Maximal degree of airway narrowing induced by methacholine and adenosine monophosphate: relationship with the decrease in forced vital capacity.

Background Changes in forced vital capacity (FVC) may represent an indirect method for the detection of plateau in response to inhaled bronchoconstrictor agents. Objective To determine the relationship between the level of plateau obtained with either methacholine or adenosine monophosphate (AMP) and the decrease in FVC induced by each bronchoconstrictor agent. Methods Airway responsiveness to high concentrations of methacholine and AMP was determined in patients with intermittent asthma (n = 41) or allergic rhinitis (n = 26). Furthermore, allergen-induced changes in the response to each bronchoconstrictor agent were investigated in 18 pollen-sensitive patients. Concentration-response curve…

The Effect of Natural Allergen Exposure on the Maximal Response Plateau to Adenosine 5′-monophosphate and on Exhaled Nitric Oxide of Alveolar and Bronchial Origin in Subjects with Pollen Allergy

Airway Responsiveness to Inhaled Acetaldehyde in Subjects with Allergic Rhinitis: Relationship to Methacholine Responsiveness

<i>Background:</i> Asthmatic subjects have an exaggerated airway response to inhaled acetaldehyde, but no information is available on airway responsiveness to this bronchoconstrictor agent in subjects with allergic rhinitis. <i>Objective:</i> The aim of this study was to determine the effect of inhaled acetaldehyde on lung function in nonasthmatic subjects with allergic rhinitis. <i>Methods:</i> A total of 78 adults (43 subjects with allergic rhinitis, 16 asthmatics and 19 healthy subjects) were challenged with increased concentrations of acetaldehyde and methacholine. The response to each bronchoconstrictor agent was measured by the provocative concentra…

El esputo inducido como método para el estudio de la inflamación bronquial

SQ HDM SLIT-tablet (ALK) in treatment of asthma – Post hoc results from a randomised trial

SummaryIntroductionIn a double-blind, placebo-controlled trial (EudraCT identifier: 2006-001795-20), the standardised quality (SQ) house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet (ALK, Denmark) was investigated.MethodThe trial included 604 subjects, ≥14 years, with mild-moderate HDM allergic asthma. Subjects were randomised 1:1:1:1 to 1, 3 or 6 SQ-HDM or placebo once daily. The primary endpoint was reduction in inhaled corticosteroid (ICS) after one year. ICS reduction, asthma quality of life questionnaire (AQLQ) and asthma control questionnaire (ACQ) score was analysed post hoc in a subgroup with daily ICS use of 400–800 μg and ACQ score of 1–1.5, corresponding to partly contr…

Effect of Salmeterol on Seasonal Changes in Airway Responsiveness and Exhaled Nitric Oxide in Pollen-Sensitive Asthmatic Subjects

Objective Using a model of natural allergen exposure, we examined the effect of regular treatment with salmeterol on allergen-induced changes in airway responsiveness and exhaled nitric oxide (ENO). Design Double-blind, randomized, parallel-group study. Setting Specialist allergy unit in a university hospital. Patients Asthmatic patients sensitized to pollen allergens were randomly allocated to monotherapy with salmeterol (n = 14) or placebo (n = 13). Interventions Salmeterol, 25 μg, and placebo inhalers, two puffs bid, for 6 weeks. Measurements Spirometry, the level of a provocative concentration of a substance (methacholine) causing a 20% fall in FEV 1 (PC 20 ), the PC 20 level for adenos…

Maximal Response Plateau to Adenosine 5′-Monophosphate in Asthma

Background No information is available on the plateau in response to adenosine 5′-monophosphate. The aims of the present study were to determine whether plateau can be detected with AMP and the relation with the plateau in response to methacholine, and to identify the relation between the plateau and indirect markers of airway inflammation, such as exhaled nitric oxide (ENO) and exhaled breath condensate (EBC) pH. Methods Airway responsiveness to high concentrations of methacholine and AMP, ENO levels, and EBC pH values were obtained in 31 subjects with well-controlled asthma. Concentration-response curves were characterized by their concentration of agonist that produces a decrease in FEV …

Induced Sputum as a Method for the Study of Bronchial Inflammation

Differences in the Response to Methacholine Between the Tidal Breathing and Dosimeter Methods

Background It has been postulated that differences in provocative concentration of methacholine causing a 20% fall in FEV 1 (PC 20 ) values between the dosimeter method and tidal breathing method might be due to differences in the dose of agonist delivered to the mouth. The aim of the present study was to determine the influence of the dose of aerosol delivered to the mouth on differences in the response obtained with each challenge method. Methods This study measured airway responsiveness to methacholine by dosimeter method and tidal breathing method in 27 subjects with suspected asthma. The dosimeter was modified to deliver an identical volume to that obtained with the tidal breathing met…

The Effect Of Spirometry On Bronchial And Alveolar Nitric Oxide In Subjects With Asthma

The Effect of Spirometry on Bronchial and Alveolar Nitric Oxide in Subjects with Asthma

The effect of spirometric maneuvers on exhaled nitric oxide (NO) at the constant flow rate of 50 ml/s (FE(NO)) has been studied with equivocal results. Furthermore, the effects of spirometry on bronchial NO flux (J'aw(NO)) and alveolar NO (CA(NO)), two measurements increasingly being used in clinical and research protocols, are unknown. The aim of this study was to evaluate the effect of spirometry on FE(NO), J'aw(NO), and CA(NO) in adults with asthma.Forty-four adults with asthma were studied. To assess the impact of exhaled NO measurement itself on exhaled NO values, FE(NO), J'aw(NO), and CA(NO) were obtained twice, at baseline and after a resting period of 10 min. Then spirometry (with o…

Exhaled Nitric Oxide Measurement Is Not Useful for Predicting the Response to Inhaled Corticosteroids in Subjects With Chronic Cough

Background Increased concentrations of exhaled nitric oxide (ENO) are identified predominantly in subjects with chronic cough due to conditions that habitually respond well to therapy with inhaled corticosteroids (ICSs). The aim of this study was to assess the usefulness of ENO in predicting the response to ICS therapy in subjects with chronic cough and to determine the relationship between either methacholine or adenosine 5′-monophosphate (AMP) responsiveness and the response to ICS therapy. Methods A total of 43 patients with chronic cough were studied. During the baseline period, ENO measurement, spirometry, and concentration-response studies with both methacholine and AMP were performed…

Relationship between airway sensitivity to adenosine 5' monophosphate and the shape of the concentration-response curve to methacholine in subjects with allergic rhinitis.

Abstract The objective of this study was to determine differences in airway sensitivity to adenosine 5′-monophosphate (AMP) between allergic rhinitis subjects with plateau and those without evidence of plateau on the concentration–response curves to methacholine. A total of 51 adults (38 subjects with allergic rhinitis and 13 healthy controls) were challenged with increasing concentrations of methacholine and AMP. The methacholine challenge was terminated when there was a 40% or more decrease in forced expiratory volume in 1 sec (FEV 1 ), whereas the AMP challenge was stopped when FEV 1 had fallen by more than 20%. A plateau for methacholine was detected in all 13 healthy controls and in 27…

The effect of different periods of argon deaeration on exhaled breath condensate pH.

Exhaled breath condensate (EBC) pH has been considered as a biomarker of airway inflammation in asthma. However, little information is available on the duration of argon deaeration required to achieve a stable pH in EBC samples.To identify differences in EBC pH after argon deaeration for 2, 4, and 8 min.EBC pH was determined in EBC samples from 48 subjects with allergic rhinitis (11 asthmatics) and 14 healthy volunteers without deaeration and after argon deaeration for 2, 4, and 8 min.The mean (95% CI) pH values obtained from samples analyzed after 4 min [7.66 (7.52-7.80)] and 8 min [7.70 (7.55-7.85)] of argon deaeration were significantly less acidic (p.001) than those identified after 2 m…

Allergen-specific Immunotherapy with Purified nAlt a1: Effects on AMP Responsiveness, Exhaled Nitric Oxide and Exhaled Breath Condensate pH

El gasto público relacionado con la droga en Europa

Este estudio fue concebido para producir las primeras estimaciones del importe que los gobiernos europeos destinan al problema de las drogas. Para ello, la red europea de información sobre drogas y toxicomanías (REITOX) identifi có el gasto público consignado en relación con las drogas en los presupuestos de los gobiernos de 30 países para el año 2005. El gasto consignado fue clasifi cado mediante la Clasifi cación internacional de las funciones de gobierno (COFOG). El gasto no consignado en relación con las drogas (las cuantías incluidas en otros programas e intervenciones) en las áreas de Orden público y seguridad y Salud, fue estimado mediante técnicas de modelado. En general, los países…

Differences In Methacholine- And Adenosine 5-Monophosphate-Induced Changes In Forced Vital Capacity Between Methacholine-Responsive Subjects With Allergic Rhinitis And Patients With Asthma

Exhaled Nitric Oxide and Bronchial Responsiveness to Adenosine 5′-Monophosphate in Subjects With Allergic Rhinitis

Study objectives: To determine differences in exhaled nitric oxide (ENO) between subjects with allergic rhinitis with and without increased responsiveness to direct and indirect bronchoconstrictor agents. Study design: Cross-sectional study with the order of challenge tests randomized. Setting: Specialist allergy unit in a university hospital. Patients: Thirty-eight subjects without asthma with allergic rhinitis and 10 healthy nonatopic control subjects. Measurements and results: Participants were challenged with increasing concentrations of adenosine 5monophosphate (AMP) and methacholine. ENO was measured with the singleexhalation method. A positive response to both bronchoconstrictor agen…

Effect of a Nutritional Intervention on the Intestinal Microbiota of Vertically HIV-Infected Children: The Pediabiota Study

This article belongs to the Special Issue Role of Prebiotics and Probiotics in Health and Disease.

Effects of allergen exposure on methacholine and AMP-induced air trapping in pollen-sensitive subjects

Summary Background The effect of pro-inflammatory stimuli on bronchoconstrictor-induced air trapping has not been studied. Objective To determine the effect of natural allergen exposure, a pro-inflammatory stimulus, on methacholine- and adenosine 5′-monophospate (AMP)-induced air trapping. Methods Airway responsiveness to methacholine and AMP before and during the pollen season was obtained in 25 subjects with pollen allergy and in 10 healthy controls. The response was expressed by the sensitivity (PC 20 value) and by the slope and intercept of the FVC values recorded at each step of the challenge against the corresponding FEV 1 values. Results The slope and intercept FVC versus FEV 1 value…

Differences in sensitivity, maximal response and position of the concentration-response curve to methacholine between asthmatics, patients with allergic rhinitis and healthy subjects

The aim of this study was to detect differences in maximal response and position of the concentration-response curves to methacholine between asthmatics and subjects with allergic rhinitis. A total of 228 adults (107 mild asthmatics, 96 allergic rhinitics and 25 healthy control subjects) were challenged with methacholine. The test was interrupted when FEV1 dropped by more than 40% or when the highest concentration of methacholine (200 mg ml-1) had been administered. Concentration-response curves were characterized by their PC20 (concentration of methacholine that produced 20% fall in FEV1 = airway sensitivity), and if possible, by their EC50 (concentration of methacholine that produced 50% …

dIvergEnt: How IgE Axis Contributes to the Continuum of Allergic Asthma and Anti-IgE Therapies

[EN] Asthma is an airway disease characterised by chronic inflammation with intermittent or permanent symptoms including wheezing, shortness of breath, chest tightness, and cough, which vary in terms of their occurrence, frequency, and intensity. The most common associated feature in the airways of patients with asthma is airway inflammation. In recent decades, efforts have been made to characterise the heterogeneous clinical nature of asthma. The interest in improving the definitions of asthma phenotypes and endotypes is growing, although these classifications do not always correlate with prognosis nor are always appropriate therapeutic approaches. Attempts have been made to identify the m…

Effect of allergen-specific immunotherapy with purified Alt a1 on AMP responsiveness, exhaled nitric oxide and exhaled breath condensate pH: a randomized double blind study

Abstract Background Little information is available on the effect of allergen-specific immunotherapy on airway responsiveness and markers in exhaled air. The aims of this study were to assess the safety of immunotherapy with purified natural Alt a1 and its effect on airway responsiveness to direct and indirect bronchoconstrictor agents and markers in exhaled air. Methods This was a randomized double-blind trial. Subjects with allergic rhinitis with or without mild/moderate asthma sensitized to A alternata and who also had a positive skin prick test to Alt a1 were randomized to treatment with placebo (n = 18) or purified natural Alt a1 (n = 22) subcutaneously for 12 months. Bronchial respons…

Le comprimé d’immunothérapie sublinguale acariens SQ est efficace dans le traitement de l’asthme allergique ; résultats de l’essai de phase III MITRA

Introduction Les allergenes d’acariens domestiques sont associes a une pathologie respiratoire persistante. La rhinite allergique et l’asthme allergique (AA) coexistent frequemment. L’immunotherapie a le potentiel de modifier la cause de la maladie sous-jacente. Nous rapportons ici l’efficacite du comprime acarien d’immunotherapie sublinguale (ITSL) SQ-HDM (ALK, Danemark) sur le controle de l’asthme allergique aux acariens (AAA). Methodes L’essai europeen randomise en double aveugle controle par placebo MITRA (EudraCT 2010-018621-19) a inclus 834 sujets de 13 pays, ayant a l’inclusion un asthme allergique depuis plus d’un an, des tests de sensibilisation aux acariens positifs et un asthme m…

Bronchoconstriction induced by inhaled adenosine 5′-monophosphate in subjects with allergic rhinitis

Adenosine and its related nucleotide, adenosine 5′-monophosphate (AMP) induce bronchoconstriction in asthmatics, probably caused by histamine release from airway mast cells. The objective of this study was to determine the effect of inhaled AMP on lung function in subjects with allergic rhinitis.A total of 52 adults (28 subjects with allergic rhinitis, 14 asthmatics and 10 healthy subjects) were challenged with increasing concentrations of AMP and methacholine. Airflow was assessed after each concentration and the response to each bronchoconstrictor agent was measured by the provocative concentration required to produce a 20% fall (PC20) in forced expired volume in one second (FEV1).All 14 …

Effect of cigarette smoking on airway responsiveness to adenosine 5'-monophosphate in subjects with allergic rhinitis.

Study objectives: The objective of this study was to determine differences in airway responsiveness to adenosine 5-monophosphate (AMP) between smokers and nonsmokers with allergic rhinitis. Methods: A total of 41 adults with allergic rhinitis (16 smokers and 25 nonsmokers) were challenged with increasing concentrations of methacholine and AMP. Airflow was assessed after each concentration, and the response to each bronchoconstrictor agent was measured by the provocative concentration required to produce a 20% fall in FEV1 (PC20). Results: The geometric mean PC20 AMP values were significantly lower in smokers than in nonsmokers: 72.4 mg/mL (95% confidence interval [CI], 33.9 to 154.9) vs 204…

Modifications of airway responsiveness to adenosine 5'-monophosphate and exhaled nitric oxide concentrations after the pollen season in subjects with pollen-induced rhinitis.

s: To determine the effect of cessation of exposure to pollen on airway responsiveness to adenosine 5'-monophosphate (AMP) in subjects with pollen-induced rhinitis, and to explore the relationship between changes in airway responsiveness and changes in exhaled nitric oxide (ENO) levels.Subjects were studied during the pollen season and out of season.Specialist allergy unit in a university hospital.Fourteen subjects without asthma with pollen-induced rhinitis who showed bronchoconstriction in response to methacholine and AMP during the pollen season and 10 healthy nonatopic control subjects.In subjects with pollen-induced rhinitis, ENO concentrations, provocative concentration of agonist cau…

Effects of cigarette smoke on methacholine- and AMP-induced air trapping in asthmatics.

Abstract Objective: No information is available on the effect of cigarette smoke on bronchoconstrictor-induced air trapping in asthma. The aim of this study was to evaluate the additional influence of smoking on methacholine- and adenosine 5'-monophosphate (AMP)-induced air trapping in subjects with asthma.Airway responsiveness to methacholine and AMP, bronchial (J'awNO) and alveolar (CANO) nitric oxide (NO) and exhaled breath condensate pH were measured in 68 adults (23 current smokers with asthma, 23 non-smokers with asthma and 22 current or former smokers with chronic obstructive pulmonary disease; COPD). The degree of air trapping induced by each bronchoconstrictor agent was expressed b…

Modifications in FVC during AMP Induced Bronchoconstriction in Asthma: Relationship with the Response to Methacholine and Influence of Inhaled Corticosteroids.

Modifications in forced vital capacity during adenosine monophosphate-induced bronchoconstriction in asthma: relationship with the response to methacholine and the effect of inhaled corticosteroids.

Background The effect of adenosine monophosphate (AMP) on forced vital capacity (FVC) has never been systematically investigated. Objective To compare methacholine- and AMP-induced changes in FVC, as a marker of air trapping, in asthmatic patients treated and not treated with inhaled corticosteroids (ICSs). Methods Airway responsiveness to equipotent concentrations of AMP and methacholine was obtained in asthmatic patients treated (n = 32) and not treated (n = 18) with ICSs. The response was expressed by the provocation concentration of agonist that caused a decrease in forced expiratory volume in 1 second (FEV 1 ) of 20% (PC 20 ) and by the slope of the FVC values recorded at each step of …

Double-blind, randomized, placebo-controlled trial of allergen-specific immunotherapy with the major allergen Alt a1

Background: There have been few studies conducted on the efficacy and safety of specific immunotherapy with allergen extracts of fungi compared with other allergen extracts, and there are no data on the major allergen Alt a 1 of the fungus Alternaria alternata. Objectives: We sought to evaluate the efficacy and safety of subcutaneous immunotherapy with 2 different doses of Alt a 1 in patients with rhinoconjunctivitis caused by sensitization to A alternata. Method: We performed a multicenter, randomized, double-blind, placebo-controlled trial with Alt a 1 administered subcutaneously in patients with allergic rhinoconjunctivitis with or without controlled asthma aged 12 to 65 years. Three gro…

Efficacy of a House Dust Mite Sublingual Allergen Immunotherapy Tablet in Adults With Allergic Asthma: A Randomized Clinical Trial.

Importance The house dust mite (HDM) sublingual allergen immunotherapy (SLIT) tablet is a potential novel treatment option for HDM allergy–related asthma. Objectives To evaluate the efficacy and adverse events of the HDM SLIT tablet vs placebo for asthma exacerbations during an inhaled corticosteroid (ICS) reduction period. Design, Settings, and Participants Double-blind, randomized, placebo-controlled trial conducted between August 2011 and April 2013 in 109 European trial sites. The trial included 834 adults with HDM allergy–related asthma not well controlled by ICS or combination products, and with HDM allergy–related rhinitis. Key exclusion criteria were FEV 1 less than 70% of predicted…

Análisis del coste-efectividad de buprenorfina y metadona para el tratamiento de la dependencia de opiáceos en España: transferencia de un modelo económico desde el Reino Unido

A pesar de que la Buprenorfi na es una opción alternativa a la Metadona para el tratamiento de mantenimiento para la dependencia de opiáceos, la evidencia fármaco-económica en España es aún insufi ciente para extraer conclusiones sobre su fi nanciación pública. En el Reino Unido, el Instituto Nacional para la Salud y la Excelencia Clínica (NICE) publicó en 2007 una Guía de Práctica clínica que incluyó un análisis coste-efectividad de Buprenorfi na frente a Metadona desde la perspectiva del Sistema Nacional de Salud Británico. La transferencia geográfi ca de evaluaciones económicas realizadas en países diferentes tiene el potencial de facilitar la disponibilidad de información para un uso má…

Specific allergen immunotherapy for the treatment of allergic asthma: a review of current evidence.

Asthma is frequently associated with atopy, characterized by the production of specific immunoglobulin E in response to environmental allergens. Currently, two types of allergen immunotherapy (AIT) are used in clinical practice: subcutaneous and sublingual immunotherapy, both accepted as key components of the therapeutic repertoire for allergic rhinitis and conjunctivitis. However, their role in asthma remains controversial. The present document is aimed at providing the clinicians with a review of the evidence on the use of AIT in asthma, focusing on the most relevant aspects of its mechanism of action, its efficacy, and existing data on safety, tolerability, and cost-effectivity, both in …

Airway Responsiveness to Adenosine 5′-Monophosphate and Exhaled Nitric Oxide Measurements

Objectives To investigate the utility of the determination of airway responsiveness to inhaled adenosine 5′-monophosphate (AMP) and exhaled nitric oxide (ENO) levels as markers for safely reducing the dose of inhaled corticosteroids (ICS) in patients with asthma well controlled with a moderately high ICS dose. Methods A total of 37 patients with asthma well controlled for at least 3 months by treatment with a moderately high ICS dose (beclomethasone dipropionate, 500 to 1,000 μg or equivalent daily) were included in the study. Patients were treated for a 2-week run-in (baseline) period with their usual dose of ICS. For the next 12 weeks, patients were treated with ICS at half the previous d…

The effect of challenge method on methacholine-induced changes in sensitivity and air trapping

Summary Background The methacholine challenge test performed with the tidal breathing method induces a greater fall in FEV 1 than the dosimeter method; however, the effect of the challenge method on methacholine-induced fall in FVC has not been investigated. Objective To determine the influence of the challenge method on methacholine-induced changes in FEV 1 and FVC. Methods Airway responsiveness to methacholine was determined by dosimeter method and tidal breathing method in 37 subjects with suspected asthma. The dosimeter was modified to deliver an identical volume to that obtained with the tidal breathing method and the same nebulizer model was used for the two challenges. The response w…