Hülyam KURT, İrfan DEĞİRMENCİ, Kurtuluş AKSU, Eren GÜNDÜZ, Emel KURT

Inflammatory markers in exhaled breath condensate in patients with asthma and rhinitis

Giriş: Hafif astım, persistan rinit ve astım-rinit birlikteliği olan hastalarda ekshale soluk havasında malondialdehid ve total protein düzeyleri incelenerek alt hava yolu inflamasyonu değerlendirilmiştir. Hastalar ve Metod: Hafif astım, en az bir yıldır semptomatik olan persistan rinitli hastalar ve sağlıklı bireyler çalışmaya dahil edildi. Astımlı ve rinitli hastalar yeni tanı almış olup, kortikosteroid tedavisi almamıştı. Hiçbir olgu sigara içmiyordu ve son bir ay içinde solunum yolu infeksiyonu öyküsü yoktu. Astım semptomları olan ve bronş provokasyonu pozitif olan rinitli hastalar persistan rinit ve astım birlikteliği olarak gruplandırıldı. Olgulardan toplanan ekshale soluk havasında malondialdehid ve total protein düzeyleri ölçüldü. Bulgular: Persistan rinitli 53, hafif astımlı 12, persistan rinit ve astımlı 16 hasta ve 13 sağlıklı kontrolden oluşan dört çalış- ma grubunun ekshale soluk havasında malondialdehid ve total protein ölçümlerinde istatistiksel olarak anlamlı fark bulunmadı (p> 0.05). Ekshale soluk havasındaki malondialdehid ve total protein düzeyleri ile atopi ve nazal eozinofili arasında ilişki saptanmadı. Sonuç: Hafif astım, rinit ve her iki hastalığın birarada bulunduğu hastalarda, alt hava yolu inflamasyonu hastalığa özgü bir durum olmadığı gibi şart da değildir

Astım ve rinitli hastalarda yoğunlaştırılmış soluk havasında inflamatuvar belirteçler

Introduction: The present study investigates the lower airway inflammation using malondialdehyde and total protein measurement in exhaled breath condensate in mild asthma, persistent rhinitis, and concomitant asthma and rhinitis. Patients and Methods: Asthmatics with mild disease, patients with persistent rhinitis symptomatic for at least one year and healthy controls were included. Asthmatics and rhinitis patients were all newly diagnosed and were free of corticosteroid therapy. Participants were nonsmokers, had no respiratoy tract infection within the previous month. Rhinitis patients with asthmatic symptoms and positive bronchial challenge were grouped as patients with persistent rhinitis and concomitant asthma. Malondialdehyde and total protein were measured in the exhaled breath condensate collected from the subjects. Results: No statistical difference was found in the malondialdehyde and total protein levels in exhaled breath condensate between the four study groups which are; 53 patients with persistent rhinitis, 12 with mild asthma, 16 persistent rhinitis patients with concomitant asthma and 13 healthy controls (p> 0.05). Atopy and nasal eosinophilia were not related to malondialdehyde and total protein levels in exhaled breath condensate. Conclusion: Lower airway inflammation is not a disease specific process and is not a prerequisite concerning patients with mild asthma or rhinitis or patients with coexistence of both diseases.

PDF

___

1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update. Allergy 2008; 63(Suppl 86): 8-160.
2. Bowler RP, Crapo JD. Oxidative stress in allergic respiratory diseases. J Allergy Clin Immunol 2002; 110: 349-56.
3. Horváth I, Hunt J, Barnes PJ, Alving K, Antczak A, Baraldi E, et al. ATS/ERS Task Force on Exhaled Breath Condensate. Exhaled breath condensate: methodological recommendations and unresolved questions. Eur Respir J 2005; 26: 523-48.
4. Bartoli ML, Novelli F, Costa F, Malagrinò L, Melosini L, Bacci E, et al. Malondialdehyde in exhaled breath condensate as a marker of oxidative stress in different pulmonary diseases. Mediators Inflamm 2011; 2011: 891752.
5. Corradi M, Folesani G, Andreoli R, Manini P, Bodini A, Piacentini G, et al. Aldehydes and glutathione in exhaled breath condensate of children with asthma exacerbation. Am J Respir Crit Care Med 2003; 167: 395-9.
6. Wood JG, Johnson JS, Mattioli LF, Gonzalez NC. Systemic hypoxia increases leukocyte emigration and vascular permeability in conscious rats. J Appl Physiol 2000; 89: 1561-8.
7. Madjdpour C, Jewell UR, Kneller S, Ziegler U, Schwendener R, Booy C, et al. Decreased alveolar oxygen induces lung inflammation. Am J Physiol Lung Cell Mol Physiol 2003; 284: 360-7.
8. Czebe K, Barta I, Antus B, Valyon M, Horváth I, Kullmann T. Influence of condensing equipment and temperature on exhaled breath condensate pH, total protein and leukotriene concentrations. Respir Med 2008; 102: 720-5.
9. Garey KW, Neuhauser MM, Robbins RA, Danziger LH, Rubinstein I. Markers of inflammation in exhaled breath condensate of young healthy smokers. Chest 2004; 125: 22-6.
10. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008; 31: 143-78.
11. American Thoracic Society. Guidelines for methacholine and exercise challenge test. Am J Respir Crit Care Med 1999; 161: 309-29.
12. Mutlu GM, Garey KW, Robbins RA, Danziger LH, Rubinstein I. Collection and analysis of exhaled breath condensate in humans. Am J Respir Crit Care Med 2001; 164: 731-7.
13. Corradi M, Pignatti P, Manini P, Andreoli R, Goldoni M, Poppa M, et al. Comparison between exhaled and sputum oxidative stress biomarkers in chronic airway inflammation. Eur Respir J 2004; 24: 1011-7.
14. Mihara M, Uchiyama M. Determination of malonaldehyde precursor in tissues by thiobarbituric acid test. Anal Biochem 1978; 86: 271-8.
15. Rahman I, Morrison D, Donaldson K, MacNee W. Systemic oxidative stress in asthma, COPD, and smokers. Am J Respir Crit Care Med 1996; 154(4 Pt 1): 1055-60.
16. Pryor WA, Bermúdez E, Cueto R, Squadrito GL. Detection of aldehydes in bronchoalveolar lavage of rats exposed to ozone. Fundam Appl Toxicol 1996; 34: 148-56.
17. Pryor WA, Godber SS. Noninvasive measures of oxidative stress status in humans. Free Radic Biol Med 1991; 10: 177-84.
18. Bhimrao SK, Wilson SJ, Howarth PH. Airway inflammation in atopic patients: a comparison of the upper and lower airways. Otolaryngol Head Neck Surg 2011; 145: 396-400.
19. Dixon AE. Rhinosinusitis and asthma: the missing link. Curr Opin Pulm Med 2009; 15: 19-24.
20. Canbaz P, Uskudar-Teke H, Aksu K, Keren M, Gulbas Z, Kurt E. Nasal eosinophilia can predict bronchial hyperresponsiveness in persistent rhinitis: evidence for united airways disease concept. Am J Rhinol Allergy 2011; 25: 120-4.
21. Stevens WJ, Vermeire PA, Van Schil LA. Bronchial hyperreactivity in rhinitis. Eur J Respir Dis 1983; 128(pt 1): 72-80.