Bronchial biopsy and reactivity in patients with chest tightness relieved with bronchodilator

Taniguchi, Hirokazu; Furuse, Hideaki; Nakanishi, Yuko; Tsuda, Takeshi; Totsuka, Kiyoto; Masaki, Yasuaki; Suzuki, Kensuke; Ishizawa, Shin; Miyazawa, Hideki

doi:10.1080/02770903.2016.1236940

Cited by 6 publications

(14 citation statements)

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“…Retrosternal tightness or heavy sensation in the chest has been previously described as a typical symptom of patients with CTRB and tightness radiating to one side of the head, back, or chest [1,2]. A subset of these patients had chest tightness at sites other than the retrosternal area.…”

Section: Discussionmentioning

confidence: 94%

“…In our previous report, patients with CTRB had significantly increased T-cell infiltration in the bronchial mucosal biopsy sample than controls; it was hypothesized that chest tightness arose from airway constriction due to T-cell inflammation [2]. In patients with CTRAEB without BA, whom we investigated in this study, we hypothesized that the chest tightness arose from inflammation alone, with a focus on airway T cells because there was significantly increased T-cell infiltration on bronchial mucosal biopsy, and symptoms did not improve with inhalation of bronchodilators.…”

Section: Discussionmentioning

confidence: 95%

“…No clear diagnostic criteria for CPVA have been established, but it should be defined as CTRB without characteristic bronchial asthma (BA) exacerbation [1]. CPVA is common in our experience [2].…”

Section: Introductionmentioning

confidence: 91%

“…We recruited 7 patients with CTRAEB, 13 patients with CTRB, 11 control subjects who had undergone bronchial biopsy, 10 patients with classic BA, and 10 healthy subjects. In our previous report, we released data on 11 out of 13 patients with CTRB and 5 out of 10 healthy subjects [2]. In this study, all patients with CTRAEB were diagnosed by noting an improvement in chest tightness after LTRA administration.…”

Section: Clinical Datamentioning

confidence: 99%

“…Whitney and coworkers reported on three patients who presented with CTRB. Because bronchodilators are effective, clinical conditions presenting as CTRB are thought to be a subtype of asthma and are called "chest pain variant asthma (CPVA)", and several articles in the medical literature have addressed this disease [1][2][3][4][5][6]. No clear diagnostic criteria for CPVA have been established, but it should be defined as CTRB without characteristic bronchial asthma (BA) exacerbation [1].…”

Section: Introductionmentioning

confidence: 99%

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Chest tightness is relieved with the use of asthma drugs except bronchodilators

et al. 2018

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Objective: Many patients with a chief complaint of chest tightness are examined in medical facilities, and a lack of diagnosis is not uncommon. We have reported that these patients often include those with chest tightness relieved with bronchodilator use (CTRB) and those with chest tightness relieved with the use of asthma drugs except bronchodilators (CTRAEB). The purpose of this study was to demonstrate the clinical characteristics of the patients with CTRAEB and compare them with data from patients with CTRB. Methods: Patients with CTRB (n ¼ 13) and CTRAEB (n ¼ 7) underwent a bronchodilator test, assessments of airway responsiveness to methacholine, bronchial biopsy, and bronchial lavage under fiberoptic bronchoscopy before receiving treatment. In all, 10 healthy subjects, 11 bronchial biopsy control patients, and 10 asthmatic patients were recruited for comparison. Results: Inhalation of a short-acting ß 2-agonist (SABA) increased the forced expiratory volume in one second (FEV 1) by 5.1% ± 4.0% in patients with CTRB and by 1.3% ± 3.5% in patients with CTRAEB, and the difference was statistically significant (p ¼ 0.0449). The bronchial biopsy specimens from the patients with CTRB and CTRAEB exhibited significant increases in T cells (p < .05) compared with those of the control subjects. The bronchial responsiveness to methacholine was increased in only a minor portion of patients with CTRB and CTRAEB. Conclusions: We hypothesized that the clinical condition of patients with CTRAEB involves chest tightness arising from inflammation alone, and this chest tightness is mostly associated with airway T cells, without constriction of the airways. There is little to distinguish CTRAEB from CTRB aside from the response to bronchodilator treatment. This clinical trial is registered at www.umin.ac.jp (UMIN13994, 13998, and 16741).

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 95%