Journal Information
Vol. 41. Issue 6.
Pages 328-333 (June 2005)
Share
Share
Download PDF
More article options
Vol. 41. Issue 6.
Pages 328-333 (June 2005)
Original Articles
Full text access
Bronchial Exudate of Serum Proteins During Asthma Attack
Visits
...
J. Beldaa,
Corresponding author
jbelda@hsp.santpau.es

Correspondence: Dr. J. Belda. Clínica d'Asma i Al·lèrgia. Departament de Pneumologia. Hospital de la Santa Creu i de Sant Pau. Antoni M. Claret, 167. 08025 Barcelona. España
, G. Margarita, C. Martínezb, P. Casana, F. Rodríguez-Jereza, M. Brufala, M. Torrejóna, C. Granela, J. Sanchisa
a Clínica d'Asma i Al-lérgia, Departament de Pneumologia, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
b Servei de Bioquímica, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Article information
Objective

Although altered vascular permeability and edema of the bronchial mucosa are associated with asthma attack, their influence on its severity remains unknown. We address this issue by comparing relative indices for the concentration of albumin (RIAlb) and α2-macroglobulin (RIα2M) in induced sputum and peripheral blood from patients with exacerbated asthma, patients with stable asthma, and control subjects.

Patients and methods

Forty-six volunteers participated in the study: 14 with exacerbated asthma (forced expiratory volume in the first second [FEV1] 74.3% [SD, 20.8%] of reference), 23 with stable asthma (FEV1 93.6% [7.5%]), and 9 controls (FEV1 101.1% [9.9%]). The concentrations of albumin and α2-macroglobulin were quantified by immunoturbidimetry and immunonephelometry, respectively. The relative index was then calculated by dividing the concentration in sputum supernatant by the concentration in peripheral blood.

Results

The mean RIAlb was 1.2 (1.1) in the control group, 2.9 (3.1) in the stable asthma group, and 6.0 (6.7) in the exacerbated asthma group. The RIα2M values were 11.7 (10.9), 11.9 (14.7), and 3.2 (3.8) for the control group and stable and exacerbated asthma groups, respectively. The increases in the RIAlb values between all groups, and the decrease in the RIα2M value between the exacerbated asthma and control groups were statistically significant (P <.05). The percentage of neutrophils, but not of eosinophils, in sputum was correlated with the RIAlb (r=0.39; P = .008) but not the RIα2M (r=-0.035; P = .82). FEV1 displayed an inverse relationship with the RIAlb (r=-0.43; P = .009) but not with the RIα2M (r=-0.206; P = .24). No correlation was found between oxyhemoglobin saturation and either the RIAlb (r=-0.33; P = .19) or the RIα2M (r=-0.12; P = .84).

Conclusions

Vascular permeability is altered during asthma exacerbations and appears to be correlated with the presence of neutrophils and the degree of bronchial obstruction.

Key words:
Albumin
α2-macroglobulin
Induced sputum
Eosinophils
Neutrophils
Crisis, asthmatic
Objetivo

La alteración de la permeabilidad vascular y el edema de la mucosa bronquial se asocian con las crisis de asma. Hay pocos datos publicados y adems no se conoce su relación con la gravedad de éstas. Así se propuso comparar los índices relativos de albúmina (IRAlb) y de macroglobulina α2 (IRMα2), entre esputo inducido y sangre periférica, de asmáticos agudizados (AA), asmáticos estables (AE) y controles.

Pacientes y métodos

Se estudió a 46 voluntarios: 14 del grupo AA (volumen espiratorio forzado en el primer segundo [FEV1]: 74,3 ± 20,8), 23 del AE (FEV1: 93,6 ± 7,5) y 9 controles (FEV1: 101,1 ± 9,9). Se cuantificó la concentración de albúmina (turbidimetría inmunoquímica) y de macroglobulina α2 (nefelometría inmunoquímica) en el sobrenadante del esputo y en sangre venosa periférica y se calcularon los índices relativos.

Resultados

La media ± desviación estándar del IRAlb fue de 1,2 ± 1,1 en el grupo control, de 2,9 ± 3,1 en AE y de 6,0 ± 6,7 en AA. El IRMα2 fue 11,7 ± 10,9,11,9 ± 14,7 y 3,2 ± 3,8, respectivamente. El incremento del IRAlb entre los grupos AA, AE y control, y el descenso del IRMα2 entre AA y control fueron estadísticamente significativos (p < 0,05). Se relacionó el porcentaje de neutrófilos, y no el de eosinófilos, con el IRAlb (r = 0,39; p = 0,008), pero no con el IRMα2 (r = -0,035; p = 0,82). El FEV1 se relacionó inversamente con el IRAlb (r = -0,43; p = 0,009) y no con el IRM?2 (r = -0,206; p = 0,24), y tampoco se relacionó la saturación de oxihemoglobina con el IRAlb (r = -0,33; p = 0,19) o el IRMα2 (r = -0,12; p = 0,84).

Conclusiones

La permeabilidad vascular está alterada en las agudizaciones de asma y parece relacionarse con la presencia de neutrófilos y el grado de obstrucción bronquial.

Palabras clave:
Albúmina
Macroglobulina α2
Esputo inducido
Eosinófilos
Neutrófilos
Crisis de asma
Full text is only aviable in PDF
REFERENCES
[1]
J Belda, J Giner, P Casan, J Sanchis.
Mild exacerbations and eosinophilic inflammation in patients with stable, well-controlled asthma after 1 year of follow-up.
Chest, 119 (2001), pp. 1011-1017
[2]
MD Inman, R Watson, DW Cockcroft, BJ Wong, FE Hargreave, PM O'Byrne.
Reproducibility of allergen-induced early and late asthmatic responses.
J Allergy Clin Immunol, 95 (1995), pp. 1191-1195
[3]
CGA Persson.
Microvascular-epithelial exudation of plasma.
Asthma: basic mechanisms and clinical management, 3rd ed., pp. 253-267
[4]
Update of NHLBI/WHO Workshop Report: Global Strategy for Asthma Management and Prevention. Issued January, 1995 [NIH publication n.° 02-3659]. 2002.
[5]
DF Schoonbrood, R Lutter, FJ Habets, CM Roos, HM Jansen, TA Out.
Analysis of plasma-protein leakage and local secretion in sputum from patients with asthma and chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 150 (1994), pp. 1519-1527
[6]
J Belda, P Hussack, M Dolovich, A Efthimiadis, FE Hargreave.
Sputum induction: effect of nebulizer output and inhalation time on cell counts and fluid-phase measures.
Clin Exp Allergy, 31 (2001), pp. 1740-1744
[7]
MM Pizzichini, E Pizzichini, L Clelland, A Efthimiadis, J Mahony, J Dolovich, et al.
Sputum in severe exacerbations of asthma: kinetics of inflammatory indices after prednisone treatment.
Am J Respir Crit Care Med, 155 (1997), pp. 1501-1508
[8]
MM Pizzichini, E Pizzichini, L Clelland, A Efthimiadis, I Pavord, J Dolovich, et al.
Prednisone-dependent asthma: inflammatory indices in induced sputum.
Eur Respir J, 13 (1999), pp. 15-21
[9]
JV Fahy, KW Kim, J Liu, HA Boushey.
Prominent neutrophilic inflammation in sputum from subjects with asthma exacerbation.
J Allergy Clin Immunol, 95 (1995), pp. 843-852
[10]
JC In't Veen, HH Smits, PS Hiemstra, AE Zwinderman, PJ Sterk, EH Bel.
Lung function and sputum characteristics of patients with severe asthma during an induced exacerbation by double-blind steroid withdrawal.
Am J Respir Crit Care Med, 160 (1999), pp. 93-99
[11]
EF Juniper, PM O'Byrne, GH Guyatt, PJ Ferrie, DR King.
Development and validation of a questionnaire to measure asthma control.
Eur Respir J, 14 (1999), pp. 902-907
[12]
A de Diego, P Casan, F Duce, JB Galdiz, A López Vina, F Manresa, et al.
Recomendaciones para el tratamiento de las crisis de asma.
Arch Bronconeumol, 32 (1996), pp. 1-7
[13]
PH Quanjer, GJ Tammeling, JE Cotes, OF Pedersen, R Peslin, JC Yernault.
Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society.
Eur Respir J Suppl, 16 (1993), pp. 5-40
[14]
PJ Sterk, LM Fabbri, PH Quanjer, DW Cockcroft, PM O'Byrne, SD Anderson, et al.
Airway responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society.
Eur Respir J Suppl, 16 (1993), pp. 53-83
[15]
J Belda, J Giner, P Casan, J Sanchis.
Esputo inducido en el asma: estudio de validez y reproducibilidad.
Arch Bronconeumol, 33 (1997), pp. 325-330
[16]
J Belda, R Leigh, K Parameswaran, PM O'Byrne, MR Sears, FE Hargreave.
Induced sputum cell counts in healthy adults.
Am J Respir Crit Care Med, 161 (1999), pp. 475-478
[17]
M South, P Vervaart, PN McDougall.
Validity of markers of dilution in small volume lung lavage.
Am J Respir Crit Care Med, 160 (1999), pp. 778-784
[18]
C Ward, J Fenwick, H Booth, EH Walters.
Albumin is not suitable as a marker of bronchoalveolar lavage dilution in interstitial lung disease.
Eur Respir J, 10 (1997), pp. 1940-1942
[19]
RE Nocker, FR Weller, TA Out, MJ de Riemer, HM Jansen, JS van der Zee.
A double-blind study on the effect of inhaled corticosteroids on plasma protein exudation in asthma.
Am J Respir Crit Care Med, 159 (1999), pp. 1499-1505
[20]
TA Out, HM Jansen, RP van Steenwijk, MJ de Nooijer, EA van de Graaf, FM Zuijderhoudt.
ELISA of ceruloplasmin and alpha2-macroglobulin in paired bronchoalveolar lavage fluid and serum samples.
Clin Chim Acta, 165 (1987), pp. 277-288
[21]
L Greiff, P Wollmer, M Andersson, C Svensson, CG Persson.
Effects of formoterol on histamine induced plasma exudation in induced sputum from normal subjects.
Thorax, 53 (1998), pp. 1010-1013
[22]
AL Echazarreta, B Dahlen, G García, C Agustí, JA Barberá, J Roca, et al.
Pulmonary gas exchange and sputum cellular responses to inhaled leukotriene D(4) in asthma.
Am J Respir Crit Care Med, 164 (2001), pp. 202-206
[23]
FP Gómez, RM Marrades, R Iglesia, J Roca, JA Barberá, KF Chung, et al.
Gas exchange response to a PAF receptor antagonist, SR 27417A, in acute asthma: a pilot study.
Eur Respir J, 14 (1999), pp. 622-626
[24]
AA Acuna, J Gabrijelcic, EM Uribe, R Rabinovich, J Roca, JA Barberá, et al.
Fluticasone propionate attenuates platelet-activating factor-induced gas exchange defects in mild asthma.
Eur Respir J, 19 (2002), pp. 872-878
[25]
L Greiff, M Andersson, P Wollmer, CG Persson.
Hypertonic saline increases secretory and exudative responsiveness of human nasal airway in vivo.
Eur Respir J, 21 (2003), pp. 308-312

This work was partially funded by a grant from Red Respira (RITC-Instituto de Salud Carlos III and the Spanish Society of Pulmonology and Thoracic Surgery [SEPAR]).

Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología

Subscribe to our newsletter

Article options
Tools

Are you a health professional able to prescribe or dispense drugs?