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L'essentiel de la littérature réçente en Pneumologie

In this heading we propose you a review of the literature through a selection of abstracts of recent original articles.
we will try to keep you informed about the last news on Pulmonology. We provide you only the summary of the article and the corresponding link, to reach the article in full text you must be registered with the corresponding review.

Click here to consult the list of the available free medical journals in lung diseases.

Characteristics of eosinophilic and non-eosinophilic asthma during treatment with inhaled corticosteroids. Print E-mail
Wednesday, 22 October 2014 06:49

eosinophilObjective: Eosinophilic inflammation in the respiratory tract is a hallmark of bronchial asthma. In naïve cases, the inflammatory profile is associated with disease severity and reactivity to inhaled corticosteroids (ICS). Sustained airway eosinophilia has been reported during ICS treatment. However, how this contributes to asthma control is unclear, nor are the immunologic characteristics of these cases known. This study was performed to determine the answer these questions.

Methods: To compare phenotypes of eosinophilic and non-eosinophilic asthma (EA and NEA, respectively) under ICS treatment, clinical data were obtained from asthmatic subjects (n = 22) and healthy controls (n = 10), and the leukocyte compositions of induced sputum and peripheral blood were determined. T lymphocyte profiles in systemic blood were assessed by flow cytometry.

Results: A higher frequency of emergency room visits was observed in the NEA group, which had a higher neutrophil count relative to the total inflammatory cell population in induced sputum than the EA group (59.5% vs. 36.6%; P < 0.01). The fraction of helper T (Th)17 lymphocytes as well as the ratio of Th17 to regulatory T cells (Treg) in the peripheral blood was higher in the NEA than in the EA group (0.24 vs. 0.13; P < 0.05).

Conclusions: Th17 were more prevalent than Treg cells in the peripheral blood of NEA patients under ICS treatment, corresponding to neutrophil-dominant airway inflammation and a severe asthmatic phenotype. Thus, an imbalance in Th17/Treg may be associated with the pathogenesis of NEA in patients undergoing ICS treatment.

PMID: 25329682 [PubMed - as supplied by publisher]

Effects of Regular Treatment with Combination of Salmeterol / Fluticasone Propionate and Salmeterol Alone in Cough Variant Asthma. Print E-mail
Wednesday, 22 October 2014 06:49

Objective: Cough variant asthma (CVA) is an important cause of chronic cough, and pathophysiological features of the disease appear to be similar to typical asthma. Because CVA is recognized as a precursor of asthma, early intervention with long-term anti-inflammatory agents may be recommended. However, the role of combination therapy with inhaled corticosteroid and b2-agonist in the treatment of CVA has not been elucidated. To evaluate the effectiveness of the combination therapy, we investigated the clinical impact of regular treatment with salmeterol/fliticasone propionate combination (SFC) and inhaled salmeterol (SAL) alone in patients with CVA.

Methods: The study was a randomized, controlled, parallel-group multi-center trial. Forty-three CVA patients were assigned to SFC (50/100mg once daily) or SAL (50mg twice daily) for 12 weeks. Then, these medications were stopped for the next 24 weeks. Main outcome measures were cough symptoms, pulmonary function and airway inflammation.

Results: Treatment with each of SFC and SAL significantly decreased cough scores and increased FEV1 and PEF, where the efficacy was more pronounced with SFC than SAL. SFC also decreased sputum eosinophil counts and eosinophil cationic protein contents, whereas SAL had no effect. After discontinuation of the treatment, cough scores increased, pulmonary function and eosinophilic airway inflammation were aggravated and returned to the baseline levels.

Conclusions: Maintenance therapy with SFC provides further improvements in cough symptoms, pulmonary function and airway inflammation, and discontinuation of the therapy causes worsening of the disease, indicating that stopping or interrupting anti-inflammatory therapy may not be advisable in patients with CVA.

The FACT Score in Predicting Pneumococcal Antibody Levels in Asthmatics. Print E-mail
Wednesday, 22 October 2014 06:49

There is no measure currently available to identify asthmatics with potential immune incompetence. Objective: We propose use of a novel scoring system called the FACT score, which is formulated based on 4 parameters:

  1. Family history of asthma,
  2. Atopic conditions,
  3. Bacterial colonization,
  4. and Th1 vs. Th2 immune profile.

Methods: This was a cross-sectional study involving 16 asthmatics and 14 non-asthmatics. The first two parameters of the FACT score were obtained via a chart review and interview. For the third parameter, nasopharyngeal swab samples were cultured. The ratio of interleukin-5 to interferon--gamma for each patient was measured by peripheral blood mononuclear cells cultured with house dust mite. Antibodies to 23 pneumococcal antigens were used for humoral immunity.

Results: The FACT scores for asthmatics (mean±SD: 5.2±1.87) were higher than those for non-asthmatics (mean±SD: 3.3±1.5)(p=0.008). Of the 16 asthmatics, 7 (44%) had 12 or more positive serotype-specific polysaccharide antibodies whereas 12 of 14 (86%) of non-asthmatics subjects had 12 or more positive serotype-specific polysaccharide antibodies (p = 0.014). Overall, the FACT score was inversely correlated with the number of positive serotype-specific antibody levels (rho (ρ) = -0.38, p = 0.04). The proportions of subjects with 12 or more positive serotype-specific antibodies among non-asthmatics and asthmatics below and above the median of the FACT scores were 86%, 50% and 38%, respectively (p = 0.052).

Conclusions: The FACT score may help us identify a subset of asthmatics with immune incompetence. Study findings need to be replicated in a larger study.

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