Inflamación bronquial, clínica respiratoria y función pulmonar en el síndrome de Sjögren primario / Bronchial Inflammation, Respiratory Symptoms and Lung Function in Primary Sjögren’s Syndrome

Introducción: En el síndrome de Sjögren primario (SSp) no se dispone de información suficiente queanalice la relación entre la clínica respiratoria o la función pulmonar y la inflamación bronquial presente,medida por esputo inducido.Objetivo: Descripción de las características clínicas y de función pulmonar en los pacientes diagnosticadosde SSp y su relación con el perfil inflamatorio de la luz bronquial.Métodos: Se analizaron síntomas respiratorios, radiología, función pulmonar, hiperrespuesta bronquiale inflamación mediante esputo inducido de 36 pacientes consecutivos diagnosticados de SSp.Resultados: El 58% de los pacientes presentó carraspera y el 42% tos y disnea. No hubo alteraciones destacablesde la función pulmonar, pero el 46% (n = 16) presentó una prueba de respuesta bronquial positiva.La linfocitosis > 2,6% en esputo estaba presente en el 69% de los esputos analizados. Presentaron toscrónica el 29% de los pacientes con linfocitosis (n = 24), frente al 73% de los normales (n = 11) (p = 0,02),con una duración de la tos inferior para el primero (p = 0,02). Por el contrario, la hiperrespuesta bronquialse asoció con linfocitosis (p = 0,02). El 55% de los esputos patológicos (n = 22) presentaron lipófagos(índice > 15) frente al 18% de los normales (n = 11) (p = 0,05).Conclusión: Los síntomas respiratorios (carraspera, tos y disnea) son frecuentes en el SSp aunque surelación con la hiperrespuesta bronquial y la inflamación de la vía aérea es variable. El hallazgo de linfocitosisen la vía aérea constituye un foco infiltrativo más de la enfermedad, siendo el esputo inducidouna herramienta complementaria en la valoración de la actividad inflamatoria pulmonar del SSp(AU)

Introduction: There is no information available regarding the relationship between the respiratory symptomsor lung function and bronchial inflammation, measured by induced sputum.Objectives: Description of the clinical characteristics, radiographic images and lung function of patientssuffering from Primary Sjögren Syndrome (PSS), and to assess the relationship with the inflammatoryairway profile.Methods: Weanalysed clinical, radiology, lung function tests, bronchial hyperresponsiveness and inflammatorydata in the induced sputum from 36 consecutive patients with PSS.Results: A total of 58% of patients had hoarseness and 42% had cough and dispnea. No lung dysfunctionwas observed, although 46% (n = 16) had a positive bronchial response. Lymphocytosis >2.6% in inducedsputum was observed in 69% of all sputa. There was chronic coughin 29% of patients with lymphocytosis(n = 24), whereas 73% were normal (n = 11) (P = .02). The duration time of cough was less for the former (P = .02). On the contrary a positive bronchial response was associated with lymphocytosis >2.6% (P = .02). Lipophages were presnt in 55% of pathological sputa (n = 22) (index >15) versus 18% of the non-pathological ones (n = 11) (P = .05). Conclusion: Hoarseness, cough and dyspnea are frequent respiratory symptoms in PSS, although there is awide variation in the relationship with bronchial responsiveness and airway inflammation. Lymphocytosisin the airways is another site of the infiltrative process in PSS, and the induced sputum is a complementarytool in the identification of active inflammatory process(AU)

Bronchial inflammation, respiratory symptoms and lung function in Primary Sjögren's syndrome.

INTRODUCTION: There is no information available regarding the relationship between the respiratory symptoms or lung function and bronchial inflammation, measured by induced sputum. OBJECTIVES: Description of the clinical characteristics, radiographic images and lung function of patients suffering from Primary Sjögren Syndrome (PSS), and to assess the relationship with the inflammatory airway profile. METHODS: We analysed clinical, radiology, lung function tests, bronchial hyperresponsiveness and inflammatory data in the induced sputum from 36 consecutive patients with PSS. RESULTS: A total of 58% of patients had hoarseness and 42% had cough and dispnea. No lung dysfunction was observed, although 46% (n=16) had a positive bronchial response. Lymphocytosis >2.6% in induced sputum was observed in 69% of all sputa. There was chronic cough in 29% of patients with lymphocytosis (n=24), whereas 73% were normal (n=11) (P=.02). The duration time of cough was less for the former (P=.02). On the contrary a positive bronchial response was associated with lymphocytosis >2.6% (P=.02). Lipophages were present in 55% of pathological sputa (n=22) (index >15) versus 18% of the non-pathological ones (n=11) (P=.05). CONCLUSION: Hoarseness, cough and dyspnea are frequent respiratory symptoms in PSS, although there is a wide variation in the relationship with bronchial responsiveness and airway inflammation. Lymphocytosis in the airways is another site of the infiltrative process in PSS, and the induced sputum is a complementary tool in the identification of active inflammatory process.

[Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin]. / Recuento de hemosiderófagos en el esputo en el diagnóstico de la disnea de origen cardíaco.

BACKGROUND AND OBJECTIVE: The respiratory or heart origin of dyspnea is not always easy to find out using the available diagnostic tools. Many patients present both heart and lung diseases that cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in this context has not been well settled so far. The objective was to describe the prediction usefulness of HC in patients suffering from dyspnea of heart origin, and to find out if HC changed after administering treatment. PATIENTS AND METHOD: HC was analyzed in 61 patients whose main symptom was dyspnea in the emergency department, and it was evaluated by means of clinical history, clinical course and performance of lung function tests and echocardiography. RESULTS: 35 patients were classified as having dyspnea of heart origin, 17 as having dyspnea of lung origin and 9 had dyspnea of both origins. The HC was higher in patients with dyspnea of heart origin 37% (95% CI, 26-47) or cardiopulmonary origin 30% (95% CI, 8-52) than in patients with dyspnea of lung origin 15% (95% CI, 4-27), and it remained higher despite administering treatment. The sensitivity (52%), specificity (88%), positive predictive value (92%) and negative predictive value (58%) was established for a 30% HC cutoff. The prediction model of heart origin dyspnea presented an area under the ROC curve of 0.978 (95% CI, 0.95-1). CONCLUSIONS: HC reflects the severity of pulmonary venocapillar disturbance, identifies the majority of patients suffering from current or past heart failure or severe cardiac dysfunction, and is useful for the prediction of dyspnea of heart origin. HC utility should focus on selected patients.

Recuento de hemosiderófagos en el esputo en el diagnóstico de la disnea de origen cardíaco / Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin

FUNDAMENTO Y OBJETIVO: El origen respiratorio o cardíaco de la disnea no siempre es fácil de establecercon las herramientas diagnósticas disponibles. Muchos pacientes presentan a la vez procesoscardiológicos y pulmonares que la justifica. El papel que puede desempeñar el recuentode hemosiderófagos (RH) en esputo en este contexto no ha sido establecido suficientemente.El objetivo fue determinar la utilidad en la predicción y el diagnóstico del RH en pacientes condisnea de origen cardíaco, y si varía tras el tratamiento.PACIENTES Y MÉTODO: Hemos realizado el RH a 61 pacientes que consultaron por disnea en urgenciasy cuyo origen fue determinado por la historia clínica de urgencias, el curso clínico y la realizaciónde pruebas funcionales respiratorias y ecocardiograma.RESULTADOS: El RH fue superior en los pacientes con disnea de origen cardíaco (n = 35), 37%(intervalo de confianza [IC] del 95%, 26-47) o de origen cardiopulmonar (n = 9), 30% (IC del95%, 8-52) que el de origen respiratorio (n = 17), 15% (IC del 95%, 4-27). La sensibilidad(52%), especificidad (88%), valores predictivos positivo (92%) y negativo (58%) se determinaronpara un punto de corte del RH del 30%. El modelo de predicción de disnea de origen cardíaco,incluido el RH, presentó un área bajo la curva ROC de 0,978 (IC del 95%, 0,95-1).CONCLUSIONES: El RH refleja la gravedad de la alteración de la permeabilidad venocapilar pulmonar,identifica a la mayoría de los pacientes que presentan o han presentado disfunción o insuficienciacardíaca moderada o grave y predice la disnea de origen cardíaco. Su utilidad debecentrarse en casos seleccionados

BACKGROUND AND OBJECTIVE: The respiratory or heart origin of dyspnea is not always easy to findout using the available diagnostic tools. Many patients present both heart and lung diseasesthat cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in thiscontext has not been well settled so far. The objective was to describe the prediction usefulnessof HC in patients suffering from dyspnea of heart origin, and to find out if HC changed afteradministering treatment.PATIENTS AND METHOD: HC was analized in 61 patients whose main symptom was dyspnea in theemergency department, and it was evaluated by means of clinical history, clinical course andperformance of lung function tests and echocardiography.RESULTS: 35 patients were classified as having dyspnea of heart origin, 17 as having dyspnea oflung origin and 9 had dyspnea of both origins. The HC was higher in patients with dyspnea ofheart origin 37% (95% CI, 26-47) or cardiopulmonary origin 30% (95% CI,, 8-52) than in patientswith dyspnea of lung origin 15% (95% CI, 4-27), and it remained higher despite administeringtreatment. The sensitivity (52%), specificity (88%), positive predictive value (92%)and negative predictive value (58%) was established for a 30% HC cutoff. The prediction modelof heart origin dyspnea presented an area under the ROC curve of 0.978 (95% CI, 0.95-1).CONCLUSIONS: HC reflects the severity of pulmonary venocapillar disturbance,identifies the majority of patients suffering from current or past heart failure or severe cardiacdysfunction, and is useful for the prediction of dyspnea of heart origin. HC utility should focuson selected patients

Bronchial plasma exudation after adenosine monophosphate or methacholine challenge.

Nonspecific hyperresponsiveness to adenosine monophosphate is better related to airway inflammation than methacholine. Adenosine induces mast cells and other cells to release inflammatory mediators that produce bronchoconstriction and perhaps other inflammatory effects, such as plasma exudation, which have not been well studied. We compared the plasma exudation effect, as measured in induced sputum, between adenosine and methacholine challenge in healthy and asthmatic subjects. In a cross-over design, 42 subjects were randomly challenged with adenosine or methacholine. After recovery, induced sputum was collected on 2 separate days, 48 to 72 hours apart. In the control group, an additional challenge with saline was performed. Differential cell counts and albumin and alpha2-macroglobulin levels were determined. The sputum volume obtained was sufficient to measure proteins in only 34 subjects: 10 healthy individuals and 24 mild asthmatics. There was a significant difference between adenosine and methacholine in sputum albumin (mean differences: 68[73.4] microg/L in controls, p = 0.039 and 48.0[162.9] microg/L in asthmatics) and cell counts, but only a tendency in alpha2-macroglobulin. PC20 adenosine was better related to eosinophil counts than methacholine (r = -0.44, p = 0.014). Albumin or alpha2-macroglubulin levels were not significantly correlated with baseline FEV1, PC20, or eosinophil counts. Adenosine, but not methacholine challenge, produces a mild airway plasma exudation that does not seem to be relevant to bronchoconstriction. However, this could be relevant, to some supernatant measurements after adenosine challenge.