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Airway inflammation and peripheral airway function in asthmatic patients with different control levels

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Author:
No author available
Journal Title:
CHINESE JOURNAL OF TUBERCULOSIS AND RESPIRATORY DISEASES
Issue:
9
DOI:
10.3760/cma.j.issn.1001-0939.2009.09.011
Key Word:
哮喘;炎症;气道阻力;Asthma;Inflammation;Airway resistance

Abstract: Objective To observe the airway inflammation and peripheral airway function in asthmatic patients with different control levels, and to investigate whether the airway inflammation profile detected by induced sputum reflects the peripheral airway dysfunction. Methods The recruited asthmatic subjects (n=66) were divided into 3 groups: asthma controlled (8 male and 13 female), asthma partly controlled (12 male and 16 female), asthma uncontrolled (6 male and 11 female). Twenty healthy subjects served as the control group (9 male and 11 female). On the 1st day, all the subjects were required to take asthma control test (ACT), and to receive measurement of lung function by osciilometry and spirometry as well as inflammatory cell profile of induced sputum and the concentration of eosinophil cationic protein (ECP). Exhaled nitric oxide (Feso) was measured on the 2nd day, and oscillometry methacholine provocation was conducted for patients whose baseline FEV_1 was ≥70% predicted. The provocation process was terminated when airway resistance was increased by twice of the basic value, or when the mcthacholine reached the highest concentration. Then airway resistance and lung function were examined after 3 minutes. Finally, airway resistance and lung function were measured again after the subjects had 5 consecutive deep inspirations (DI). Correlation analysis was conducted between ACT scores and inflammatory cells count, ECP concentrations of induced sputum and FE_(NO) among different groups. The correlations were also made between the change of peripheral airway resistance triggered by provocation or DI and ACT scores, total eosinophil, ECP level of induced sputum, FE_(NO) respectively. Results The total eosinophil count and ECP level in induced sputum and FE_(NO) in asthmatic patients increased with the decline of control level. Negative correlations between ACT scores and total eosinophil count as well as the ECP level were observed (r = -0.43, -0.56, P < 0.01). In the healthy control group, the percentage of increase in peripheral airway resistance (R_5-R_(20)) and central airway resistance (R_(20)) did not show significant difference (F = 3.472, P > 0.05) with methacholine provocation, while the percentage of increase in R_5-R_(20) was greater than in R_(20) in both controlled and partly controlled asthmatic patients with provocation (F=18.09 and 14.14, P< 0.01), though the change of R_5-R_(20) showed no correlations with ACT scores, eosinophil count of induced sputum, ECP level and FE_(NO). After DI, R_5-R_(20), decreased from (0. 13 ±0. 14) kPa · L~(-1) · s~(-1) to (0. 08 ± 0. 09) kPa · L~(-1) · s~(-1) (t = 2. 84, P < 0. 05) in the healthy control group, while R_5-R_(20), increased from (0. 24 ±0. 15) kPa · L~(-1) · s~(-1) to (0.30 ±0. 16) kPa · L~(-1) · s~(-1) in the controlled asthma group, from (0.31 ±0. 18) kPa · L~(-1) · s~(-1) to (0. 39 ±0. 17) kPa · L~(-1) · s~(-1) in the partly controlled asthma group (t =3.90 and 4. 68, P <0. 01, respectively). No correlations were observed between the change of R_5-R_(20) after DI and ACT scores, total eosinophil counts, ECP level as well as FE_(NO)(r= -0. 07, 0. 28, -0. 14, 0. 14, P >0. 05). Conclusions Even in asthma patients with controlled disease, eosinophilic inflammation in the airway was still present, and the eosinophilic inflammation became more severe with the decline of control level. Bronchodilatory effect caused by DI disappeared in asthmatic patients. The inflammation profile detected by induced sputum did not reflect the dysfunction of peripheral airways.

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