Certain subphenotypes of aspirin-exacerbated respiratory disease distinguished by latent class analysis.

BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) is recognized as a distinct asthma phenotype. It usually has a severe course accompanied by chronic hyperplastic eosinophilic sinusitis with nasal polyps, blood eosinophilia, and increased concentrations of urinary leukotriene E4 (LTE4). More insightful analysis of individual patients shows this group to be nonhomogeneous. OBJECTIVE: We sought to identify any likely subphenotypes in a cohort of patients with AERD through the application of latent class analysis (LCA). METHODS: Clinical data from 201 patients with AERD (134 women) were collected from questionnaires. Standard spirometry, atopy traits, blood eosinophilia, and urinary LTE4 concentrations were evaluated. LCA was applied to identify possible AERD subphenotypes. RESULTS: Four classes (subphenotypes) within the AERD phenotype were identified as follows: class 1, asthma with a moderate course, intensive upper airway symptoms, and blood eosinophilia (18.9% of patients); class 2, asthma with a mild course, relatively well controlled, and with low health care use (34.8% of patients); class 3, asthma with a severe course, poorly controlled, and with severe exacerbations and airway obstruction (41.3% of patients); and class 4, poorly controlled asthma with frequent and severe exacerbations in female subjects (5.0% of patients). Atopic status did not affect class membership. Patients with particularly intensive upper airway symptoms had the highest levels of blood eosinophilia and the highest concentrations of urinary LTE4. CONCLUSIONS: LCA revealed unique AERD subphenotypes, thus corroborating the heterogeneity of this population. Such discrimination might facilitate more individualized treatment in difficult-to-treat patients.

Aspirin desensitization in patients with aspirin-induced and aspirin-tolerant asthma: a double-blind study.

BACKGROUND: Numerous open trials have demonstrated the beneficial clinical effects of aspirin desensitization (AD) in patients with aspirin-induced asthma (AIA). These beneficial effects might be attributable to aspirin's potent anti-inflammatory properties, but that supposition requires further corroboration. OBJECTIVE: We sought to compare the clinical and biochemical responses to chronic oral AD in 20 patients with AIA and 14 patients with aspirin-tolerant asthma (ATA). All of the patients had chronic rhinosinusitis and nasal polyposis, and these responses were investigated in a pilot, double-blind, placebo-controlled study. METHODS: Twelve patients with AIA and 6 patients with ATA were randomly assigned to receive 624 mg of aspirin, and 8 patients with AIA and 8 patients with ATA received placebo. Both aspirin and placebo were administered once daily for 6 months. Nasal symptoms, Sino-Nasal Outcome Test (SNOT20) scores, peak nasal inspiratory flows, Asthma Control Questionnaire scores, spirometric parameters, peak expiratory flows, blood eosinophilia, and corticosteroid doses were assessed on a monthly basis. Levels of urinary leukotriene E4 and the stable plasma prostaglandin (PG) D2 metabolite 9α,11ß-PGF2 were evaluated at baseline and after 1, 3, 5, and 6 months. RESULTS: Only the patients with AIA subjected to AD reported improvements in smell and reductions in sneezing and nasal blockade. The SNOT20 and Asthma Control Questionnaire scores of these patients decreased, and their peak nasal inspiratory flows increased. The dosages of inhaled corticosteroids were reduced. There were no changes in leukotriene E(4) or 9α,11ß-PGF(2) levels after AD. CONCLUSION: The clinically beneficial effects of AD on nasal and bronchial symptoms occurred only in the patients with AIA.

Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls.

Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95 % confidence intervals [CI]: 0.98-1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR = 4.22; 95 % CI: 3.35-5.32; and OR = 2.79;95 % CI: 2.25-3.46, respectively), in double heterozygotes (OR = 3.42; 95 %CI 1.64-7.13), and in homozygous FVL or PT20210A (OR = 11.45; 95 %CI: 6.79-19.29; and OR: 6.74 (CI 95 % 2.19-20.72), respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤ 45 years (p value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.

Increased production of IL-5 and dominant Th2-type response in airways of Churg-Strauss syndrome patients.

OBJECTIVE: Churg-Strauss syndrome (CSS) is a rare systemic vasculitis associated with eosinophilia and asthma. We assessed the local immune response in airways of CSS patients with different activity of the disease. METHODS: Concentration of IL-5, CCL17, CCL22 and CCL26 (ELISA) together with cell expression of T-helper-related genes (real-time PCR array) were measured in bronchoalveolar lavage fluid (BALF) sampled from 11 patients with active CSS, 11 patients with CSS in remission and 9 control subjects with bronchial asthma. RESULTS: In active CSS, both BALF and blood eosinophil counts were increased (P<0.01). BALF cells in active disease were characterized by an increased expression of Th2 and regulatory-type transcripts: STAT6, STAT3, GATA3, IL4, IL5 and IL10 as compared with asthmatics, and STAT5A, CCR4, FOXP3, IL4, IL5 and IL10 when compared with inactive CSS. There was significant increase in BALF concentration of IL-5 and CCL26 in exacerbation of CSS. CCR4-active chemokines were detected more frequently in active disease. We found a strong positive correlation between clinical parameters of disease activity (BVAS, eosinophilia) and expression of IL4, IL5, IL10 and STAT5A. CONCLUSION: These results indicate that as compared with asthma, active-CSS patients have much stronger local Th2 response in the airways. Airway cells may contribute to lung eosinophilia in CSS by producing IL-5 and eosinophil active chemokines.

Mild asthmatics benefit from music therapy.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of pulmonary rehabilitation with music therapy in patients with asthma. METHODS: Seventy-six selected inpatients (54 women and 22 men; mean age = 56.4 years; SD = 11.8) with stable asthma underwent pulmonary rehabilitation in two groups: standard versus music therapy. RESULTS: After the intervention, an increase in analyzed spirometric values (forced expiratory volume at the first second (FEV(1)), FEV(1) as a percentage of vital capacity (FEV(1) % FVC), forced expiratory flow at 25%, 50%, and 75% of vital capacity (FEF(25), FEF(50), and FEF(75), respectively), and peak expiratory flow) was observed in both the groups (p < .05) but without any intergroup differences (p > .05). A greater increase of mean FEV(1) % FVC, FEF(50), and FEF(75) values was observed only in the patients with mild asthma from the music therapy group (p < .05). In both the groups, a dyspnea reduction was noted (p < .001). However, it was influenced neither by the type of rehabilitation nor by the gender (p > .05), but the interaction of these variables was significant (p = .044). A dyspnea reduction was observed in women in both the groups (p < .001) and in men in the music therapy group only (p = .001). A change in the value of anxiety (6.43, SD = 7.73) on the 10th day compared with the first day of the study was noticed (p < .001). However, this change was not influenced by the type of rehabilitation, gender, or a combination of these two variables (p > .05). CONCLUSION: Music therapy improves the respiratory function in patients with mild asthma and reduces dyspnea mainly in men with asthma.

Both Th2 and Th17 responses are involved in the pathogenesis of Churg-Strauss syndrome.

OBJECTIVES: Churg-Strauss syndrome (CSS) is a rare systemic vasculitis associated with eosinophilia and granuloma formation. The contribution of individual T-helper cell lineages in pathogenesis of CSS is unknown. We hypothesised that in CSS an imbalance of major effector T-cell subpopulations takes place, and is further influenced by the mode of treatment. METHODS: We investigated the immunophenotype, cytokine production and transcriptome profile in peripheral blood lymphocytes (PBL) from 19 patients with stable CSS (10 were treated with glucocorticoids alone (CSS/GC), 9 with steroids and other immunosuppressive drugs (CSS/IS)), and 13 healthy controls. Furthermore, serum IL-5 and CCR4-active chemokines (CCL17, CCL22) were measured in six patients with active disease and upon remission. RESULTS: All CSS patients had decreased percentage of FoxP3+ regulatory T cells. In the CSS/GC group we found an increase in the Th17/Treg ratio and up-regulation of both Th2 and Th17 markers as evidenced by (1) over expression of Th2-related genes (GATA3, STAT6) in PBL, (2) elevated concentrations of serum IL-5 and CCL17, and (3) a concomitant increase in the number of Th17 cells, and secretion of IL-17A by stimulated PBL. The level of CCR4-active chemokines was increased in active-CSS, and correlated with blood eosinophilia. The combined treatment with steroids and other immunosuppressive drugs was associated with a significant decrease in both Th2-related chemokines and the number of Th17 cells. CONCLUSIONS: Our results indicate that both Th2 and Th17 lineages are involved in the pathogenesis of CSS, while CCR4-active chemokines contribute to eosinophilia in the active disease. These phenomena are down regulated by immunosuppressive therapy.

Eoxins: a new inflammatory pathway in childhood asthma.

BACKGROUND: Increased levels of leukotrienes (LTs) in exhaled breath condensate (EBC) are associated with asthma and bronchial hyperresponsiveness (BHR), whereas eicosanoids generated through the 15-lipoxygenase (LO) pathway (15-hydroxyeicosatetraenoic acid [HETE] and eoxins) have been less studied. OBJECTIVE: We investigated whether metabolites of the 5- and 15-LO pathways in EBC are associated with childhood asthma, asthma severity, and clinical parameters. METHODS: The present study included 131 school-aged children (27 children with problematic severe asthma, 80 children with mild-to-moderate asthma, and 24 healthy children) from the Severe Asthma Recognized in Childhood study and 19 children with other nonasthmatic chronic lung diseases. Clinical work-up included spirometry, fractional exhaled nitric oxide measurements, skin prick testing, and methacholine challenge. Eicosanoids were analyzed in EBC by using mass spectrometry and are reported as concentrations (in picograms per milliliter) and eicosanoid/palmitic acid (PA) ratios. RESULTS: Eoxin C4/PA, eoxin D4/PA, eoxin E4/PA, 15-HETE/PA, and LTC4/PA ratios were significantly increased in asthmatic versus healthy children. Eoxin D4/PA and LTE4/PA ratios were also significantly higher in children with BHR. A nonsignificant trend was observed toward higher eoxin/PA ratios with increasing asthma severity. In contrast to asthma, children with chronic lung disease had the highest 15-HETE/PA, LTC4/PA, LTE4/PA, and LTB4/PA ratios. CONCLUSION: The results point to increased activity of the 15-LO inflammatory pathway in childhood asthma. Mass spectrometric analyses of EBC demonstrate that increased eoxin levels not only accompany the increased 5-LO product LTC4 but are also associated with BHR. These markers might represent a new therapeutic target for asthma treatment.

Clinical course and urinary eicosanoids in patients with aspirin-induced urticaria followed up for 4 years.

BACKGROUND: Little is known about the course of aspirin-induced urticaria. A special regulatory role of cysteinyl leukotrienes and prostaglandin D(2) (PGD(2)) has been postulated. OBJECTIVE: We performed a long-term observation on clinical course, aspirin sensitivity, and urinary eicosanoids in patients with aspirin-induced urticaria. METHODS: For 4 years, we followed up 22 patients with chronic idiopathic urticaria and aspirin hypersensitivity who restrained from the use of aspirin and other COX-1 inhibitors. Aspirin challenges were performed in 2002 (all results were positive) and repeated in 2006. Levels of urinary leukotriene E(4) (LTE(4)) and the main PGD(2) metabolite, 9 alpha 11 beta PGF(2), were measured at the same time points. RESULTS: During the follow-up period, the severity of urticaria has decreased. In 14 of 22 patients, the results of aspirin challenge remained positive. In 2002, these 14 patients responded to aspirin with a significant increase in urinary LTE(4) and 9 alpha 11 beta PGF(2) levels. When studied 4 years later, they showed a similar response of 9 alpha 11 beta PGF(2) (P = .047) and a tendency toward an increase in LTE(4) level (P = .057). There was a correlation between the urinary LTE(4) concentration after aspirin challenge and the intensity of skin eruptions. The dose of aspirin had no effect on the magnitude of response of both LTE(4) and the PGD(2) metabolite. In the remaining 8 patients, negative aspirin challenge results were not associated with changes in the urinary eicosanoids studied. CONCLUSIONS: Aspirin hypersensitivity manifesting as urticaria/angioedema remains present after 4 years in about two thirds of patients. Aspirin-precipitated skin reactions associate with increased excretion of LTE(4) and PGD(2).

Intrinsic pathway of apoptosis in peripheral blood eosinophils of Churg-Strauss syndrome.

OBJECTIVES: Churg-Strauss syndrome (CSS) is a rare necrotizing vasculitis associated with asthma, blood and tissue eosinophilia and granuloma formation. We wondered whether eosinophil accumulation in CSS results from the defect of intrinsic apoptosis pathway in blood eosinophils, leading to their prolonged survival. METHODS: We analysed immunophenotype (flow cytometry), expression of apoptosis-related genes (real-time PCR) and spontaneous apoptosis in blood eosinophils isolated from nine patients in exacerbation (active CSS), seven patients in remission (inactive CSS) and 14 matched healthy subjects. Serum IL-5 levels were also measured. RESULTS: In active CSS, blood eosinophils were characterized by small (<2-fold) decrease in expression of a few genes, primarily proapoptotic (e.g. BCL2L13, CASP2, CARD4) or involved in regulation of NF-kappaB (IKBKB, REL), but they did not differ in the rate of spontaneous apoptosis, when compared with other groups. Only selected genes were positively (BNIPL, PYCARD, CASP8, CRADD, BCAP31), or negatively (IKBKE) correlated with disease activity. In active CSS, eosinophils expressed activation markers (CD69, CD25), especially in subjects with most severe disease and elevated serum IL-5. CONCLUSIONS: High susceptibility of peripheral blood eosinophils to spontaneous apoptosis in vitro, and minor changes in expression of apoptotic-related genes in transcriptome analysis, do not support the hypothesis on intrinsic defect in apoptosis, as the cause of eosinophil accumulation in CSS.

High-resolution computed tomography evaluation of peripheral airways in asthma patients: comparison of focal and diffuse air trapping.

BACKGROUND: Air trapping evaluated in high-resolution computed tomography (HRCT) reflects changes in small bronchi. We simultaneously evaluated focal and diffuse air trapping in asthmatic patients. OBJECTIVES: (1) To evaluate air trapping and bronchial wall thickness in asthmatics. (2) To estimate the relationship between air trapping and bronchial wall thickness, pulmonary function tests (PFTs), age, gender and asthma severity. (3) To compare air trapping between subgroups of asthmatic patients with normal FEV(1) % pred. and FEV(1)/FVC % and controls. (4) To compare air trapping and bronchial wall thickness between aspirin-induced asthmatics (AIA) and aspirin-tolerant asthmatics (ATA). METHODS: Both groups (asthmatics and controls) included 30 patients. All patients underwent HRCT and PFTs. RESULTS: Focal (p < 0.0001) and diffuse (p = 0.0004) air trappings and bronchial wall thickness (T: p < 0.0001; T/D: p < 0.0001; WA%: p < 0.0001) were significantly greater in asthmatics. Focal and diffuse air trappings were inversely correlated (p = 0.021). Diffuse air trapping correlated with bronchial wall thickness: T/D (p = 0.047), T (p = 0.037), and WA% (p = 0.048). There was a significant difference in the extent of focal air trapping between a subgroup of asthmatics with normal FEV(1) % pred. and FEV(1)/FVC % and controls (p < 0.0001). There were no significant differences in focal (p = 0.095) and diffuse air trapping (p = 0.186) and bronchial wall thickness (T: p = 0.086; T/D: p = 0.428; WA%: p = 0.428) between AIA and ATA patients. CONCLUSIONS: Both focal and diffuse air trappings provide valuable diagnostic information and therefore deserve to be estimated. The lack of significant differences in air trapping and bronchial wall thickness between AIA and ATA patients needs further investigation.

[The frequency of hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) in the population of adult asthmatics in Poland based on an epidemiological questionnaire]. / Czestosc wystepowania nadwrazliwosci na niesteroidowe leki przeciwzapalne w populacji osób doroslych chorych na astme w Polsce - badanie epidemiologiczne.

INTRODUCTION: Hypersensitivity reactions to drugs account for 25% of all side effects related to drugs, affecting more than 7% of the population. One in four such reactions is caused by acetylic acid and other non-steroidal anti-inflammatory drugs. MATERIAL AND METHODS: Between 1998 and 2000 epidemiological research was carried out in various centers, with the aim of estimating the frequency of allergy-based diseases in Poland. The objective of the study was to evaluate the frequency of hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs), based on an epidemiological questionnaire, in the Polish adult population. RESULTS: Bronchial asthma was diagnosed in 582 patients (5.4%). Of that group, 75 patients (12.9%) additionally reported symptoms of hypersensitivity to NSAIDs. Aspirin-induced asthma was diagnosed in 11 patients (14.7%) with clinical manifestations of hypersensitivity responses. Frequency of aspirin-induced asthma with clinical symptoms amounted to 1.9% of asthmatics. In the assessment of severity of the disease, aspirin intolerance was the only statistically significant factor (p = 0.0003; odds ratio 28.6 with assumed 95% confidence interval). CONCLUSIONS: In the population of adults in Poland, the frequency of aspirin-induced asthma amounted to 0.1%. Hypersensitivity to NSAIDs was observed in 12.9% of asthmatics. In asthmatics with symptoms of hypersensitivity to non-steroidal anti-inflammatory drugs, which takes the course of clinically demonstrable aspirin-induced asthma, the risk of severe asthma is 30-fold higher.

[Congestive cardiomyopathy and left intraventricular thrombus as a manifestation of Churg-Strauss syndrome]. / Kardiomiopatia zastoinowa i skrzeplina w lewej komorze jako manifestacje zespolu Churga i Strauss.

A case of a 38-year-old female with symptomatic Churg-Strauss syndrome and congestive cardiomyopathy, complicated by cardiac arrest and left ventricular thrombus formation, is presented. Prompt institution of low molecular weight heparin and steroids resulted in rapid thrombus lysis and improvement of systolic left ventricular function.

[Thrombotic thrombocytopenic purpura with myocardial ischaemia: two case reports]. / Zakrzepowa plamica maloplytkowa z objawami niedokrwienia miesnia sercowego--opis dwóch przypadków.

Thrombotic thrombocytopenic purpura (TTP) is mainly perceived by cardiologists as a rare complication of ticlopidine or clopidogrel treatment. However, this life-threatening disease is provoked not only by antiplatelet drugs and may lead to myocardial ischaemia and necrosis caused by microvascular thrombosis and anaemia. We present two thienopiridine-naive patients who had acquired TTP and myocardial ischaemia, and were successfully treated by plasma exchanges.

[Cholestatic hepatitis as a ticlopidine-induced complication of treatment - a case report]. / Cholestatyczne zapalenie watroby jako powiklanie leczenia tiklopidyna - opis przypadku.

Ticlopidine, a thienopyridine derivative, is widely used in Poland in vascular procedures. Ticlopidine-induced acute cholestatic hepatitis is a very rare adverse reaction. We present a case of a patient with possible ticlopidine-induced cholestatic hepatitis occurring a few days after introducing this drug.

[Severe COPD and gender of patients versus the presence of profound psychological trauma]. / Ciezka POChP i plec chorych a obecnosc doznanych urazów psychicznych.

UNLABELLED: The authors examined psychiatrically a group of 45 patients suffering from severe COPD. The special interest of the study was the careful analysis of the time, context and content of different psychological traumas that the patients had experienced throughout their lives. METHODS: The authors examined 45 patients suffering from severe COPD (according to GOLD classification) during the present hospitalisation. There were 19 women (42%) and 26 men (58%). The average age was M = 64.56 years (SD = 10.64), and average duration of illness was M = 10.53 years (SD = 10.18). Mini International Neuropsychiatric Interview, Polish version 5.0.0, Panic and Agoraphobia Scale, Beck's Depression Inventory, Family Functioning Questionnaire (KOR), Sense of Coherence Scale (SOC-29), Defence Style Questionnaire (DSQ-40) and Life Inventory were used. RESULTS: Although the proportion of women in the group of 45 patients with severe COPD was 42%, they seem to be more prone to depression and panic than men. It may be due to specific trauma of suffering and/or death of an emotionally close person, which occurred in 64.4% of the study group. This trauma may have an impact on the intensity of anxious and depressive symptoms, catastrophic interpretation of bodily symptoms and also the sense of coherence of patients with COPD. CONCLUSIONS: It is possible, that strictly psychological and psychiatric problems affect the course and severity of COPD in women.

[Links between panic disorder, depression, defence mechanisms, coherence and family functioning in patients suffering from severe COPD]. / Zwiazki pomiedzy zespolem leku napadowego i depresja a mechanizmami obronnymi, koherencja i funkcjonowaniem rodzinnym u pacjentów z rozpoznaniem ciezkiej PoChP.

UNLABELLED: Chronic Obstructive Pulmonary Disease (COPD) is a slowly progressive lung disorder characterised by airflow obstruction. It is one of the major causes of morbidity, disability and mortality in the older population. Comorbid psychiatric and psychological impairments (depression and anxiety, most often panic disorder) are common in COPD. They impair the quality of life in COPD severely and are often not fully explored in the clinical management of COPD patients. AIM: The aim of our study was to assess the prevalence of anxiety (especially panic disorder) and depression among patients with COPD. A secondary objective was to find out a correlation between the psychological aspects (defence style, sense of coherence and family functioning) and psychiatric symptoms. METHODS: The authors examined 45 patients suffering from severe COPD (according to GOLD classification) during their present hospitalisation. There were 19 women (42%) and 26 men (58%). The average age was M = 64.56 years (SD = 10.64), and the average duration of illness was M = 10.53 years (SD = 10.18). Mini International Neuropsychiatric Interview, Polish version 5.0.0, Panic and Agoraphobia Scale, Beck's Depression Inventory, Family Functioning Questionnaire (KOR), Sense of Coherence Scale (SOC-29), Defence Style Questionnaire (DSQ-40) and Life Inventory were used. RESULTS: The study revealed that 44.4% of the group with severe COPD were patients who suffered also from panic disorder and 40% from depression. Depression was linked with more severe panic symptoms. All psychiatric symptoms were associated with a psychological problems. CONCLUSION: It is highly possible, that psychiatric and psychological problems affect the quality of life, self-management and treatment outcome in patients with COPD.

The broken balance in aspirin hypersensitivity.

Aspirin was introduced into medicine over a century ago and has become the most popular drug in the world. Although the first hypersensitivity reaction was described soon after aspirin had been marketed, only recently a phenomenon of cysteinyl leukotriene overproduction brought new insights on a balance between pro- and anti-inflammatory mediators derived from arachidonic acid. We describe the most common clinical presentations of aspirin hypersensitivity, i.e. aspirin-induced asthma, rhinosinusitis and aspirin-induced urticaria. We also present their biochemical background. Despite relatively high incidence of these reactions, aspirin hypersensitivity remains underdiagnosed worldwide. Acute reactions of aspirin hypersensitivity are elicited via cyclooxygenase inhibition by non-steroid anti-inflammatory drugs. Coxibs, selective inhibitors of cyclooxygenase-2 isoenzyme, do not precipitate symptoms in susceptible patients. Though hypersensitivity correlates with cyclooxygenase-1 inhibition, diminished tissue expression was described only for cyclooxygenase-2. Aspirin-induced asthma and aspirin-induced urticaria, in a substantial part of the patients, are driven by a release of mediators from activated mast cells. These cells in physiological conditions are under inhibitory control of prostaglandin E2. The origin of aspirin hypersensitivity remains unknown, but accumulating data from genetic studies strongly suggest that environmental factor, possibly a common viral infection, can trigger the disease in susceptible subjects.

[Difficult asthma and gender of patients versus the presence of profound psychological trauma]. / Astma ciezka i plec chorych a obecnosc doznanych urazów psychicznych.

BACKGROUND: The authors examined psychiatrically a group of 97 patients suffering from severe asthma (classified according to GINA 2002). The special interest of the study was the careful analyse the time, context and content of different psychological traumas that the patients had throughout their lives. METHODS: Mini International Neuropsychiatric Interview, Polish version 5.0.0., Panic and Agoraphobia Scale, The Body Sensations Interpretation Questionnaire, Beck's Depression Inventory, Family Functioning Questionnaire (KOR), Antonovsky's Sense of Coherence Scale (SOC-29), Bond's Defence Style Questionnaire (DSQ-40) and Life Inventory were used. RESULTS: The proportion of women in the group of 97 severe asthmatics was 75%, which is in compliance with literature. This fact is probably due to specific trauma of suffering and/or death of an emotionally close person, which occurred in 80% of the study group. This trauma may have direct impact on the intensity of anxious and depressive symptoms, catastrophic interpretation of bodily sensations, coherence, a more frequent use of immature defence style and impaired family functioning. CONCLUSION: It is highly possible, that strictly psychological and psychiatric problems affect the severity of asthma more, than it was realised before.