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Persisting remodeling and less airway wall eosinophil activation in complete remission of asthma.
MedLine Citation:
PMID:  20813885     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Rationale: Individuals with asthma may outgrow symptoms despite not using treatment, whereas others reach complete remission (CoR) with absence of airway obstruction and bronchial hyperresponsiveness. It is uncertain whether this associates with remission of all inflammatory and remodeling asthma features. Objectives: To compare the pathologic phenotype of individuals with asthma with CoR and clinical remission (ClinR) and those with active asthma, with and without the use of inhaled corticosteroids (ICS). Methods: We investigated 165 individuals known with active asthma, on reexamination having CoR (n = 18), ClinR (n = 44), and current asthma (CuA, n = 103, 64 with and 39 without ICS). Measurements Main Results: Inflammatory cells were measured in blood, induced sputum, and bronchial biopsies; histamine and ECP in sputum; and eosinophilic peroxidase (EPX) immunopositivity and remodeling (epithelial changes, E-cadherin expression, basement membrane [BM] thickening, collagen deposition) in bronchial biopsies. Median (range) blood eosinophils from CoR were significantly lower than those from CuA (0.10 [0.04-0.24] vs. 0.18 [0.02-1.16] × 10(9)/L). Bronchial EPX immunopositivity was lower in CoR than in both ClinR and CuA (67 [0.5-462] vs. 95 [8-5329] and 172 [6-5313] pixels). Other inflammatory findings were comparable. BM thickness was lowest in CuA, caused by lower BM thickness in those using ICS (CoR, 6.3 [4.7-8.4]; ClinR, 6.5 [3.8-11.7]; CuA, 5.7 [2.8-12.6]; and ICS using CuA, 5.3 [2.8-8.2] μm). Conclusions: CoR is still accompanied by airway abnormalities because BM thickness is similar in individuals with asthma with CoR, ClinR, and CuA without ICS. Airway eosinophilic activation best differentiates these three groups, signifying their importance in the clinical expression and severity of bronchial hyperresponsiveness in asthma.
Authors:
Martine Broekema; Wim Timens; Judith M Vonk; Franke Volbeda; Monique E Lodewijk; Machteld N Hylkema; Nick H T Ten Hacken; Dirkje S Postma
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Publication Detail:
Type:  Journal Article     Date:  2010-09-02
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  183     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  310-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Pulmonology, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands. d.s.postma@long.umcg.nl.
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