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Measurement of Exhaled Breath Temperature to Assess Changes in Airway Inflammation
Abstracts S193
J ALLERGY CLIN IMMUNOL VOLUME 117, NUMBER 2
Fungi Play an Important Role in Bronchial Asthma
T. Hofman, A. M. Hofman, A. Urbanowicz, J. Michalik; Center of Allergology, Poznan, POLAND. RATIONALE: The cause of bronchial asthma (BA) is not known, yet. The aim of this study was to establish if the fungi play the role in BA. METHODS: The examination group was composed of 58 patients (34 women, 25 men) with BA in age 4-76, average 36.4 y. and control group -12 healthy persons in age 18-55 (12 women).The diagnosis of BA was performed along the ATS criteria. From patients sputum inhalation test was taken. In the sputum DNA-fungi by PCR method was examinated. We examinated only four fungi: Candida albicans, Aspergillus fumigatus, Fusarium moniliforme, Penicillium notatum.In all patients skin prick test (SPT), spirometry, cultures, history and examination was performed. RESULTS: In sputum from patients with BA in 53/58(91.4%) positive PCR test with fungi was found. Among them: 34/58(58.6%) was Aspergillus fumigatus, 17/58(29.3%) - Candida albicans, 5/58 (8.6%) Fusarium moniliforme, 2/58(3.4%) - Penicillium notatum. In 5 patiens few fungi in sputum were detected. In healthy patients no fungi DNA was found. In examination group with BA 20/58(34.4%) had positive SPT, among them 3 had food allergy, 7/58(12.1%)- aspirin intolerance, 38/58(65.5%) chronic sinusitis and/or chronic gastrointestinal disorders or recurrent vaginal fungal infections, 36/58 (62.1%) had positive mycological cultures from nose, throat or stool- the most often Candida albicans. CONCLUSIONS: The fungi, especially Aspergillus fumigatus and Candida albicans, play important role in ethiopathogenesis of BA. Measurement of Exhaled Breath Temperature to Assess Changes in Airway Inflammation T. Popov1, S. Dunev1, T. Kralimarkova1, L. M. DuBuske2; 1Medical University of Sofia, Sofia, BULGARIA, 2Immunology Research Institute of New England, Gardner, MA. RATIONALE: Inflammation is characterized by increased heat production. Inflamed airways contribute to overall exhaled breath temperature (EBT) which can be detected and is perhaps clinically useful to assess. METHODS: A simple device to measure EBT tested for reproducibility in 11 healthy controls. The ability to discriminate between healthy controls (n=17) and asthmatics (n=19), and to detect changes in asthma control in 14 asthmatics before and after anti-inflammatory treatment was assessed. RESULTS: The reproducibility in healthy subjects calculated as intraclass correlation coefficient was 0.99. The reproducibility of atrial and axillary temperatures measured in parallel was much lower, suggesting EBT is a more consistent physiological variable. There was a difference between the exhaled air temperature of asthmatics (34.41 ± 0.27C) and controls (35.02 ± 0.2C), but there was considerable overlap (p=0.081). There was also a difference between the exhaled air temperature of asthmatics before (35.33 ± 0.17C) and after treatment (34.64 ± 0.21C). CONCLUSIONS: The EBT device can measure the temperature of exhaled air in human subjects in a simple way. EBT may assist in determining the degree of control of asthmatic airway inflammation. Funding: Association Asthma
745
The Role of Histamine Challenge and Progressive Exercise Testing in the Diagnosis of Vocal Cord Dysfunction A. E. Stanton1, K. MacKenzie2, R. Carter1, C. E. Bucknall1; 1Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UNITED KINGDOM, 2Department of Otolaryngology, Glasgow Royal Infirmary, Glasgow, UNITED KINGDOM. RATIONALE: We sought to establish if combined histamine challenge testing (HCT) and progressive exercise testing (PET) was of value in the
746
diagnosis of Vocal Cord Dysfunction (VCD). To our knowledge no previous study has evaluated both methods of challenge testing for VCD diagnosis in the same group of patients. METHODS: 9 patients with asthma and clinical suspicion of VCD took part in the study. Baseline laryngoscopy, flow volume loop (FVL) and airway resistance using the forced oscillation technique (with separate values obtained for inspiration (Ri), expiration (Re) and over the whole breath (Rt)) were performed. All measures were repeated following HCT and PET. RESULTS: 1 patient was unable to perform either challenge due to airflow obstruction (FEV1 48% predicted). 1 patient performed HCT only with the remaining 7 patients completing the study protocol. At baseline no patient had VCD. 5/9 had appearances of mild chronic laryngitis. There was no change in laryngeal appearances following HCT or PET in any patient. Furthermore there was no evidence of inspiratory FVL truncation with either challenge in any patient. Mean (SD) Ri increased from 0.41 (0.17) kPa/l/sec to 0.69 (0.16) (95% CI for difference -0.45, -0.12, p = 0.005) during HCT but there was no change following PET. Changes in Re and Rt were similar following HCT. CONCLUSIONS: In a small sample of patients with asthma in whom VCD was suspected, our strategy of histamine and exercise testing was of no diagnostic value. Funding: Royal College of Physicians and Surgeons of Glasgow
747
Cytokines Epistasis Contributes to Childhood Asthma
I. R. Genov1, A. Goncalves-Primo, Jr.1, A. Yambartsev2, L. K. Arruda3, A. S. Zampolo3, V. P. L. Ferriani4, D. Solé1, C. K. Naspitz1, M. GerbaseDeLima1, A. Morgun1; 1Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, BRAZIL, 2Mathematics and Statistics Institute, University of Sao Paulo, Sao Paulo, BRAZIL, 3Department of Medicine, University of Sao Paulo, Ribeirao Preto, BRAZIL, 4Department of Pediatrics, University of Sao Paulo, Ribeirao Preto, BRAZIL. RATIONALE: Asthma is a complex disease with multiple genetic and environmental components. Some evidences indicate that the underlying genetics of asthma is not based on single major gene, but on interactions among genes. METHODS: Polymorphisms of TNFA(-308G/A), TGFB1(+869 T/C and +915 C/G), IL10(-1082 G/A, -819 C/T and -592 C/A), IL6(-174 G/C) and INFG(+874 T/A) genes were determined in White (W)(n=129) and Mulatto (M)(n=131) asthmatic children and in W(n=168) and M(n=178) healthy controls. Isolated or combined SNPs frequencies were compared between asthmatic children and ethnically matched controls and, within the group of asthmatic children, between patients with mild (MA) and moderate/severe (MSA) asthma. For each genotypic combination of SNPs, significant associations were searched using the delete-d-jackknife resampling method with significance level set at 0.001. To circumvent multiple hypotheses problem we separately analyzed each ethnicity and estimated the probability of finding the same association(s) in two independent case/control studies by chance using binomial distribution (p<0.0003). RESULTS: The frequency of TGFB1+869CC/IL10-1082AA combination was lower in asthmatic children than in controls (6% vs 11% in both ethnicities). Also, we observed lower frequencies of TNFA-308GG/IL10819CT in MA than in MSA patients, (28% vs 44% in W; 33% vs 49% in M) and higher frequencies of TGFB1+915GG/ IL10-819CC (41% vs 26% in W; 40% vs 29% in M) and IL10-819CC/ IFNG TA (24% vs 13% in W; 19% vs 9% in M) in MA than in MSA patients. CONCLUSIONS: Our results suggest that epistatic interactions between cytokine genes may contribute to susceptibility and severity of asthma.
MONDAY
744
J ALLERGY CLIN IMMUNOL VOLUME 117, NUMBER 2
Fungi Play an Important Role in Bronchial Asthma
T. Hofman, A. M. Hofman, A. Urbanowicz, J. Michalik; Center of Allergology, Poznan, POLAND. RATIONALE: The cause of bronchial asthma (BA) is not known, yet. The aim of this study was to establish if the fungi play the role in BA. METHODS: The examination group was composed of 58 patients (34 women, 25 men) with BA in age 4-76, average 36.4 y. and control group -12 healthy persons in age 18-55 (12 women).The diagnosis of BA was performed along the ATS criteria. From patients sputum inhalation test was taken. In the sputum DNA-fungi by PCR method was examinated. We examinated only four fungi: Candida albicans, Aspergillus fumigatus, Fusarium moniliforme, Penicillium notatum.In all patients skin prick test (SPT), spirometry, cultures, history and examination was performed. RESULTS: In sputum from patients with BA in 53/58(91.4%) positive PCR test with fungi was found. Among them: 34/58(58.6%) was Aspergillus fumigatus, 17/58(29.3%) - Candida albicans, 5/58 (8.6%) Fusarium moniliforme, 2/58(3.4%) - Penicillium notatum. In 5 patiens few fungi in sputum were detected. In healthy patients no fungi DNA was found. In examination group with BA 20/58(34.4%) had positive SPT, among them 3 had food allergy, 7/58(12.1%)- aspirin intolerance, 38/58(65.5%) chronic sinusitis and/or chronic gastrointestinal disorders or recurrent vaginal fungal infections, 36/58 (62.1%) had positive mycological cultures from nose, throat or stool- the most often Candida albicans. CONCLUSIONS: The fungi, especially Aspergillus fumigatus and Candida albicans, play important role in ethiopathogenesis of BA. Measurement of Exhaled Breath Temperature to Assess Changes in Airway Inflammation T. Popov1, S. Dunev1, T. Kralimarkova1, L. M. DuBuske2; 1Medical University of Sofia, Sofia, BULGARIA, 2Immunology Research Institute of New England, Gardner, MA. RATIONALE: Inflammation is characterized by increased heat production. Inflamed airways contribute to overall exhaled breath temperature (EBT) which can be detected and is perhaps clinically useful to assess. METHODS: A simple device to measure EBT tested for reproducibility in 11 healthy controls. The ability to discriminate between healthy controls (n=17) and asthmatics (n=19), and to detect changes in asthma control in 14 asthmatics before and after anti-inflammatory treatment was assessed. RESULTS: The reproducibility in healthy subjects calculated as intraclass correlation coefficient was 0.99. The reproducibility of atrial and axillary temperatures measured in parallel was much lower, suggesting EBT is a more consistent physiological variable. There was a difference between the exhaled air temperature of asthmatics (34.41 ± 0.27C) and controls (35.02 ± 0.2C), but there was considerable overlap (p=0.081). There was also a difference between the exhaled air temperature of asthmatics before (35.33 ± 0.17C) and after treatment (34.64 ± 0.21C). CONCLUSIONS: The EBT device can measure the temperature of exhaled air in human subjects in a simple way. EBT may assist in determining the degree of control of asthmatic airway inflammation. Funding: Association Asthma
745
The Role of Histamine Challenge and Progressive Exercise Testing in the Diagnosis of Vocal Cord Dysfunction A. E. Stanton1, K. MacKenzie2, R. Carter1, C. E. Bucknall1; 1Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UNITED KINGDOM, 2Department of Otolaryngology, Glasgow Royal Infirmary, Glasgow, UNITED KINGDOM. RATIONALE: We sought to establish if combined histamine challenge testing (HCT) and progressive exercise testing (PET) was of value in the
746
diagnosis of Vocal Cord Dysfunction (VCD). To our knowledge no previous study has evaluated both methods of challenge testing for VCD diagnosis in the same group of patients. METHODS: 9 patients with asthma and clinical suspicion of VCD took part in the study. Baseline laryngoscopy, flow volume loop (FVL) and airway resistance using the forced oscillation technique (with separate values obtained for inspiration (Ri), expiration (Re) and over the whole breath (Rt)) were performed. All measures were repeated following HCT and PET. RESULTS: 1 patient was unable to perform either challenge due to airflow obstruction (FEV1 48% predicted). 1 patient performed HCT only with the remaining 7 patients completing the study protocol. At baseline no patient had VCD. 5/9 had appearances of mild chronic laryngitis. There was no change in laryngeal appearances following HCT or PET in any patient. Furthermore there was no evidence of inspiratory FVL truncation with either challenge in any patient. Mean (SD) Ri increased from 0.41 (0.17) kPa/l/sec to 0.69 (0.16) (95% CI for difference -0.45, -0.12, p = 0.005) during HCT but there was no change following PET. Changes in Re and Rt were similar following HCT. CONCLUSIONS: In a small sample of patients with asthma in whom VCD was suspected, our strategy of histamine and exercise testing was of no diagnostic value. Funding: Royal College of Physicians and Surgeons of Glasgow
747
Cytokines Epistasis Contributes to Childhood Asthma
I. R. Genov1, A. Goncalves-Primo, Jr.1, A. Yambartsev2, L. K. Arruda3, A. S. Zampolo3, V. P. L. Ferriani4, D. Solé1, C. K. Naspitz1, M. GerbaseDeLima1, A. Morgun1; 1Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, BRAZIL, 2Mathematics and Statistics Institute, University of Sao Paulo, Sao Paulo, BRAZIL, 3Department of Medicine, University of Sao Paulo, Ribeirao Preto, BRAZIL, 4Department of Pediatrics, University of Sao Paulo, Ribeirao Preto, BRAZIL. RATIONALE: Asthma is a complex disease with multiple genetic and environmental components. Some evidences indicate that the underlying genetics of asthma is not based on single major gene, but on interactions among genes. METHODS: Polymorphisms of TNFA(-308G/A), TGFB1(+869 T/C and +915 C/G), IL10(-1082 G/A, -819 C/T and -592 C/A), IL6(-174 G/C) and INFG(+874 T/A) genes were determined in White (W)(n=129) and Mulatto (M)(n=131) asthmatic children and in W(n=168) and M(n=178) healthy controls. Isolated or combined SNPs frequencies were compared between asthmatic children and ethnically matched controls and, within the group of asthmatic children, between patients with mild (MA) and moderate/severe (MSA) asthma. For each genotypic combination of SNPs, significant associations were searched using the delete-d-jackknife resampling method with significance level set at 0.001. To circumvent multiple hypotheses problem we separately analyzed each ethnicity and estimated the probability of finding the same association(s) in two independent case/control studies by chance using binomial distribution (p<0.0003). RESULTS: The frequency of TGFB1+869CC/IL10-1082AA combination was lower in asthmatic children than in controls (6% vs 11% in both ethnicities). Also, we observed lower frequencies of TNFA-308GG/IL10819CT in MA than in MSA patients, (28% vs 44% in W; 33% vs 49% in M) and higher frequencies of TGFB1+915GG/ IL10-819CC (41% vs 26% in W; 40% vs 29% in M) and IL10-819CC/ IFNG TA (24% vs 13% in W; 19% vs 9% in M) in MA than in MSA patients. CONCLUSIONS: Our results suggest that epistatic interactions between cytokine genes may contribute to susceptibility and severity of asthma.
MONDAY
744