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

Author(s):  
A. G. Prikhodko ◽  
J. M. Perelman

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.

Author(s):  
A. B. Pirogov ◽  
A. G. Prikhodko ◽  
J. M. Perelman

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. 


2016 ◽  
Vol 1 (61) ◽  
pp. 16-24 ◽  
Author(s):  
Приходько ◽  
Anna Prikhodko ◽  
Пирогов ◽  
Aleksey Pirogov ◽  
Перельман ◽  
...  

The cell pattern of bronchi inflammatory infiltrate has a significant impact on the course of the disease and may affect the achievement and maintenance of the asthma control. The aim of the study was to determine the influence of neutrophilic component of the bronchial inflammation on the asthma control, lung function and airway responsiveness. 114 patients with mild persistent asthma were assessed upon the level of the asthma control by Asthma Control Test (ACT); lung function (FEV1) by spirometry; airway responsiveness (∆FEV1) to 3-minute isocapnic hyperventilation with cold air (-20ºС) (IHCA) and 3-minute ultrasound inhalation with distilled water (IDW). The cell composition of the induced sputum (IS) was also studied. The patients were divided into groups with low contents of neutrophils in IS (39 people; 1st group) and with high contents of neutrophils (75 people, 2nd group). The contents of neutrophils in the 1st group was 10.9±0.53%, eosinophils – 19.4±2.1%; in the 2nd group – 29.9±1.6% (р=0.0001) and 20.4±1.4% (р=0.66), respectively. By ACT data the people of the 2nd group managed their disease worse than in 1st group (15.0±0.6 and 19.0±0.8 points, respectively; р=0.0001). They also had lower FEV1 (88.0±2.0 and 96.7±2.4%; р=0.009) and more intensive airway response to IHCA and DW (-13.7±1.7% and -11.2±1.9%, respectively) in comparison with the 1st group (-2.7±0.86%; р=0.0001 and -5.3±1.90%; р=0.055). The patients of the 2nd group had a close correlation between baseline neutrophils in IS and ∆FEV1 in response to IHCA (r=-0.22; р=0.045) as well as the content of myeloperoxidase in IS (r=0.31; р=0.0008). A level of myeloperoxidase in IS correlated with ∆FEV1 in response to IDW (r=0.29; р=0.030) in these patients. The increase of neutrophilic component of inflammation in asthma patients worsens the asthma control, lung function and enhances airway responsiveness to exogenous stimuli.


2018 ◽  
Vol 64 (3) ◽  
pp. 234-242 ◽  
Author(s):  
Alessandro Gonçalves Campolina ◽  
Rossana Veronica Mendoza Lopez ◽  
Elene Paltrinieri Nardi ◽  
Marcos Bosi Ferraz

Summary Objective: This study describes the summary scores of the Short Form-12 (SF-12) questionnaire, according to socio-demographic factors obtained in a probabilistic and representative sample of the Brazilian urban population. Method: Five thousand (5,000) individuals, over the age of 15, were assessed in 16 capital cities, in the five regions of the country. The selection of households was random. Face-to-face approach was applied in the household interviews. The SF-12 questionnaire was used to assess quality of life. Demographic and socioeconomic characteristics were also evaluated: gender, age, marital status, skin color, region of the country and use of the public health service. Results: The mean value (SD) of the SF-12 for the entire population was 49.3 (8.7) for the physical component (PCS-12) and 52.7 (9.7) for the mental component (MCS-12). Statistical differences were found for gender (PCS-12 and MCS-12), age (PCS-12) and working status (PCS-12 and MCS-12). Women, elderly, widowed and unemployed individuals, those with lower income and with complaints in the last seven days showed lower mean values (PCS-12 and MCS-12). Conclusion: From this point forward, we can provide the basis for comparisons with future research that use the SF-12 for quality of life assessment in Brazil. The Brazilian population has a lower degree of quality of life related do the physical component, and the SF-12 is a useful and discriminative instrument for assessing quality of life in different socio-demographic groups.


Medicina ◽  
2009 ◽  
Vol 45 (12) ◽  
pp. 943 ◽  
Author(s):  
Guoda Pilkauskaitė ◽  
Kęstutis Malakauskas ◽  
Raimundas Sakalauskas

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.


2016 ◽  
Vol 1 (60) ◽  
pp. 15-22 ◽  
Author(s):  
Приходько ◽  
Anna Prikhodko ◽  
Пирогов ◽  
Aleksey Pirogov ◽  
Перельман ◽  
...  

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.


2016 ◽  
Vol 1 (61) ◽  
pp. 8-15 ◽  
Author(s):  
Ульянычев ◽  
Nikolay Ulyanychev ◽  
Нахамчен ◽  
Leonid Nakhamchen ◽  
Приходько ◽  
...  

The aim of the research was to identify the frequency of development of the syndrome of post-exercise bronchial spasm in patients with asthma against physical load and the study of clinical-functional features of its course. 197 patients (122 women and 75 men) with mild persistent partially controlled and uncontrolled asthma were observed. The mean age of the patients was 36.1±0.73 years old; the mean height was 168.8±0.63 cm; the mean weight was 74.6±1.03 kg. The patients did not have strong obstructive disorders of the ventilation pulmonary function; forced expiratory volume for the first second (FEV1) was 91.6±2.5% from the predicted value. All the patients had clinical-anamnestic test and the assessment of apnoea degree by the scale of mMRC and identification of disease control by validated questionnaire Asthma Control Test; the airway response was evaluated in reaction to dosed physical load calculated and fulfilled at the research complex for ergospirometric studies OxyconPro (VIASYS Healthcare, Germany); basic study of the lung function at the device Easyone-PC (Switzerland) was done. As a result of the study post-exercise bronchial spasm was diagnosed in 18.3% of patients with asthma. Close positive correlation between the baseline FEV1 (in %) and bronchial response to the dosed physical load measured at the first minute of the recovery period (r=0.19; р<0.05) as well as the intensity of the further bronchial response at the 10th minute of the recovery period (r=0.19; р<0.05) was registered. The intensity of bronchial response at the 10th minute of the recovery period in patients with airway hyperresponsiveness to dosed physical load was directly related with the degree of asthma control (r=0.56; р˂0.05). It was found out that the degree of the asthma control correlated with the airway hyperresponsiveness to physical load.


2021 ◽  
Vol 27 (3) ◽  
pp. 146045822110429
Author(s):  
Mohammad K Al-Nawayseh ◽  
Montaha AL-Iede ◽  
Eman Elayeh ◽  
Rima Hijazeen ◽  
Khaled Al Oweidat ◽  
...  

The main aim of this study is to assess the effectiveness of using a developed asthma mobile application to enhance medication adherence in Jordan. Asthma patients visiting outpatient respiratory clinics and using inhalers were recruited. Patients were assigned into two groups: intervention and control. The intervention group was instructed to download and use the application. Asthma control was assessed using Asthma Control Test (ACT) at baseline and at follow-up of 3 months for both groups. A total of 171 patients (control, n = 83, and intervention, n = 88) participated in the study. After 3 months of usage, patients in the intervention group achieved a significant improvement in ACT score compared to control ( p-value <0.05), and reported a significant satisfaction of the application use. Therefore, the asthma mobile application is found as an effective tool to enhance medication adherence in asthma patients.


2021 ◽  
Vol 1 ◽  
pp. 1016-1022
Author(s):  
Kurnia Fitri ◽  
Dian Kartikasari

AbstractAsthma is an inflammation of the respiratory tract characterized by shortness of breath, coughing, and wheezing. A person with asthma will experience a descreace in physical condition, emotional changes, and changes inactivity. Based on previous research, the number of uncontrolled asthma patients in Persahabatan Hospital is still large. Asthma cannot be cured, but it can be observed using the asthma control test (ACT) to keep asthma under control in the long term. The purpose of this literature review was to describe the level of asthma control in asthmatic patients. The data collection technique used a literature review method of six articels sourced from online databeses with electronic searches on Garuda and Pubmed. The searching process used key words : “ tingkatkontrol” and “ pasienasma”. The English articles that were searched used key word : “ level of control” AND “asthma patients”. The research instrument used was the JBI critical appraisal checklist for cross-sectional.The results of a literature review of six articels showed that the describption of the level of asthma control was mostly uncontrolled. From this literature review, the results obtained were 71 (9,8%) controlled, 234 (32,19%) partially controlled, and 422 (58%) uncontrolled.The results of this literature review show that the level of asthma control in asthmatic patients is not controlled.Keywords : level of control, asthma patients AbstrakAsma merupakan gangguan pada saluran pernafasan yang mengalami inflamasi ditandai dengan sesak nafas, batuk dan mengi. Seseorang dengan asma akan mengalami penurunan kondi sifisik, perubahan emosional, dan perubahan aktivitas. Berdasarkan penelitian sebelumnya jumlah pasienasma yang tidak terkontrol di rumah sakit persahabatan masih banyak. Asma tidak dapat disembuhkan, tetapi dapat di observasi menggunakan Asthma Control Test (ACT) untuk mempertahankan asma dalam keadaan terkontrol dalam jangka panjang. Tujuan dari literature review ini adalah untuk mengetahui gambaran tingkat control asma pada pasienasma.Teknik pengumpulan data menggunakan metode literature reviewe nama artikel yang bersumber dari data base online dengan penelusuran elektronik pada Garuda dan Pubmed. Pencarian artikel dengan menggunakan kata kunci : “tingkat kontrol” dan “pasien asma”, sedangkan artikel berbahasa inggris menggunakan kata kunci : “level of control” AND “patients asthma”. Instrumen telaah yang digunakan yaitu dengan menggunakan JBI critical appraisal checklist for cross-sectional. Hasil literature review dari enam artikel didapatkan bahwa gambaran tingkat control asma Sebagian besar tidak terkontrol. Dari literatuyre review ini diperoleh hasil sebanyak 71(9,8%) terkontrol, 234 (32,19%) terkontrol sebagian dan 422 (58%) tidak terkontrol. Hasil penelitian literature review ini menunjukkan bahwa tingkat control asma pada pasien asma adalah tidak terkontrol. Kata kunci: tingkat kontrol, pasien asma


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