Correlation Analysis of Traditional Chinese Medicine Syndrome Types and Influencing Factors of Asthmatic Bronchitis in Children

Objective:To explore the correlation between traditional Chinese medicine(TCM)syndrome types and the influencing factors of asthmatic bronchitis in children,as well as to provide clinical syndrome differentiation basis and reference for the treatment of children with asthmatic bronchitis.Methods:The clinical data of 197 inpatients with asthmatic bronchitis in our hospital from March 2021 to March 2022 were collected,referring to“Zhu Futang Practical Pediatrics”(7th Edition,2002)and“Chinese Medicine Industry Standards-Standards for Diagnosis and Efficacy of Pediatric Diseases and Syndromes of Traditional Chinese Medicine”(1994,State Administration of Traditional Chinese Medicine)for diagnosis,classification,and analysis of TCM syndrome types and the influencing factors of asthmatic bronchitis in children.Results:(i)cold asthma syndrome contributed to the majority of TCM syndrome types of pediatric asthmatic bronchitis;(ii)gender had a great influence on TCM syndromes types in children with asthmatic bronchitis,and the differences among the TCM syndrome types were statistically significant(P<0.05);(iii)there was no significant difference in the distribution of TCM syndrome types of pediatric asthmatic bronchitis among different age groups(P>0.05);(iv)birth status had no effect on the distribution of TCM syndrome types of pediatric asthmatic bronchitis(P>0.05);(v)no significant correlation was observed between the mode of delivery and the distribution of TCM syndrome types in children with asthmatic bronchitis(P>0.05);(vi)children with cold asthma syndrome,heat asthma syndrome,and mixed cold and heat syndrome were not breastfed,and there was no significant difference in the feeding methods of children with mixed deficiency and excess syndrome(P>0.05);(vii)no significant correlation was observed between the TCM syndrome types of pediatric asthmatic bronchitis and family history of asthma/allergy(P>0.05);(viii)a significant correlation was observed between different TCM syndrome types and history of drug and food allergy(P<0.05);(ix)normal or high eosinophil percentage was commonly observed in children with asthmatic bronchitis,and there was no significant difference among the different TCM syndrome types(P>0.05).Conclusion:The TCM syndrome types of pediatric asthmatic bronchitis are related to gender,feeding history,allergy history,and other factors,which may be influencing factors of the TCM syndrome types of pediatric asthmatic bronchitis.

Mechanism of hypothalamic paraventricular nucleus in regulating asthmatic attack

BACKGROUND: It has been confirmed that c-fos expression increased markedly in hypothalamic paraventricular nucleus (PVN) during asthmatic attack in rats, and PVN has extensive physiological functions, involving in the regulation of respiratory system, etc. OBJECTIVE: To observe the alteration of electroencephalogram (EEG) and power spectra in PVN during the asthmatic attack, and the alteration of lung function and diaphragmatic muscle discharge after bilateral PVN lesion in asthmatic rats. DESIGN: A randomized control study. SETTING: Laboratory of Physiology and Pharmacology, School of Basic Medical Sciences, Southeast University. MATERIALS: Forty-eight male adult SD rats of 260-300 g were used. The rats were randomly divided into 6 groups(n =8): control group, asthma group, electrolytic lesion of PVN group, KA-induced lesion of PVN group, sham electrolytic lesion of PVN group and sham kainic acid (KA)-induced lesion of PVN group. KA, chicken ovalbumin and aluminum hydroxide were purchased from American Sigma Company. Bordetella pertussis vaccine (Institute of Biological Products of Shanghai); stereotaxic apparatus (Jiangwan Ⅱ, China); lesion-producing device (YC-2 programmable stimulato, Chengdu Instrument Company); MD2000 signal processing system (Nanjing Medical School); data acquisition system (RM6240B, Chengdu Instrument Company). METHODs: The experiments were carried out in the Laboratory of Physiology and Pharmacology, School of Basic Medical Sciences, Southeast University from January to August in 2006. ① Rats except for control group were sensitized with an intraperitoneal injection of 100 mg chicken ovalbumin and 100 mg aluminum hydroxide and Bordetella pertussis vaccine containing 5×109 heat-killed in 1 mL of sterile saline. From the fifteenth to seventeenth days rats received three times aerosolized ovalbumin challenge. In rats of the control group and asthma group three steel electrodes were placed into the left PVN (AP -1.8 mm, LR 0.4 mm, OH -7.9 mm), parietal cortex and subcutaneous tissue in lower limb. Lung function tests were carried out simultaneously. Small holes were drilled in the skull to introduce a concentric bipolar electrode in the direction of the PVN in order to perform electrolytic lesion. The electrodes were connected to a lesion-producing device and a current of 1.0 -1.5 mA was passed over a period of 10-15 s on each side of the PVN. The rats received 0.5 μg/0.5 μL of KA in phosphate buffer (0.1 mol/L, pH 7.4), and the speed of infusion was 0.1 μL per minute in order to perform KA-induced lesion of PVN. ② Three days after operation of lesion, lung function tests were carried out. All the electrode and transducer were connected with data acquisition system. This technique yielded airway resistance (Raw), dynamic compliance (Cdyn), the expiratory time (Te)/the inspiratory time (Ti), minute ventilation volume (MVV), EMGdi frequency and EMGdi integral. ③The differences of the measurement data were compared using the t test. MAIN OUTCOME MEASURES: ① The alteration of EEG and power spectrum of PVN during asthmatic attack in sensitized rats; ② The effects of electrolytic lesion or KA-induced lesion of PVN on lung function in asthmatic rats. RESULTS: All the 48 rats were involved in the analysis of results. ① Alteration of EEG and power spectrum: Five minutes after injection of ovalbumin into caudal vena, the breathing rate of the rat was obviously speeded up and the total power spectrum was increased [(18 476.71±2 140.94), (13 838.75±2 983.26) mV2, P < 0.01], the percentage of the δ power and θ power decreased significantly (P < 0.01), while the percentage of α power and β1 power were enhanced (P < 0.05, 0.01). Ten minutes after injection, the EEG power spectrum of PVN further shifted rightward, the total power gradually increased (P < 0.01) which suggesting that the intensive hypersynchrony activities of PVN neurons. The percentage of δ power was decreased significantly (P < 0.01), but the α, β1 and β2 were increased (P < 0.01). Twenty-five minutes later, the breathing movements became steady, and the EEG power spectrum of PVN returned to the control level step by step. ② The alteration of lung function was detected during asthmatic attack after electrolytic lesion or KA-induced lesions of PVN respectively. It was found that EMGdi frequency, Te/Ti and RL were all decreased (P < 0.01), EMGdi integral, MVV and Cdyn were all enhanced (P < 0.01), while there were no significant changes in the sham surgery group (P > 0.05). CONCLUSION: The excitability of PVN is increased during the asthmatic attack. PVN plays a key role in the regulation of asthma. Both electrolytic and KA lesions of PVN can significantly relieve the asthmatic symptoms of rats, and improve their lung function.

A Study to Assess the Psychosocial Problems and Quality of Life of Parents with Asthmatic Children in Opd’s of Ramaiah Hospitals, Bengaluru

The study was undertaken to assess the level of psychosocial problems and quality of life of parents with asthmatic children in Ramaiah hospitals, Bengaluru. Statement of the problem: “A study to assess the psychosocial problems and quality of life of parents with asthmatic children in opd’s of Ramaiah hospitals, Bengaluru”. Objectives of the study: 1) To assess the level of psychosocial problems and level of quality of life of parents with asthmatic children. 2) To find the correlation between scores of psychosocial problem and quality of life among parents with asthmatic children. 3) To find the association between level of psychosocial problem and selected socio demographic variables. 4) To find the association between level of quality of life and selected socio-demographic variable. Method: A descriptive survey approach was used for the study. Purposive sampling technique was used to select 50 parents with asthmatic children. Data was collected through interview schedule by using structured rating scale to assess psychosocial problems and quality of life. Data was collected and analyzed using descriptive and Inferential statistics in terms of frequencies, Percentage, Mean, Mean percentage, Standard deviation, Karl Pearson’s correlation co-efficient and chi-square test. Findings: The major findings of the study indicated that majority of the parents with asthmatic children that is 33 (66%) were having moderate psychosocial problems and 16 (32%) were having mild psychosocial problem and 1 (2%) were having severe psychosocial problem and 38 (76%) were having good quality of life, 8 (16%) were having better quality of life and 4 (8%) were having poor quality of life. Karl Pearson’s correlation co-efficient test revealed that there is a correlation that exists between psychosocial problem and quality of life of parents with asthmatic children 0.314 weak positive correlation. Chi-square test revealed that there was no significant association between level of psychosocial problems and quality of life with selected socio demographic variables at 0.05 level of significance. Interpretation and conclusion: The findings show that majority of the parents with asthmatic children had moderate level of psychosocial problems (66%) and majority had good quality of life (76%). There is no significant correlation between psychosocial problem and quality of life. There is no significant association between psychosocial problem and quality of life with selected socio demographic variable. This null hypothesis was accepted.

Effect of 1,25-dihydroxyvitamin D3 on mast cells tryptase in asthmatic guinea pigs

Objective:To explore the effect of 1,25-dihydroxyvitamin D3 on the mast cell tryptase(MCT) in asthmatic guinea pigs.Methods:A total of 60 male or female healthy guinea pigs were randomly divided into control group(group A),asthmatic group(group B).and 1,25-dihydroxyvitamin D3 group(group C),with 20 cases in each group.To establish asthmatic guinea pig models,1ml peanut oil was tilled into stomach in the morning in group A and group B.and 1 ml peanut oil with 1,25-dihydroxyvitamin D3 was filled into stomach in group C.Airway resistance(Re) of asthmatic guinea pigs was detected,and the bronchoalveolar lavage fluid(BALF) cells were counted.Lung tissue with HE and MCT immunohistochemical staining were used to observe the pathological changes in lung tissue and the distribution of MCT.Results:After injection of different concentration of acetylcholine chloride,the Re in group B and group C were increased significantly compared with group A(P<0.05):compared with group B.the Re in group C were decreased significantly(t=-5.385.-5.761.-6.184.-13.574.P<0.05):the total number of BALF cells and eosinophils were increased significantly in group B and C(t=19.618.9.598.10.854.5.388.P<0.05);compared with group B.the total number of BALF cells and eosinophils in group C was decreased significantly(t=-5.555.-5.392.P<0.05):the number of tryptase positive cells in group B was increased significantly than that in group A(t=21.312,P<0.05),and in addition to the alveolar septum and submucosa,the cells were also distributed around blood vessels and outside the cells:the number of tryptase positive cells in group C was decreased significantly compared with group B.and the difference was statistically significant(t=5.043.P<0.05).Conclusions:After the asthmatic guinea pigs arc treated with 1,25-dihydroxyvitamin D3,their BALF.Re.infiltration degree of inflammatory cells in the trachea and lung tissue and airway inflammatory reaction are reduced significantly.1,25-dihydroxyvitamin D3 has a certain inhibiting effect on the activation of mast cells and the release of MCT granules.

Cellular Profiles in Peripheral Blood Accompanying Particular Asthmatic Response Types

Background: Patients with allergic bronchial asthma develop various asthmatic response types to bronchial challenge with allergen, such as immediate (IAR), late (LAR), dual late (DLAR) or delayed (DYAR), displaying different clinical, immunologic and pharmacologic features. This study deals with count changes of particular blood cells accompanying the IAR, LAR and DYAR. Methods: In 63 patients developing 22 IAR, 26 LAR and 15 DYAR, the repeated allergen challenges were supplemented with recording of blood cell counts, Th1/Th2 ratio, leukotrines B4 (LTB4) and C4 (LTC4), eosinophil cationic protein (ECP), myeloperoxidase (MPO), and histamine in blood, and intracellular IFN-γ and IL-4 in peripheral blood mononuclear cells. Results: The IAR was accompanied by increased eosinophil and basophil counts, increased serum concentrations of histamine, LTC4 and ECP, decreased Th1/Th2 ratio in favour of Th2 cells, and increased intracellular IL-4. The LAR was associated with increased eosinophil and neutrophil counts, increased serum concentrations of LTC4 and LTB4, unchanged Th1/Th2 ratio, and increased intra-cellular IL-4. The DYAR was accompanied by increased total leukocyte, neutrophil, monocyte, lymphocyte and thrombocyte counts, increased serum concentrations of LTB4 and MPO, increased Th1/Th2 ratio in favour of Th1 cells, and increased intracellular IFN-γ. Conclusions: These results provide evidence for different involvement of particular blood cell types and different hypersensitivity mechanisms in IAR, LAR and DYAR. The monitoring of peripheral blood cell counts seems to be an useful supplementary parameter to the bronchial challenge with allergen.

The expression of CD40 and CD40L on the surface of peripheral blood mononuclear cells in asthmatic rats and the effect of anti-CD40L McAb on Th1 and Th2 cytokines

Objective： To investigate the expression of CD40 and CD40 ligand （CD4OL） on the surface of peripheral blood mononuclear cells（PBMCs） in asthmatic rats and the effect of anti-CD40L McAb on cytokines of PBMCs. Methods： Flow cytometry and RT-PCR were used to detect the expression of CD40 and CD40L of PBMCs in asthmatic rats. After the PBMCs was treated with anti-CD40L McAb, ELISA was used to detect the IL-4 and IFN-γ levels of culture supernatants. Results： Compared with the normal control group, the expression of CD40 and CD40L of PBMCs in asthmatic rats increased （P 〈 0.05）. Compared with the untreated group, the level of IL-γ and the ratio of IL-4/IFN-γ decreased after the PBMCs was treated with anti-CD40L McAb（P 〈 0.05）. Conclusion： The expression of CD40 and CD40L on the surface of PBMCs in asthmatic rats was up-regulated. Anti-CD40L McAb can rectify the imbalance of Th1 and Th2 cytokines.

Cytokines Released from Allergen-Stimulated Blood Cells during the Delayed Asthmatic Response to Allergen Challenge

Background: Bronchial asthma patients may develop various asthmatic response types to bronchial challenge with allergen, such as immediate (IAR), late (LAR), dual (DAR) or delayed (DYAR), due to different immunologic mechanisms. The DYAR, beginning between 26-32 hrs and lasting up to 56 hrs after the allergen challenge, differs from the IAR, LAR and DAR in clinical, diagnostic and immunologic aspects. The aim of this study was to investigate the concentrations of the particular intracellular cytokines released by blood cells stimulated with relevant allergens “in vitro”, before and during the DYAR. Methods: In 23 patients, the repeated DYAR (p < 0.001) was supplemented with cytokine determination in the supernatants of the blood cells stimulated with relevant allergens before and up to 72 hours after the bronchial challenge, by means of enzyme-linked immunoassay. Results: The significantly elevated pre-challenge concentrations (p < 0.05) of IL-2, IL-17, IFN-γ and G-CSF released by allergen-stimulated blood cells “in vitro” were recorded in the DYAR patients as compared with healthy controls. The significantly increased post-challenge concentrations (p β, IL-2, IL-8, IL-12p70, IL-18, IFN-γ and TNF-α, whereas decreased concentrations of IL-4, IL-6 and IL-17, were released by blood cells stimulated with relevant allergens “in vitro”, as compared both with their pre-challenge concentrations and with the corresponding PBS control values. Conclusions: The profiles of cytokines released by allergen-stimulated peripheral blood cells during the DYAR would suggest an activation of Th1 cells, neutrophils, monocytes and probably also bronchial macrophages, epithelial and endothelial cells and their involvement in the immunologic mechanism(s) underlying the clinical DYAR.

Impact of Asthma Educational Intervention on Self-Care Management of Bronchial Asthma among Adult Asthmatics

Asthma is one of the most common chronic diseases worldwide [1]. Despite advancement in science and technology and pharmacological revolutions, worldwide asthma prevalence is uncontrolled, morbidity and mortality from asthma. The most common reasons are non adherence to treatment, poor knowledge and skills in disease management [2]. Aim: The study aims to assess the impact of Asthma Education on self care management among Bronchial asthma patients. Objectives: 1) to assess the knowledge on self care management of Bronchial asthma;2) to develop and administer the Asthma educational intervention on self care management of asthma;3) to evaluate the impact of Asthma educational intervention on patient knowledge levels in comparison of pre and post test scores. Design: Quasi experimental Pre test-post test design was chosen. Methods: Study was done to assess the effectiveness of structured asthma education program on self care management of Bronchial asthma. Thirty patients, meeting the inclusive criteria, were selected by simple random sampling, and were tested for their knowledge levels on identification of asthma triggers, and warning signs, adherence to specified drugs, diet and breathing exercises. Based on the patient needs, structured education program was developed, validated and administered. Two weeks after administering structured asthma education, post-test was conducted. The Pre-test and Post-test scores were compared to evaluate the effectiveness of the Asthma education. Results: There was significant enhancement on knowledge levels on four areas of assessment and education. After asthma education the knowledge levels on disease process raised from minimum of 10% in the pre test to 77.50% in the post test. The knowledge scores on asthma triggers and warning signs enhanced 12% to 72%. The area of self monitoring and management records a rise in knowledge levels from 20% minimum scoring in pre test to 82.5% in the post test. The scores in diet, breathing exercises and adherence to drugs rose from 12.5% to 72.5% after asthma education. Conclusion: The findings reveal that educating patients remarkably increased their knowledge levels, which facilitate their behavioral modification thus enhances their self-care. Effective self care management at home level decreases asthma related morbidity and frequent visit to hospitals.

The transcription factor PU.1 promotes alternative macrophage polarization and asthmatic airway inflammation

The transcription factor PU.1 is involved in regulation of macrophage differentiation and maturation.However,the role of PU.1 in alternatively activated macrophage(AAM)and asthmatic inflammation has yet been investigated.Here we report that PU.1 serves as a critical regulator of AAM polarization and promotes the pathological progress of asthmatic airway inflammation.In response to the challenge of DRA(dust mite,ragweed,and Aspergillus)allergens,conditional PU.1-deficient(PU/ER(T)^(+/-))mice displayed attenuated allergic airway inflammation,including decreased alveolar eosinophil infiltration and reduced production of IgE,which were associated with decreased mucous glands and goblet cell hyperplasia.The reduced asthmatic inflammation in PU/ER(T)^(+/-) mice was restored by adoptive transfer of IL-4-induced wild-type(WT)macrophages.Moreover,after treating PU/ER(T)^(+/-) mice with tamoxifen to rescue PU.1 function,the allergic asthmatic inflammation was significantly restored.In vitro studies demonstrate that treatment of PU.1-deficient macrophages with IL-4 attenuated the expression of chitinase 3-like 3(Ym-1)and resistin-like molecule alpha 1(Fizz-1),two specific markers of AAM polarization.In addition,PU.1 expression in macrophages was inducible in response to IL-4 challenge,whichwas associated with phosphorylation of signal transducer and activator of transcription 6(STAT6).Furthermore,DRAchallenge in sensitized mice almost abrogated gene expression of Ym-1 and Fizz-1 in lung tissues of PU/ER(T)^(+/-) mice compared with WT mice.These data,all together,indicate that PU.1 plays a critical role in AAM polarization and asthmatic inflammation.

Clinical experiment of exercise-induced asthma and respiratory impedance asesed with impulse oscilometry to measure exercise response of asthmatics

Objective In order to investigate pathophysiology of exercise induced asthma (EIA), the impedance of the respiratory system was studied using impulse oscillometry (IOS). EIA is a temporary increase in airway resistance, which occurs after several minutes of strenuous exercise. Most asthmatics experience EIA. Patients and methods Respiratory impedance was measured with IOS (MasterScreen, Jaeger, Germany) in 14 healthy volunteers and 14 asthmatics as baseline value at first. The procedure of exercise challenge with an ergometer (Corival 300 Gould Co.) increased heart rate to 90% of predicted maximum values in 3-4 min and maintained for 6 min. After challenge, measurements with IOS were made immediately at 5 min intervals for 5 times. Results The maximal increase of respiratory impedance occurred at 5-10 min after exercise and the increment magnitude of peripheral resistance (99.6%) was more than that of central resistance (13.5%) in asthmatics. After challenge, R5Hz, R5Hz-R20Hz, Zrespir (total impedance), resonance frequency (Fres) and X5Hz from patients changed significantly. The increment value of R5Hz-R20Hz from asthmatics was≥0.032kpa/l·s -1 and the change ratio of X5Hz from 71.4% of asthmatics was ≥41% (2SD beyond the mean response of nonashmatics). Air trapping loop was expressed in V T Zrespir graph in 57.1% patients. All subjects underwent IOS measurement. Conclusion Exercise test can diagnose asthma and evaluate efficacy of treatment for bronchial asthma. Because the patients usually have shortness of breath after exercise challenge, the measurement with spirometry (FEV 1) may not be accurate. IOS is based on measurement of the relationship between an external pressure pulse applied to the respiratory system and the resulting respiratory airflow. The spectral ratio of the amplitude of the pressure wave signal to the resulting flow signal constitutes the impedance of the respiratory system, from which the resistance (R) and the reactance (X, including elastance and inertance) of respiratory system in the frequency range 5Hz to 35Hz can be calculated. Our data showed that the increment value of R5Hz-R20Hz was more sensitive than other indices for detecting exercise induced asthma. The bronchoconstriction took place in peripheral airway mainly after exercise. Because obstruction of small bronchi during expiration and impedance increased abruptly, air trapping loops were expressed in V T Zrespir graph after challenge in asthmatics. Fres is the frequency point where the absolute value of elastance equals to that of inertance. X5Hz reflects the condition of compliance of lungs. Fres shifted right and change ratio of X5Hz increased after exercise were relative to the compliance decrease of lungs. The airway response of exercise challenge may be assessed more accurately and more conveniently with IOS that did not require a maximal inspiration and forced expiration.

Effects of 3-methyladenine on airway inflammation,airway hyperresponsiveness and mucus secretion in asthmatic mice

Objective To investigate the effects of 3-methyladenineon airway inflammation,airway hyperresponsivenessand mucus secretion in asthmatic mice,and to explore itsmechanism. Methods C57BL /6J female mice were randomlydivided into normal control group ( PBS),OVAgroup(OVA),OVA with 3-methyladenine group (OVA +3-MA),and OVA with 4-phenylbutyrate group (OVA +4-PBA). OVA group,OVA + 3-MA group and OVA + 4-PBA groups were all sensitized and challenged with OVAto establish asthmatic models,while PBS group was givenPBS as a control. At 2 h before challenge,OVA + 3-MAgroup was intraperitoneally injected with 3-methyladenine,and OVA + 4-PBA group was intraperitoneally injectedwith 4-phenylbutyrate. Airway hyperresponsiveness,eosinophils,and pathological changes of pulmonarytissue (hematoxylin-eosin,HE staining) were measuredto confirm the establishment of asthmatic models.