Serum lipoproteins are not associated with the severity of asthma.

BACKGROUND: Asthma is a chronic inflammatory disorder of the bronchi with a complicated and largely unknown pathogenesis. In this context, an emerging role is attributed to the apolipoproteins which serve as structural components of plasma lipoproteins. Low density lipoproteins (LDL) may be involved in the inflammatory pathways of the asthmatic airways; in particular, small dense LDL (sdLDL) particles were associated with increased oxidative susceptibility compared to medium and large sized LDL. In our previous study, we found a positive correlation between forced expiratory volume 1 s (FEV1) % predicted and larger LDL particles (LDL-1), and an inverse correlation between FEV1% predicted and sdLDL (LDL-3) in mild, untreated asthmatics. Although LDL appear to be important modulators of inflammation, data on their clinical implications are still lacking. OBJECTIVE: The aim of the study is to investigate whether LDL subclasses correlate with the severity of asthma, assuming that the atherogenic and most pro-inflammatory LDL contribute to ignite and perpetuate the airway inflammatory processes. METHODS: The study was conducted in one visit, and included clinical and lung functional assessments, as well as measurements of serum concentrations of the LDL subclasses. Non-denaturing, linear polyacrylamide gel electrophoresis was used to separate and measure LDL subclasses, with the LipoPrint© System (Quantimetrix Corporation, Redondo Beach, CA, USA). LDL subclasses were distributed as seven bands (LDL-1 to LDL-7), LDL-1 and -2 being defined as large LDL (least pro-inflammatory), and LDL-3 to 7 defined as sdLDL (most pro-inflammatory). RESULTS: 70 asthmatics under inhaled treatment (M/F: 35/35) were enrolled; 10 healthy subjects (M/F: 3/7) served as controls. In the asthmatic group, FEV1% predicted was 81 ±â€¯22% (mean ±â€¯SD), vital capacity (VC) % predicted was 97 ±â€¯18%, and FEV1/FVC was 0.68 ±â€¯0.1. The mean asthma control test (ACT) score was 18 ±â€¯5. LDL-1 were significantly lower in asthmatics as compared to controls (18 ±â€¯4% vs. 22 ±â€¯4%, p = 0.008). On the contrary, LDL-2 (12 ±â€¯4% vs. 12 ±â€¯5%) and LDL-3 (3 ±â€¯3% vs. 2 ±â€¯2%) were not statistically different between the two groups; smaller subclasses were undetectable. To comply with the design of the study, subjects were classified according to their degree of severity into the 5 Global Initiative for Asthma (GINA) steps: Step 1 (M/F: 4/3, 44 ±â€¯12 yrs), Step 2 (M/F: 1/2, 37 ±â€¯11 yrs), Step 3 (M/F: 12/7, 47 ±â€¯12 yrs), Step 4 (M/F: 8/15, 54 ±â€¯12 yrs), and Step 5 (M/F: 7/9, 56 ±â€¯9 yrs). None of the LDL subclasses showed significant differences between classes of severity: LDL-1 were 16.1 ±â€¯5.6% in Step 1, 18 ±â€¯2.8% in Step 2, 16.7 ±â€¯3.7% in Step 3, 18 ±â€¯3.3% in Step 4, and 19.5 ±â€¯3.2% in Step 5 (p = NS); LDL2 were 14 ±â€¯3.6%, 15 ±â€¯3.4%, 12.4 ±â€¯5.3%, 12.7 ±â€¯4.4% and 11.3 ±â€¯4.2%, respectively (p = NS); LDL3 were 5 ±â€¯5.2%, 4.4 ±â€¯2.6%, 3.3 ±â€¯3.6%, 3.2 ±â€¯2.6% and 2.4 ±â€¯1.8%, p = NS. Finally, no relationship was detected between LDL subclasses and lung function parameters as well as the ACT scores. CONCLUSIONS: The current findings confirm a role of LDL as a potential biomarker in the diagnostic process for asthma, and suggest that LDL cannot be used as marker of severity of the disease.

Use of bronchoscopic steam thermal ablation (BTVA) in a clinically compromised patient.

BACKGROUND: Bronchoscopic lung volume reduction (BLVR) techniques improve lung function and increase exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) and BLVR treatment is included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines for these patients. BTVA (Intervapor Uptake Medical, Tustin, CA, USA) represents a recent therapy of this group that allows to treat sublobar areas and for this reason is used clinically compromised patients, like in this case report. CASE PRESENTATION: In this paper we describe a case report of an 85-year-old male with severe respiratory failure and a diagnosis of emphysema presented with dyspnea and clinical worsening, despite the best medical therapy practiced. For comorbidity and pathology's features he was excluded from surgical treatment options, like lung volume reduction surgical (LVRS) and from positioning of endobronchial valves (EBV) for the presence of collateral ventilation and he was addressed to BTVA. The procedure was successful for this patient. CONCLUSIONS: This case supports recent suggestions that BTVA can be a good alternative treatment for patients properly selected.

Fever and dyspnoea in a tracheostomised patient.

Pneumonia of unknown origin in tracheostomised patient https://bit.ly/3hZHBA0.