哮喘患者迟发过敏反应的小气道受累
2017/10/23
摘要
背景：过敏与哮喘密切相关。吸入过敏原能够诱发过敏性哮喘患者气道的早发过敏反应，50%的过敏性哮喘患者随后会出现迟发过敏反应。迟发过敏反应被定义为暴露于过敏原后4-8小时左右出现的第1秒用力呼气量（FEV1）较基线的下降，被认为主要影响小气道。然而，FEV1对小气道的生理变化并不敏感。
目的：本研究的目的是为了研究比较大小气道在早发过敏反应与迟发过敏反应中病理生理学改变，同时描述受试者中存在双相过敏反应者（早发型和迟发型）与仅存在早发型过敏反应者之间的不同。
方法：43名过敏性哮喘患者接受了过敏原激发试验。通过测定肺功能、脉冲振荡、体积描记法、惰性气体清除，单次呼吸甲烷稀释一氧化碳扩散和呼出气体的温度描述肺的呼吸生理，分别在基线和过敏原激发后23 h重复测定。
结果：与单相反应者相比，双相反应者的外周气道阻力、空气潴留和通气异质性显著增加。分别用IOS和惰性气体洗出法测量出的外周气道阻力和通气异质性参数，在所有受试者中均与基线和过敏性气道反应存在相关性。
结论：迟发过敏反应涉及外周气道阻力增加及通气不良。应考虑将小气道病理生理变化囊括于迟发型过敏反应的定义中。
临床意义：在迟发过敏反应中的小气道功能障碍表明，双相反应者可能有更广泛的气道病理改变，并强调评估哮喘患者的小气道评估的重要性。
Small airway involvement in the late allergic response in asthma.
Stenberg H, Diamant Z, Ankerst J, Bjermer L, Tufvesson E
Abstract
BACKGROUND:Allergy and asthma are closely linked. Inhalation of allergen induces an early allergic response (EAR) within the airways of allergic asthmatic subjects, which is followed by a late allergic response (LAR) in approximately 50% of the subjects. The LAR is defined as a drop in forced expiratory volume in 1 s (FEV1 ) from baseline usually occurring 4-8 h after exposure, and is believed to affect small airways. However, FEV1 is insensitive to changes in small airway physiology.
OBJECTIVE:Our aim was to investigate and compare the pathophysiological processes in large and small airways during the EAR and the LAR, and to characterize subjects with both an EAR and a LAR (dual responders) versus those with an EAR only (single responders).
METHODS:Thirty-four subjects with allergic asthma underwent an inhaled allergen challenge. Lung physiology was assessed by spirometry, impulse oscillometry (IOS), body plethysmography, inert gas washout, single breath methane dilution carbon monoxide diffusion and exhaled breath temperature, at baseline and repeatedly for 23 h post-allergen challenge.
RESULTS:Peripheral airway resistance, air trapping and ventilation heterogeneity were significantly increased in dual responders (n=15) compared to single responders (n=19) 6-8 h post-challenge. Parameters of peripheral airway resistance and ventilation heterogeneity, measured with IOS and inert gas washout, respectively, correlated at baseline and during the allergic airway response in all subjects.
CONCLUSIONS:The LAR involves increased resistance and ventilation defects within the peripheral airways. Alternative definitions of the LAR including small airways pathophysiology could be considered.
CLINICAL RELEVANCE:Small airway dysfunction during the LAR suggests that dual responders may have more extensive airway pathology and underscores the relevance of small airways assessment in asthma.
背景：过敏与哮喘密切相关。吸入过敏原能够诱发过敏性哮喘患者气道的早发过敏反应，50%的过敏性哮喘患者随后会出现迟发过敏反应。迟发过敏反应被定义为暴露于过敏原后4-8小时左右出现的第1秒用力呼气量（FEV1）较基线的下降，被认为主要影响小气道。然而，FEV1对小气道的生理变化并不敏感。
目的：本研究的目的是为了研究比较大小气道在早发过敏反应与迟发过敏反应中病理生理学改变，同时描述受试者中存在双相过敏反应者（早发型和迟发型）与仅存在早发型过敏反应者之间的不同。
方法：43名过敏性哮喘患者接受了过敏原激发试验。通过测定肺功能、脉冲振荡、体积描记法、惰性气体清除，单次呼吸甲烷稀释一氧化碳扩散和呼出气体的温度描述肺的呼吸生理，分别在基线和过敏原激发后23 h重复测定。
结果：与单相反应者相比，双相反应者的外周气道阻力、空气潴留和通气异质性显著增加。分别用IOS和惰性气体洗出法测量出的外周气道阻力和通气异质性参数，在所有受试者中均与基线和过敏性气道反应存在相关性。
结论：迟发过敏反应涉及外周气道阻力增加及通气不良。应考虑将小气道病理生理变化囊括于迟发型过敏反应的定义中。
临床意义：在迟发过敏反应中的小气道功能障碍表明，双相反应者可能有更广泛的气道病理改变，并强调评估哮喘患者的小气道评估的重要性。
(中日友好医院呼吸与危重症医学科 张科文 摘译 林江涛 审校)
(Clin Exp Allergy. 2017 Sep 21. doi: 10.1111/cea.13036. [Epub ahead of print])
(Clin Exp Allergy. 2017 Sep 21. doi: 10.1111/cea.13036. [Epub ahead of print])
Small airway involvement in the late allergic response in asthma.
Stenberg H, Diamant Z, Ankerst J, Bjermer L, Tufvesson E
Abstract
BACKGROUND:Allergy and asthma are closely linked. Inhalation of allergen induces an early allergic response (EAR) within the airways of allergic asthmatic subjects, which is followed by a late allergic response (LAR) in approximately 50% of the subjects. The LAR is defined as a drop in forced expiratory volume in 1 s (FEV1 ) from baseline usually occurring 4-8 h after exposure, and is believed to affect small airways. However, FEV1 is insensitive to changes in small airway physiology.
OBJECTIVE:Our aim was to investigate and compare the pathophysiological processes in large and small airways during the EAR and the LAR, and to characterize subjects with both an EAR and a LAR (dual responders) versus those with an EAR only (single responders).
METHODS:Thirty-four subjects with allergic asthma underwent an inhaled allergen challenge. Lung physiology was assessed by spirometry, impulse oscillometry (IOS), body plethysmography, inert gas washout, single breath methane dilution carbon monoxide diffusion and exhaled breath temperature, at baseline and repeatedly for 23 h post-allergen challenge.
RESULTS:Peripheral airway resistance, air trapping and ventilation heterogeneity were significantly increased in dual responders (n=15) compared to single responders (n=19) 6-8 h post-challenge. Parameters of peripheral airway resistance and ventilation heterogeneity, measured with IOS and inert gas washout, respectively, correlated at baseline and during the allergic airway response in all subjects.
CONCLUSIONS:The LAR involves increased resistance and ventilation defects within the peripheral airways. Alternative definitions of the LAR including small airways pathophysiology could be considered.
CLINICAL RELEVANCE:Small airway dysfunction during the LAR suggests that dual responders may have more extensive airway pathology and underscores the relevance of small airways assessment in asthma.
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内凝集素促进了过敏原诱导的IL-25、IL-33、TSLP表达及哮喘、特异性皮炎中的2型过敏反应
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重症哮喘气道病理学与气道阻塞有关，与症状控制无关
