HOUSE DUST MITE ALLERGEN (Derp1 AND Blot5) LEVELS IN ASTHMATICS' HOME IN HONGKONG

To measure Derp1 and Blot5 allergen levels in asthmatics’ homes in Hongkong. Methods Seventy houses were enrolled for a mite indoor environment study. Dust samples were obtained from two sites of each patients’ house: bed and floor. Derp1 and Blot5 levels were quantified by a two-site monoclonal antibody-based ELISA technique. Results The levels of Derp1 allergens found in bed (geometric mean (GM) 3.43 μg/g of dust; 95%CI, 1.89-4.96 μg/g) and on the floor (GM 1.12 μg/g of dust; 95%CI, 0.71-1.53 μg/g) indicated significant differences (P = 0.005). However, the levels of Blot5 allergens found in bed (GM 19.00 μg/g of dust; 95%CI, 0.89-38.90 μg/g) and on the floor (GM 6.14 μg/g of dust; 95%CI, 0.40-11.90 μg/g) showed no statistically significant difference. In addition, in regards to the exposure index for Derp1 and Blot5 allergens found in bed and on the floor, 17.6% in bed and 8.6% on the floor had levels of Blot5 ≥ 10 μg/g of dust, higher than those obtained for Derp1 (7.2% and 0% in bed and on the floor respectively, P < 0.05); higher percentages in bed and on the floor (25.0% and 35.7%) were observed for levels of Blot5 = 0 μg/g of dust as compared with Derp1 in bed and on the floor (4.3% and 14.5% respectively, P < 0.05). Conclusions Derp1 and Blot5 are the major allergens found in this regional study, Blot5 is a more potent allergen in Hongkong, probably reflecting the high level of exposure to Blomia tropicalis (Bt). Bt and Dermatophagoides pteronyssinus(Dp) allergens should be included for precise diagnosis and effective immuno-therapeutic treatment of mite allergy in Hong-kong.

Asthma and gastroesophageal reflux disease: Effect of long-term pantoprazole therapy

AIM： To define the prevalence of gastroesophageal reflux disease （GERD） in mild persistent asthma and to value the effect of pantoprazole therapy on asthmatic symptoms.METHODS： Seven of thirty-four asthmatic patients without GERD served as the non-GERD control group. Twenty-seven of thirty-four asthmatic patients had GERD （7/27 also had erosive esophagitis, sixteen of them presented GERD symptoms. An upper gastrointestinal endoscopy was performed in all the subjects to obtain five biopsy specimens from the lower 5 cm of the esophagus. Patients were considered to have GERD when they had a dilation of intercellular space （DIS）〉0.74 μm at transmission electron microscopy. Patients with GERD were treated with pantoprazole, 80 mg/day. Forced expiratory volume in one second （FEV1） was performed at entry and after 6 mo of treatment. Asthmatic symptoms were recorded. The required frequency of inhaling rapid acting β2-agonists was self-recorded in the patients＇ diaries.RESULTS： Seven symptomatic patients presented erosive esophagitis. Among the 18 asymptomatic patients, 11 presented DIS, while all symptomatic patients showed ultrastructural esophageal damage. Seven asymptomatic patients did not present DIS. At entry the mean of FEV1 was 1.91 L in symptomatic GERD patients and 1.88 L in asymptomatic GERD patients. After the treatment, 25 patients had a complete recovery of DIS and reflux symptoms. Twenty-three patients presented a regression of asthmatic symptoms with normalization of FEV1. Four patients reported a significant improvement of symptoms and their FEV1 was over 80%.CONCLUSION： GERD is a highly prevalent condition in asthma patients. Treatment with pantoprazole （80 mg/day） determines their improvement and complete regression.

Sirolimus-related pulmonary toxicity mimicking 'asthma like' symptoms

Sirolimus is an immunosuppressant with expanding use in pediatric organ transplantation, dermatology and rheumatology. We report two cases of children who developed asthma like symptoms and were diagnosed with interstitial lung disease, which responded to discontinuation of sirolimus. Pediatricians should be aware about the pulmonary side effects of sirolimus.

Remission of bronchial asthma after viral clearance in chronic hepatitis C

A 53-year-old man with a history of blood transfusion at the age of 20 was admitted to our hospital because of liver dysfunction. He had bronchial asthma when he was 18 years old, which naturally resolved within 2 years. However, his bronchial asthma recurred at the age of 45 and was treated with oral theophylline. He was diagnosed as having chronic hepatitis C based on the histological and clinical findings, and then interferon (IFN) therapy was administered. The frequency of bronchial asthma attack was gradually decreasing after IFN therapy with marked improvement of hypereosinophilia. He achieved sustained viral response (SVR) and his bronchial asthma did not worsen even after the cessation of IFN. Hepatitis C virus (HCV) infection and IFN therapy were considered in the remission of asthma in this case. HCV infection could be the cause of bronchial asthma, especially in patients with late appearance of asthma.

Relationship between Chlamydia pneumoniae infection and occurrence of bronchial asthma

Objective: To study the relationship between Chlamydia pneumoniae (C. pneumoniae) infection and asthma exacerbation. Methods: A prospective study of C. pneumoniae infection was conducted in 75 patients with asthma and 63 patients with respiratory tract infection, and 100 blood donors served as controls. The presence of infection was convinced by the polymerase chain reaction and direct immunofluorescence assay for C. pneumoniae DNA from throat swab specimens and micro-immunofluorescence testing for C. pneu-moniae-specific IgG, IgM and IgA antibodies. Results: Prevalence of specific IgG in asthma patients (81. 3%) was higher than that of the blood donors (68. 0%, P<0. 05) and was not significantly different from respiratory tract infection patients (68. 0%, P>0. 05). The acute C. pneumoniae infection rate of symptomatic asthma patients (59. 4%) was markedly higher than that of respiratory tract infection patients (34. 9% , P<0. 05). The average titer of C. pneumoniae IgG instead of IgA in asthma patients (48. 38±6. 94) was significantly higher than respiratory tract infection patients (24. 70±8. 77, P<0. 05). Other pathogens were identified in 12 of 21 (57. 1%) asthma patients with C. pneumoniae. The symptoms of 7 asthma patients with C. pneumoniae infection were improved through antibiotic treatment. Conclusion: The findings suggest a possible role of C. pneumoniae infection in asthma.

Airborne Pollen Grains Of Afyon, Turkey

The airborne pollen grains of Afyon have been studied for a two_year period (1999-2000) with a Durham sampler. A total of 14 367 pollen grains belonging to 40 taxa have been identified and recorded with some unidentified ones. Of them, 6 732 were identified in 1999 and 7 635 in 2000. Of the total pollen grains, 69.67% were arboreal, 26.64% non_arboreal and 3.68 % unidentified. The majority of the investigated pollen grains were from Pinus, Gramineae, Cupressaceae, Platanus , Chenopodiaceae/Amaranthaceae, Quercus, Ailanthus, Moraceae, Juglans , Salix, Cedrus and Rosaceae. The highest level of pollen grains was in May.

Effect of intratracheally administered BCG-DNA on murine model of asthma

Objective: To investigate the effect of intratracheally administered BCG DNA on a murine model of asthma. Methods: BALB/C mice were divided into 4 groups: normal control group, asthma model group, BCG DNA administered before OVA sensitization group, BCG DNA administered after OVA challenge group. The asthma models were developed by immunizing BALB/C mice with OVA. A total of 100 μg BCG DNA was intratracheally administered before OVA sensitization and after OVA challenge. WBC count and eosinophil percentage (EOS%) in bronchoalveolar lavage fluid (BALF) were measured. Changes of IL 4 , IL 5,IL 12, IFN γ in BALF were determined by ELISA. Pulmonary inflammation was observed on normal pathological slides and the proliferation and mucus secretion of goblet cells stained by AB PAS were also observed. Results: IL 4 , IL 5,IL 12, IFN γ in BALF of normal control group were(32.3±5.7)pg/ml,(15.6±3.9)pg/ml,(80±8.5)pg/ml,(153.2±9.4)pg/ml respectively. IL 4,IL 5 in BALF of asthma model group increased to (299±15.6)pg/ml and (206.7±9.3)pg/ml, while IL 12 and IFN γ decreased to (20.4±4.1)pg/ml and (51.6±5.5) pg/ml respectively. BCG DNA administered intratracheally before OVA sensitization and after OVA challenge significantly increased IL 12 [(71.6±8.3)pg/ml,(67.8±8.1pg/ml)] and IFN γ [(119.0±11.3)pg/ml,(114.7±10.1)pg/ml] in the BALF. Meanwhile, BCG DNA decreased IL 4 [(82.1±6.1)pg/ml,(86.3±5.9)pg/ml] and IL 5 [(32.3±4.6)pg/ml,(37.4±5.3)pg/ml]. Eosinophil level in BALF was inhibited and the pulmonary inflammation was dramatically relieved compared to asthma model group. Conclusion: Intratracheally administered BCG DNA can induce IL 12 and IFN γ secretion,inhibit Th2 response which can relieve allergic airway inflammation and provide a new way in the treatment and prevention of asthma.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPOINT APPLICATION OF FAR-INFRARED ASTHMA-RELIEVING PLASTER FOR ASTHMA

Objective To observe the clinical effect of acupoint application of Yuanhongwai Xiaochuankang Plaster （Far-infrared Asthma-relieving Plaster, FIRARP） for prevention and treatment of asthma. Methods Three hundred and sixty-six cases of bronchial asthma were randomly divided into treatment group （n = 185） and control group （n = 181 ）. Patients of treatment group were treated with FIRARP and those of control group treated with external application of traditional ＂Sonfu （Dog-days） moxibustion＂ （herbal-paste-cake separated moxibustion） and acupoints used were Dazhui（大椎 GV14）, Feishu（肺俞BL13）, Tiantu （天突 CV22）, etc. which were given to the patients. Forced expiratory volume in 1 second （FEV1） and peak expiratory flow （PEF） of the pulmonary function were determined and the changes of main symptoms and signs were observed before and after the treatment. Results The pulmonary functions were effectively improved, the symptoms were controlled, and the asthma attack was reduced in the two groups with no significant difference between the two groups （P 〉0.05）. Conclusion There is no significant difference between Yuanhongwai Xiaochuonkong Plaster and traditional ＂Sanfu moxibustion＂ on bronchial asthma. It may substitute for traditional ＂Sonfu moxibustion＂.

CIRCULATING INTERCELLULAR ADHESION MOLECULE 1 LEVELS IN SERA OF BRONCHIAL ASTHMA

Objective The aim of the study was to determine whether bronchial asthma was associated with increased levels of soluble intercellular adhesion molecule 1(sICAM 1) in serum, which might be valuble data for the effective therapy of these patients Patients and methods The concentrations of sICAM 1 were determined in sera of healthy donors and asthmatic patients using a sensitive enzyme immunoassay Results The mean(±SD) levels of serum sICAM 1 of 26 asthmatic patients (205±72 0 μg/L)was significantly higher than that of the 30 healthy volunteers (154±63 9 μg/L,P<0 01) There was no much difference between the serum levels in 12 patients suffering from atopic asthma and the levels in 14 patients with nonatopic asthma The serum concentrations of sICAM 1 were higher during asthma attacks than that during remissions in the same patients (P<0 05) Conclusion These results suggest that sICAM 1 may play a certain role in the pathophysiology of bronchial asthma,and might be signals for successful treatment

Efficacy evaluation of summer acupoint application treatment on asthma patients: a two-year follow-up clinical study

OBJECTIVE: To evaluate the self-efficacy and satisfaction of asthma patients subjected to summer acupoint application treatment(SAAT).METHODS: A two-year follow-up clinical study was conducted. Patients with asthma were treated by applying a herbal paste onto the Feishu(BL 13) and Fengmen(BL 12) acupoints on the three hottest days of summer, according to the traditional Chinese calendar, from 2008 to 2010. During a two-year follow-up, these patients were asked tofill out a questionnaire evaluating asthma degree,exacerbation frequency, concomitant medications and self-satisfaction. The self-rate and doctor-report outcomes obtained in parallel were evaluated to assess the efficacy of SAAT.RESULTS: A total of 527 asthma patients were initially enrolled in this study, of which 97 elderly patients and those with more severe cases of asthma were lost to follow-up. Thus, a total of 430 patients were valid for analysis using self-rate data. Nevertheless, occasional negative returns were obtained;almost all of the outcomes were rated as "No change", "Moderate effective", or "Very effective". In addition, 80% of the patients were satisfied with this treatment. Moreover, 391(91.4%) patients were somewhat improved after SAAT in 2009, and further improvement was observed in 2010. After SAAT, the average asthma-degree score decreased from 5.3 in 2008 to 4 in 2009 and, subsequently to3.5 in 2010.CONCLUSION: With pronounced patient satisfaction, SAAT can reduce the exacerbation severity and frequency, concomitant medications and asthma degree. Prolonging the treatment course might enhance the efficacy of SAAT.

otassium channels in airway smooth muscle and airway hyperreactivity in asthma

Our knowledge of the physiology of ion channels has increased tremendously during the past 20 years because of the advances of the single-channel recording and molecular cloning techniques. More than 50 different identified potassium channels have already been found.1,2 They are distributed ubiquitously in wide variety of cells including airway smooth muscle （ASM） cells and inflammatory cells in airway such as eosinophils, basophils, macrophages and so on.3 Several types of K+ channels have been identified in ASM cells, e.g., a large-conductance, voltgage-dependent Ca2+-activated K+ channel(BKCa), a voltage-dependent delayed-rectifier K+ channel（Kv）, and an ATP-sensitve K+ channel(KATP).1 In such excitable cells,

Case Report:Subglottic adenoid cystic carcinoma mistaken for asthma

Adenoid cystic carcinoma rarely occurs within the subglottic larynx. In this study, a case of subglottic adenoid cystic carcinoma was reported. A 54 year-old Chinese woman developed a sudden onset of chest distress and cough worsening after physical exertion, and was diagnosed with, and treated as, bronchial asthma. Regular anti-asthmatic therapy did not improve the symptoms. Until a sudden dyspnea, a cervicothoracic computerized tomography （CT） revealed that her upper airway was obstructed by a laryngeal tumor. The patient was diagnosed with a subglottic adenoid cystic carcinoma and treated with complete surgical excision and adjuvant radiation therapy. Follow-up endoscopy and laryngeal magnetic resonance imaging （MR1） at six months showed no recurrence of the tumor. The diagnosis of subglottic adenoid cystic carcinoma should be considered in patients who are characterized by dyspnea, cough, and stridor, but do not respond to regular anti-asthmatic therapy.

Effect of Gubenfangxiao decoction on respiratory syncytial virus-induced asthma and expression of asthma susceptibility gene orosomucoid 1-like protein 3 in mice

OBJECTIVE： To investigate the effect of Gubenfangxiao decoction （GBFXD） on respiratory-syncytial-virus （RSV） -induced asthma and the expression of asthma susceptibility gene, orosomucoid 1-1ike protein 3 （ORMDL3） in mice. METHODS： Seventy-two female BALB/c mice were randomly assigned to normal, model, GBFXD high dose, GBFXD moderate dose, GBFXD low dose and montelukast groups. An asthma model was induced via intraperitoneal injection and aerosol inhalation of ovalbumin （OVA） and repeated intranasal instillation of RSV in all mice, except those in the normal group. All treatments were administered at the first onset of asthma （within 8 weeks of model establishment） and the mice were euthanized after 28 days of treatment. The levels of transforming growth factor-β （TGF-β） and interleukin-6 （IL-6） in bronchoalveolar lavage fluid （BALF） of the mice were measured and the expression of asthma sus- ceptibility gene ORMDL3 in lung tissue was deter- mined using real-time polymerase chain reaction （RT-PCR） and western blotting. RESULTS： Expression of ORMDL3 and levels of TGF-β and IL-6 were significantly higher in the mod- el group （P 〈 0.05, P 〈 0.01） compared with the normal mice. Levels of ORMDL3, TGF-β and IL-6 were significantly lower in all three GBFXD treated groups （P 〈 0.05） compared with the model group. However, the levels in the GBFXD treatment groups did not differ significantly from the montelukast group. CONCLUSION： GBFXD had a therapeutic effect in this experimental model. The functional mechanism of GBFXD may involve multiple factors, including alleviation of airway inflammation, down-regulation of asthma susceptibility gene ORMDL3 and inhibition of airway remodeling.