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Comparative Study
. 2005 Sep;116(3):586-93.
doi: 10.1016/j.jaci.2005.04.035.

Airway immunopathology of asthma with exercise-induced bronchoconstriction

Teal S Hallstrand  1 , Mark W Moody, Moira L Aitken, William R Henderson Jr
Affiliations
Comparative Study

Airway immunopathology of asthma with exercise-induced bronchoconstriction

Teal S Hallstrand et al. J Allergy Clin Immunol. 2005 Sep.

Erratum in

  • J Allergy Clin Immunol. 2007 Aug;120(2):307
  • J Allergy Clin Immunol. 2008 Apr;121(4):999

Abstract

Background: Exercise-induced bronchoconstriction (EIB) is a common cause of symptoms in a subgroup of asthmatic subjects. The pathobiology that makes this group of asthmatic subjects susceptible to bronchoconstriction after a brief period of exercise remains poorly understood.

Objective: We sought to determine whether there are differences in lower airway inflammation and production of cytokines and eicosanoids between asthmatic subjects with and without EIB.

Methods: Two distinct groups of asthmatic subjects based on a priori definitions were identified, one with moderate-to-severe EIB and the other without significant bronchoconstriction after exercise challenge. Both groups met the definition of asthma on the basis of bronchodilator response, bronchial hyperresponsiveness, or both. A comparative immunopathology study was conducted by using induced sputum to identify differences in lower airway inflammation and production of cytokines and eicosanoids.

Results: The groups had similar baseline lung function and bronchodilator response and did not have any asthma exacerbations within the prior year. The concentration of columnar epithelial cells was markedly higher in the group with EIB (1.4 x 10(5) vs 2.9 x 10(4) cells/mL, P=.01). The concentration of eosinophils was higher in the group with EIB (3.6 x 10(4) vs 4.9 x 10(3) cells/mL P=.04). Cysteinyl leukotrienes (CysLTs; 727.7 vs 151.9 pg/mL, P=.01) and the ratio of CysLTs to prostaglandin E(2) (1.85 vs 1.04, P=.002) in the airways were higher in the group with EIB.

Conclusion: Injury to the airway epithelium, overexpression of CysLTs, relative under production of prostaglandin E(2), and greater airway eosinophilia are distinctive immunopathologic features of asthma with EIB.

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Figures

FIG 1
FIG 1
Comparison of lung function response after exercise challenge in asthmatic subjects with EIB and an asthmatic control group without EIB. The severity of EIB measured on the basis of the AUC30 was markedly greater in the EIB+ group (P < .001).
FIG 2
FIG 2
Relationship between lung function and severity of EIB measured on the basis of the AUC30 (A) and lung function response to a short-acting β2-agonist and severity of EIB (B). No relationship was identified between either of these 2 physiologic parameters and the severity of EIB.
FIG 3
FIG 3
Comparison of the concentration of columnar epithelial cells (A) and the concentration of eosinophils (B) in induced sputum between asthmatic subjects with EIB and asthmatic control subjects without EIB. The median concentration of columnar epithelial cells and eosinophils was higher in the group with EIB.
FIG 4
FIG 4
Comparison of the levels of CysLTs (A) and the ratio of CysLT to PGE2 (B) in the airways of asthmatic subjects with EIB compared with those seen in asthmatic control subjects without EIB. The median concentrations of CysLT and the CysLT/PGE2 ratio were higher in the group with EIB.
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