Protective Effect of Antiasthma Drugs on Late Asthmatic Reactions and Increased Airway Responsiveness Induced by Toluene Diisocyanate in Sensitized Subjects

Mapp, C. E.; Boschetto, Pierà; Vecchio, L. Dal; Crescioli, S.; Marzo, N. De; Paleari, Davide; Fabbri, Leonardo

doi:10.1164/ajrccm/136.6.1403

Cited by 108 publications

(47 citation statements)

References 2 publications

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“…Four studies have looked at the effect of theophylline on the allergen-induced increase in airway responsiveness. In two studies on six patients each, theophylline had no significant effect on the increase in methacholine responsiveness following the late asthmatic reaction [65,67]. CRESCIOLI et al [66] observed that in five out of six subjects theophylline significantly inhibited the increase of airway responsiveness to methacholine compared to placebo and control day.…”

Section: Effect In Allergen Challenge Studiesmentioning

confidence: 98%

See 1 more Smart Citation

Theophylline in the management of asthma: time for reappraisal?

Barnes¹,

Pauwels²

1994

Eur Respir J

250

107

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T Th he eo op ph hy yl ll li in ne e i in n t th he e m ma an na ag ge em me en nt t o of f a as st th hm ma a: : t ti im me e f fo or r r re ea ap pp pr ra ai is sa al l? ?P.J. Barnes*, R.A. Pauwels** Theophylline is now considered to be a bronchodilator, but it is increasingly recognized that theophylline has other anti-asthma activities, which may be more important. Theophylline, even at low plasma concentrations, inhibits the late asthmatic reaction following allergen challenge. These clinical pharmacological observations are substantiated by experimental animal and in vitro data showing that theophylline has several anti-inflammatory activities relevant to asthma. These include the inhibition of cytokine synthesis and release, the inhibition of inflammatory cell activation and microvascular leakage, and the prevention of airway hyperresponsiveness induced by airway inflammation. Theophylline appears to have immunomodulatory effects, even at relatively low plasma concentrations.Based on these considerations, theophylline can be regarded as a useful alternative to other anti-inflammatory drugs for the chronic treatment of mild to moderate asthma. Theophylline should be used at lower doses to achieve plasma concentrations of 5-10 mg·l -1 , which will avoid the risk of side-effects.Further studies are required to evaluate the role of low-dose theophylline as an adjunct to low-dose inhaled steroids in the management of chronic asthma. It may now be appropriate to re-evaluate the role of theophylline in asthma management.

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Section: Effect In Allergen Challenge Studiesmentioning

confidence: 98%

“…Several studies have been performed, and have observed either no or only partial protection against the early response [60][61][62][63][64][65][66][67][68][69]. However, all studies except one observed, a marked protective effect against the late asthmatic reaction following allergen challenge ( fig 2).…”

Section: Effect In Allergen Challenge Studiesmentioning

confidence: 99%

Theophylline in the management of asthma: time for reappraisal?

Barnes¹,

Pauwels²

1994

Eur Respir J

250

107

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“…It is clear, however, that the effect of theophylline is modest compared with inhaled glucocorticosteroids, although it is possible that a longer treatment period may have had a greater effect. Certainly, theophylline has now been shown to have many properties like glucocorticosteroids, including the ability to attenuate allergen-induced late asthmatic responses following single [1,2] and regular prophylactic [4,5] treatment. Again, these observations are in contrast to recent observations showing that regular β 2 -adrenoceptor agonists exacerbate responses to allergen [21,23,25], suggesting that the beneficial effect of theophylline is unlikely to be due to bronchodilation.…”

Section: Discussionmentioning

confidence: 99%

“…The intravenous administration of theophylline or enprophylline prior to allergen [1] or toluene di-isocyanate [2] has been shown to inhibit the development of the late asthmatic response [1] without any significant effect on the acute bronchoconstrictor response or the associated bronchial hyperresponsiveness to methacholine [2][3][4]. Recent studies have investigated the effect of low-dose theophylline on the inflammatory process in the airway when administered chronically.…”

mentioning

confidence: 99%

Effect of chronic theophylline treatment on the methacholine dose-response curve in allergic asthmatic subjects

Page

Cotter²,

Kilfeather³

et al. 1998

Eur Respir J

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Theophylline is a bronchodilator and immunomodulator drug which has recently been demonstrated to attenuate the recruitment and activation of inflammatory cells into lungs of asthmatics. This study investigated the effect of chronic treatment with theophylline for its ability to alter airway responsiveness, as indicated by changes in airway sensitivity and reactivity to inhaled methacholine. The subjects studied were mild asthmatics who relied on beta-agonist medication only and who were randomized into two groups, one receiving theophylline (median dose 250 mg twice daily; range 250-375 mg twice daily) and the other placebo. A number of parameters was measured before and after treatment, including baseline forced expiratory volume in one second (FEV1), the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20; sensitivity), dose-response slope (reactivity) and percentage eosinophils, eosinophil cationic protein and T-cell markers in peripheral blood (by flow cytometry). After 2 months of treatment with theophylline there was a significant lowering of airway reactivity (slope) to methacholine and improvement in methacholine sensitivity (PC20). However, such changes were not associated with any significant change in the number or activation status of eosinophils and lymphocytes in peripheral blood. In conclusion, chronic treatment with theophylline reduces the reactivity of the airways to methacholine, which might be beneficial in the treatment of persistent asthma. The cellular mechanisms of this improvement remain to be clarified.

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“…Желательно также отменить ингаляционные глюко кортикостероиды (иГКС). В исследованиях показа но, что при воздействии ингаляционных и перораль ных кортикостероидов в дозозависимом режиме значительно ослабляются бронхиальная реакция на аллергены, особенно поздняя, и связанная с ней НБГр, хотя и не подавляется полностью реакция бронхов [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. Протективный эффект иГКС при аллерген индуцированной ранней реакции, эозино филия дыхательных путей и повышение НБГр час тично или полностью сохраняются в течение 12 ч после прекращения терапии [48].…”

Section: меры предосторожностиunclassified

Challenge inhalation tests in the diagnosis of occupational asthma: the guidelines of European Respiratory Society

Редакционная¹

2015

Pulʹmonologiâ (Mosk.)

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РезюмеВ данном документе содержатся клинические рекомендации по проведению ингаляционных тестов для диагностики профессиональ ной бронхиальной астмы (ПБА). Представленные Рекомендации разработаны на основе систематического обзора литературы, исследо ваний, проводившихся в крупных медицинских центрах Европы, материалов конференций и мнений экспертов. В статье подробно описана пошаговая процедура выполнения специфических ингаляционных провокационных тестов (СИПТ), в т. ч. требования без опасности, способы ингаляционной доставки провоцирующего вещества и методы оценки результатов. Также обсуждаются недостатки этой процедуры. Ингаляционные провокационные тесты должны выполняться только в условиях медицинских учреждений, где имеет ся опыт подобного тестирования. В тестах также должны использоваться контрольные провокационные вещества, доза провоцирующе го вещества должна повышаться постепенно при тщательном наблюдении пациента во время исследования и как минимум в течение 6 ч после его окончания. При соблюдении всех требований побочные эффекты СИПТ встречаются редко. Положительным результатом теста считается снижение объема форсированного выдоха за 1 ю секунду на ≥ 15 %исх. Иногда положительный результат может объяс няться неспецифической бронхиальной гиперреактивностью, эозинофилией мокроты или повышением содержания оксида азота в вы дыхаемом воздухе. Ингаляционные провокационные тесты обладают высокой чувствительностью и специфичностью, поэтому счита ются решающим методом диагностики ПБА. Ключевые слова: специфические ингаляционные провокационные тесты, профессиональная бронхиальная астма, диагностика, методи ка, пиковая скорость выдоха, объем форсированного выдоха за 1 ю секунду. Challenge inhalation tests in the diagnosis of occupational asthma: the guidelines of European Respiratory Society SummaryThis consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close moni toring of the patient during the challenge and for at least 6 hours afterwards. In expert centres, excessive reactions provoked by SIC are rare. A pos itive response is defined by a fall in forced expiratory volume in 1 second ≥ 15 % from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually...

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Protective Effect of Antiasthma Drugs on Late Asthmatic Reactions and Increased Airway Responsiveness Induced by Toluene Diisocyanate in Sensitized Subjects

Cited by 108 publications

References 2 publications

Theophylline in the management of asthma: time for reappraisal?

Theophylline in the management of asthma: time for reappraisal?

Effect of chronic theophylline treatment on the methacholine dose-response curve in allergic asthmatic subjects

Challenge inhalation tests in the diagnosis of occupational asthma: the guidelines of European Respiratory Society

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