No abstract available.
Asthma*

BACKGROUND: Wheezing which is defined as a continuous sound with a musical quality is commonly auscultated in patients with chronic obstructive airway diseases. The correlation between wheezing and airway obstruction is unclear. OBJECTIVE: This study was designed to evaluate the relationships among wheezing, severity of airway obstruction, and pulmonary function tests. METHOD: Forty-one subjects were examined by the same observer. Wheezing during normal breathing and maximal forced exhalation, was auscultated respectively. Posterior lung bases were auscultated bilaterally with the seated patient taking repeated inspiratory capacity breaths through an open mouth. To quantify wheezing intensity, a regional score was assigned for each area after a minimum of 3 breaths, according to the following scale: zero, no wheezing heard: one, faint or intermittent wheezes: two, moderate wheezing during every expiration: three, loud wheezing during every expiration. The lung function tests by standard pneumotachograph were performed by skilled technicians. RESULTS: Wheezing was auscultated more in forced exhalation than in normal breathing in patients with asthma and COPD [8/9(88%) vs 1/9(11%), p<0.01 ll/15(73%) vs 1/15(6%), p<0.05)]. Forced expiratory wheezes group (n=25) compared to no wheezes group (n=16) had significantly lower FEVl (75+-5.8% vs 95.6+-6.6%, p<0.05). Compared to no wheezes group, the group with forced expiratory wheezes had lower FEV1 and FEV1/FVC (50.4+- 21.3% vs 81.15+-27.7%, 70.4+-22.4% vs 92.5+-19.3%, respectively, p<0.05). Bronchial asthma compared with COPD tended to have higher wheezing scores (Wheeze scores Bronchial asthma 3.5 vs COPD 2.4, p=0.08). Wheezing scores were correlated to FEV1 (normal breathing: r=-0.35, p<0.05: forced exhalation: r=-0.45, p<0.05), but no differences were found in wheezing incidence according to severity of airway obstruction. CONCLUSION: These findings suggest that wheezing on maximal forced exhalation may be a useful physical indicator for evaluating the severity of airway obstruction.
Airway Obstruction ; Asthma ; Exhalation ; Humans ; Incidence ; Inspiratory Capacity ; Lung ; Mouth ; Music ; Pulmonary Disease, Chronic Obstructive* ; Respiration ; Respiratory Function Tests ; Respiratory Sounds*

BACKGROUND: Few studies have demonstrated an enhanced skin responsiveness to opiates in atopic subjects. OBJECTIVE: To determine whether the skin response to morphine is increased in atopics and to assess the clinical usefulness of morphine skin prick test in diagnosis of allergic diseases. METHOD: Allergy skin prick tests were performed using 55 common allergens, histamine, and morphine in 158 patients with allergic diseases. RESULTS: Wheal and flare sizes for morphine (1mg/mL) were significantly related to and smaller than those for histamine (1mg/mL). Although the proportion of subjects with allergic rhinitis and the level of serum total IgE were not different between responders (wheal >- 2mm) and nonresponders to morphine, the positive response rate to allergens was significantly lower in nonresponders. The flare sizes for morphine were significantly higher in positive allergen test group (A/H ratio >- 0.5). Among positive allergen test group, the subjects with atopy score >- 5 showed a larger flare size for morphine than those with atopy score < 5 while the sizes for histamine were not different. CONCLUSION: Morphine skin prick test is helpful for detecting false negative responses to allergens, and morphine skin test responses are increased in highly atopic patients probably due to enhanced mast cell releasability.
Allergens ; Diagnosis* ; Histamine ; Humans ; Hypersensitivity ; Immunoglobulin E ; Mast Cells ; Morphine* ; Rhinitis ; Skin Tests ; Skin*

Because genetic characteristics vary among subjects, the therapeutic effects of a certain drug differ among patients with the same disease. For this reason, special interest has focused on tailored treatments. Although it is well known that sex is genetically determined, little attention has been paid to sex differences in the clinical features and treatment of asthma. Females are more likely to suffer allergic asthma, to have difficulty controlling asthma symptoms, and to show adverse effects to drugs. As asthma symptoms show cyclic changes depending on female hormone levels in many women of child-bearing age, the use of contraceptives may specifically help to treat female patients with asthma such as those with perimenstrual asthma and severe asthma. Generally, testosterone seems to suppress asthma, and dehydroepiandrosterone (DHEA), a less virilizing androgen, may be effective for treating asthma. Evidence exists for a therapeutic and steroid-sparing effect of DHEA. However, further studies on the optimal dose and route of DHEA for each sex are needed. Monitoring of the serum DHEA-S level is necessary for patients with asthma on inhaled steroid treatment, and at minimum, replacement therapy for patients with a low level of DHEA may be helpful for treating their asthma.
Asthma ; Contraceptive Agents ; Dehydroepiandrosterone ; Female ; Humans ; Sex Characteristics ; Testosterone

No abstract available.
Asthma*

Hypertonic saline aerosols are being used increasingly for bronchial provocation testing and induction of sputum. The aims of this study were to assess the response to challenge with 3% hypertonic saline administered via a ultrasonic nebulizer in patients with asthma, and to evaluate relationship between % fall of FEV1 during induction of sputum (osmotic airway hyperresponsiveness; osmotic AHR) and biochemical markers of induced sputum. We investigated changes in FEV1 in response to inhaling ultrasonically nebulized 3% saline in 25 patients with asthma and 10 control subjects. FEV1 was measured before, during, and after induction of sputum. We used fluoroimmunoassay to detect eosinophil cationic protein (ECP), immunohistochemical staining to detect EG2+ (secretory form of ECP) eosinophils, and a sandwich ELISA to detect interleukin (IL)-5. Protein concentration was determined by using bicinchoninic acid protein assay reagent. Asthmatics, compared with controls, had significantly higher osmotic AHR. Moderate to severe asthmatics had significantly higher osmotic AHR compared to mild asthmatics. Osmotic AHR was significantly correlated with the proportion of eosinophils, the levels of ECP, EG2+ eosinophils, IL-5, and proteins. These data suggest that osmotic AHR is closely related to the clinical status and biochemical markers of sputum supernatant in asthmatic patients.
Adult ; Asthma/*physiopathology ; Biological Markers ; Blood Proteins/analysis ; Bronchial Hyperreactivity/*etiology ; Female ; Forced Expiratory Volume ; Human ; Interleukin-5/analysis ; Male ; Middle Age ; Osmotic Pressure ; Sputum/*chemistry ; Vital Capacity

No abstract available.
Asthma ; Immune Tolerance ; T-Lymphocytes, Regulatory

OBJECTIVES: Eosinophils play an important role in asthmatic airway inflammation collaborately with other inflammatory cells. The present study was aimed to determine whether the eosinophil activation markers in induced sputum reflect the clinical status in asthmatics. METHODS: The clinical severity and FEV1 were measured. Hypertonic saline induced sputum was obtained from 25 asthmatics and ten control subjects. We processed freshly expectorated sputum separated from saliva by treatment with an equal volume of dithiothreitol 0.1+ACU-, cytospins for cell count and special stain, and a collection of the supernatant for biochemical assay. We used a fluoroimmunoassay to detect eosinophil cationic protein (ECP), and a sandwich ELISA to detect interleukin (IL)-5. RESULTS: Asthmatics, compared with control subjects, had a significantly higher proportion of eosinophils (25.6 4.6+ACU- vs 1.7 0.2+ACU-, p +ADw- 0.01) and higher levels of ECP (1117.8 213.9 micrograms/L vs 154.6 47.4 micrograms/L, p +ADw- 0.01) in their sputum. IL-5 was detected more frequently in asthmatics than in control subjects +AFs-11/25 (44+ACU-) vs 1/10 (10+ACU-), p +ADw- 0.05+AF0-. Moderate to severe asthmatics had a significantly higher proportion of eosinophils, higher levels of ECP and IL-5 compared to mild asthmatics. FEV1, FEV1/FVC were significantly correlated with the proportion of eosinophils and the levels of ECP and IL-5. Significant positive correlations were noted between the proportion of eosinophils and the level of ECP and IL-5. Sputum ECP level showed a significant positive correlation with IL-5 level. CONCLUSION: These findings demonstrate that eosinophils and the eosinophil activation markers, such as ECP and IL-5 in induced sputum, are closely related to the clinical status in asthmatics. Induced sputum study may thus be useful in clinically measuring indices of airway inflammation in asthma.
Adult ; Asthma/physiopathology ; Asthma/classification+ACo- ; Biological Markers/analysis ; Blood Proteins/analysis+ACo- ; Bronchoalveolar Lavage ; Enzyme-Linked Immunosorbent Assay ; Female ; Fluoroimmunoassay ; Human ; Inflammation Mediators/analysis+ACo- ; Interleukin-5/analysis+ACo- ; Male ; Middle Age ; Prognosis ; Respiratory Function Tests ; Sensitivity and Specificity ; Severity of Illness Index ; Sputum/cytology+ACo-

PURPOSE: Long-term treatment with inhaled steroids (ICS), especially fluticasone that developed lately, may suppress the hypothalamic-pituitary-adrenal (HPA) axis. This study investigated the relationship between ICS use and HPA axis suppression in asthmatics under ICS treatment for average 4.5 years. METHODS: The medical records of 129 adult asthmatics who received ICS treatment for 6 months or more and underwent a corticotropin stimulation test from January 2005 to August 2013 were retrospectively reviewed. RESULTS: The patients received ICS only (n=87) were found to have an abnormal response to the corticotropin test in as high as 32.2%, and those received ICS in combination with oral steroids (n=42) had a significantly higher prevalence of the response (71.4%, P<0.001). Abnormal responses to corticotropin occurred depending on ICS daily doses (low, n=8, 12.5%; medium, n=19, 36.8%; high, n=102, 49.0%; chi2=4.384, P=0.036). Among the subjects received ICS only, nasal steroid doses (P=0.016) but not ICS doses (P=0.159) were significantly higher in those with abnormal responses than the others. Among all the subjects, oral steroid use (odds ratio [OR], 4.27; 95% confidence interval [CI], 2.35-11.80; P<0.001) and nasal steroid dose (OR, 1.02; 95% CI, 1.00-1.04; P=0.015) were significant risk factors for HPA axis suppression. CONCLUSION: One-third of asthmatics under long-term treatment with ICS showed a suppression of the HPA axis in a dose-dependent manner. Oral or nasal steroid use may be a risk factor for the suppression. However, since our results may have been overestimated due to subject selection bias, further prospective case-control studies are warranted.
Adrenal Glands ; Adrenocorticotropic Hormone ; Adult ; Asthma* ; Axis, Cervical Vertebra* ; Case-Control Studies ; Humans ; Medical Records ; Prevalence ; Retrospective Studies ; Risk Factors ; Selection Bias ; Steroids* ; Fluticasone

BACKGROUND: Several investigators have demonstrated a considerable disagreement between FEV1 and PEFR to assess the severity of airflow obstruction. The purpose of this study was to examine whether the discrepancy between the two measurements affects the assessment in the severity of acute asthma. METHODS: Thirty-five consecutive asthma patients measured both FEV1 and PEFR at 0, 1hr, 1, 3, 5, 7 days of an emergency room admission using a spirometer and a Ferraris PEFR meter. The degree of discrepancy between FEV1 and PEFR expressed as % predicted values was determined. RESULTS: When predictive equations that recommended by the instrument manufacturers were used, PEFR measured with the PEFR meter (f-PEFR) was significantly higher than FEV1 at all time points, with 16.1% mean difference and unacceptable wide limits of agreement (-20.0~52.3%). The classification in severity was significantly different between FEV1 and f-PEFR (p < 0.001). The discrepancy was inter-instrumental in large part because f-PEFR was 10.1% higher than spirometric PEFR. Different predictive equations altered the degree of the differences but could not completely correct it. CONCLUSION: These results indicate that f-PEFR values underestimate the severity of airflow obstruction in acute asthma despite using recommended predictive equations. Therefore, these confounding factors should be considered when the severity of airflow obstruction is assessed with PEFR.
Acute Disease ; Adult ; Aged ; Airway Obstruction/diagnosis/*physiopathology ; Asthma/*physiopathology ; Comparative Study ; Female ; Forced Expiratory Volume/physiology ; Human ; Male ; Middle Age ; Peak Expiratory Flow Rate/*physiology ; Predictive Value of Tests