bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproducibility of exhaled nitric oxide measurements in healthy and asthmatic adults and children
Authors: Kharitonov S.A. , Gonio F. , Kelly C. , Meah S. , Barnes P.J. 
Published: September 2008

Airway inflammation in asthma is not measured routinely in clinical practice. Fractional exhaled nitric oxide (FENO), a marker of airway inflammation, is increasingly used as an outcome measure in asthma intervention studies and yet the reproducibility of FENOmeasurements is unknown.The reproducibility, day­to­day, diurnal variation and perception of standardised FENOmeasurements were examined in 59 subjects (40 children aged 7–13 yrs and 19 adults aged 18–60 yrs), both healthy (n=30) and with mild (n=29) asthma. FENOwas measured on five consecutive days (four measurements on the same day) for adults and twice on the same day for children.The coefficient of reproducibility expressed as the mean pooled standard deviation (n=59, 675 estimations) was 2.11 parts per billion (ppb) and intraclass correlation coefficient was 0.99 in both children and adults. FENOwas significantly higher in asthma subjects (32.3 ppb) than in healthy subjects (16.3 ppb). There was no diurnal or day­to­day variation, or a learning effect, as the result of FENOmeasurements were identical at results of the beginning and at the end of the study.It was concluded that fractional exhaled nitric oxide measurements are simple, reproducible, free from diurnal and day­to­day variation, and acceptable by both healthy and asthmatic adults and children, as a part of their routine visit to a physician.
Replacement of physiologically autoinhaled nitric oxide in intubated patients
Authors: Röhrig L. , Kuhlen R. , Baumert J. , Rossaint R. 
Published: September 2008

Autoinhaled nitric oxide (NO) is produced mainly in the upper airways. Orotracheal intubation disrupts the natural autoinhalation of NO from the naso- and oropharynx. The effect of disrupting and then replacing autoinhaled NO on arterial oxygenation was investigated in intubated patients.Two groups of nine patients without lung disease were examined during anaesthesia using an inspired oxygen fraction of 0.50. In both groups, the individually produced NO of the whole respiratory tract and the upper airways was determined. The amount of NO normally autoinhaled from the upper airways was replaced for 5 min after orotracheal intubation in one group.The amount of NO from the upper respiratory tract was 47±19 parts per billion (ppb) in the test group and the replaced NO concentration was 48±20 ppb. No significant increase in arterial oxygen tension could be detected during the replacement of the autoinhaled NO. Haemodynamic parameters remained unchanged. In the control group, the NO from the upper airways was 34±16 ppb. In contrast to the test group, it was not replaced after intubation.These findings suggest that in healthy subjects the autoinhalation of nitric oxide does not play an important role in arterial oxygenation during anaesthesia.
Inhaled synthetic surfactant abolishes the early allergen-induced response in asthma
Authors: Babu K.S. , Woodcock D.A. , Smith S.E. , Staniforth J.N. , Holgate S.T. , Conway J.H. 
Published: September 2008

Allergen-induced inhibition of pulmonary surfactant in asthma may promote airway oedema and consequently potentiate the severity of the asthmatic response. A randomised, single-blind, cross-over study of an inhaled synthetic phospholipid dry-powder surfactant (Pumactant) was conducted in atopic, asthmatic subjects with previously documented early and late asthmatic responses (EAR and LAR) to an inhaled allergen. This was conducted to evaluate the role of exogenous surfactant administration on EAR and LAR. A total of seven subjects had complete evaluable data and received the full dose of Pumactant.Asthmatic subjects inhaled two separate doses of 400 mg Pumactant prior to an allergen exposure. The first dose was administered 8 h in advance and the second dose 30 min in advance. The dosage occurred through a purpose-built administration device. This was followed by a standard bronchial-provocation test, and forced expiratory volume in one second (FEV1) was measured at regular intervals over a 10-h period.Pumactant was well tolerated and, surprisingly, abolished the EAR but not the LAR in all seven subjects. The mean area under the curve between 0–2 h (EAR) following bronchial provocation test was 0.08 for the Pumactant treatment group (PT) and 13.29 for the no treatment (NT) group. The maximum drop in FEV1for EAR was 4.19% and 23.98% in the PT and the NT group, respectively.The demonstration of inhibition of the early asthmatic response by exogenous surfactant, provides the first evidence that pulmonary surfactant dysfunction may also contribute to the very early asthmatic response to allergen. Exogenous surfactant administration could serve as a useful adjunct in controlling the early allergen-induced symptoms in patients with allergic asthma.
Relationship between FEV1reduction and respiratory symptoms in the general population
Authors: Jakeways N. , McKeever T. , Lewis S.A. , Weiss S.T. , Britton J. 
Published: September 2008

Obstructive airways diseases typically present with dyspnoea, cough and wheeze, and are defined by a reduced forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio. Traditionally, however, the severity of chronic obstructive pulmonary disease is graded by the FEV1% predicted rather than the FEV1/FVC ratio, whilst other potentially valid measures of FEV1impairment, such as the absolute difference of FEV1from predicted or the absolute level of FEV1, tend not to be used. The authors have therefore explored the relationship between these different measures of FEV1impairment and chronic respiratory symptoms in a general population sample.FEV1and FVC were measured and questionnaire data were obtained on cough, wheeze, shortness of breath and general self-reported breathing trouble in a cross-sectional survey of 2,633 adults aged 18–70 yrs from a district of Nottingham, UK. Odds ratios for each symptom were calculated for declining levels of absolute FEV1, FEV1% pred, absolute difference of FEV1from predicted, and FEV1/FVC ratio. They were plotted to display the shape and strength of these relationships before and after adjustment for each other measure.The odds of symptoms increased with declining levels of all FEV1measures, particularly for wheeze and general breathing trouble. Although this study was not sufficiently powerful to detect significant differences between measures, these relationships were consistently strongest, before and after adjustment, for FEV1% pred, particularly below a threshold of ∼75%.The authors conclude that forced expiratory volume in one second % predicted appears to be the measure of airflow impairment most closely associated with chronic respiratory symptoms in the general population.
Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy
Authors: Bottini P. , Dottorini M.L. , Cristina Cordoni M. , Casucci G. , Tantucci C. 
Published: September 2008

To assess the occurrence and nature of sleep-disordered breathing (SDB) in 26 adult, nonobese diabetics (18 with autonomic neuropathy (DAN+) (age 45 (41–50) yrs; body mass index (BMI) 24.1 (22–26) kg·m−2) and eight without autonomic neuropathy (DAN−) (age 45 (35–55) yrs; BMI 24.8 (23–26) kg·m−2)) overnight full sleep studies and measurements of central and peripheral carbon dioxide (CO2) chemosensitivity were performed.DAN+ were divided in two subgroups, according to the presence (DAN+PH+; n=10) or absence (DAN+PH−; n=8) of postural hypotension. Ten normal subjects were studied as controls (age 42 (36–48) yrs; BMI 24.4 (23–25) kg·m−2).In contrast to DAN− and controls, who did not show SDB, five DAN+ (four DAN+PH− and one DAN+PH+) had an apnoea/hypopnoea index ≥10 and four DAN+ (two DAN+PH− and two DAN+PH+) had an apnoea index ≥5. All the events were obstructive, occurring mainly during rapid eye movement (REM) sleep. Ten DAN+ exhibited a mean lowest oxygen saturation <90% during REM sleep. No periodic breathing or central sleep apnoeas were found in DAN+PH+, although they had an enhanced central chemoresponsiveness to CO2. Both DAN+ subgroups showed a marked reduction in peripheral CO2chemosensitivity.In conclusion, adult nonobese diabetics with autonomic neuropathy, independent of the severity of their dysautonomy, have obstructive sleep apnoea/hypopnoea with a frequency >30%. A decrease in peripheral carbon dioxide chemosensitivity prevents adult nonobese diabetics with autonomic neuropathy and postural hypotension from experiencing posthyperventilatory central sleep apnoea, despite an increased hypercapnic central drive.
Comparative bronchial vasoconstrictive efficacy of inhaled glucocorticosteroids
Authors: Mendes E.S. , Pereira A. , Danta I. , Duncan R.C. , Wanner A. 
Published: September 2008

The vasoconstrictive efficacies of glucocorticosteroids (GS) are usually compared by the McKenzie skin-blanching test and taken as an index of relative potency. The rationale for the present study was to transpose the McKenzie test to the airway and to compare the airway vascular effects of three inhaled GS: beclomethasone dipropionate (BDP), fluticasone propionate (FP) and budesonide (BUD), in healthy subjects and patients with mild stable asthma.A soluble, inert gas-uptake method was used to measure airway blood flow (Qaw). Baseline mean±sdQawnormalised for anatomical dead space was 53.1±1.4 µL·min−1·mL−1in healthy subjects (n=10) and 67.8±3 µL·min−1·mL−1in asthmatics (n=10).All GS caused a transient decrease inQaw. The magnitude of the vasoconstriction was greater in asthmatics. The relative vasoconstrictive effect of BDP, FP and BUD was 1, 1.9, and 2.7, respectively, in asthmatics and 1, 3.3 and 3.0, respectively, in healthy subjects, as assessed by the dose required to decreaseQawby 20% from the baseline, 30-min postdrug inhalation.Therefore, measuring airway blood flow may be a useful, site-specific parameter to assess the tissue bioavailability and vasoconstrictive efficacy of inhaled glucocorticosteroids.
Methodological issues in evaluating measures of health as outcomes for COPD
Authors: Jones P.W. , Kaplan R.M. 
Published: September 2008

The selection of an appropriate outcome measure depends on the aspect of the disease being addressed and the purpose of the study being conducted. The most fundamental property of any outcome is its ability to measure the biological variable under question. Other properties such as discriminative and evaluative abilities are also important.Specific outcomes measure a single biological variable, such as forced expiratory volume in one second or depression. The specificity of such measures is attractive but requires precise definition of what is being measured and why. Other, summative, outcomes are used to quantify the overall effect of a number of different biological processes.The simplest summative measures are global questions such as “How would you rate your health overall?” Others are complex with many items. If designed and used correctly, these questionnaires can provide an estimate of the overall impact of disease or response to therapy and an index of whether that response was clinically worthwhile.Standardisation of measurements is important to permit comparisons between patients and studies, which makes the measurement of an individual's “quality of life” difficult. The term “health-status measurement” may be better when referring to the use of standardised questionnaires. Utility-based measures help address concerns regarding clinicalversusstatistical improvement and place outcomes for chronic obstructive pulmonary disease treatment trials in the context of all healthcare treatments.
Plasma TARC concentration may be a useful marker for asthmatic exacerbation in children
Authors: Leung T.F. , Wong C.K. , Lam C.W.K. , Li A.M. , Ip W.K. , Wong G.W.K. , Fok T.F. 
Published: September 2008

Recent studies suggested the T-helper cells type-2 lymphocytes-specific thymus and activation-regulated chemokine (TARC) and monocyte-derived chemokine (MDC) are useful inflammatory markers for chronic asthma. However, their roles in assessing the severity of acute asthma are unknown. This study aims to evaluate the serial changes of plasma TARC and MDC concentrations in children with asthmatic exacerbation.All patients with acute asthma were treated with systemic corticosteroid for 5 days. The severity of asthmatic exacerbation was classified according to the Global Initiative for Asthma guidelines. Plasma TARC and MDC concentrations were measured by sandwich enzyme immunoassays.Sixteen children, with a median (interquartile range) age of 9.3 (7.2–10.6) yrs and asthmatic exacerbation, were recruited. Plasma TARC concentration showed inverse correlation with peak expiratory flow rate at presentation. The median plasma TARC concentration was highest during the acute attacks (46 pg·mL−1) as compared to those levels at 1 (31 pg·mL−1) and 5 weeks (32 pg·mL−1) following treatment. The median plasma MDC level similarly decreased from 698 pg·mL−1at baseline to 261 pg·mL−11 week later, but increased back to 574 pg·mL−1at 5 weeks.These results suggest that plasma T-helper cells type-2 lymphocytes-specific thymus and activation-regulated chemokine but not monocyte-derived chemokine concentration may be a useful inflammatory marker in assessing asthmatic exacerbation in children.
Evaluation of airway wall thickness and air trapping by HRCT in asymptomatic asthma
Authors: Gono H. , Fujimoto K. , Kawakami S. , Kubo K. 
Published: September 2008

The aim of this study was to examine the relationship between the structural changes in large and small airways in asymptomatic asthmatics quantified by high-resolution computed tomography (HRCT) and airflow obstruction.The bronchial wall thickness at the trunk of the apical bronchus (B1) of the right upper lobe was used for assessment of the large airways. Air trapping, evaluated by the ratio of the average CT‐determined values for the bilateral upper and lower lung segments at full expiration to that at full inspiration (E/I ratio), was used for assessment of the small airways. Measurements were obtained with a helical HRCT in 24 asymptomatic asthmatics followed by optimal treatment with inhaled and/or oral corticosteroids for >6 months. Prior (20–30 min) to the HRCT examination, all patients were given an inhaled bronchodilator.The ratio of airway wall thickness to outer diameter (T/D) and the percentage wall area (WA%) at the B1 bronchus and the E/I ratio were significantly greater for the 14 asthmatics with deficient reversible airflow obstruction (forced expiratory volume in one second (FEV1) <80% prediced or FEV1/forced vital capacity <70% after bronchodilator inhalation) than for the 10 asthmatics with normal spirometry and seven normal subjects. T/D, WA%, and E/I ratio showed significant negative correlations with FEV1% pred after bronchodilator inhalation. The E/I ratio also showed significant positive correlations with T/D, WA%, and residual volume/total lung capacity.These findings suggest that, in spite of optimal treatment, structural changes in both large and small airways may simultaneously occur in asthmatics with deficient reversible airflow obstruction.
Aspirin-sensitive rhinitis-associated changes in upper airway innervation
Authors: Groneberg D.A. , Heppt W. , Welker P. , Peiser C. , Thai Dinh Q. , Cryer A. , Zweng M. , Witt C. , Fischer A. 
Published: September 2008

Aspirin-sensitive rhinitis is the manifestation of aspirin intolerance in the upper respiratory tract. The disease represents a pseudoallergy against aspirin or related nonsteroidal anti-inflammatory drugs. As a major immunomodulatory role for airway innervation has been proposed in airway inflammatory diseases, the present study assessed changes in human nasal mucosa innervation in patients with aspirin-sensitive rhinitis in comparison to a control group.Immunohistochemistry for protein gene product 9.5, tachykinins, calcitonin gene-related peptide, vasoactive intestinal peptide (VIP) and neuropeptide tyrosine was performed on cryostats sections of nasal mucosa and neuropeptide containing nerves were examined independently using a score grading.In comparison to the control, the aspirin-sensitive rhinitis group had a significant increase of VIP‐like immunoreactivity in mucosal nerve fibres. In contrast to constant numbers of mast cells, highly significant increases in the numbers of eosinophils were found in the group of aspirin-sensitive rhinitis patients.In summary, the present quantification of neuropeptide-immunoreactivity of mucosal nerves demonstrated differences in the human nasal mucosa innervation between nonrhinitic and aspirin-sensitive rhinitic individuals. These differences may reflect a pathophysiological role of upper airway innervation in pseudoallergic reactions.
Distribution of technetium-99m-labelled QVARTMdelivered using an AutohalerTMdevice in children
Authors: Devadason S.G. , Huang T. , Walker S. , Troedson R. , Le Souëf P.N. 
Published: September 2008

QVARTM, an extrafine hydrofluoroalkane/beclomethasone dipropionate formulation, has been shown to double lung deposition in adults. The aim of the present study was to assess the total body deposition and distribution oftechnetium-99m-labelled (99mTc) QVARTMin children after inhalationviaan AutohalerTM.Sixteen male asthmatic children (5–14 yrs) inhaled labelled drug (<4 MBq99mTc; 100 µg beclomethasone dipropionate)viaan Autohaler within 30 min after salbutamol (200 µg) administration. Simultaneous anterior and posterior planar scintigraphic scans(120 s acquisition time) were collected after inhalation of labelled drug.Mean±sd lung deposition of labelled drug (attenuation-corrected; percentage of ex-actuator dose) was 36.9±9.2, 46.5±11.6 and 54.1±10.7% in children aged 5–7, 8–10 and 11–14 yrs, respectively. Combined oropharyngeal and gastrointestinal deposition was 59.7±8.2, 48.9±12.3 and 40.3±11.8%. Lung deposition positively correlated with the forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Gastrointestinal dose negatively correlated with the FEV1, FVC, height and age.In older children (11–14 yrs), lung deposition was almost identical to that reported inadults using QVARTM. In children aged 5–10 yrs, lung deposition using QVARTMwas greater than the levels measured using other commercial aerosol delivery systems. Oropharygeal and gastrointestinal deposition was inversely related toage.
Pulmonary actinomycosis
Authors: Mabeza G.F. , Macfarlane J. 
Published: September 2008

Pulmonary actinomycosis is a rare but important and challenging diagnosis to make. Even when the clinical suspicion is high, the disease is commonly confused with other chronic suppurative lung diseases and with malignancy.An early, accurate diagnosis will prevent the considerable psychological and physical morbidity, including unwarranted surgery, associated with delayed diagnosis.The clinical, radiological and therapeutic characteristics of the infection are reviewed here.Respiratory physicians should be aware of this important differential when investigating patients for persistent pulmonary shadowing. This will expedite the diagnosis of an otherwise highly treatable condition with an excellent prognosis if picked up early.
Arginine as an adjuvant to chemotherapy improves clinical outcome in active tuberculosis
Authors: Schön T. , Elias D. , Moges F. , Melese E. , Tessema T. , Stendahl O. , Britton S. , Sundqvist T. 
Published: September 2008

Nitric oxide (NO) is involved in the host defence against tuberculosis (TB). Patients with TB exhibit increased catabolism and reduced energy intake. Thus the hypothesis for this study was that restoring a relative deficiency in the amino acid arginine, the substrate for mycobactericidal NO production, would improve the clinical outcome of TB by increasing NO production.In a randomised double-blind study, patients with smear-positive TB (n=120) were given arginine or placebo for 4 weeks in addition to conventional chemotherapy. Primary outcomes were sputum conversion, weight gain, and clinical symptoms after week 8. Secondary outcomes were sedimentation rate and levels of NO metabolites, arginine, citrulline, and tumour necrosis factor‐α.Compared with the human immunodeficiency virus (HIV)−/TB+ placebo group, the HIV−/TB+ patients in the arginine group showed significant improvement, defined as increased weight gain, higher sputum conversion rate and faster reduction of symptoms, such as cough. The arginine level increased after week 2 in the HIV−/TB+ arginine group (100.2 µM (range 90.5–109.9)versus142.1 µM (range 114.1–170.1)) compared with the HIV−/TB+ placebo group (105.5 µM (range 93.7–117.3)versus95.7 µM (range 82.4–108.9)). HIV seroprevalence was 52.5%. No clinical improvement or increase in serum arginine was detected in arginine supplemented HIV+/TB+ patients compared with placebo.Arginine is beneficial as an adjuvant treatment in human immunodeficiency virus-negative patients with active tuberculosis, most likely mediated by increased production of nitric oxide.
Individual and area-based indicators of socioeconomic status and childhood asthma
Authors: Cesaroni G. , Farchi S. , Davoli M. , Forastiere F. , Perucci C.A. 
Published: September 2008

The current study evaluated the association between individual and area-based indicators of socioeconomic status and the prevalence, severity, and lifetime hospitalisation for asthma in children.The representative sample of 4,027 children from Rome, aged 6–7 yrs, used for the 1994 ISAAC (International Study on Asthma and Allergies in Childhood) initiative, was selected. Individual and small area indicators of socioeconomic status were used. Individual data on parents' education and on childhood asthma were gathered from self-administered parental questionnaires. Two small-area indicators (socioeconomic status index (SES) and average income in 1994) were derived using information available at the census tract of residence. Logistic regression models were used to estimate the association of parental education and small area indicators with asthma prevalence, severity, and hospitalisation. Parental smoking was considered in the analysis as a potential confounder.Prevalence of physician diagnosis of asthma (11.3%) increased as father's education decreased. Prevalence of severe asthma (1.6%) increased as maternal and paternal educational levels decreased. Lifetime hospitalisation for asthma (2.8%) was strongly associated with both parental education and small-area indicators of social disadvantage, even when considered simultaneously in the same logistic model.Socioeconomic conditions are associated with asthma occurrence, its severity, and hospitalisation. The association was stronger for asthma severity and hospitalisation. Individual indicators correlated better with the outcomes than area-based indicators. However, living in an underprivileged area is a strong independent predictor of hospital admission for asthma.