Berrin Ceyhan

Bronchial hyperreactivity and Allergic status in inflammatory bowel disease

Background: Despite the known systemic manifestations of inflammatory bowel disease (IBD) and a large number of reports associating lung disease and IBD, the frequency of atopy and bronchial hyperreactivity (BHR) in IBD remains obscure. Objectives: The aim of this study was to investigate the prevalence of abnormal pulmonary function tests, BHR and the atopic status in patients with IBD. Methods: Thirty patients with IBD (19 with ulcerative colitis and 11 with Crohn’s disease; 19 male, 11 female) and 16 controls without any gastrointestinal disease (9 female, 7 male) were included. Patients were questioned with respect to pulmonary and allergic symptoms; subsequently, lung function tests, BHR, skin prick test positivity, peripheral eosinophilia and serum IgE levels were evaluated and compared with those of control subjects. Results: The mean duration of IBD was 5.3 ± 4.8 years. IBD patients had significantly more often respiratory symptoms in comparison with controls (odds ratio, OR: 9.0, p < 0.04). A previous diagnosis of asthma and antiasthmatic drug treatment were noted in 3/30 (10%) IBD patients. Allergic symptoms were more prevalent in IBD patients in comparison with the controls (OR: 13, p < 0.007), particularly in patients with ulcerative colitis (OR: 16, p < 0.004). The mean FEV1 was 3.1 ± 0.9 liters (96 ± 18% predicted), mean methacholine PD20: 14.7 ± 3.6 mg/ml, mean IgE: 190.5 ± 305.6 IU/ml (normal value <94 IU/ml) and the percentage of peripheral eosinophils was 3.1 ± 3.3% in the IBD patients. These values did not result in statistically significant differences in comparison with controls. Furthermore, abnormal lung function and BHR were observed in 8/30 (27%) and 5/30 (17%) IBD patients, respectively. Abnormal lung function tests were more prevalent in the IBD patients than in the controls (OR: 12, p < 0.04). Skin prick tests were positive in 15/30 (50%) IBD patients. The risk of a positive skin prick test increased in the IBD patients in comparison with the controls (OR: 7.0, p < 0.02). Duration and activity of IBD did not influence the prevalence of BHR, allergic and respiratory symptoms, abnormal lung function, high serum IgE levels and skin test positivity. Conclusions: Allergic symptoms, respiratory symptoms, abnormal lung function tests and skin prick test positivity were more common among the IBD patients in comparison with the controls.

Transforming growth factor beta-1 level in pleural effusion.

Objective:  Transforming growth factor‐β1 is an important immunomodulator. The diagnostic role of TGF‐β1 has not been systematically investigated in pleural effusion.

Angiotensin converting enzyme gene polymorphism in Turkish asthmatic patients.

Asthma is a chronic inflammatory disease of the airways. Several candidate genes have been identified with a potential role in the pathogenesis of asthma, including the angiotensin converting enzyme (ACE) gene. We aimed to investigate the frequency of an ACE gene polymorphism in Turkish asthmatic patients and to determine its impact on clinical parameters and disease severity. Ninety-seven asthmatic patients (M/F 25/72, mean age 39 ± 13 years) and 96 healthy subjects (M/F 26/70, mean age 38 ± 12 years) were included. At baseline, all participants completed a questionnaire on demographics, symptoms, triggering factors, severity of asthma, and the presence of atopism. Blood samples were obtained from all patients and genomic DNA was isolated. The frequency of the ACE genotypes (I = insertion and D = deletion) among asthmatics and controls were compared: asthmatics showed a 40.2% prevalence of the DD genotype (n = 39), ID was 45.4% (n = 44), and II was 14.4% (n = 14.4). In the control subjects, the frequency of DD was18.8% (n = 18), ID was 50% (n = 48) and II was 31.3% (n = 30). The DD ACEgenotype was significantly more frequent in asthmatics compared with controls (p < 0.001). Asthmatics with the ID ACE genotype showed a higher frequency of drug allergies, although this was not statistically significant (p = 0.08). Asthmatics with the DD genotype appeared to have a higher incidence of asthmatic episode exacerbations due to viral infections, but again this was not statistically significant (p = 0.08). Patients with mild or moderate-severe asthma had similar frequencies of these mutations. We found a higher frequency of the ACE DD gene mutation in Turkish asthmatic patients compared with non-asthmatics, suggesting that this ACE gene polymorphism may be a risk factor for asthma but does not increase the severity of the disease.

Non‐atopic asthma in children is related to maternal bronchial hyperreactivity

Data on the pathogenic mechanisms underlying the development of non‐atopic asthma in children are scarce. Our aim was to evaluate the association and compare the atopic status, pulmonary functions, bronchial hyperresponsiveness and serum total immunoglobulin E (IgE) levels of parents of atopic and non‐atopic asthmatic children by using objective methods. Fifty‐one asthmatic children aged 4–16 yr and their parents were included into the study. Initially the American Thoracic Society’s Respiratory Disease questionnaire inquiring data on symptoms of asthma, rhinitis and past medical history was filled in. Afterwards, skin prick test with aeroallergens, pulmonary function and methacholine bronchial provocation tests and serum sampling for total IgE level determinations were carried out. Bronchial hyperresponsiveness to methacholine was significantly more common in the mothers of non‐atopic children compared to those of atopic ones, although no significant difference was observed in the skin prick test reactivity, pulmonary function test parameters and serum IgE levels. Questionnaire data revealed that the presence of asthmatic symptoms such as wheezing and phlegm and doctor‐diagnosed asthma were more common in the mothers of non‐atopic children. Meanwhile, asthmatic symptoms were also found to be significantly more common in fathers of non‐atopic children. Logistic regression analyses revealed that maternal PC20 was the only predictive factor for the risk of displaying non‐allergic asthma in children. The results demonstrate that among the risk factors studied, maternal bronchial hyperreactivity was associated with the development of asthma in non‐atopic children.

Serum-effusion Albumin Gradient in Separation of Transudative and Exudative Pleural Effusions

Communications to the Editor 5 Aoki T, Inoue H, Sasaki H, Shimura S. Maeda S, Tomioka M, et al. Relation between selective alveolo-bronchograms and pulmonary function tests in patients with chronic obstructive lung disease. Am Rev Respir Dis 1984; 129:465-72 6 Honda I, Shimura S, Sasaki T, Sasaki H, Takishima T, Nakamura M. Airway mucosal permeability in chronic bronchitis and bronchial asthmatics with hypersecretion. Am Rev Respir Dis 1998; 137:866-71 7 Aikawa T, Shimura S. Sasaki H, Takishima T, Yaegasi H, Takahashi T. Morphometric analysis of intraluminal mucus in airways in obstructive lung disease. Am Rev Respir Dis 1989; 140:477-82

Effects of biomass smoke on pulmonary functions: a case control study

Background Biomass smoke is the leading cause of COPD in developing countries such as Turkey. In rural areas of Turkey, females are more exposed to biomass smoke because of traditional lifestyles. Aim The aim of this study was to determine the adverse effects of biomass smoke on pulmonary functions and define the relationship between duration in years and an index (cumulative exposure index) with altered pulmonary function test results. Participants and methods A total of 115 females who lived in the village of Kağizman (a borough of Kars located in the eastern part of Turkey) and were exposed to biomass smoke were included in the study. The control group was generated with 73 individuals living in the same area who were never exposed to biomass smoke. Results Twenty-seven (23.8%) females in the study group and four (5.5%) in the control group had small airway disease (P=0.038). Twenty-two (19.1%) females in the study group and ten (13.7%) in the control group had obstruction (P=0.223). Twenty (17.3%) females in the study group who were exposed to biomass smoke had restriction compared with ten (13%) in the control group (P=0.189). The duration needed for the existence of small airway disease was 16 years, for obstructive airway disease was 17 years, and for restrictive airway disease was 17 years. The intensity of biomass smoke was defined in terms of cumulative exposure index; it was calculated by multiplying hours per day, weeks per month, and total years of smoke exposure and dividing the result by three. Conclusion Exposure to biomass smoke is a serious public health problem, especially in rural areas of developing countries, because of its negative effects on pulmonary functions. As the duration and the intensity of exposure increase, the probability of having altered pulmonary function test results is higher.

Role of the Adhesion Molecule ICAM-1 in Asthma

Cells need to interact with one another for the inflammatory response to occur. The intercellular adhesion molecule-1 (ICAM-1), a member of the immunoglobulin supergene family, plays an important role in inflammation, and circulating ICAM-1 has been reported to be elevated in patients with some inflammatory disorders. To study the influence of asthma on circulating ICAM-1 levels, we measured concentrations of circulating ICAM-1 in patients with asthma. Fifteen patients (6 male, 9 female, mean age: 30 +/- 7 years) and 5 controls (2 male, 3 female, mean age: 25 +/- 6 years) were included in the study. Daily peak flow rates and symptom scores were monitored over a week in all patients and methacholine challenge tests were performed in 7 patients. The spirometric analysis of asthmatic patients demonstrated mean FEV1: 2.57 +/- 0.97 L (74.9 +/- 17.7% predicted), mean FEV1/FVC: 70.1 +/- 9.6%, mean bronchodilator response: 19.2 +/- 8.4%. The mean morning peak flow rate was 331.0 +/- 122.2 L/min, the mean evening peak flow rate 389.0 +/- 118.5 L/min, the mean peripheral eosinophil count 268 +/- 451/mm3, and the mean serum IgE level 327.4 +/- 238.2 IU/ml. The mean serum ICAM-1 levels of asthmatic patients and controls were 429 +/- 133 ng/ml and 405.0 +/- 81.0 ng/ml, respectively. There was no statistical difference between these levels. Furthermore, we could find no correlation between serum ICAM-1 levels and FEV1, serum IgE levels, peak flow rates, and symptom scores, or methacholine PD20 values in asthmatic patients. The results of this study suggest that serum ICAM-1 levels are not increased in asthmatic patients over controls and do not correlate with clinical asthma status.

Asociación del déficit grave de vitamina D con la función pulmonar y el control del asma

INTRODUCTION To examine the relationship between severe vitamin D deficiency, asthma control, and pulmonary function in Turkish adults with asthma. METHODS One hundred six asthmatic patients underwent pulmonary function tests skin prick test, peripheral blood eosinophil counts, IgE, body mass index and vitamin D levels were determined. Patients were divided into 2 subgroups according to vitamin D levels (vitamin D level<10ng/ml and vitamin D level≥10 ng/ml). Asthma control tests were performed. RESULTS The mean age of subgroup i (vitamin D level<10) was 37±10 and the mean age of subgroup ii (vitamin D level≥10ng/ml) was 34±8. Sixty-six percent of patients had severe vitamin D deficiency (vitamin D level<10 ng/ml). There was a significant trend towards lower absolute FEV1 (L) values in patients with lower vitamin D levels (P=.001). Asthma control test scores were significantly low in the severe deficiency group than the other group (P=.02). There were a greater number of patients with uncontrolled asthma (asthma control test scores<20) in the severe vitamin D deficiency group (P=.040). Patients with severe vitamin D deficiency had a higher usage of inhaled corticosteroids than the group without severe vitamin D deficiency (P=.015). There was a significant trend towards lower absolute FEV1 (L) (P=.005, r=.272) values in patients with lower vitamin D levels. Vitamin D levels were inversely related with body mass index (P=.046). CONCLUSION The incidence of severe vitamin D deficiency was high in adult Turkish asthmatics. In addition, lower vitamin D levels were associated with poor asthma control and decreased pulmonary function.

Interstitial pneumonitis associated with pegylated interferon-alpha 2a and ribavirin for chronic hepatitis C infection: a case report

Interstitial pneumonitis is a rare but potentially fatal side effect occurring from 2 weeks to 16 weeks after the initiation of treatment with pegylated interferon alpha and ribavirin for chronic hepatitis C.Herein, we present a 68-year-old man with chronic hepatitis C virus infection who developed interstitial pneumonitis association with pegylated interferon after 36 weeks initiation of pegylated interferon-alpha and ribavirin therapy. He did not recover after discontinuation of pegylated interferon/ribavirin and improved by steroid therapy.

Effect of Inhaled Ingredients of a Commercial Cyclosporin A Ampoule on Airway Inflammation

This article is also accessible online at: http://BioMedNet.com/karger Dear Sir, We have published a study documenting the effect of inhaled cyclosporin A (Cyc-A) on the rat airway inflammation in this issue [1]. Our approach to assess the effect of pure Cyc-A was not rigorous since we used a commercial Cyc-A ampoule (50 mg cyclosporin A, 278 mg ethanol and 650 mg castor oil in a 1-ml intravenous ampoule; Sandoz, Basel, Switzerland). We have recently studied 10 additional rats to evaluate the effect of the ingredients (ethanol, castor oil) on the airway inflammation of sensitized rats. Twenty-one days after the initial intraperitoneal ovalbumin injection (1 mg ovalbumin and 100 mg Al(OH)3 in 1 ml 0.9% NaCl), animals were administered a nebulized ethanol and castor oil solution (278 mg ethanol and 650 mg castor oil in 1 ml 0.9% NaCl, adjusted dose: 0.4 ml/kg diluted to 2 ml with 0.9% NaCl) 1 h prior to exposure to nebulized ovalbumin; the same procedure was repeated on the 2nd day. 18–24 h later, bronchoalveolar lavage (BAL), peripheral blood and lung tissue sampling were performed as previously described [2, 3]. There was a nonsignificant decrease in the percentage of neutrophils (26.3 B 26.8 vs. 7.4 B 2.1%; p ! 0.06), a significant decrease in macrophages (66.1 B 7.7 vs. 63.6 B 7.2%; p ! 0.02), a nonsignificant increase in lymphocytes (21.1 B 12.4 vs. 24.4 B 7.0%; p 1 0.05) and a significant increase in eosinophils (2.4 B 2.6 vs. 4.7 B 2.0%; p ! 0.02) in the BAL of the ingredient pretreated group as compared with the group pretreated with the commercial Cyc-A ampoule. On light microscopic examination of the lung tissue samples, a significantly higher eosinophil count per high-powered field (HPF) (!400) (0 B 0 vs. 2.6 B 3.9/HPF in trachea, p ! 0.05; 4.3 B 9.4 vs. 16.1 B 12.4 in bronchi, p ! 0.008; 19.4 B 38.4 vs. 35 B 2.2 in bronchioles, p ! 0.02 was obtained in the ingredient-pretreated group compared to the group pretreated with the commercial Cyc-A ampoule. The percentage of peripheral blood eosinophil was significantly decreased in the ingredient-treated group (6.9 B 4.7 vs. 2.2 B 2.7%; p ! 0.004) compared with the group treated with the commercial Cyc-A ampoule. Our former study published in this issue demonstrated that commercial Cyc-A ampoule inhalation inhibits eosinophilia nonsignificantly in BAL and significantly in lung tissue in sensitized rat airway walls, with an increase of neutrophils in BAL and increase of peripheral blood eosinophils. This second part of the study showed that ingredients have no effect on BAL and lung tissue eosinophilia. It is likely that the immunosuppressive effect of the commercial Cyc-A ampoule is not mediated by the ingredients. Interestingly, we were unable to find neutrophilia in BAL and lung tissue or eosinophilia in the peripheral blood in rats pretreated with the ingredients. We postulate that eosinophils migrate from the lung to the peripheral blood with pure Cyc-A; however, we are unable to explain the pulmonary neutrophilia due to pure Cyc-A and this should be tested prospectively. Nevertheless, the definitive suggestions as to the most appropriate Cyc-A therapy in asthma still await the results of pure Cyc-A solution studies.