Effects of cigarette smoke on methacholine- and AMP-induced air trapping in asthmatics.

UNLABELLED: Abstract Objective: No information is available on the effect of cigarette smoke on bronchoconstrictor-induced air trapping in asthma. The aim of this study was to evaluate the additional influence of smoking on methacholine- and adenosine 5'-monophosphate (AMP)-induced air trapping in subjects with asthma. METHODS: Airway responsiveness to methacholine and AMP, bronchial (J'awNO) and alveolar (CANO) nitric oxide (NO) and exhaled breath condensate pH were measured in 68 adults (23 current smokers with asthma, 23 non-smokers with asthma and 22 current or former smokers with chronic obstructive pulmonary disease; COPD). The degree of air trapping induced by each bronchoconstrictor agent was expressed by the percent fall in forced vital capacity (FVC) at a 20% fall in forced expiratory volume in 1 s relative to FVC after saline inhalation (ΔFVC%). RESULTS: The ΔFVC% for AMP was higher in both smokers with asthma and patients with COPD than in non-smokers with asthma (p<0.001). By contrast, ΔFVC% for methacholine was similar in the three groups of subjects (p=0.69). In smokers with asthma, but not in the other two groups, there was a correlation between the residual volume/total lung capacity at baseline and the ΔFVC% induced by each bronchoconstrictor agent. Mean values for J'awNO were higher in non-smokers with asthma than in the other two groups (p<0.05). CONCLUSIONS: The results of this study suggest that factors underlying bronchoconstriction induced by indirect agonists are different in smokers and non-smokers with asthma. These observations might be clinically relevant, because triggers that frequently induce bronchial obstruction in the real world act by an indirect mechanism.

[Low doses of megestrol acetate increase weight and improve nutrition status in patients with severe chronic obstructive pulmonary disease and weight loss]. / Dosis bajas de acetato de megestrol aumentan el peso y mejoran la nutrición de los pacientes con enfermedad pulmonar obstructiva crónica grave y pérdida de peso.

BACKGROUND AND OBJECTIVE: Weight loss in patients with severe chronic obstructive pulmonary disease (COPD) is a prognostic bad factor. The objective of this study is to analyze the effectively of megestrol acetate (MA) to increase appetite of these patients. PATIENTS AND METHODS: Randomized double blind placebo controlled trial to study the effect of 160 mg/bid of MA, for 8 weeks, on nutritional, functional, analytical and quality of life parameters, in 38 patients with severe COPD and body mass index (BMI) < 21 kg/m(2), or between 21-25 with involuntary weight loss of 5% in the last 3 months. RESULTS: At 8 weeks, in the MA group the body weight increased (2.3 kg) with respect to the control group (0.1 kg) (p<0.04). MA improved significantly the triceps skin-fold thickness (p < 0.04), prealbumin (p<0.004), lymphocytes (p<0.0006), C3 (p<0.04), PCO(2) (p<0.007) and bicarbonate levels (p<0.008). MA did not increase the MRC and SGRQ scales, the distance of 6 MWT nor BODE index. The IL-6 and TNF alpha levels were not modified in the MA group, but leptin did increase (p<0.043). MA improved the sense of wellbeing (p<0.02) and the appetite (p<0.008), compared to the control group. Adverse effects were similar in both groups. CONCLUSIONS: MA safely increases the body weight and the appetite in severe COPD patients with weight loss. MA improves blood gases and nutritional parameters and the sense of wellbeing, but it does not improve the respiratory muscular function or exercise tolerance.

Dosis bajas de acetato de megestrol aumentan el peso y mejoran la nutrición de los pacientes con enfermedad pulmonar obstructiva crónica grave y pérdida de peso / Low doses of megestrol acetate increase weight and improve nutrition status in patients with severe chronic obstructive pulmonary disease and weight loss

Fundamento y objetivo:La pérdida de peso en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) grave indica mal pronóstico. El objetivo de este estudio es analizar la efectividad del acetato de megestrol (AM) como estimulante del apetito en estos pacientes. Pacientes y método: Ensayo clínico aleatorizado, doble ciego y controlado con placebo para estudiar el efecto de 320mg/d de AM durante 8 semanas sobre parámetros nutricionales, funcionales, analíticos y de calidad de vida en 38 pacientes con EPOC grave e índice de masa corporal (IMC) < 21kg/m2, o entre 21-25kg/m2 con pérdida involuntaria del 5% del peso en los últimos 3 meses. Resultados: A las 8 semanas, el peso aumentó en el grupo AM (2,3kg) respecto al control (0,1kg) (p < 0,04). Mejoraron con AM de forma significativa el grosor del pliegue tricipital (p < 0,04), los valores de prealbúmina (p<0,004), linfocitos (p<0,0006), fracción 3 del complemento (C3) (p<0,04), presión parcial de dióxido de carbono (PCO2) (p<0,007) y bicarbonato (p<0,008). No mejoraron las escalas MCR y SGRQ, la distancia recorrida en 6 minutos (6MWT) ni el índice BODE. La interleucina 6 (IL-6) y el factor de necrosis tumoral alfa (TNF-alfa) tampoco se modificaron en el grupo AM, pero aumentó la leptina (p<0,043). El AM mejoró la sensación de bienestar (p<0,02) y el apetito (p<0,008) frente al control. El índice de acontecimientos adversos fue similar en ambos grupos. Conclusiones: El AM incrementa de forma segura el peso y el apetito en pacientes con EPOC grave y pérdida de peso. Mejora los parámetros gasométricos, nutricionales y la sensación de bienestar, pero no la función muscular respiratoria o la tolerancia al ejercicio (AU)

Background and objective: Weight loss in patients with severe chronic obstructive pulmonary disease (COPD) is a prognostic bad factor. The objective of this study is to analyze the effectively of megestrol acetate (MA) to increase appetite of these patients. Patients and methods: Randomized double blind placebo controlled trial to study the effect of 160mg/bid of MA, for 8weeks, on nutritional, functional, analytical and quality of life parameters, in 38 patients with severe COPD and body mass index (BMI) < 21kg/m2, or between 21-25 with involuntary weight loss of 5% in the last 3 months. Results: At 8weeks, in the MA group the body weight increased (2.3kg) with respect to the control group (0.1kg) (p<0.04). MA improved significantly the triceps skin-fold thickness (p < 0.04), prealbumin (p<0.004), lymphocytes (p<0.0006), C3 (p<0.04), PCO2 (p<0.007) and bicarbonate levels (p<0.008). MA did not increase the MRC and SGRQ scales, the distance of 6MWT nor BODE index. The IL-6 and TNF alpha levels were not modified in the MA group, but leptin did increase (p<0.043). MA improved the sense of wellbeing (p<0.02) and the appetite (p<0.008), compared to the control group. Adverse effects were similar in both groups. Conclusions: MA safely increases the body weight and the appetite in severe COPD patients with weight loss. MA improves blood gases and nutritional parameters and the sense of wellbeing, but it does not improve the respiratory muscular function or exercise tolerance (AU)

Exhaled nitric oxide measurement is not useful for predicting the response to inhaled corticosteroids in subjects with chronic cough.

BACKGROUND: Increased concentrations of exhaled nitric oxide (ENO) are identified predominantly in subjects with chronic cough due to conditions that habitually respond well to therapy with inhaled corticosteroids (ICSs). The aim of this study was to assess the usefulness of ENO in predicting the response to ICS therapy in subjects with chronic cough and to determine the relationship between either methacholine or adenosine 5'-monophosphate (AMP) responsiveness and the response to ICS therapy. METHODS: A total of 43 patients with chronic cough were studied. During the baseline period, ENO measurement, spirometry, and concentration-response studies with both methacholine and AMP were performed. For the next 4 weeks, the patients were treated with inhaled fluticasone propionate, 100 microg twice daily. At baseline (1 week) and during the 4-week treatment period, patients twice daily completed entries in a diary, in which they recorded daytime and nighttime cough symptom scores. RESULTS: Nineteen patients (44%) responded well to fluticasone therapy. The receiver operating characteristic curve analysis showed that the accuracy of identifying the response to ICS therapy for ENO at baseline was poor. The sensitivity and specificity of ENO for predicting the response to ICS therapy, using 20 parts per billion as the ENO cutoff point, were 53% and 63%, respectively. Differences in both prevalence and degree of airway responsiveness to either methacholine or AMP between fluticasone-responsive subjects and nonresponsive subjects were also not significant. CONCLUSIONS: Although a significant proportion of subjects with chronic cough respond well to ICS therapy, these patients cannot be identified by ENO levels or AMP responsiveness at baseline.