Chronic bronchial asthma from challenge to treatment: epidemiology and social impact.

Asthma is an important cause of chronic morbidity and a crucial health problem among children and adults worldwide, with high prevalence rates particularly in many developed countries.Increasing morbidity, hospital admission rates, use of medical services, drug use and, in some countries, increasing mortality rates have been reported.3 However, controversy still exists regarding the epidemiology of asthma. There are two serious problems which need to be considered when trying to obtain reliable data on the prevalence, morbidity, and mortality of asthma. The first relates to definition; despite substantial advances in understanding the pathogenesis, genetics, and clinical characteristics of asthma, we do not have a useful definition of asthma for epidemiological purposes.2 The second problem concerns the different methods used to collect epidemiological data and information. More recently two international studies\u2014the European Community Respiratory Health Survey (ECRHS)4 and the International Study of Asthma and Allergies in Childhood (ISAAC)5\u2014have used the same internationally standardised questionnaire to provide important data on the prevalence of asthma

Tidal breathing affects airway responsiveness to methacholine.

Abstract Asthma is characterized by increased airway responsiveness and airway inflammation. Airway hyperresponsiveness may be caused by increased airway smooth muscle contractility or by a decrease in the mechanical load that opposes airway smooth muscle contraction. Under static conditions, the equilibrium between contractility and load will determine the final airway smooth muscle length and therefore airway caliber. Because of tidal breathing, however, lungs normally function under dynamic conditions where both airway contractility and opposing load are affected. The capability of tidal breathing to appropriately modulate airway function might be the mechanism that differentiates airways of asthmatics from those of normal subjects

Induced sputum in the management of COPD: clinical implications

Sputum induction can be used as a non-invasive technique to investigate airway inflammation in asthma and COPD. We reported the case of a 68 year old man with COPD, stage III GOLD, that underwent sputum induction during two exacerbation episodes. The first cell count showed a typical sputum neutrophilia, whereas the second showed sputum eosinophilia. On the basis of sputum cellularity, we decided to treat the first episode with a course of antibiotics and the second exacerbation with a course of antibiotics and oral steroids. The patient showed improvement in both cases, obtaining clinical stabilisation. The induced sputum cell count could be a useful technique in a clinical setting to evaluate the cellular characteristics of airway inflammation during COPD exacerbation and modulate the antinflammatory therapy

The fight against tobacco

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Improving tuberculosis surveillance in Europe is key to controlling the disease.

As underlined by the joint ECDC and World Health Organization Regional Office for Europe TB report, launched on 18 March the importance of good surveillance to stem this trend cannot be underestimated. Where do we go with surveillance in Europe? Can we do more? How many MDR and XDR TB cases occur because of sub-optimal patient management? This issue of Eurosurveillance casts light on these important questions with four interesting articles. The results of the studies reported in this issue of Eurosurveillance allow us to point out some key topics: \u2022The completeness of reporting information (including treatment outcomes), the proportion of culture-confirmed TB cases reported as well as the proportion of strains on which DST for both first- and second-line drugs is performed and reported are still sub-optimal overall in Europe. The relevance of these pitfalls goes beyond the \u201csimple\u201d surveillance limitation, having the potential to affect other important TB control pillars, e.g. infection control and case-management. \u2022MDR and XDR TB still persist in Europe. The high proportion of MDR TB identified among new TB cases reported by certain countries indicates that sub-optimal infection control practices are likely to occur, while the high percentage of MDR TB notified among retreatment cases is probably the result of sub-optimal case management in the past decade

Effects of intradermal injection of atrial natriuretic peptide.

Abstract Atrial natriuretic peptide (ANP) causes mast cell degranulation in rats in vivo and in vitro but is bronchodilator in humans. The aim of this study was to investigate the wheal and flare dose-response to intradermal injection of alpha-human ANP in normal humans. Eight normal subjects received five 30 microliters injections containing 1, 10, 39, 78, 117 pmol ANP and one each of normal saline, histamine 675 pmol and substance P 30 pmol. Maximum ANP flare response was greater but not significantly than that to saline at 1.55 +/- 0.6 (mean +/- s.e. mean) compared with 0.42 +/- 0.17 cm2, but much less than to histamine 9.86 +/- 0.97 or to substance P 12.5 +/- 1.2. Maximum ANP wheal response was significantly greater than that to saline at 0.38 +/- 0.08 compared with 0.18 +/- 0.05 cm2 (difference between means 0.20, 95% CI 0.05, 0.35), but much less than to histamine 0.75 +/- 0.06 or to substance P 1.05 +/- 0.08 cm2. No dose-response to ANP was demonstrated, though responses to the highest dose differed significantly from those to the lowest dose studied. We conclude that human cutaneous responses to ANP differ from those of animals and that the skin is less responsive than other tissues in humans

Improving the TB case management: The International Standards for Tuberculosis Care.

Tuberculosis (TB) is currently the leading cause of death from a curable infectious disease. The World Health Organization (WHO) estimates that 8.9 million new TB cases occurred in 2004 (of which 3.9 million were sputum smear positive), although only about half of the estimated number were reported by public health systems. Whilst the highest TB incidence rate is in sub-Saharan Africa (estimated to be 356 new cases per 100,000 population per yr), in most countries of the former Soviet Union the estimated incidence rate exceeds 100 new cases per 100,000 population per yr. Although the rate of increase in the TB incidence rate is decreasing, the global TB notification grew by 1% between 2003 and 2004, the last year for which data are available. This continued increase is largely the result of the striking increase in cases in sub-Saharan Africa and, to a lesser extent, in the former USSR. Whilst the worsening of the TB incidence in Africa is due to the HIVepidemic compounded by an insufficient health infrastructure, it is due to different causes in Eastern Europe, including economic decline, increased poverty, social disruption and sub-standard health services. In addition, as a result of these factors, .10% of new TB cases in the Baltic states and in some parts of Russia are multidrug-resistant (MDR-TB), i.e. resistant to at least isoniazid and rifampicin. In the European region, 445,000 new TB cases and nearly 70,000 deaths were estimated to have resulted from TB in 2004. In the Eastern part of the region, the levels of directly observed treatment, short-course (DOTS) strategy coverage and case detection are the lowest among the world regions, and the overall treatment success rate is the second lowest (75%) after Africa

Markers of airway inflammation in pulmonary diseases assessed by induced sputum.

ABSTRACT: During recent years there has been a growing interest in using non-invasive biomarkers to understand and monitor the airway inflammation in subjects with respiratory tract disorders. To date, the best validated and performing non-invasive biomarkers are measures of inflammation in induced sputum in both cellular and fluid phase, which can provide biological insights into the pathogenesis of respiratory diseases such as asthma and chronic obstructive pulmonary disease. The purpose of this review is to examine the principal literature on the different markers of inflammation in pulmonary diseases assessed by induced sputum analysis in either cellular or fluid phase