The utility of transbronchial lung biopsies to guide the treatment decision in patients with rheumatic inflammatory diseases: a retrospective cross-sectional study.

The role of transbronchial lung biopsies (TBB) in the diagnostic workup of systemic inflammatory rheumatic disease-associated interstitial lung disease (SIRD-ILD) is unclear and TBB is not generally recommended. The study objective was to examine the utility of TBB to guide treatment in a population of patients with SIRD-ILD. All patients from the Department of Rheumatology, Rigshospitalet, Denmark, who had TBB performed, from 2002 to 2016 were identified. Patient demographics as well as smoking status, previous lung disease, pulmonary function test, SIRD-diagnosis, imaging results and immunomodulatory therapy pre- and post-bronchoscopy were obtained. Histology findings were used to dichotomize patients into a high-inflammatory group or a low-inflammatory group. The high-inflammation group primarily consisted of non-specific interstitial pneumonia, organizing pneumonia, lymphocytic infiltrating pneumonia and granulomatous inflammation whereas the low inflammation group primarily consisted of histological findings of usual interstitial pneumonitis and biopsies describing fibrosis and/or sparse unspecific inflammation. Therapeutic consequence was defined as intensification of therapy. Differences in treatment intensification were calculated using a binominal logistic regression model. Ninety-six patients had TBB performed. Biopsies from 55 patients were categorized as high inflammatory and 41 as low inflammatory, respectively. In the high-inflammatory group, 38 (69%) had their therapy intensified compared to 6 (14%) in the low-inflammatory group (Odds ratio 8.0, 95% confidence limits 3.2-20.0, P < 0.001). No procedure-related complications were registered. TBB findings can guide treatment strategy in SIRD-ILD patients with suspected activity in the pulmonary disease. TBB appears safe and could be considered as part of the diagnostic workup.

Airway responsiveness and inflammation in adolescent elite swimmers.

BACKGROUND: Whereas increased airway hyperresponsiveness (AHR) and airway inflammation are well documented in adult elite athletes, it remains uncertain whether the same airway changes are present in adolescents involved in elite sport. OBJECTIVE: To investigate airway responsiveness and airway inflammation in adolescent elite swimmers. METHODS: We performed a cross-sectional study on adolescent elite swimmers (n = 33) and 2 control groups: unselected adolescents (n = 35) and adolescents with asthma (n = 32). The following tests were performed: questionnaire, exhaled nitric oxide (FeNO), spirometry, induced sputum, methacholine challenge, eucapnic voluntary hyperpnea (EVH) test, and exhaled breath condensate pH. RESULTS: There were no differences in FeNO, exhaled breath condensate pH, cellular composition in sputum, or prevalence of AHR to either EVH or methacholine among the 3 groups. When looking at airway responsiveness as a continuous variable, the swimmers were more responsive to EVH than unselected subjects, but less responsive to methacholine compared with subjects with asthma. We found no differences in the prevalence of respiratory symptoms between the swimmers and the unselected adolescents. There was no difference in FeNO, cellular composition of sputum, airway reactivity, or prevalence of having AHR to methacholine and/or EVH between swimmers with and without respiratory symptoms. CONCLUSION: Adolescent elite swimmers do not have significant signs of airway damage after only a few years of intense training and competition. This leads us to believe that elite swimmers do not have particularly susceptible airways when they take up competitive swimming when young, but that they develop respiratory symptoms, airway inflammation, and AHR during their swimming careers.

Blood and urinary concentrations of salbutamol in asthmatic subjects.

PURPOSE: Data on blood and urinary concentrations of salbutamol after inhalation and oral administration in healthy subjects are scarce. Accordingly, we examined the pharmacokinetics of inhaled and oral salbutamol in asthmatic subjects. METHODS: We enrolled 10 men aged 18-45 yr in an open-label study in which 0.8 mg of inhaled or 8 mg of systemic salbutamol was administered in a crossover design. All subjects had doctor-diagnosed asthma, used beta2 agonist when needed, and abstained from any medicine, beta2 agonist inclusive, for 14 d before visit. Urine was collected from all subjects (0-4, 4-8, and 8-12 h), and blood samples were taken at 0, 0.5, 1, 2, 3, 4, and 6 h after salbutamol administration. RESULTS: Maximum urine concentration was reached during the first 4 h after administration of both inhaled and oral salbutamol. We found differences in median urinary concentrations (Cmax) of 260.9 and 2422.2 ng x mL(-1), respectively (P < 0.005). Urinary concentrations show high individual variability irrespective of the route of administration. Blood analyses showed a systemic exposure of salbutamol after both inhaled and oral salbutamol with peak concentration after inhalation before the oral intake (P < 0.05). A difference in median Cmax after inhalation and oral treatment was found: 1.75 and 18.77 ng x mL(-1), respectively (P < 0.05). CONCLUSIONS: Median urinary concentrations after oral administration of 8 mg of salbutamol were significantly higher than those after inhalation of 0.8 mg of salbutamol.

[The use of anti-asthmatic medication among Danish elite athletes]. / Forbruget af antiastmatisk medicin blandt danske sportsfolk.

INTRODUCTION: The prevalence of asthma and the use of anti-asthmatic medication is high among elite athletes. Elite athletes require a TUE certificate (Therapeutic Use Exemption) if they require anti-asthmatic medication which is on the prohibited list. The aim of the study was to determine the distribution of Danish TUE certificates and to examine the use of anti-asthmatic medication among Danish elite athletes. MATERIALS AND METHODS: A cross-sectional study of all applications for TUE certificates in 2005 was carried out. We focused on applications including anti-asthmatic medication. All applications resulted in certificates being issued. RESULTS: A total of 694 TUE certificates were issued. Of these, 445 (64%) concerned anti-asthmatic medication. Short-acting beta-2-agonists (SABA) were the most frequent medication (79%). Only 2% received long-acting beta-2-agonists (LABA) as single therapy. Inhaled steroids were used by 69%. Swimmers received significantly higher doses of inhaled steroids compared to all others athletes (1031 microg/day (148); p=0.01). The applications for TUE certificates were generally handled by general practitioners (78%). CONCLUSION: Most TUE certificates issued in 2005 concerned anti-asthmatic medication. Only a few athletes were treated with non-recommended anti-asthmatic medication like LABA as single therapy. Swimmers received higher doses of inhaled steroids compared to all others athletes. Most of the applications for TUE certificates were handled by general practitioners.