Specifična bronhijalna hiperreaktivnost i kožna preosetljivost kod bolesnika sa alergijskom astmom
Sažetak
Uvod/Cilj. Bronhijalna astma je bolest koja se odlikuje varijabilnošću kliničke slike, fizičkog i funkcijskog statusa i postojanjem bronhijalne hipersenzitivnosti i hiperreaktivnosti različitog stepena. Bronhijalna reaktivnost i senzitivnost ispituje se kod bolesnika sa kliničkom sumnjom na postojanje astme i normalnim spirometrijskim testom. Cilj rada je bio da se kod bolesnika sa atopijskom astmom analiziraju rezultati testova kožne preosetljivosti na inhalacione alergene, nespecifične bronhijalne hiperreaktivnosti i specifične hiperreaktivnosti procenjene bronhoprovokacijskim testovima sa inhalacionim alergenima. Metode. Prospektivnom studijom u Klinici za pulmologiju Vojnomedicinske akademije tokom 2014. godine, obuhvaćeno je 70 ispitanika muškog pola starosti od 18 do 30 godina, koji su imali višegodišnje simptome astme. Svi su bili nepušači, urednog spirometrijskog i radiološkog nalaza na snimku grudnog koša, bez simptoma i znakova respiratornih infekcija tokom prethodna dva meseca. Svim ispitanicima rađeni su testovi kožne preosetljivosti sa inhalacionim alergenima i nespecifični bronhoprovokacijski test sa histaminom. Na osnovu histaminskog testa ispitanici su podeljeni u dve grupe: I grupu, kod koje postoji lakši stepen hipersenzitivnosti [provokaciona koncentracija histamina koja uzrokuje 20% smanjenja forsiranog ekspiratornog volumena u jednoj sekundi (PC20) = 6,09 ± 1,1 mg/mL] i II grupu sa negativnim histaminskim testom (PC20 = 14,58 ± 6,34 mg/mL). Kod svih ispitanika izvršeno je specifično bronhoprovokacijsko testiranje, a izbor alergena vršen je na osnovu rezultata testiranja kožne preosetljivosti. Rezultati. Rezultati kožne preosetljivosti pokazuju najveću učestalost grinje Dermatophagoides pterronissinus (83,3% u grupi I i 85% u grupi II), zatim polena trave (53,3% u grupi I i 52% u grupi II) i kućne prašine (33,3% u grupi I i 50% u grupi II), bez statistički značajne razlike u zastupljenosti alergena između ovih grupa (p > 0,05). U obe grupe spirometrijski nalaz bio je u granicama referentnih vrednosti [forsirani vitalni kapacitet (FVC) i forsirani ekspiratorni volumen u jednoj sekundi (FEV21) > 80% prediktivne vrednosti], ali je postojala statistički značajna razlika u vrednosti FEV1 između grupa (p < 0,05). Specifičnim bronhoprovokcijskim testovima sa rastvorima inhalacionih alergena kod obe grupe ispitanika izazvano je značajano smanjenje FEV1 (≥ 20%) kod svih ispitanika. Nije bilo statistički značajne razlike u plućnoj funkciji među grupama, a ni u preosetljivosti na pojedine alergene (prosečano smanjenje FEV1: I grupa – 32,9 ± 2,4% i II grupa – 31,5 ± 2,2%). Zaključak. Nije utvrđena direktna povezanost između stepena specifične i nespecifične bronhijalne hiperreaktivnosti kod bolesnika sa alergijskom astmom.
Reference
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2015. Available from: http://ginasthma.org/gina-report-global-strategy-for-asthma-management-and-prevention/
Worth A, Pinnock H, Fletcher M, Hoskins G, Levy ML, Sheikh A. Systems for the management of respiratory disease in primary care: An international series: United Kingdom. Prim Care Respir J 2011; 20(1): 23−32.
O'Byrne PM, Inman MD. Airway hyperresponsiveness. Chest 2003; 123(3Suppl): 411S−6S.
Borak J, Lefkowitz RY. Bronchial hyperresponsiveness. Occup Med (Lond) 2016; 66(2): 95−105.
Novković D, Skuletić V, Vulin A, Cvetković G. Exercise-induced bronchoconstriction and non-specific airway hyperreactivity in patients suffering from bronchial asthma. Vojnosanit Pregl 2014; 71(2): 191−4.
Cockcroft DW. Bronchoprovocation methods: Direct challeng-es. Clin Rev Allergy Immunol 2003; 24(1): 19−26.
Anderson SD. Provocative challenges to help diagnose and monitor asthma: Exercise, methacholine, adenosine, and man-nitol. Curr Opin Pulm Med 2008; 14(1): 39−45.
Anderson SD, Brannan JD. Bronchial provocation testing: The future. Curr Opin Allergy Clin Immunol 2011; 11(1): 46−52.
Zhong NS, Chen RC, Yang MO, Wu ZY, Zheng JP, Li YF. Is asymptomatic bronchial hyperresponsiveness an indication of potential asthma?, A two-year follow-up of young students with bronchial hyperresponsiveness. Chest 1992; 102(4): 1104−9.
Leuppi JD. Bronchoprovocation tests in asthma: Direct versus indirect challenges. Curr Opin Pulm Med 2014; 20(1): 31−6.
Katial RK, Covar RA. Bronchoprovocation testing in asthma. Immunol Allergy Clin North Am 2012; 32(3): 413−31.
Guan WJ, Zheng XY, Zheng JP, Boudewijn IM, Telenga ED, van der Wiel E, et al. Small airway dysfunction in asymptomatic bron-chial hyperresponsiveness and asthma. Allergy 2014; 69(9): 1258−9.
Ortega HG, Weissman DN, Carter DL, Banks D. Use of specific inhalation challenge in the evaluation of workers at risk for oc-cupational asthma: A survey of pulmonary, allergy, and occu-pational medicine residency training programs in the United States and Canada. Chest 2002; 121(4): 1323−8.
Alvarez-Puebla MJ, Olaguibel-Rivera JM, Urbiola-Marcilla E, Garcia BE, Tabar-Purroy AI. Determinants of allergen-induced late bronchial responses in mild asthmatics. Chest 2001; 119(1): 120−7.
Reddel HK, Levy ML. Global Initiative for Asthma Scientific Committee and Dissemination and Implementation Commit-tee. The GINA asthma strategy report: what's new for primary care? NPJ Prim Care Respir Med 2015; 25: 15050.
European Lung White Book. The economic burden of lung disease. The first comprehensive survey on respiratory lung health in Europe. Available from: http://www.erswhitebook.org/chapters/the-economic-burden-of-lung-disease/
Parkerson J, Ledford D. Mannitol as an indirect bronchoprovo-cation test for the 21st century. Ann Allergy Asthma Immunol 2011; 106(2): 91−6.
Farrokhi S, Gheybi MK, Movahed A, Tahmasebi R, Iranpour D, Fatemi A, et al. Common aeroallergens in patients with asthma and allergic rhinitis living in southwestern part of Iran: based on skin prick test reactivity. Iran J Allergy Asthma Immunol 2015; 14(2): 133−8.
Bazarbachi T, Haddad Y, Irani C, Salameh P, Khoury D, Khayat G, et al. Choosing the best panel of aeroallergen prick-tests for patients in Lebanon with rhinitis and asthma: A retrospective study of 2350 patients. Rev Mal Respir 2014; 31(9): 839−48.
Cockcroft DW, Ruffin RE, Frith PA, Cartier A, Juniper EF, Dolovich J,et al. Determinants of allergen-induced asthma: Dose of allergen, circulating IgE antibody concentration, and bronchial responsiveness to inhaled histamine. Am Rev Respir Dis 1979; 120(5): 1053−8.
Cockroft DN. Provocations tests. In: O'Byrne PM, Tompson NC, editors. Manual of asthma management. Philadelphia: Saun-ders Ltd; 1995. p. 120−31.
Boulet LP, Gauvreau G, Boulay ME, O'Byrne PM, Cockcroft DW. Allergen-induced early and late asthmatic responses to inhaled seasonal and perennial allergens. Clin Exp Allergy 2015; 45(11): 1647−53.
Sulakvelidze I, Inman MD, Rerecich T, O'Byrne PM. Increases in airway eosinophils and interleukin-5 with minimal broncho-constriction during repeated low-dose allergen challenge in atopic asthmatics. Eur Respir J 1998; 11(4): 821−7.
Djukanović R, Feather I, Gratziou C, Walls A, Peroni D, Bradding P, et al. Effect of natural allergen exposure during the grass pollen season on airways inflammatory cells and asthma symptoms. Thorax 1996; 51(6): 575−81.
Kurt E, Bavbek S, Aksu O, Erekul S, Misirligil Z. The effect of natural pollen exposure on eosinophil apoptosis and its rela-tionship to bronchial hyperresponsiveness in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2005; 95(1): 72−8.