331 research outputs found
Personal exposure to the air pollutant nitrogen dioxide and the risk of lower respiratory disease with upper respiratory infection
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Cell counts in severe asthma: concordance of sputum and BAL in Wessex Severe Asthma Cohort
No full textBackground: Asthma is widely considered an eosinophilic disease however severe asthma is frequently non-eosinophilic. Treatment options can depend on airway cell counts but proximal and distal airways may not be concordant in terms of cell differential. The Wessex Severe Asthma Cohort (WSAC) recruited 342 participants with severe asthma for detailed phenotyping with some participants undergoing sputum induction and/or bronchoscopy with bronchoalveolar lavage (BAL). We aimed to use data from the WSAC to assess the agreement between sputum and BAL cell differentials.Methods: WSAC participants with severe asthma were included if they underwent both BAL and successful sputum induction. Correlation coefficients and classification tables were used to calculate the agreement between the proximal (sputum) and distal (BAL) compartments.Results: 38 participants were included in the analysis. Correlation coefficients were 0.429 for neutrophil count (p=0.007) and 0.569 for eosinophil count (p<0.001). Sputum and BAL eosinophilia (3% and 1%) were concordant in 68% with Sputum eosinophilia alone in 21% and BAL alone in 11%. Neutrophilia (60% and 3%) were concordant in 45%, with sputum neutrophilia alone in 50% and BAL alone in 5%.Conclusions: Sputum and BAL cell counts showed moderate correlation, but significant classification discrepancies were found when using recognised thresholds. Sampling of multiple compartments may be required for optimal assessment of individuals with severe asthma
Assessment of small airways dysfunction with impulse oscillometry, multiple flow nitric oxide and spirometry in the Wessex severe asthma cohort study
No full textRationale: Asthma is a disease of the conducting airways. Small airway events are poorly reflected by standard lung function.
Methods: IOS, spirometry and FeNO measures were made in healthy controls (HC, n=76), non-steroid treated mild asthmatics (MA, n=30), steroid treated step 2/3 asthmatics (ModA, n=35) and treatment-resistant step4/5 severe asthmatics (SA n=71), to assess disease related small airways dysfunction. Group comparisons and correlations were undertaken using both parametric and non-parametric statistical analyses.
Results: Maximum airway nitric oxide flux (JawNO) , reflecting central airways inflammation, was increased in MA (median 2740, p<0.001) compared to both HC (640)and SA (700). By contrast, alveolar nitric oxide (CANO), which reflects peripheral airway inflammation, was significantly increased in all asthma groups compared to HC (p<0.05). Increased peripheral resistance was significantly elevated in asthma (p<0.001), with R5-R20>10% in absolute values being present in 53.3% of MA, 74.3% of ModA and 84.5% of SA.. A significant negative correlation was noted between R5-R20 and MEF25-75(r=-0.537), p<0.001),and both parameters correlated with asthma control ACQ6 (p<0.001) and asthma quality of life (p<0.001).
Conclusion: Increased small airways resistance and distal inflammation is a feature of asthma with increasing peripheral resistance with disease severity. In SA this is associated with worse asthma control and greater impairment in quality of life. These findings emphasise the importance of the small airways to disease pathophysiology in asthma
Personal exposures of children to nitrogen dioxide relative to concentrations in outdoor air
No full textObjectives: To investigate the relation between fluctuations in personal exposure to nitrogen dioxide (NO2) in school children and changes in outdoor NO2 concentrations.Methods: 114 Asthmatic school children aged 7-12 years were recruited from the Southampton area. Weekly average personal exposures to NO2 were measured over a 13 month period with passive diffusion tubes. At the same time, outdoor NO2 concentrations were monitored at a fixed site in the centre of Southampton. Correlations between weekly personal exposures and mean outdoor concentrations during the same periods were examined.Results: Mean duration of follow up was 32 weeks. Measurements of weekly mean personal NO2 exposures were generally low and ranged from 0.7 to 496 µg/m3 with a geometric mean of 17 µg/m3. Substantial variation in personal exposures occurred between children and more especially within individual children from week to week. Daily outdoor concentrations of NO2 ranged from 4.3 to 29.8 µg/m3, with a geometric mean of 12.3 µg/m3. There was no evidence of seasonal variation in outdoor concentrations. No significant correlation was found between each child's weekly mean personal exposures to NO2 and mean outdoor concentrations for the corresponding periods.Conclusion: At low outdoor NO2 concentrations, fluctuations in NO2 in outdoor air as measured at a central monitoring station do not contribute importantly to variations in personal exposure when averaged over a week
Hear the patient voice: their perspectives speak loudly to trusts
No full textPatients and the public have lived experiences of a condition, medicine or service that can benefit research teams. Carole Fogg and colleagues explain the reasons why trusts should be investing in public and patient involvement post
Using the Inflammacheck Device to Measure the Level of Exhaled Breath Condensate Hydrogen Peroxide in Patients With Asthma and Chronic Obstructive Pulmonary Disease (The EXHALE Pilot Study): Protocol for a Cross-Sectional Feasibility Study
No full textBackground - Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common conditions that affect over 5 million people in the United Kingdom. These groups of patients suffer significantly from breathlessness and recurrent exacerbations that can be difficult to diagnose and go untreated. A common feature of COPD and asthma is airway inflammation that increases before and during exacerbations. Current methods of assessing airway inflammation can be invasive, difficult to perform, and are often inaccurate. In contrast, measurement of exhaled breath condensate (EBC) hydrogen peroxide (H2O2) is performed during normal tidal breathing and is known to reflect the level of global inflammation in the airways. There is a need for novel tools to diagnose asthma and COPD earlier and to detect increased airway inflammation that precedes an exacerbation.Objective - The aim of this study was to explore the use of a new handheld device (called Inflammacheck) in measuring H2O2 levels in EBC. We will study whether it can measure EBC H2O2 levels consistently and whether it can be used to differentiate asthma and COPD from healthy controls.Methods - We will perform a cross-sectional, feasibility, pilot study of EBC H2O2 levels, as measured by Inflammacheck, and other markers of disease severity and symptom control in patients with asthma and COPD and volunteers with no history of lung disease. Participants will be asked to provide an exhaled breath sample for measurement of their EBC H2O2 using Inflammacheck. The result will be correlated with disease stage, spirometry, fractional exhaled nitric oxide (FeNO), and symptom control scores.Results - This study's recruitment is ongoing; it is anticipated that the results will be available in 2018.Conclusions - The EXhaled Hydrogen peroxide As a marker of Lung diseasE (EXHALE) pilot study will provide an evaluation of a new method of measuring EBC H2O2. It will assess the device's consistency and ability to distinguish airway inflammation in asthma and COPD compared with healthy controls
The impact of obesity in patients with severe asthma in the Wessex Severe Asthma Cohort (WSAC)
No full textThe impact of maintenance oral corticosteroids (OCS) on disease burden and type-2 inflammatory signal in the Wessex Severe Asthma Cohort (WSAC)
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