Effect of Glucocorticoids Following Application of Adenosine Receptor Blockers in Patients with Chronic Obstructive Bronchitis and Bronchial Asthma

AIM: The effects of the glucocorticoids (GR) fluticasone and budesonide and a blocker of the adenosine receptor in the treatment of patients with chronic obstructive pulmonary disease (COPD) and bronchial asthma were studied in this work. METHODS: The parameters of lung function were determined with body plethysmography. Airway resistance (Raw) was registered and measured and the intrathoracic gas volume and specific resistance (SRaw) of the airways were also calculated. RESULTS: The results of this study of patients with COPD and bronchial asthma used doxofylline as a blocker of the adenosine receptor. Doxofylline was given orally on 7 consecutive days at home with a dose of 2 × 400 mg orally. Raw and IGTV were then measured, and SRaw was calculated. The results indicated a significant decrease in the airway specific resistance (p < 0.05). On the 8th day, the same patients were given two inhalations with spray fluticasone and budesonide (budesonide, 2 inh × 2 mg; Pulmicort 2 inh × 125 mcg). After the inhalations were given, Raw and IGTV were measured after 5, 15, 30, 60, and 120 min, SRaw was then calculated. CONCLUSION: After the preliminary application of doxofylline, the GRs fluticasone and budesonide have a significant effect (p < 0.01) on the decrease of the airway SRaw. This effect suggests that the blocking effect of the adenosine receptor (p < 0.05) emphasizes the bronchodilation effect of GRs (p < 0.01).

Relationship of spirometric, body plethysmographic, and diffusing capacity parameters to emphysema scores derived from CT scans

Phenotyping of chronic obstructive pulmonary disease (COPD) with computed tomography (CT) is used to distinguish between emphysema- and airway-dominated type. The phenotype is reflected in correlations with lung function measures. Among these, the relative value of body plethysmography has not been quantified. We addressed this question using CT scans retrospectively collected from clinical routine in a large COPD cohort. Three hundred and thirty five patients with baseline data of the German COPD cohort COPD and Systemic Consequences-Comorbidities Network were included. CT scans were primarily evaluated using a qualitative binary emphysema score. The binary score was positive for emphysema in 52.5% of patients, and there were significant differences between the positive/negative groups regarding forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity (FVC), intrathoracic gas volume (ITGV), residual volume (RV), specific airway resistance (sRaw), transfer coefficient (KCO), transfer factor for carbon monoxide (TLCO), age, pack-years, and body mass index (BMI). Stepwise discriminant analyses revealed the combination of FEV1/FVC, RV, sRaw, and KCO to be significantly related to the binary emphysema score. The additional positive predictive value of body plethysmography, however, was only slightly higher than that of the conventional combination of spirometry and diffusing capacity, which if taken alone also achieved high predictive values, in contrast to body plethysmography. The additional information on the presence of CT-diagnosed emphysema as conferred by body plethysmography appeared to be minor compared to the well-known combination of spirometry and CO diffusing capacity.

Comparison of Effect of Leukotriene Biosynthesis Blockers and Inhibitors of Phosphodiesterase Enzyme in Patients with Bronchial Hyperreactivity

AIM: Blocking effect of leukotriene biosynthesis–zileuton and blocking the effect of phosphodiesterase enzyme–diprophylline in the treatment of patients with bronchial asthma and bronchial increased reactivity, and tiotropium bromide as an antagonist of the muscarinic receptor studied in this work.METHODS: Parameters of the lung function are determined with Body plethysmography. The resistance of the airways (Raw) was registered and measured was intrathoracic gas volume (ITGV), and specific resistance (SRaw) was also calculated. For the research, administered was zileuton (tabl. 600 mg) and diprophylline (tabl. 150 mg).RESULTS: Two days after in-house administration of leukotriene biosynthesis blocker–zileuton (4 x 600 mg orally), on the day 3 initial values of patients measured and afterwards administered 1 tablet of zileuton, and again measured was Raw and ITGV, after 60, 90 and 120 min. and calculated was SRaw; (p < 0.01). Diprophylline administered 7 days at home in a dose of (2 x 150 mg orally), on the day 8 to same patients administered 1 tablet of diprophylline, and performed measurements of Raw, ITGV, after 60, 90 and 120 min, and calculated the SRaw (p < 0.05). Treatment of the control group with tiotropium bromide - antagonist of the muscarinic receptor (2 inh. x 0.18 mcg), is effective in removal of the increased bronchomotor tonus, by also causing the significant decrease of the resistance (Raw), respectively of the specific resistance (SRaw), (p < 0.05).CONCLUSION: Effect of zileuton in blocking of leukotriene biosynthesis is not immediate after oral administration, but the effect seen on the third day of cys-LTs’ inhibition, and leukotriene B4 (LTB4) and A4 (LTA4) in patients with bronchial reactivity and bronchial asthma, which is expressed with a high significance, (p < 0.01). Blockage of phosphodiesterase enzyme–diprophylline decreases the bronchial reactivity, which is expressed with a moderate significance, (p < 0.05).