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 di...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.展开更多
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 ...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.展开更多
Abstract 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 airwa...Abstract 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.展开更多
文摘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.
文摘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.
文摘Abstract 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.
