The effects of smoking and smoking cessation on nasal mucociliary clearance, mucus properties and inflammation

OBJECTIVE: The aim of the present study was to assess nasal mucociliary clearance, mucus properties and inflammation in smokers and subjects enrolled in a Smoking Cessation Program (referred to as quitters). METHOD: A total of 33 subjects with a median (IQR) smoking history of 34 (20-58) pack years were examined for nasal mucociliary clearance using a saccharine transit test, mucus properties using contact angle and sneeze clearability tests, and quantification of inflammatory and epithelial cells, IL-6 and IL-8 concentrations in nasal lavage fluid. Twenty quitters (mean age: 51 years, 9 male) were assessed at baseline, 1 month, 3 months and 12 months after smoking cessation, and 13 smokers (mean age: 52 years, 6 male) were assessed at baseline and after 12 months. Clinicaltrials.gov: NCT02136550. RESULTS: Smokers and quitters showed similar demographic characteristics and morbidities. At baseline, all subjects showed impaired nasal mucociliary clearance (mean 17.6 min), although 63% and 85% of the quitters demonstrated significant nasal mucociliary clearance improvement at 1 month and 12 months, respectively. At 12 months, quitters also showed mucus sneeze clearability improvement (∼26%), an increased number of macrophages (2-fold) and no changes in mucus contact angle or cytokine concentrations. CONCLUSION: This study showed that smoking cessation induced early improvements in nasal mucociliary clearance independent of mucus properties and inflammation. Changes in mucus properties were observed after only 12 months of smoking cessation.

Th-1 and Th-2 cytokine production in infants with virus-associated wheezing

Wheezing associated with respiratory viral infections in infancy is very common and results in high morbidity worldwide. The Th1/Th2 pattern of immune response in these patients remains unclear and previous studies have shown controversial results. The aim of the present study was to compare the type of Th1/Th2 cytokine response between infants with acute bronchiolitis, recurrent wheezing and upper respiratory infections from a developing country. Infants younger than 2 years of age admitted to Hospital São Lucas, Porto Alegre, RS, Brazil, between May and November 2001, with an acute episode of wheezing associated with viral respiratory infection were selected. Subjects with upper respiratory infections from the emergency department were selected for the control group. Interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) levels from nasal aspirates were determined by ELISA from peripheral mononuclear cell cultures. Twenty-nine subjects with acute bronchiolitis, 18 with recurrent wheezing and 15 with upper respiratory infections were enrolled. There were no differences in family history of atopy or parental smoking between groups. Oxygen requirement was similar for the acute bronchiolitis and recurrent wheezing groups. The percentage of positive tests for the cytokines studied and the IFN-gamma/IL-4 ratio was similar for all groups. Comparison of the polarized Th1/Th2 cytokine results for the various groups showed no specific pattern of cytokine production. Infants with wheezing from a developing country do not show any specific predominant pattern of Th1/Th2 cytokine production, suggesting that multiple factors may be involved in the pathogenesis of this illness.

Inflammatory mediators in nasal lavage among school-age children from urban and rural areas in São Paulo, Brazil

CONTEXTO: Alguns estudos demonstram que o processo inflamatório nas vias aéreas nasais poderia refletir ou mesmo afetar as vias aéreas inferiores. Decidimos avaliar indiretamente o estado inflamatório das vias aéreas nasais de dois grupos de escolares com diferente sensibilização aos aeroalérgenos mais comuns. OBJETIVO: Comparar a atividade inflamatória nas vias aéreas nasais, através da determinação de mediadores inflamatórios no lavado nasal em duas populações distintas de crianças em idade escolar. TIPO DE ESTUDO: Estudo transversal. LOCAL: O estudo foi realizado em duas escolas públicas de ensino fundamental, uma em zona urbana e outra em zona rural, no Estado de São Paulo. MÉTODOS: Foram constituídos dois grupos de 40 escolares que apresentam diferentes taxas de sensibilização a aeroalérgenos comuns. Amostras do lavado nasal foram colhidas para determinação de proteína catiônica eosinofílica (ECP) e triptase. Testes não-paramétricos foram usados na análise estatística. RESULTADOS: Níveis significativamente maiores de proteína catiônica eosinofílica foram encontrados nos estudantes da área urbana (p < 0,05). Não houve diferença estatística nos níveis de triptase entre os dois grupos. Observou-se ainda que, na área urbana, as crianças sensibilizadas aos aeroalérgenos apresentaram maiores concentrações de proteína catiônica eosinofílica, o que não foi observado nas crianças da zona rural. DISCUSSAO: A ausência de atividade de mastócitos e a degranulação aumentada de eosinófilos revelaram uma inflamação crônica nas vias aéreas das crianças estudadas. A maior atividade de eosinófilos na zona urbana, coincidindo com a maior sensibilização aos aeroalérgenos, sugere que deve haver algum fator a mais na área urbana que modula a resposta das vias aéreas influenciando a ativação das células inflamatórias locais. CONCLUSAO: Nossos achados não mostraram diferenças nos níveis de triptase no lavado nasal entre os dois grupos estudados. Por outro lado, as crianças da area urbana apresentaram maiores concentrações de proteína catiônica eosinofílica do que aquelas da zona rural. Observamos ainda que, na area urbana, as crianças sensibilizadas por aeroalérgenos apresentaram maiores concentrações de proteína catiônica eosinofílica do que aquelas não sensibilizadas, enquanto esta diferença não foi observada nas crianças da area rural.

Disposition of rifampicin following intranasal and oral administration.

Leprosy is transmitted by dissemination of M.leprae which are lodged in the nose of the patients suffering from multibacillary (MB) type of the disease. Rifampicin, a potent bactericidal antileprotic drug is given orally to the patients with a view to make the infective cases non-infective. Earlier work by us has shown that intranasal administration of rifampicin helps in reducing the M.leprae load in the nose much faster than after conventional oral administration. In the present study, rifampicin concentrations in plasma/urine/nasal wash of healthy volunteers following oral and intranasal administration were determined. Following intranasal administration, rifampicin was not detectable in plasma and high concentrations were measured in the nasal wash. Following oral administration, rifampicin was not detectable in the nasal wash indicating that enough antibiotic levels are not available for clearing M.leprae from nose.