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Respiratory Research Dec 2022Studies in adult severe treatment-resistant asthma (STRA) have demonstrated heterogeneous pathophysiology. Studies in the pediatric age group are still scarce, and few...
Bronchial eosinophils, neutrophils, and CD8 + T cells influence asthma control and lung function in schoolchildren and adolescents with severe treatment-resistant asthma.
BACKGROUND
Studies in adult severe treatment-resistant asthma (STRA) have demonstrated heterogeneous pathophysiology. Studies in the pediatric age group are still scarce, and few include bronchial tissue analysis.
OBJECTIVE
We investigated 6-18-year-old patients diagnosed with STRA in Sao Paulo, Brazil, by characterizing the different lung compartments and their correlations with asthma control and lung function.
METHODS
Inflammatory profiles of 13 patients with a confirmed diagnosis of STRA were analyzed using blood, induced sputum, bronchoalveolar lavage, viral and bacterial screens and endobronchial biopsy. Inflammatory cells, cytokines, and basement membrane thickening were tested for correlations with the asthma control test (ACT) and spirometry and plethysmography parameters.
RESULTS
Endobronchial biopsy specimens from 11 patients were viable for analysis. All biopsies showed eosinophilic infiltration. Submucosal (SM) eosinophils and neutrophils were correlated with worse lung function (pre-BD FEV1), and SM neutrophils were correlated with fixed obstruction (post-BD FEV1). Intraepithelial (IE) neutrophils were positively correlated with lung function (pre-BD sGaw). CD8 + T cells had the highest density in the IE and SM layers and were positively correlated with ACT and negatively correlated with the cytokines IL1β, IL2, IL5, IL7, IL10, IL12, IL17, GCSF, MCP-1, INF-δ, and TNFα in sputum supernatant. The ASM chymase + mast cell density correlated positively with quality-of-life score (pAQLQ) and ACT.
CONCLUSION
Eosinophils and SM neutrophils correlated with worse lung function, while IE neutrophils correlated with better lung function. Most importantly, CD8 + T cells were abundant in bronchial biopsies of STRA patients and showed protective associations, as did chymase + mast cells.
Topics: Adolescent; Adult; Humans; Child; Brazil; Eosinophils; Asthma; Neutrophils; Sputum; Lung; T-Lymphocytes
PubMed: 36494835
DOI: 10.1186/s12931-022-02259-4 -
Korean Journal of Radiology 2018In 2014, the American College of Radiology (ACR) announced the guideline for the appropriate diagnostic approach and treatment of patients according to the severity of... (Review)
Review
In 2014, the American College of Radiology (ACR) announced the guideline for the appropriate diagnostic approach and treatment of patients according to the severity of hemoptysis and risk for lung cancer. However, the application of the ACR guideline in Korea may not be appropriate, because many patients in Korea have active tuberculosis or pulmonary fibrosis due to previous tuberculosis. The Korean Society of Radiology and Korean Society of Thoracic Radiology have proposed a new guideline suitable for Korean practice. This new guideline was prepared through the consensus of a development committee, working party, and an advisory committee. The guideline proposal process was based on an evidence-based clinical imaging guideline proposed by the development committee. Clinical imaging guideline for adult patients with hemoptysis is as follows: Chest radiography is an initial imaging modality to evaluate hemoptysis. Contrast-enhanced chest CT is recommended in patients with two risk factors for lung cancer (> 40 years old and > 30 pack-year smoking history), moderate hemoptysis (> 30 mL/24 hours) or recurrent hemoptysis. Contrast-enhanced chest CT is also recommended in patients with massive hemoptysis (> 400 mL/24 hours) without cardiopulmonary compromise.
Topics: Bronchial Arteries; Embolization, Therapeutic; Hemoptysis; Humans; Radiation Dosage; Radiography, Thoracic; Republic of Korea; Societies, Medical; Tomography, X-Ray Computed
PubMed: 30174475
DOI: 10.3348/kjr.2018.19.5.866 -
Internal Medicine (Tokyo, Japan) 2013Diffuse alveolar haemorrhage (DAH) is a serious complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). A literature review was... (Review)
Review
Diffuse alveolar haemorrhage (DAH) is a serious complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). A literature review was performed to ascertain the diagnostic features, treatment, and outcome of this rare but serious condition. Haemoptysis and dyspnoea are common but non-specific features. Chest radiography is usually abnormal, and high-resolution computerised tomographic scanning is more sensitive. Increased uptake of inhaled carbon monoxide and reduced clearance of C(15)O on lung function testing is suggestive of intra-alveolar blood. Fiberoptic bronchoscopy and bronchoalveolar lavage are useful when a super-added infection is suspected. Concurrent renal disease is common and contributes to the morbidity and mortality. Treatment should be individualised, and it is based on glucocorticoid and cyclophosphamide induction with azathioprine maintenance. The role of plasmapheresis is unclear, and is currently being evaluated. Patients are at risk of disease and treatment-related long-term complications. Ongoing research into the most efficacious therapeutic regimens associated with the least side effects is especially important.
Topics: Adrenal Cortex Hormones; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Bronchial Diseases; Cause of Death; Combined Modality Therapy; Disease Progression; Female; Hemoptysis; Hemorrhage; Humans; Male; Plasmapheresis; Prognosis; Pulmonary Alveoli; Recurrence; Risk Assessment; Severity of Illness Index; Survival Rate
PubMed: 23291668
DOI: 10.2169/internalmedicine.52.8863 -
The Journal of Allergy and Clinical... Oct 2020Respiratory viral infection causes chronic obstructive pulmonary disease (COPD) exacerbations. We previously reported increased bronchial mucosa eosinophil and...
BACKGROUND
Respiratory viral infection causes chronic obstructive pulmonary disease (COPD) exacerbations. We previously reported increased bronchial mucosa eosinophil and neutrophil inflammation in patients with COPD experiencing naturally occurring exacerbations. But it is unclear whether virus per se induces bronchial mucosal inflammation, nor whether this relates to exacerbation severity.
OBJECTIVES
We sought to determine the extent and nature of bronchial mucosal inflammation following experimental rhinovirus (RV)-16-induced COPD exacerbations and its relationship to disease severity.
METHODS
Bronchial mucosal inflammatory cell phenotypes were determined at preinfection baseline and following experimental RV infection in 17 Global Initiative for Chronic Obstructive Lung Disease stage II subjects with COPD and as controls 20 smokers and 11 nonsmokers with normal lung function. No subject had a history of asthma/allergic rhinitis: all had negative results for aeroallergen skin prick tests.
RESULTS
RV infection increased the numbers of bronchial mucosal eosinophils and neutrophils only in COPD and CD8 T lymphocytes in patients with COPD and nonsmokers. Monocytes/macrophages, CD4 T lymphocytes, and CD20 B lymphocytes were increased in all subjects. At baseline, compared with nonsmokers, subjects with COPD and smokers had increased numbers of bronchial mucosal monocytes/macrophages and CD8 T lymphocytes but fewer numbers of CD4 T lymphocytes and CD20 B lymphocytes. The virus-induced inflammatory cells in patients with COPD were positively associated with virus load, illness severity, and reductions in lung function.
CONCLUSIONS
Experimental RV infection induces bronchial mucosal eosinophilia and neutrophilia only in patients with COPD and monocytes/macrophages and lymphocytes in both patients with COPD and control subjects. The virus-induced inflammatory cell phenotypes observed in COPD positively related to virus load and illness severity. Antiviral/anti-inflammatory therapies could attenuate bronchial inflammation and ameliorate virus-induced COPD exacerbations.
Topics: B-Lymphocyte Subsets; Biomarkers; Eosinophils; Female; Humans; Inflammation Mediators; Leukocyte Count; Male; Neutrophils; Picornaviridae Infections; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Respiratory Mucosa; Rhinovirus; Severity of Illness Index; Sputum; T-Lymphocyte Subsets
PubMed: 32283204
DOI: 10.1016/j.jaci.2020.03.021 -
Acta Bio-medica : Atenei Parmensis Jul 2021We aimed to demonstrate the safety and efficacy of bronchial artery embolization (BAE) in patients with pulmonary tuberculosis in the planned management of "mild"...
BACKGROUND
We aimed to demonstrate the safety and efficacy of bronchial artery embolization (BAE) in patients with pulmonary tuberculosis in the planned management of "mild" hemoptysis. This treatment, already widely documented and used as a life-saving therapy in an emergency regimen, if properly planned in poorly controlled patients through medical therapy alone, can provide a valid opportunity by reducing the frequency and extent of non-fatal bleeding, but which still worsen the quality of life of these already significantly traumatized patients.
METHODS
All procedures were conducted through a right common femoral access with a 5 Fr catheter and a 2.7 Fr super-selective catheter coaxial technique of the branches of the bronchial arteries with suspected bleeding sources. Embolizations were performed with 500-700 micron Terumo PVA plastic microparticles. We decided to adopt the following inclusion criteria for the selection of patients to be enrolled: documented diagnosis of pulmonary TB, the presence of at least one bleeding episode that required at least two blood transfusions, evaluation with bronchoscopic examination to ascertain the bronchial origin of bleeding and the affected lobar site, execution of an angio-ct radiological study for the evaluation of the bronchial systemic anatomy as well as the patency of the pulmonary arterial circulation, general hemodynamic compensation and an age of enrollment between 25 and 65 years.
RESULTS
All selective embolization interventions demonstrated a technical success of 100% of the total number of patients. 11 out of 12 patients did not show any signs of relapse or complications related to the interventional procedure at a first check-up carried out at 48 hours, instead a fatal massive hemoptysis occurred in only one patient. At the next three-month follow-up, no relapses were documented in all selected patients. Only one patient required a second embolization four months after the first procedure.
CONCLUSIONS
Radiological-interventional approach in the elective regimen of super-selective embolization of the bronchial arteries (BAE) in the management and control of "mild" hemoptysis in patients with pulmonary tuberculosis not controlled exclusively by medical therapy, according to a strategy systematic of planned intervention and respecting clear and standardized inclusion criteria, represented in our experience a safe and effective procedure, free from significant short and long term complications, especially in well selected patients, which, although not always allows a definitive and stable control of hemoptysis, can in any case significantly limit the risks, also allowing a better planning of the most appropriate therapeutic intervention strategy.
Topics: Adult; Aged; Bronchial Arteries; Embolization, Therapeutic; Hemoptysis; Humans; Middle Aged; Quality of Life; Retrospective Studies; Treatment Outcome; Tuberculosis, Pulmonary
PubMed: 34212920
DOI: 10.23750/abm.v92i3.10648 -
Diagnostic and Interventional Imaging 2015Severe hemoptysis is life-threatening to patients because of the asphyxia it causes. The diagnosis and treatment are therefore urgent and chest imaging is essential.... (Review)
Review
Severe hemoptysis is life-threatening to patients because of the asphyxia it causes. The diagnosis and treatment are therefore urgent and chest imaging is essential. Multidetector CT-angiography provides an exhaustive non-invasive assessment which includes localization, mechanisms, causes and severity of the hemoptysis. It is an invaluable step in preparation for endovascular treatment which is the first line invasive therapy, particularly with bronchial arteriography embolization in the majority of cases (over 90%) and erosion or rupture of the pulmonary artery in less than 10% of cases. Hemoptysis control is achieved in 65 to 92% of cases depending on the cause.
Topics: Adult; Algorithms; Aneurysm, False; Angiography; Bronchi; Bronchiectasis; Bronchoscopy; Diagnosis, Differential; Embolization, Therapeutic; Emergency Medical Services; Female; Hemoptysis; Humans; Male; Multidetector Computed Tomography; Pulmonary Artery
PubMed: 26141487
DOI: 10.1016/j.diii.2015.06.007 -
The Korean Journal of Internal Medicine Mar 2011Prostaglandin D₂ (PGD₂) is a major prostanoid, produced mainly by mast cells, in allergic diseases, including bronchial asthma. PGD₂-induced vasodilatation and... (Review)
Review
Prostaglandin D₂ (PGD₂) is a major prostanoid, produced mainly by mast cells, in allergic diseases, including bronchial asthma. PGD₂-induced vasodilatation and increased permeability are well-known classical effects that may be involved in allergic inflammation. Recently, novel functions of PGD₂ have been identified. To date, D prostanoid receptor (DP) and chemoattractant receptor homologous molecule expressed on T(H)2 cells (CRTH2) have been shown to be major PGD₂-related receptors. These two receptors have pivotal roles mediating allergic diseases by regulating the functions of various cell types, such as T(H)2 cells, eosinophils, basophils, mast cells, dendritic cells, and epithelial cells. This review will focus on the current understanding of the roles of PGD₂ and its metabolites in T(H)2 inflammation and the pathogenesis of bronchial asthma.
Topics: Asthma; Basophils; Eosinophils; Humans; Mast Cells; Prostaglandin D2; Receptors, Immunologic; Receptors, Prostaglandin; Th2 Cells
PubMed: 21437156
DOI: 10.3904/kjim.2011.26.1.8 -
American Family Physician Oct 2005Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes. The patient's history should help determine the amount of blood and differentiate... (Review)
Review
Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes. The patient's history should help determine the amount of blood and differentiate between hemoptysis, pseudohemoptysis, and hematemesis. A focused physical examination can lead to the diagnosis in most cases. In children, lower respiratory tract infection and foreign body aspiration are common causes. In adults, bronchitis, bronchogenic carcinoma, and pneumonia are the major causes. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution computed tomography, which are useful in difficult cases and when malignancy is suspected. The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the underlying cause. Mild hemoptysis often is caused by an infection that can be managed on an outpatient basis with dose monitoring. If hemoptysis persists, consulting with a pulmonologist should be considered. Patients with risk factors for malignancy or recurrent hemoptysis also require further evaluation with fiberoptic bronchoscopy or high-resolution computed tomography. In up to 34 percent of patients, no cause of hemoptysis can be found.
Topics: Adult; Algorithms; Child; Decision Trees; Hemoptysis; Humans; Medical History Taking; Physical Examination
PubMed: 16225028
DOI: No ID Found -
Diagnostic and Interventional Radiology... Mar 2011We evaluate the use of multidetector row computed tomography (MDCT) angiography for the depiction of bronchial and non-bronchial systemic arteries (NBSAs), which...
We evaluate the use of multidetector row computed tomography (MDCT) angiography for the depiction of bronchial and non-bronchial systemic arteries (NBSAs), which frequently become enlarged as a secondary finding in a wide array of chronic lung diseases and other diseases that affect the pulmonary vascular system. MDCT angiography has enabled radiologists to provide thin-slice axial images, multi-planar reconstructions, interactive maximum intensity projections, and volume-rendered images to evaluate the origin and course of the abnormal bronchial arteries and enlarged NBSAs that may be the cause of hemoptysis. Embolization of the bronchial arteries is the primary treatment option in patients with massive hemoptysis. Precise localization of the bleeding vessel(s) prior to catheter arteriography not only is the most important factor for prompt and successful embolization but also prevents the recurrence of hemoptysis from missed NBSAs during procedures.
Topics: Aged; Aged, 80 and over; Angiography; Bronchial Arteries; Embolization, Therapeutic; Female; Hemoptysis; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Radiography, Interventional; Sampling Studies; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 20658446
DOI: 10.4261/1305-3825.DIR.2694-09.1 -
Radiologia 2023To evaluate the safety and efficacy of the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate (NBCA) in patients with...
OBJECTIVES
To evaluate the safety and efficacy of the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate (NBCA) in patients with hemoptysis.
METHODS
We analyzed a total of 55 consecutive patients with hemoptysis (14 mild, 31 moderate, and 10 massive) treated with the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate between November 2013 and January 2020. The main variables analyzed were the rates of technical success, of clinical success, of recurrence, and of complications. Statistics included a descriptive analysis and Kaplan-Meier survival curves.
RESULTS
Embolization was a technical success in 55 (100%) and a clinical success in 54 (98.2%). During follow-up (mean, 23.8 months; interquartile range, 9.7-38.2 months), hemoptysis recurred in 5 (9.3%) patients. The nonrecurrence rate was 91.9% one year after the initial procedure and 88.7% two years and four years after the initial procedure. Minor complications related with the procedure occurred in 6 (10.9%); no major complications occurred.
CONCLUSIONS
The embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate is safe and efficacious for controlling hemoptysis, resulting in low recurrence rates.
Topics: Humans; Bronchial Arteries; Hemoptysis; Enbucrilate; Retrospective Studies; Embolization, Therapeutic
PubMed: 37059585
DOI: 10.1016/j.rxeng.2020.12.003