Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease

Abstract

With the aim of investigating the presence of latent inflammatory process in the lungs of patients with Crohn's disease, 15 patients with Crohn's disease were evaluated by spirometry, the methacholine challenge test, induced sputum, and skin tests for inhaled antigens. Serum IgE, erythrocyte sedimentation rate and hematocrit were also determined. The patients were compared with 20 healthy controls by the Mann-Whitney and Fisher exact tests. Their respiratory physical examination was normal. None had a personal or family history of clinical atopy. None had a previous history of pulmonary disease, smoking or toxic bronchopulmonary exposure. None had sinusitis, migraine, diabetes mellitus, or cardiac failure. Four (26.6%) of the patients with Crohn's disease had a positive methacholine challenge test whereas none of the 20 controls had a positive methacholine test (P = 0.026, Fisher exact test). Patients with Crohn's disease had a higher level of lymphocytes in induced sputum than controls (mean 14.59%, range 3.2-50 vs 5.46%, 0-26.92%, respectively; P = 0.011, Mann-Whitney test). Patients with Crohn's disease and a positive methacholine challenge test had an even higher percentage of lymphocytes in induced sputum compared with patients with Crohn's disease and a negative methacholine test (mean 24.88%, range 12.87-50 vs 10.48%, 3.2-21.69%; P = 0.047, Mann-Whitney test). The simultaneous findings of bronchopulmonary lymphocytosis and bronchial hyperresponsiveness in patients with Crohn's disease were not reported up to now. These results suggest that patients with Crohn's disease present a subclinical inflammatory process despite the absence of pulmonary symptoms.

Bronchial Hyper‐Reactivity in Migraine Without Aura: Is It a New Clue for Inflammation?

“…Bartholo et al reported that MPT was found in 27% of patients with Crohn's disease and none of the control subjects. There were also increased lymphocytes in sputum of these patients with Crohn's disease suggesting the presence of an inflammatory response at respiratory tract 22 . Vigorous activation of CD4 cells in the intestinal mucosa of patients with active Crohn's disease was previously reported 23 .…”

“…There were also increased lympho-cytes in sputum of these patients with Crohn's disease suggesting the presence of an inflammatory response at respiratory tract. 22 Vigorous activation of CD4 cells in the intestinal mucosa of patients with active Crohn's disease was previously reported. 23 Recent studies have suggested that the common mucosal immune system may be involved in various T-lymphocyte mediated disorders.…”

Chronic rhinosinusitis and psoriasis: do mutually exclusive systemic Th1 and Th2 disease patterns exist?

“…Our search found a few works with somewhat similar but inconclusive reports as discussed below. One study showed a high level of sinonasal disease in patients with Crohn's disease [19], but this is most likely due to an alternate basal airway inflammatory process reported in this patient population [20]. Further supporting our theory is the fact that medically controlling the Th1-predominant Crohn's disease results in the expected counterbalance and emergence of the Th2 sinusitis [21].…”

Interpretation of the “positive” methacholine challenge

“…Multiple studies have identified gastrointestinal disorders such as irritable bowel syndrome (IBS), Crohn's disease, ulcerative colitis, and gastroesophageal reflux (GERD) as risk factors for BHR [White et al, 1991;Louis et al, 1995Louis et al, , 1999Bartholo et al, 2005]. In the case of IBS, White et al [1991] suggested these individuals may have common alterations in smooth muscle function outside the gastrointestinal tract.…”