Sputum eosinophilia can predict responsiveness to inhaled corticosteroid treatment in patients with overlap syndrome of COPD and asthma

Background: Chronic obstructive pulmonary disease (COPD) and asthma may overlap and converge in older people (overlap syndrome). It was hypothesized that patients with overlap syndrome may have different clinical characteristics such as sputum eosinophilia, and better responsiveness to treatment with inhaled corticosteroid (ICS). Methods: Sixty-three patients with stable COPD (forced expiratory volume in 1 second [FEV1] <= 80%) underwent pulmonary function tests, including reversibility of airflow limitation, arterial blood gas analysis, analysis of inflammatory cells in induced sputum, and chest high-resolution computed tomography. The inclusion criteria for COPD patients with asthmatic symptoms included having asthmatic symptoms such as episodic breathlessness, wheezing, cough, and chest tightness worsening at night or in the early morning (COPD with asthma group). The clinical features of COPD patients with asthmatic symptoms were compared with those of COPD patients without asthmatic symptoms (COPD without asthma group). Results: The increases in FEV1 in response to treatment with ICS were significantly higher in the COPD with asthma group. The peripheral eosinophil counts and sputum eosinophil counts were significantly higher. The prevalence of patients with bronchial wall thickening on chest high-resolution computed tomography was significantly higher. A significant correlation was observed between the increases in FEV1 in response to treatment with ICS and sputum eosinophil counts, and between the increases in FEV1 in response to treatment with ICS and the grade of bronchial wall thickening. Receiver operating characteristic curve analysis revealed 82.4% sensitivity and 84.8% specificity of sputum eosinophil count for detecting COPD with asthma, using 2.5% as the cutoff value. Conclusion: COPD patients with asthmatic symptoms had some clinical features. ICS should be considered earlier as a potential treatment in such patients. High sputum eosinophil counts and bronchial wall thickening on chest high-resolution computed tomography might therefore be a good predictor of response to ICS.ArticleINTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE. 7:283-289 (2012)journal articl

Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators

The purpose of this study was to clarify the additive efficacy of short-acting beta(2)-agonists (SABA) or muscarinic antagonists (SAMA) on dynamic hyperinflation and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) who had been treated with long-acting bronchodilators. Thirty-two patients with stable COPD who had been treated with long-acting bronchodilators, including long-acting muscarinic antagonists (LAMA), were examined by pulmonary function tests, dynamic hyperinflation evaluated by the method of step-wise metronome-paced incremental hyperventilation, and the incremental shuttle walking test before and after inhalation of SABA or SAMA. The additive efficacy of the two drugs was analyzed. Inhalation of SABA and SAMA improved airflow limitation and dynamic hyperinflation in stable COPD patients who had been treated with LAMA. Inhalation of SABA decreased respiratory resistance and the difference in respiratory resistance at 5 Hz and 20 Hz. On the whole, the additive efficacy of SABA on airflow limitation and dynamic hyperinflation was superior to that of SAMA. Furthermore, inhalation of SABA resulted in relief of breathlessness during exercise and significant improvement in exercise capacity. Inhalation of SABA resulted in significant improvement in exercise tolerance, which may have been due to improvement in dynamic hyperinflation. Single use of SABA before exercise, in addition to regular treatment with LAMA, may therefore be useful in stable COPD patients.ArticleRESPIRATORY MEDICINE. 107(3):394-400 (2013)journal articl

Usefulness of the Measurement of Fractional Exhaled Nitric Oxide in Asthmatic Patients :Correlation with Pulmonary Function, Asthma Control and Health Status

Background and objective:This study was conducted to investigate whether or not FeNO correlates with lung function tests, the Asthma Control Test (ACT) for assessing asthma control or the Asthma Health Questionnaire (AHQ-33) for evaluating the health status in asthmatics. Methods :FeNO was compared with the results of spirometry,ACT and AHQ-33 in 57 non-smoking patients with asthma and 17 healthy individuals without pulmonary diseases who had never smoked. Sixteen of 57 asthmatics treated with inhaled corticosteroid (ICS)underwent step-down therapy if they showed good/total control or step-up therapy if they showed poor control, and were evaluated by spirometry, ACT and AHQ- 33 prior to and more than one month after starting step-down or step-up therapy. Results :FeNO in asthmatics was significantly higher than that in the control group.There were no significant correlations between FeNO and FEV1, ACT score or AHQ-33 scores. However, there were significant correlations between the changes in FeNO and changes in FEV1, ACT score or AHQ-33 scores following stepdown or step-up therapy. Conclusion :FeNO is a useful marker not only for the diagnosis of asthma but also for asthma control and determining the health status in an individual patient, although it is variable without any correlation with symptoms and lung function among asthmatics. Shinshu Med J 59 : 239 ―247, 2011Article信州医学雑誌 59(4): 239-247(2011)departmental bulletin pape

A novel device (SD-101) with high accuracy for screening sleep apnoea-hypopnoea syndrome

Background and objective: The SD-101 is a non-restrictive, sheet-like medical device with an array of pressure sensors, to detect sleep-disordered breathing by sensing gravitational alterations in the body corresponding to respiratory movements. This study evaluated the accuracy of the SD-101 for screening sleep apnoea-hypopnoea syndrome (SAHS) by comparison with polysomnography. Methods: Nocturnal polysomnography and SD-101 monitoring were conducted simultaneously and compared in 201 patients with suspected SAHS (suspected SAHS group) and 165 male employees of a transport company (screening group). Results: Polysomnography revealed an AHI of = 60 events/h in 39, 35, 38, 68 and 21 subjects in the suspected SAHS group and 103, 34, 12, 12 and four subjects in the screening group, respectively. Central SAHS and obstructive SAHS were subsequently diagnosed in 11 (5.5%) and 135 (67.2%) of subjects in the suspected SAHS group and five (3.0%) and 39 (23.6%) of subjects in the screening group, respectively. Significant correlations were apparent between AHI and the respiratory disturbance index (RDI) measured with the SD-101 in both the suspected SAHS group (r = 0.88) and screening group (r = 0.92). Receiver operating characteristic curve analysis revealed 89.5% sensitivity and 85.8% specificity in identifying SAHS, using an RDI of 14.0 events/h. Conclusions: These findings suggest that the SD-101 is a useful device for screening SAHS.ArticleRESPIROLOGY. 14(8):1143-1150 (2009)journal articl

Endobronchial Argon Plasma Coagulation for the Palliation of Recurrent Tracheobronchial Adenoid Cystic Carcinoma

This is a non-final version of an article published in final form in Journal of Bronchology, 14(4):278-280, October 2007.The standard treatment of adenoid cystic carcinoma (ACC) of the airway is surgery, if possible, because survival rate is better than other treatments including radiotherapy. Although ACC shows frequent recurrence during the long-term follow-up unless there has been a complete resection (negative surgical margin), no further treatments are recommended. This report describes how argon plasma coagulation using flexible bronchoscopy has been successfully employed in the treatment of ACC after conventional therapy in 1 case of recurrence after surgery and 2 cases of inoperable patients. All of the patients are alive and healthy more than 6 years after diagnosis.ArticleJournal of Bronchology. 14(4):278-280 (2007)journal articl

Increased Interleukin-8 in Epithelial Lining Fluid of Collapsed Lungs During One-Lung Ventilation for Thoracotomy

The present study was designed to evaluate inflammatory changes in collapsed lungs during one-lung ventilation using the assistance of a bronchoscopic microsampling probe. Serial albumin and interleukin (IL)-8 concentrations in epithelial lining fluid (ELF) were measured in seven patients undergoing resection of lung tumors. The samples were taken after induction of anesthesia (baseline), 30 min after one-lung ventilation was started (point 2), just before resuming two-lung ventilation (point 3), and 30 min after two-lung ventilation was restarted (point 4). The albumin and IL-8 concentrations in ELF were significantly increased at point 2 and point 3, respectively, and remained to be high, compared to the baseline. The increase in IL-8 at point 3 was correlated with the interval of one-lung ventilation; however, none developed specific acute lung injury. These findings suggest that inflammatory changes can occur on the epithelium of a collapsed lung even in patients who underwent successful and standard thoracic surgery.ArticleINFLAMMATION. 35(6):1844-1850 (2012)journal articl

Evaluation of Respiratory Impedance in Asthma and COPD by an Impulse Oscillation System

Objective The purpose of this study was to clarify the differences in physiological properties of the airways between asthma and COPD using an impulse oscillation system (IOS). Patients and Methods Subjects comprised 95 stable COPD patients, 52 never-smoker asthma patients and 29 healthy never-smokers > 60 years old, all matched for age, in whom respiratory impedance was examined by IOS. Results In both asthma and COPD patients, a significant increase in respiratory resistance (Rrs5) and more negative value of respiratory reactance (Xrs5) at 5 Hz of oscillatory frequency with an increase in resonant frequency (fres) were observed when compared with healthy never-smokers. In asthma, a significant increase in respiratory resistance at 20 Hz (Rrs20) was also observed when compared with healthy never-smokers and COPD. The increases in Rrs5 and relative changes of Xrs5 to more negative were remarkable with increasing severity of COPD. On the other hand, among patients with asthma, these changes in Rrs5 and Xrs5 were also observed in asthmatics with normal FEV1/FVC. Interestingly, Xrs5 showed further changes to more negative in expiration of tidal breath in severe COPD, whereas no significant changes in Xrs5 to more negative in expiration was observed in healthy never-smokers and asthmatics with and without normal FEV1/FVC. Conclusion IOS may be useful for detecting pathophysiological changes of respiratory system in accordance with severity of COPD and even in asthmatics with normal FEV1/FVC. The larger within-breath changes of Xrs5 to more negative in severe COPD may represent easy collapsibility of small airways in expiration of tidal breath. These properties may help to analyze airway mechanics and to identify abnormalities of the airways that cannot be found by spirometry alone.ArticleINTERNAL MEDICINE. 49(1):23-30 (2010)journal articl