The utility of the mannitol challenge in the assessment of chronic cough: a pilot study

There is a need for more objective outcome measures for chronic cough. In this pilot study we sought to investigate the utility of the mannitol challenge as a cough-provocation test in non-asthmatic chronic cough. We studied 16 healthy controls and 13 subjects with chronic cough. We assessed cough severity using a visual analogue score, capsaicin cough sensitivity, health status using the Leicester Cough Questionnaire and the dose of mannitol to cause 2 (C2) or 5 (C5) coughs. In all of the subjects with chronic cough and 6 of the controls we assessed the 1-week repeatability of the mannitol challenge. We found that in those subjects with chronic cough the geometric mean (logSEM) mannitol C2 and C5 was heightened compared to controls (C2: 4 (0.2) versus 16 (0.1); p = 0.04 and C5: 63 (0.1) versus 251 (0.1); p = 0.04). Cough visual analogue score, capsacin-induced cough sensitivity and health status were also altered in chronic cough compared to healthy controls, but in those subjects with chronic cough none of these outcomes was correlated with the mannitol C2 or C5. The repeatability of the mannitol challenge assessed by intraclass correlation was C2 = 0.53 and C5 = 0.59. A cut-off in the dose of mannitol of 62 mg/ml for C2 and 550 mg/ml for C5 had a sensitivity of 69 and 62% and specificity of 69 and 81% respectively to distinguish chronic coughers from healthy controls. In conclusion, the mannitol challenge my have potential as a novel cough challenge test and further work is required to extend our findings and to assess whether it has utility in different causes of chronic cough

Magmatic and geotectonic significance of Santa Elena Peninsula, Costa Rica

We present a new integrated interpretation of the geochemistry and geotectonic significance of the Santa Elena Peninsula, which is divided in three units: 1) an overthrust allocthonous unit of ultramafic and mafic rocks, the Santa Elena Nappe; 2) an autochthonous basaltic sedimentary suite, resting immediately below the overthrust, the Santa Rosa Accretionary Complex; and 3) Islas Murciélago pillow and massive basaltic flows. In the Santa Elena Nappe three petrological affinities have been recognized: 1) the ultramafic complex, that corresponds to depleted (MORB-like) mantle serpentinizated peridotites, with very low TiO2 and high Ni and Cr; 2) the pegmatitic gabbros, layered gabbros and plagiogranites and basaltic dikes with low TiO2 (0.89%). These mafic associations have geochemical signatures that suggest an island arc origin and petrographic evidences of low grade metamorphism and hydrothermal alteration. The Santa Rosa Accretionary Complex includes pelagic and volcanoclastic sediments, tuffs and alkaline magmatic rocks, originated by low degree melting of enrichment OIB mantle source, and probably related with seamount portions incorporated into the accretionary prism. Islas Murciélago pillow and massive basalts show no clear structural relationship with the rest of the units, but are geochemically similar to the dolerites of the Santa Elena Nappe. Sr, Nd, and Pb isotopic ratios of the Santa Elena Nappe and the Santa Elena Accretionary Complex samples do not correspond to the Galapagos Mantle array, and have different mantle reservoirs and geochemical characteristics than the Nicoya Complex

Free-living Haemophilus Influenzae is associated with increased pulmonary inflammation

The most common pathogen in the lower airway of patients with COPD is Haemophilus influenzae. H. influenzae has been shown to be linked to inflammation and increased inflammation. Emerging evidence shows that pathogens can exist as either cell-associated or free-living (non-cell associated). We investigated whether detectable free-living H. influenzae correlates with pulmonary inflammation

How to get the most out of the ERS International Congress 2021 and an overview of the Early Career Member session

Sociedad Respiratoria Europea (ERS); Ayudar a los asistentesSocietat Respiratòria Europea (ERS); Ajudar els assistentsEuropean Respiratory Society (ERS); Help attendeesThis article provides a brief description of the Early Career Member session and guidance on how to get the most out of the European Respiratory Society (ERS) International Congress 2021, to help attendees plan their Congress in advance

IL-13 expression by blood T cells and not eosinophils is increased in asthma compared to non-asthmatic eosinophilic bronchitis

<p>Abstract</p> <p>Background</p> <p>In asthma interleukin (IL)-13 is increased in the airway compared with non-asthmatic eosinophilic bronchitis. Whether this differential expression is specific to the airway or is more generalised is uncertain.</p> <p>Methods</p> <p>We sought to examine IL-13 expression in peripheral blood T-cells and eosinophils in asthma and non-asthmatic eosinophilic bronchitis. Peripheral blood CD3+ cell and eosinophil intracellular IL-13 expression from subjects with asthma, non-asthmatic eosinophilic bronchitis and healthy controls was assessed. The effect of priming by asthmatic serum on the release of IL-13 by peripheral blood mononuclear cells from healthy subjects was examined and the serum from these subjects was analysed for a range of chemokines and cytokines.</p> <p>Results</p> <p>The median (IQR)% intracellular IL-13 expression by CD3+ cells was increased in asthma [5.3 (2.7–9.8)%; n = 12] compared to non-asthmatic eosinophilic bronchitis [1.1 (0.5–3)%; n = 7] and healthy controls [1.7 (0.2–3%); n = 9] (p = 0.02), but was not significantly different in eosinophils across the groups. IL-13 released from healthy peripheral blood mononuclear cells (n = 10) was increased by asthmatic serum [117 (47.8–198)pg/ml] compared to control [78.5 (42.6–128)pg/ml; p = 0.02), but was not affected by non-asthmatic serum.</p> <p>Conclusion</p> <p>Our findings support the view that IL-13 expression is increased in peripheral blood-derived T cells in asthma and that asthmatic serum up-regulates IL-13 release from healthy peripheral blood mononuclear cells.</p

A theoretical model of inflammation- and mechanotransduction- driven asthmatic airway remodelling

Inflammation, airway hyper-responsiveness and airway remodelling are well-established hallmarks of asthma, but their inter-relationships remain elusive. In order to obtain a better understanding of their inter-dependence, we develop a mechanochemical morphoelastic model of the airway wall accounting for local volume changes in airway smooth muscle (ASM) and extracellular matrix in response to transient inflammatory or contractile agonist challenges. We use constrained mixture theory, together with a multiplicative decomposition of growth from the elastic deformation, to model the airway wall as a nonlinear fibre-reinforced elastic cylinder. Local contractile agonist drives ASM cell contraction, generating mechanical stresses in the tissue that drive further release of mitogenic mediators and contractile agonists via underlying mechanotransductive signalling pathways. Our model predictions are consistent with previously described inflammation-induced remodelling within an axisymmetric airway geometry. Additionally, our simulations reveal novel mechanotransductive feedback by which hyper-responsive airways exhibit increased remodelling, for example, via stress-induced release of pro-mitogenic and procontractile cytokines. Simulation results also reveal emergence of a persistent contractile tone observed in asthmatics, via either a pathological mechanotransductive feedback loop, a failure to clear agonists from the tissue, or a combination of both. Furthermore, we identify various parameter combinations that may contribute to the existence of different asthma phenotypes, and we illustrate a combination of factors which may predispose severe asthmatics to fatal bronchospasms

Investigating the role of pentraxin 3 as a biomarker for bacterial infection in subjects with COPD.

Background Pentraxin-3 (PTX3) is an acute phase protein, involved in antibacterial resistance. Recent studies have shown PTX3 levels to be elevated in the presence of a bacterial infection and in a murine sepsis model. Objective We aim to investigate if sputum PTX3 can be used as a biomarker for bacterial infection in subjects with COPD. Methods Sputum samples from 142 COPD patients (102 men) with a mean (range) age 69 years (45 to 85) and mean (SD) post-bronchodilator percentage predicted FEV1 of 50% (19) were analysed for PTX3, using a commercial assay at stable state and during an exacerbation. Association with bacteria, from culture, quantitative real time polymerase chain reaction (qPCR) and colony forming units (CFU) was investigated. Results The geometric mean (95%CI) PTX3 level at stable state was 50.5ng/mL (41.4 to 61.7). PTX3 levels correlated with absolute neutrophil count in sputum (r=0.37; p105 CFU/mL at stable state) with a receiver operator characteristic (ROC) area under the curve (AUC) of 0.59, 95% confidence interval (CI) 0.43 to 0.76, p=0.21). During an exacerbation there was a modest increase in PTX3 (fold difference 0.15, 95% of difference 0.02 to 0.29; p=0.02 and PTX3 fared better at identifying a bacteria-associated exacerbation (ROC AUC 0.65, 95%CI 0.52 to 0.78, p=0.03). Conclusions PTX3 is associated with bacterial infection in patients with COPD, but its utility as a biomarker for identifying a bacteria-associated exacerbation warrants further studies