scholarly journals Relationship of granulocytic inflammation of bronches with the level of asthma control in patients with cold airway hyperresponsiveness under inhalation therapy of extrafine beclomethasone/formoterol

2021 ◽  
pp. 42-51
Author(s):  
A. B. Pirogov ◽  
A. G. Prikhodko ◽  
J. M. Perelman
Keyword(s):  
Asthma Control ◽  
Airway Hyperresponsiveness ◽  
Inhalation Therapy ◽  
Term Therapy ◽  
Small Airways ◽  
Asthma Control Test ◽  
Cold Air ◽  
Before And After ◽  
Metered Dose ◽  
Asthma Patients

Introduction. Obstruction of small airways in asthma is accompanied by greater hypersensitivity to nonspecific irritants and inflammation activity, which is associated with a worsening of the clinical course of the disease. The combination of beclomethasone dipropionate/formoterol fumarate (BDP/FF), used in the form of an extrafine metered dose aerosol, is capable of having an anti-inflammatory effect on the small airways. Dynamic changes in the structure and function of granulocytes of inflammatory bronchial infiltrate after exposure to cold air in patients with asthma treated with BDP/FF have been little studied.Aim. To study the nature of changes in eosinophil and neutrophil pools of bronchial granulocytes in asthma patients with cold airway hyperresponsiveness (CAHR) during long-term therapy with extrafine BDP/FF.Materials and methods. The clinical study involved 25 asthma patients with CAHR. The design of the work included a questionnaire survey of patients using the Asthma Control Test (ACT) questionnaire, spirometry (Easy on PC, ndd Medizintechnik AG, Switzerland), an isocapnic hyperventilation by cold air (IHCA), collection and cytological examination of induced and spontaneously produced sputum. The examination was carried out at the beginning and after 12 weeks of BDP/FF therapy (100/6 μg, twice a day).Results. 12-week treatment with extrafine BDP/FF led to an improvement in asthma control (ACT increased from 17.1±1.1 to 22.5±0.5 points, p˂0.001) and patency of small bronchi (increase in МEF50 was 0.47±0.21 L/s, МEF25-75 – 0.42±0.17 L/s). BDP/FF therapy had a positive effect on cellular inflammation, leading to a decrease in the number of eosinophils in sputum from 9.5 (3.0; 19.5) to 2.2 (1.3; 4.7)% (p˂0,05). A decrease in the number of eosinophils was also observed after cold bronchoprovocation: from 9.0 (2.8; 15.4) to 4.7 (2.8; 7.8)% (p˂0.05). There was no dynamics in neutrophils after BDP/FF treatment before and after IHCA (59.9±1.3 and 57.1±2.0%, respectively, p>0.05).Conclusion. Improvement of disease control in asthma patients with CAHR after 12 weeks of therapy with extrafine BDP/FF is associated with the regulation of eosinophilic inflammation, a decrease in the number of eosinophils in the airways and suppression of the activity of the neutrophilic pool of bronchial granulocytes in response to cold bronchoprovocation. 

DYNAMICS OF INFLAMMATORY-CELLULAR PROFILE OF THE INDUCED SPUTUM IN PATIENTS WITH BRONCHIAL ASTHMA AND COLD AIRWAY HYPERRESPONSIVENESS UNDER BASIC ANTI-INFLAMMATORY THERAPY

2016 ◽  
Vol 1 (60) ◽  
pp. 15-22 ◽  
Author(s):  
Приходько ◽  
Anna Prikhodko ◽  
Пирогов ◽  
Aleksey Pirogov ◽  
Перельман ◽  
...  
Keyword(s):  
Lung Function ◽  
Asthma Control ◽  
Airway Hyperresponsiveness ◽  
Good Control ◽  
Induced Sputum ◽  
Asthma Control Test ◽  
Clinical Criteria ◽  
Bronchial Inflammation ◽  
Before And After ◽  
Anti Inflammatory

The character of changes of inflammatory-cellular pattern of bronchial secretion in patients with asthma in association with cold airway hyperresponsiveness (CAHR) under the influence of standard therapy has been studied little. The aim of the present work is to study dynamics of cellular profile, neutrophilic component of bronchial inflammation under the combination therapy of asthmatics with CAHR. 12 asthma patients with CAHR were studied upon the number of cells of the induced sputum (IS), peroxidase, cytolytic and destructive activity of eosinophils and neutrophils in the sputum, lung function and asthma control with the help of questionnaire Asthma Control Test (АСТ) before and after the therapy with the combination of budesonide/formoterol. Before the therapy the patients had a low level of asthma control (14.4±1.2 points of ACT), FEV1 was 87.4±3.3% from predicted values; in IS neutrophils prevailed (26.4±1.7%) over eosinophils (18.5±2.6%); the level of myeloperoxidase (mean cytochemical coefficient) was 65.9±5.4 pixels. After 48 weeks of the observation only in 58% of patients the criteria of good control of asthma and the improvement of lung function were achieved. In IS there was a decrease of eosinophils (11.4±3.2%; p=0.045); the intensiveness of eosinophils and neutrophils cytolysis dropped; intracellular concentration of myeloperoxidase grew (98.2±14.1 pixels; p=0.0637); destructive changes in granulocytes were registered but the number of neutrophils remained high (34.0±8.2%, р=0.34), which was considered as the factor of stable initiation of inflammation and oxidative stress. Thus, the use of anti-inflammatory treatment regime lasting 48 weeks with combination of budesonide/formoterol oriented to achieve clinical criteria of asthma control in patients with CAHR does not allow to achieve correction of the level of neutrophilic inflammatory component. Quantitative index of neutrophils in IS in these patients has prognostic value for the possible loss of achieved asthma control.

scholarly journals Seasonal dynamics of cold airway hyperresponsiveness in patients with asthma

2021 ◽  
pp. 45-54
Author(s):  
A. G. Prikhodko ◽  
J. M. Perelman
Keyword(s):  
Asthma Control ◽  
Seasonal Dynamics ◽  
Airway Hyperresponsiveness ◽  
Clinical Symptoms ◽  
Mean Value ◽  
Life Assessment ◽  
Asthma Control Test ◽  
Mean Values ◽  
Asthma Patients ◽  
Airway Response

Introduction. Cold air-induced bronchoconstriction in patients with asthma, leading to a breakdown in disease control, is one of the most serious problems in the northern countries of the world.Aim. To assess the seasonal dynamics of the airway response (ΔFEV1CA) to cold bronchoprovocation in asthma patients with cold airway hyperresponsiveness (CAHR).Materials and methods. Out of 513 asthma patients who underwent primary bronchoprovocation testing, 273 patients (140 women; 133 men) with diagnosed CAHR took part in the retrospective analysis. The design objectification of clinical data using the Asthma Control Test questionnaire (ACT, Quality Metric Inc., 2002), a screening questionnaire for identifying clinical symptoms of response to low ambient temperature in everyday life; assessment of the lung function; bronchoprovocation test of 3-minute isocapnic hyperventilation with cold (-20ºC) air (IHCA).Results. At the time of testing, the average age of patients was 34.8±0.87 years, FEV1 88.5±1.3% of predicted, FEV1/VC 70.9±0.7%; ACT 16 (12; 19) points. On average in the group, ΔFEV1CA was -19.2±0.6%. The frequency of CAHR detection in the winter was 22%, spring – 34%, summer – 22%, autumn – 24% (p>0.05). The minimum changes in FEV1 in response to IHCA were recorded in May-June (mean value ΔFEV1CA -16.2±1.3 and -14.5±1.6%, respectively) and were significantly less in comparison with February (-21.9±2.3%, p˂0.05) and April (-23.0±2.36%, p˂0.01). A correlation has been found between the monthly mean values of meteorological parameters and CAHR, as well as the value of ACT in points and ΔFEV1 (r=0.16; p=0.018).Conclusion. Seasonal changes in the strength of the action of meteorological factors produce a change in the response of the airways to cold bronchoprovocation, and contribute to the loss of asthma control. The maximum values of CAHR fall on February-April, August, November. The data obtained reflect the presence of a complex  interaction of physical environmental factors in the induction of seasonal fluctuations of CAHR, which requires a search for specific mechanisms for the formation of altered airway reactivity associated with the characteristics of molecular reception of low temperatures and humidity in the human airways.

scholarly journals Inhaled medication for asthma management: evaluation of how asthma patients, medical students, and doctors use the different devices

2003 ◽  
Vol 29 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Janaína Barbosa Muniz ◽  
Carlos Roberto Padovani ◽  
Irma Godoy
Keyword(s):  
Health Care ◽  
Medical Students ◽  
Health Care Professionals ◽  
Airflow Obstruction ◽  
Asthma Management ◽  
Outpatient Service ◽  
Inhalation Therapy ◽  
Metered Dose ◽  
Asthma Patients ◽  
Inhaled Medication

Asthma results from a combination of three essential features: airflow obstruction, hyperresponsiveness of airways to endogenous or exogenous stimuli and inflammation. Inadequacy of the techniques to use different inhalation devices is one of the causes of therapeutic failure. The main purpose of this study was to evaluate how 20 medical students, 36 resident physicians of Internal Medicine/Pediatrics, and 40 asthma patients used three devices for inhalation therapy containing placebo. All patients were followed at the Pulmonary Outpatient Service of Botucatu Medical School and had been using inhaled medication for at least six months. The following devices were evaluated: metered dose inhalers (MDI), dry powder inhalers (DPI), and MDI attached to a spacer device. A single observer applied a protocol containing the main steps necessary to obtain a good inhaler technique to follow and grade the use of different devices. Health care professionals tested all three devices and patients tested only the device being used on their management. MDI was the device best known by doctors and patients. MDI use was associated with errors related to the coordination between inspiration and device activation. Failure to exhale completely before inhalation of the powder was the most frequent error observed with DPI use. In summary, patients did not receive precise instruction on how to use inhaled medication and health care professionals were not well prepared to adequately teach their patients.

scholarly journals Assessment of disease control in patients with asthma

Medicina ◽  
2009 ◽  
Vol 45 (12) ◽  
pp. 943 ◽  
Author(s):  
Guoda Pilkauskaitė ◽  
Kęstutis Malakauskas ◽  
Raimundas Sakalauskas
Keyword(s):  
Lung Function ◽  
Asthma Control ◽  
Control Level ◽  
Asthma Management ◽  
Control Test ◽  
Uncontrolled Asthma ◽  
Asthma Control Test ◽  
Inhaled Steroids ◽  
Asthma Patients ◽  
Β2 Agonists

International guidelines indicate that the main criterion of asthma management is asthma control level. The aim of this study was to assess asthma control and its relation with age, gender, and lung function. Material and methods. A total of 106 family physicians and 13 pulmonologists and allergists took part in this study. Each doctor had selected 10–15 asthma patients and had sent invitations to them by post. On the visit day, the patients themselves filled in the Asthma Control Test. The doctors interviewed the patients and filled in a special questionnaire. Pulmonologists and allergists also assessed lung function by performing spirometry. According to the results of the Asthma Control Test, the disease control level was indicated as “totally controlled” (25 points), “well controlled” (24–20 points), and “uncontrolled” (19 points or less). Results. A total of 876 asthma patients were examined. Uncontrolled asthma was diagnosed to 56.2% of the patients, 36.5% of patients had well controlled and 7.3% totally controlled asthma. There was no significant difference in asthma control level comparing men and women. A correlation between asthma control level and age was found revealing poorer asthma control in older patients. Ninety-five percent of patients were treated with inhaled steroids; most of them had used inhaled steroids in combination with long-acting β2 agonists. It was found that lung function correlated with clinical symptoms of asthma, the demand of shortacting β2 agonists, and asthma control level. Conclusion. The study showed that uncontrolled asthma was diagnosed to more than half of the patients, despite most of them used inhaled steroids. Asthma control was worsening with the age of patients with asthma and it correlated with lung function. We suggest that periodical assessment of asthma control should help to optimize asthma management.

Effects of atropine on potentiation of exercise-induced bronchospasm by cold air

1978 ◽  
Vol 45 (2) ◽  
pp. 238-243 ◽  
Author(s):  
E. C. Deal ◽  
E. R. McFadden ◽  
R. H. Ingram ◽  
J. J. Jaeger
Keyword(s):  
Ambient Air ◽  
Small Airways ◽  
Flow Limitation ◽  
Ambient Conditions ◽  
Cold Air ◽  
Relative Contribution ◽  
Maximal Expiratory Flow ◽  
Before And After ◽  
Expiratory Flow ◽  
Exercise Induced

The role of vagal efferent activity in the cold air potentiation of exercise-induced asthma was assessed by exercising nine subjects who breathed air at ambient and subfreezing temperatures before and after cholinergic blockade. Lung volumes and maximal expiratory flow volume curves with air and with 80% helium-20% oxygen were obtained before and 5--10 min after each challenge. Isovolume comparisons of maximal expiratory flow rates with the two gases were used to assess relative contributions of large and small airways to flow limitation. Exercise under ambient conditions resulted in the expected airway obstruction and cold air exaggerated the response. Atropine pretreatment had no effect on the cold air potentiation. After atropine with ambient air exercise, there was an increase in the relative contribution of large airways to flow limitation, whereas exercise with cold air resulted in an increase in the contribution of small airways. We concluded that the potentiating effects of cold air are local and suggest that the immediate stimulus is related to cooling of intrathoracic airways.

scholarly journals Deposition Dosages of Three Cromolyn Forms by Cascade Impactor

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Norihide Murayama ◽  
Kei Asai ◽  
Kikuno Murayama ◽  
Chihiro Kitatsuji ◽  
Satoru Doi
Keyword(s):  
Particle Distribution ◽  
Cascade Impactor ◽  
Dosage Forms ◽  
Inhalation Therapy ◽  
Dose Inhaler ◽  
Small Airways ◽  
Metered Dose Inhaler ◽  
Metered Dose ◽  
Size Of Particles ◽  
Airway Deposition

Among inhaled asthma therapies, the present study aimed to identify factors for selecting the type of inhalation therapy for asthma. Three methods are used to deliver inhaled cromoglycate, and the airway deposition rate was evaluated using a cascade impactor with 3 dosage forms: dry powder (DP), pressurized metered dose inhaler (pMDI), and solution (jet- and mesh-types). The percentage of particles with diameters of 2–6 μm was 17.0% for the capsule, 51.8% for pMDI, 49.0% for jet-type NE-C28, and 40.4% for mesh-type NE-U22. The amounts of drug deposited in the bronchi were based on the particle distribution of the various dosage forms: 3.4 mg for the capsule, 1.0 mg for pMDI, 9.8 mg for one solution (jet-type NE-C28), and 8.1 mg for the other solution (mesh-type NE-U22). Jet-type or mesh-type electric nebulizers delivered 2-3 times more of the drug than capsules, and, compared with pMDI, 8-9 times more of the drug was deposited in the bronchi/bronchioles. Electric nebulizers are considered the best method. This study suggests that the size of particles deposited at sites of obstruction is larger than previously reported, and no obstruction of small airways occurs (<2 mm).

Dynamics of blood and sputum eosinophils in asthma patients with cold airway hyperresponsiveness during cold air provocation

2019 ◽  
Author(s):  
Juliy M. Perelman ◽  
Aleksey B. Pirogov ◽  
Anna G. Prikhodko ◽  
Elena V. Ushakova ◽  
Victor P. Kolosov
Keyword(s):  
Airway Hyperresponsiveness ◽  
Cold Air ◽  
Asthma Patients ◽  
Sputum Eosinophils

Long-term safety and asthma control with budesonide/ formoterol versus budesonide pressurized metered-dose inhaler in asthma patients

2008 ◽  
Vol 29 (5) ◽  
pp. 499-516 ◽  
Author(s):  
Stephen P. Peters ◽  
Bruce M. Prenner ◽  
William S. Mezzanotte ◽  
Paula Martin ◽  
Christopher D. O'Brien
Keyword(s):  
Asthma Control ◽  
Dose Inhaler ◽  
Metered Dose Inhaler ◽  
Metered Dose ◽  
Asthma Patients ◽  
Pressurized Metered Dose Inhaler
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