[Urinary leukotriene E4 concentration in patients with bronchial asthma and intolerance of non-steroids anti-inflammatory drugs before and after oral aspirin challenge]

[Article in Polish]

Chazan R.

Katedra i Klinika Chorob Wewnetrznych Pneumonologii i Alergologii AM w Warszawie.

BACKGROUND: Leukotrienes (LTC4, LTD4, LTE4) belong to eicosanoids and they play important role in allergic inflammation. Leukotrienes are 5-lipooxygenaze products of arachinoid acid. It is known that concentration of LTE4 increases in patients with bronchial asthma, after some allergy provocation and in patients with bronchial asthma and intolerance of on steroids anti-inflammatory drugs. The aim of the study was estimated the urinary concentration of LTE4 in patients with bronchial asthma and intolerance of no steroids anti-inflammatory drugs. MATERIAL AND METHODS: The study group consisted of 21 patients with asthma and intolerance of non steroids antiinflammatory drugs (F 19, M 2) in age from 21 to 72 years old (mean = 49 +/- 14), with middle time of asthma duration mean = 13.4 +/- 12.9 years In study group 11 person had positive skin test, 7 nasal polyps, and 8 person positive family history of bronchial asthma. After oral provocation aspirin challenge in 5 subjects' aspirin induced asthma was confirmed, 3 persons were not qualified to test. Urinary concentration of LTE4 before and 24 h after aspirin provocation was analyzed in all the patients. Leukotriene were detected by enzymatic Leukotriene E4, EIA Kit, Cayman Chemical test. RESULTS: In group of patients with aspirin asthma basic concentration of LTE4 was 416.6 +/- 374.4 pg/mL, and after provocation 496.6 +/- 485.3 pg/mL, in the group without sensitivity to aspirin appropriate 262.9 +/- 404.0 vs 261.2 +/- 259.66 pg/mL, and in the group disqualified to test 181.6 +/- 55.75 pg/mL. CONCLUSION: 1 Patients with aspirin asthma have higher concentration of LTE4. 2. Excretion of LTE4 in patients with aspirin induced asthma raised after oral aspirin provocation and higher level was detected is til 24 hours after challenge. 3. This results confirmed the role of cysteinic leukotrienes in pathogenesis of aspirin induced asthma.

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Prevalence of and major risk factors for adult bronchial asthma in Taipei City.

Kuo SH.

Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

BACKGROUND AND PURPOSE: The prevalence of bronchial asthma has been on the rise worldwide, but the prevalence of adult asthma in Taiwan has not been reported. The objective of this study was to determine the current 1-year and lifetime asthma prevalence rates, and to identify major risk factors for adult asthma in Taiwan. METHODS: A cluster sampling was conducted in 1999, where 21 clusters and 4549 adults (age > or = 18 years) were selected randomly. Face-to-face interviews were conducted with a total of 2076 adults (45.6%; men/women, 987/1089) using a questionnaire designed to assess asthma and asthma-like symptoms adapted from the American Thoracic Society with minor modifications to include information about current asthma status. RESULTS: The results showed that 50 cases had a previous diagnosis of asthma and 94 had been classified as probably having asthma with intermittently audible wheezing. The lifetime prevalence rate of asthma in adults in Taipei City was 7.8%. Seventy three out of 144 patients had asthmatic symptoms or wheezing in the past 12 months. The 1-year prevalence of asthma was 4.1%. A multiple logistic regression model showed the odds ratio (95% confidence interval) of a history of maternal asthma to be 5.8 (2.77 to 12.18), that of allergic rhinitis to be 3.2 (2.03 to 5.16), that of paternal asthma to be 2.2 (0.91 to 5.21), that of older age (> or = 50 years) to be 2.0 (1.25 to 3.19), and that of smoking habit to be 1.7 (1.02 to 2.72). CONCLUSIONS: The lifetime prevalence rate of adult bronchial asthma in Taipei City was 7.8% and related to both genetic and environmental factors, which included maternal or paternal history of asthma, history of allergic rhinitis, older age (> or = 50 years), and smoking habits.

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[Factors related to severe acute asthma in childhood - epidemiologic and clinical aspects]

[Article in Portuguese]

Carvalho PR.

Medico Pediatra Intensivista do Hosp. Sao Lucas-PUCRS, UFRGS.

OBJECTIVE: To study the epidemiologic and clinical factors related to severe acute asthma in patients hospitalized in pediatric intensive care unit (PICU). STUDY PROFILE: Prospective, epidemiologic. All admissions were observed. PATIENTS AND METHODS: All children with severe asthma admitted to PICU-HSL-PUCRS between January, 1994, and December, 1994. Their parents were asked to answer a questionnaire about clinical history and precipitating factors of bronchospasm. Clinical evolution was observed in each patient. RESULTS: 31 children were admitted on 42 occasions to the PICU for the treatment of severe asthma (7.3% of all admissions). The male: female ratio was 1.2:1.0 and the age mean was 25 months. Respiratory viral infections were the main precipitating factor of asthma attacks (74%). Family history of asthma, atopy or tabagism were observed in 97% of the cases. A longer hospitalization period was associated with less than 1 year age (p=0.0005), family history of tabagism (OR= 2.3) and occurrence of pneumonitis (p= 0.03). The long stay in PICU was associated with previous PICU admission (p=0.03), family history of tabagism (OR=2.0) and occurrence of pneumonitis (p=0.02). The main complication observed, especially in patients under 1 year receiving public health care, was pneumonitis, that was diagnosed in 42% of these children. Patients assisted by a private doctor had a shorter hospitalization period and less pneumonitis complication. Mechanical ventilation was necessary in 10% of these patients. There was no death in our series. CONCLUSIONS: The incidence of severe acute asthma, associated with long staying in PICU and hospitalization, is related to low age (under 1 year), previous hospitalization due to bronchospasm, family history of asthma, atopy or tabagism, and ineffective medical care. These factors seem related to frequent crises causing more hospitalization indications. These children frequently present pneumonitis during their clinical evolution. Early and aggressive management in general benefit the clinical course of severe acute asthma. The mortality ratio for children with acute asthma who need PICU admissions is small.

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[Risk factors and clinical evolution of asthma in children]

[Article in Portuguese]

Naspitz CK.

Universidade Federal de Sao Paulo, Escola Paulista de Medicina.

OBJECTIVE: The purpose of this study was to obtain data on the clinical evolution and risk factors related to asthma in children followed as outpatients in our Division of Allergy. METHODS: The asthmatic group consisted of 165 children (107 boys, 58 girls), between the ages of 3 and 14 years. All children were atopic and had a positive skin prick test to D. pteronyssinus. The control group consisted of 40 healthy children (20 boys, 20 girls), within the same age range, without personal history of asthma or other atopic disease and with negative skin prick test to D. pteronyssinus. The mothers were interviewed to obtain data on: a) clinical evolution, b) family history of asthma or any other atopic disease, c) description of the house environment. RESULTS: 1) in approximately half of the cases symptoms started on the first year of life. Mothers were not informed of the condition at the time; 2) upper respiratory tract infections and bronchiolitis were responsible for triggering the first wheezing episode in most cases and remain the main precipitating factors in the first year of the disease whilst allergens, irritants, sinusitis, physical exertion and emotional factors were the main precipitating factors between the ages of 5 and 13; 3) changes in climatic conditions precipitated acute attacks throughout the evolution of the disease and; 4) asthma was not the only allergic manifestation, allergic rhinitis being the most frequent associated condition; 5) family history of atopy (Relative Risk (RR) = 2.40; 95% confidence interval (CI95%) = 1.60-3.50); maternal history of asthma (RR = 2.23; CI95% = 1.10-4.63) and the presence of smokers in the house (RR = 2.30; CI95% = 1.20-4.31) were the main risk factors for the manifestation of asthma. CONCLUSIONS: a) there were no differences between boys and girls regarding the evolutionary aspects, b) asthma was underdiagnosed, c) family history of atopy, maternal history of asthma, and the presence of smokers in the house were risk factors for the manifestation of asthma.

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[Prevalence of asthma in schoolchildren in Curitiba - ISAAC]

[Article in Portuguese]

Callefe LG.

Universidade Federal do Parana (UFPR), Curitiba, PR, Brazil.

OBJECTIVE: To verify the prevalence of asthma in schoolchildren from Curitiba.METHOD: A written questionnaire of asthma symptoms (ISAAC-International Study of Asthma and Allergies in Childhood) was applied to children ages 6-7 years and adolescents 13-14 years registered in 32 public schools.RESULTS: 3,200 questionnaires were applied to 13-14 year-old adolescents, and 2,863 questionnaires to 6-7 year-old children. The questionnaire should be answered by the parents of 6-7 year-old children (group I) and by the adolescents themselves (13-14 year-old, group II). The rate of questionnaires returned was 58% for group I and 92% for group II. A presumptive diagnosis of asthma was based on having had 4 or more attacks of wheezing in the last 12 months, or 1-3 wheezing episodes in addition to night awakening for wheezing, nocturnal cough and wheezing after exercise. Under these criteria there were 15.7% asthmatics in group I and 11.6% in group II. Symptoms of rhinoconjunctivitis were found in 38% and 36%, and eczema in 11% and 10% for groups I and II, respectively. Among those with presumed asthma, over 70% denied having had asthma. The question "have you ever had asthma" although specific is not sensitive enough.CONCLUSION: The prevalence of asthma in Curitiba was 15.7% for children 6-7 years old and 11.6% for adolescents 13-14 years. The question "have you ever had asthma" did not contribute to defining cases with asthma.

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The association analysis of FcepsilonRIbeta with allergic asthma in a Chinese population.

Xie J.

Immunology Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. Tianpencui hotmail.com

OBJECTIVE: To investigate the link between the polymorphism of -109 and Glu237 in the high-affinity IgE receptor beta (FcepsilonRIbeta) gene and susceptibility to allergic asthma in a Chinese population. METHOD: Blood samples from 216 allergic asthma patients and 198 age- and sex-matched controls were studied. A -109C/T and a coding variant Glu237Gly in FcepsilonRIbeta were detected with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The genotype frequencies were 0.403 for -109T/T, 0.491 for -109T/C and 0.106 for -109C/C in allergic asthma in a Chinese population. No significant difference in the distribution of -109C/T polymorphism was found between allergic asthma subjects and healthy controls, however, homozygosity for the -109T allele was associated with increased total plasma IgE levels in subjects with allergic asthma (F = 4.020, P < 0.05). The allele frequency of Gly237 in the patients and control was 0.236 and 0.136 respectively. There was a significant association between the Gly/Gly genotype and allergic asthma. Among allergic asthma patients Gly237 was significantly associated with high IgE levels. CONCLUSIONS: These results suggest that the Gly237 variant of the FcepsilonRIbeta gene is involved in the development of allergic asthma. The -109C/T and Glu237Gly polymorphisms are two of the genetic factor identified thus far, which affect total plasma IgE levels of allergic asthma patients in a Chinese population.

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Elevation of plasma transforming growth factor beta1 levels in stable nonatopic asthma.

Nicholls MG.

Pulmonary & Critical Care Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. jjoseph uaeu.ac.ae

BACKGROUND: Increased transforming growth factor beta1 (TGF-beta1) levels have been reported in bronchoalveolar lavage fluid and bronchial biopsy specimens from asthmatic patients. However, systemic TGF-beta1 levels have not been reported in asthma. OBJECTIVE: To evaluate the levels of plasma TGF-beta1 in asthmatic patients and matched, healthy controls to determine the associations with atopic status, disease severity, and duration. METHODS: Asthmatic patients and healthy controls were recruited prospectively from a university hospital outpatient department between January 2001 and May 2002. Plasma TGF-beta1 and serum IgE levels were estimated using established methods. Patients were classified as atopic or nonatopic based on the presence or absence of serum specific IgE directed to common allergens. RESULTS: Of the 56 patients recruited for the study, 32 were atopic and 24 nonatopic. The median value of plasma TGF-beta1 was significantly higher in nonatopic asthmatic patients (2.5 ng/mL) compared with controls (1.5 ng/mL, P = .002) and atopic asthmatic patients (1.4 ng/mL, P = .008). The median absolute neutrophil count in the nonatopic asthmatic patients (4.0 x 10(9)/L) was significantly higher compared with atopic asthmatic patients (3.0 x 10(9)/L) and healthy controls (3.5 x 10(9)/L) (P = .01 and P = .04). There was no significant correlation between the duration or severity of asthma and plasma TGF-beta1 levels. The distribution of moderate-persistent asthma cases was similar in atopic and nonatopic groups. CONCLUSION: Compared with atopic asthmatic patients and healthy controls, patients with nonatopic asthma have elevated plasma TGF-beta1 levels and leukocytosis. These data suggest that nonatopic asthmatic patients exhibit an altered inflammatory response, perhaps to a respiratory infection.

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Prevalence of asthmatic phenotypes and bronchial hyperresponsiveness in Turkish schoolchildren: an International Study of Asthma and Allergies in Childhood (ISAAC) phase 2 study.

Kocabas C.

Hacettepe University, Faculty of Medicine, Pediatric Allergy and Asthma Unit, Ankara, Turkey. mysaraclar ttnet.net.tr

BACKGROUND: Numerous epidemiologic studies have revealed that bronchial asthma affects populations without regard to frontiers. However, standardized methodological approaches are necessary to compare these populations. OBJECTIVE: To investigate objective markers of childhood asthma on an epidemiologic basis and to include Turkish children in international comparisons. METHODS: Parental questionnaires were collected and skin prick tests performed on fourth grade primary schoolchildren, aged 8 to 11 years, residing in Ankara, Turkey. Pulmonary function tests and bronchial challenge with hypertonic saline (HS) were conducted in children selected from this cohort with a stratified random sampling according to the presence of current wheezing. RESULTS: A total of 3,041 questionnaires were included in the evaluation. Skin prick tests were performed on 2,774 children (97.1%). A total of 347 children from this cohort underwent pulmonary function and bronchial challenge tests. In 18 (5.1%) of the 347 children, bronchial challenge tests could not be successfully completed. The prevalence values were 11.5% for current wheezing, 6.9% for physician-diagnosed asthma, and 7.7% for physician-diagnosed recurrent bronchitis. Population-based weighted prevalence of bronchial hyperresponsiveness (BHR) was 21.8%. Frequency of responses to HS was 38.6% among physician-diagnosed asthma cases and 30.5% among patients with current wheezing. Skin test positivity was present in 38.7% of the children with a diagnosis of asthma or asthmatic bronchitis, 35.0% of current asthmatic patients, and 19.2% of patients with current wheezing. CONCLUSIONS: Objective markers, in addition to the questionnaire-based prevalence figures, need to be used in epidemiologic surveys for asthma, especially in countries with inadequate health care facilities or problems with interpretation of the wheeze concept.

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