Iwona Grzelewska-Rzymowska

Intercellular adhesion molecule 1 and tumor necrosis factor α in asthma and persistent allergic rhinitis: relationship with disease severity

BACKGROUND Tumor necrosis factor alpha (TNF-alpha) is involved in the up-regulation of intercellular adhesion molecule 1 (ICAM-1). Allergic rhinitis is often associated with bronchial hyperresponsiveness. OBJECTIVE We investigated the relationship between allergic airway disease severity and serum concentrations of soluble ICAM-1 (sICAM-1) and TNF-alpha and nasal expression of ICAM-1. METHODS Serum concentrations of TNF-alpha and sICAM-1 were investigated in 85 adults with persistent rhinitis and 90 patients with asthma. Seventy patients with rhinitis were challenged with methacholine. Nasal biopsy for ICAM-1 expression was performed in 6 patients with moderate-severe rhinitis and in 6 patients with mild rhinitis. RESULTS In patients with rhinitis, serum sICAM-1 concentrations were as follows: group without bronchial hyperresponsiveness (n = 29), 206.85 ng/mL; group with bronchial hyperresponsiveness but without asthma symptoms (n = 20), 233.39 ng/mL; and group with newly recognized asthma (n = 21), 260.06 ng/mL. The sICAM-1 level was significantly lower in patients with mild rhinitis (216.21 ng/mL) than in patients with moderate-severe rhinitis (244.08 ng/mL). Nasal ICAM-1 expression was significantly higher in the moderate-severe rhinitis group than in the mild rhinitis group. In patients with asthma, serum concentrations of sICAM-1 were as follows: patients with mild asthma, 272.8 ng/mL; patients with moderate asthma, 340.16 ng/mL; patients with severe asthma without oral corticosteroids therapy, 426.74 ng/mL; and patients with severe asthma with oral corticosteroids therapy, 314 ng/mL. The serum TNF-alphaa concentration differed between patients with rhinitis (n = 15) (1.065 pg/mL) and patients with asthma (n = 12) (3.46 pg/mL). Among patients with asthma, TNF-alpha concentrations were similar in all groups classified according to the disease severity. CONCLUSIONS sICAM and ICAM-1 expression correlates with airways diseases severity.

Stratification of patients with COPD according to the 2011 GOLD report.

INTRODUCTION The authors aimed to compare the distribution of COPD based on the new GOLD grading with stadium based exclusively on spirometry. MATERIAL AND METHODS Eligible patients had an average age of 64.8 years and smoked at least 10 pack-years. COPD was defined according to GOLD fixed cut-off criterion FEV1/FVC < 0.70. In all patients postbronchodilator spirometry was performed. Categories were defined with the mMRC dyspnoea scale and CAT scale. COPD exacerbations in the previous year and lung function were evaluated. Statistical comparisons were done using t-student test. RESULTS 315 COPD patients, 99 (31.4%) women and 216 (68.6%) men, were examined. Mean pack-years in the whole group was 47.1 ± 17.8. In women this figure was less than in men, 43.7 ± 19.2 vs 49.5 ± 16.5 (p > 0.05), respectively. At study entry, 144 subjects (45.7%) were current smokers, and the majority of them (n-87, 60.4%) belonged to category D - 26/66 (54.5%) women and 51/102 (50%) men. Based on spirometry alone, the patients were classified as moderate COPD 144 (45.71%), severe - 154 (48.89%), and very severe 17 (5.4%). According to the 2011 GOLD report stratification, 60 patients (19.04%) were graded as category A, 63 (20%) as category B, 24 (7.62%) as category C, and 168 (53.33%) as category D, although 21 (12.5% of them) were in category B, but the number of exacerbations classified them as category D. CONCLUSIONS The COPD population is heterogeneous in reference to the symptoms, value of FEV1, and susceptibility to exacerbations. Clinical symptoms assessed using validated questionnaires characterized COPD patients better than the value of spirometric parameters (which are necessary for diagnosis of this disease). Some patients were difficult to classify, especially those belonging to category C.

Association between asthma control test, pulmonary function tests and non-specific bronchial hyperresponsiveness in assessing the level of asthma control

INTRODUCTION Global Initiative for Asthma (GINA) reports emphasize the use of validated and simple tools in order to assess the level of asthma control, as the Asthma Control Test (ACT). However, an ACT does not include assessment of airway inflammation, which is better reflected when measuring nonspecific bronchial hyperresponsiveness (BHR). The authors aimed to find out if the level of asthma control quantified by an ACT correlates with BHR and pulmonary function tests. MATERIAL AND METHODS 118 asthmatics participated in the study. All patients completed an ACT. The scores of the ACTs were compared with pulmonary function tests and BHR assessed with the methacholine challenge test and expressed as a provocative concentration of methacholine, inducing a 20% decline in the FEV1 (PC20 M in mg/ml). RESULTS Patients with controlled asthma amounted to 52 (44%) while those with uncontrolled asthma amounted to 66 (56%). In patients with controlled asthma (ACT score ≥ 20) the mean geometric value of PC20M was 2.72 mg/ml (range from 0.25 to > 8.0), whereas 0.94 mg/ml (range from 0.28 to 8.0) (p = 0.02) was observed in patients with uncontrolled asthma (ACT score < 20). Almost 64% (21/33) of uncontrolled asthmatics achieved normal lung function (FEV1 > 80% pred. value) while 19% (5/26) patients with controlled asthma presented an FEV1 < 80% predicted value. Asthma duration in years in controlled asthmatics was significantly shorter than in uncontrolled patients (6.2 ± 8.9 vs. 12.0 ± 11.4, p = 0.005) CONCLUSION: In determining the most accurate level of asthma control it is reasonable to use an ACT in conjunction with BHR, which provides more accurate assessment of bronchial inflammation than ventilatory parameters alone.