Department of Pulmonology, University Medical Center Groningen, University of Groningen, The Netherlands.
Respir Res. 2010 Aug 2;11(1):106. doi: 10.1186/1465-9921-11-106.
The definition of "clinical asthma remission" is based on absence of symptoms and use of medication. However, in the majority of these subjects airway inflammation is still present when measured. In the present study we investigated whether "complete asthma remission", additionally defined by the absence of bronchial hyperresponsiveness (BHR) and the presence of a normal lung function, is associated with the absence of airway inflammation.
Patients with a former diagnosis of asthma and a positive histamine provocation test were re-examined to identify subjects with complete asthma remission (no asthma symptoms or medication, PC20 histamine > 32 mg/ml, FEV1 > 90% predicted). Patients with PC20 histamine < or = 32 mg/ml were defined as current asthmatics and were divided in two groups, i.e. asthmatics with and without BHR to adenosine 5'monophoshate (AMP). Sputum induction was performed 1 week before and 1 hour after AMP provocation. Sputum induction and AMP provocation were previously shown to be sensitive markers of airway inflammation.
Seven patients met criteria for complete asthma remission. Twenty-three were current asthmatics, including twelve without hyperresponsiveness to AMP. Subjects with complete asthma remission showed no AMP-induced sputum eosinophilia (median (range) 0.2 (0 - 4.6)% at baseline and 0.2 (0 - 2.6)% after AMP). After AMP, current asthmatics had a significant increase in sputum eosinophils (0.5 (0 - 26.0)% at baseline and 2.6 (0 - 32.0) % after AMP), as had the subgroup of current asthmatics without hyperresponsiveness to AMP (0.2 (0 - 1.8)% at baseline and 1.3 (0 - 6.3)% after AMP).
Subjects with complete asthma remission, in contrast to subjects with current asthma, do not respond with eosinophilic inflammation in sputum after AMP provocations. These data lend support to the usefulness of the definition of complete asthma remission.
“临床哮喘缓解”的定义基于症状缺失和药物使用。然而，在大多数情况下，当进行气道炎症测量时，这些患者的气道炎症仍然存在。在本研究中，我们研究了“完全哮喘缓解”（另外定义为不存在支气管高反应性（BHR）且肺功能正常）是否与气道炎症的缺失相关。
对以前被诊断为哮喘且组胺激发试验阳性的患者进行重新检查，以确定完全哮喘缓解的患者（无哮喘症状或药物治疗，PC20 组胺＞32mg/ml，FEV1＞90%预计值）。PC20 组胺≤32mg/ml 的患者被定义为当前哮喘患者，并分为两组，即存在和不存在对腺苷 5'-单磷酸（AMP）的 BHR 的哮喘患者。在 AMP 激发前一周和激发后一小时进行痰诱导。痰诱导和 AMP 激发先前被证明是气道炎症的敏感标志物。
有 7 名患者符合完全哮喘缓解的标准。23 名患者为当前哮喘患者，其中 12 名患者对 AMP 无高反应性。完全哮喘缓解的患者未显示 AMP 诱导的痰嗜酸性粒细胞增多（基线时中位数（范围）为 0.2（0-4.6）%，AMP 后为 0.2（0-2.6）%）。在 AMP 后，当前哮喘患者的痰嗜酸性粒细胞显著增加（基线时为 0.5（0-26.0）%，AMP 后为 2.6（0-32.0）%），对 AMP 无高反应性的当前哮喘亚组也如此（基线时为 0.2（0-1.8）%，AMP 后为 1.3（0-6.3）%）。
与当前哮喘患者相比，完全哮喘缓解的患者在 AMP 激发后不会出现痰嗜酸性粒细胞炎症反应。这些数据支持完全哮喘缓解定义的有用性。
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