FEV(1) (difference=98+/-23 ml, p<0.001). Significant differences in favor of tiotropium were observed for pre-dose FVC (difference=128+/-34 ml, p<0.001) and FVC AUC 0-6h (difference=232+/-35 ml, p<0.001). Compared to baseline, the mean weekly number of daily puffs of prn salbutamol was reduced by 0.05+/-0.12 puffs/day in the placebo group and by 0.50+/-0.12 puffs/day in the tiotropium group at week 12 (p<0.05). CONCLUSIONS: Patients with COPD and concomitant asthma achieve spirometric improvements with tiotropium along with symptomatic benefit as seen by reduced need for rescue medication.     

诱导痰炎性标志物对支气管哮喘和慢性阻塞性肺疾病稳定期的鉴别诊断价值

目的 探讨诱导痰中嗜酸细胞（Eos）和嗜酸细胞阳离子蛋白（ECP）水平对支气管哮喘与慢性阻塞性肺疾病（COPD）稳定期的鉴别诊断价值.方法 选择支气管哮喘患者62例,检测肺功能并分别采用瑞氏染色及荧光免疫法检测高渗盐水诱导痰中Eos数量和ECP水平.选择51例慢性阻塞性肺疾病稳定期患者和30名健康人作为对照.结果 支气管哮喘患者诱导痰中Eos数量[（14.4±6.3）%]和ECP水平[（413±199）μg/L]显著高于COPD稳定期组[（3.2±1.5）%、（54±35）μg/L,P〈0.01]和对照组[（1.1±0.6）%、（46±23）μg/L,P〈0.01].以诱导痰中Eos≥7%和ECP≥100μg/L作为与稳定期COPD鉴别的标准,诊断哮喘的敏感性分别为79.3%和81.2%,特异性分别为81.0%和83.0%.联合检测两者的敏感性和特异性分别为85.2%和86.0%.结论 检测诱导痰Eos和ECP水平有助于支气管哮喘与COPD稳定期的鉴别.     

神经生长因子在哮喘患者诱导痰炎性细胞的表达

目的　通过观察神经生长因子 (NGF)在哮喘气道炎性细胞的表达 ,探讨NGF与哮喘气道炎症形成的关系。方法　取 11例哮喘急性发作期、19例哮喘非急性发作期患者及 11例健康对照者的诱导痰 ,其中 12例哮喘非急性发作期患者予丙酸氟替卡松 (ICS)治疗 2周后再取诱导痰。做诱导痰炎性细胞分类计数 ;SP法测诱导痰炎性细胞NGF表达 ;ELISA测其上清中白细胞介素 (IL) 5浓度。结果　 (1)诱导痰巨噬细胞、淋巴细胞、粒细胞NGF表达阳性率哮喘组较健康对照组高 (P值均<0 0 1) ,且急性发作期较非急性发作期高 (P <0 0 1)。急性发作期IL 5水平较非急性发作期和健康对照组高 (P值均 <0 0 1)。 (2 ) 12例非急性发作期患者经ICS治疗后 ,诱导痰巨噬细胞、淋巴细胞、粒细胞NGF表达阳性率及IL 5水平均较治疗前下降 (P值均 <0 0 1)。 (3)巨噬细胞、粒细胞NGF表达阳性率与淋巴细胞相对计数构成比、IL 5水平均呈正相关。结论　哮喘患者气道内巨噬细胞、淋巴细胞和粒细胞NGF表达增加 ,提示NGF可能与哮喘气道炎症的形成有关。     

白细胞介素13在哮喘、COPD中的变化研究

目的探讨白细胞介素13（IL-13）在支气管哮喘、慢性阻塞性肺疾病（COPD）的变化。方法选择正常组30例、哮喘急性发作期和COPD急性加重期各30例,哮喘缓解期和COPD稳定期各30例。取静脉血,用ELISA方法测定血清中IL-13的水平,并进行统计学分析。结果哮喘IL-13水平分析：急性发作期68．18±2．24（pg／ml）显著高于缓解期43．49±4．04（pg／ml）,P〈0．01,且两组均显著高于正常对照组25．45±5．49（pg／m1）,P〈0．01;COPD IL-13水平分析：急性加重期组51．55±3．16（pg／m1）显著高于稳定期组34．89±2．16（pg／m1）,P〈0．01。且两组均显著高于对照组,P〈0．01。结论IL-13参与了哮喘和COPD慢性炎症的形成。     

大鼠被动吸烟气道磷酸二酯酶4D和白细胞介素-8的关系研究

目的观察香烟介导的大鼠慢性支气管炎气道磷酸二酯酶4D（PDE4D）与白细胞介素-8（interleukin-8,IL-8）相互关系。方法烟雾吸入建立大鼠慢性支气管炎模型,两组干预组（低剂量和高剂量）大鼠香烟吸入之前分别给予腹腔内注射甲基强的松龙1mg/kg和10mg/kg,均1次/d。采用免疫组化检测气管及肺气道上皮PDE4D表达的变化;收集支气管肺泡灌洗液（BALF）进行细胞计数及分类;ELISA检测BALF中IL-8和肿瘤坏死因子-α（tumournecrosis factor alpha,TNF-α）浓度的变化。结果与对照组相比,吸烟显著增加大鼠气管与肺组织气道黏膜上皮PDE4D的表达,且PDE4D阳染增加与BALF中IL-8和TNF-α释放量增加呈正相关。甲强龙干预后,PDE4D蛋白阳染减低,BALF中IL-8和TNF-α释放减少;增大甲强龙剂量,PDE4D和IL-8浓度进一步减少,以上差异均具有统计学意义（P〈0.05）;大剂量甲强龙对中性粒细胞数量和TNF-α浓度的影响,与小剂量甲强龙相比无显著差异（P〉0.05）。结论香烟烟雾诱导后,大鼠气道PDE4D活性迅速上升,BALF中IL-8和TNF-α浓度增加;运用甲强龙干预后,PDE4D被抑制并下调TNF-α活性进而减少IL-8的释放,减轻气道炎症。     

Respiratory rehabilitation in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD) in Kinshasa]

A number of studies in western countries have shown that respiratory and physical rehabilitation of patients with chronic obstructive pulmonary disease (COPD) only has a minimal effect on respiratory function but can significantly improve physical capacity. The aim of our study was to apply these methods to patients in Kinshasa, Democratic Republic of Congo. We treated 38 patients (20 women) who had bronchial asthma (n=14) or COPD (n=24). These ambulatory patients were treated in two different hospitals in Kinshasa, the university hospital and the general hospital, three times per week for twelve weeks. The patients were treated with kinestherapy and inhaled bronchodilator drugs (salbutamol, and/or ipratropium bromide with a boreal nebulizer) as well as bronchial hygiene and performed breathing exercises on a Bodyguard Ergometer 990 with walking, running and climbing steps until exhaustion. After the rehabilitation program FEV1 increased from 1.37 +/- 0.62 (50% expected) to 1.54 +/- 0.69 (56% expected) (p<0.01). The same trend was observed for walking distance (from 644 +/- 459 m to 1213 +/- 569 m, p<0.001) and for maximal power developed on the cycloergometer (from 45 +/- 20 w to 73 +/- 37 w, p<0.001). In contrast, the maximal work load performed during climbing steps (from 106 +/- 44 w to 115 +/- 23 w) did not improve significantly. COPD patients improved their FEV1 significantly compared with asthma patients. Our study show that pulmonary rehabilitaion increase the level of spontaneous physical activity. The pulmonary rehabilitation program changes the quality of life of COPD patients who are able to move about better for longer periods of time, have a longer walking distance, and improved physical activity level.     

A pulmonary rehabilitation program for patients with asthma and mild chronic obstructive pulmonary diseases (COPD)

The effects of a pulmonary rehabilitation program on 44 patients with chronic obstructive pulmonary disease (COPD) were compared to a control group. The treated group was admitted to the program for a period of three months. The program consisted of several parts, such as physical training, health education, and psychological and social matters. Before participation, the patients were thoroughly examined and provided with optimal medical treatment. Both groups were assessed by means of biometrical tests and questionnaires for a period of 2 years. The rehabilitation group improved significantly in endurance, psychological parameters, and consumption of medical care. Working days increased and their way of life became more active. Smoking habits and body fat percentage decreased. Bronchial hyperreactivity, need for pulmonary drugs, and coughing and sputum production did not improve in the rehabilitation group compared to the control group. Airway obstruction, expressed as forced expiratory volume in one second, and complaints of dyspnea, allergy and hyperreactivity scores on questionnaires improved only in the short term (<1 year), but did not improve significantly in the long term. This study shows that pulmonary rehabilitation can result in improvements in patients with asthma or COPD who have many complaints despite the fact that their pulmonary function is not severely disturbed.     

Phosphodiesterase 5 (PDE5) restricts intracellular cGMP accumulation during enterotoxigenic Escherichia coli infection

ABSTRACT

Diarrhea caused by enterotoxigenic Escherichia coli (ETEC) has a continuing impact on residents and travelers in underdeveloped countries. Both heat-labile (LT) and heat-stable (ST) enterotoxins contribute to pathophysiology via induction of cyclic nucleotide synthesis, and previous investigations focused on intracellular signal transduction rather than possible intercellular second messenger signaling. We modeled ETEC infection in human jejunal enteroid/organoid monolayers (HEM) and evaluated cyclic nucleotide pools, finding that intracellular cAMP was significantly increased but also underwent apical export, whereas cGMP was minimally retained intracellularly and predominantly effluxed into the basolateral space. LT and virulence factors including EatA, EtpA, and CfaE promoted ST release and enhanced ST-stimulated cGMP production. Intracellular cGMP was regulated by MK-571-sensitive export in addition to degradation by phosphodiesterase 5. HEMs had limited ST-induced intracellular cGMP accumulation compared to T84 or Caco-2 models. Cyclic nucleotide export/degradation demonstrates additional complexity in the mechanism of ETEC infection and may redirect understanding of diarrheal onset.     

Inhalation therapy with Respimat soft inhaler in patients with COPD and asthma

Developing more effective and convenient inhalation devices for the treatment of obstructive pulmonary diseases is at least as important as designing new drugs. In recent years, existing inhalation systems have undergone many technical modifications and there have also been many new developments. All of these systems have their own particular attributes and characteristics. Two fundamentally different modes of operation are represented by propellant-driven metered-dose inhalers (pMDI) on the one hand and dry powder inhalers (DPI) on the other. However, none of the systems developed so far can be considered ideal. The Respimat Soft Inhaler (Respimat SI) was developed in the light of experience with previous systems and was launched in Germany at the beginning of 2004. The aim in developing this new type of inhaler was to avoid the well-known drawbacks typically associated with pMDI and DPI. The Respimat SI requires neither a chemical propellant nor batteries. The active ingredients are dissolved in water and the solution is atomised using mechanical energy only imparted by a spring which, when released, provides the power to force the solution through an extremely fine nozzle system. Two fine jets of liquid are produced. They converge at an optimised angle and the resulting impact generates a fine mist which is slow-moving and lasts for about 1.5 seconds; moreover, a high proportion of the droplets fall into the fine particle fraction. All of these features allow excellent lung deposition and reduced oropharyngeal deposition. Coordination between actuation and inhalation is less critical as compared with pMDI due to the fact that the mist is both slow-moving and long-lasting. A further advantage is that the mist is generated independently of the patient's inspiratory flow. The Respimat SI meets the requirements for an ideal inhaler better than any other previous device and must therefore be regarded as a significant new development.