Clinical aspects and treatment of asthma and allergic respiratory diseases

printing supported by . Visit Chiesi at Stand B2.10 MONDAY, SEPTEMBER 3RD 2012 bronchial hyperresponsiveness, airway obstructive damage, newly diagnosed 46 cough variant asthma patients and 57 bronchial asthma patients naive to oral or inhaled corticosteroids and free of asthma execerbation were subjected to spirometry, impulse oscillometry (IOS), bronchial hyperesponsiveness test, induction of sputum, and measurement of fractional exhaled nitric oxide (FeNO). Spirometry revealed lower values of FEV1.0/FVC, FEV1.0%pred, V50%pred, and V25%pred in patients with BA than in those with CVA (p<0.01). Both IOS parameters and FeNO values were significantly higher in patients with BA than in those with CVA (p<0.01). The log PC20 was significantly lower in patients with BA than in those with CVA (p<0.05). Induced sputum eosinophil counts were significantly higher in patients with BA than in those with CVA for both central and peripheral airways (p<0.001). However, the values of IOS, PC20, FeNO, and induced sputum eosinophil counts did not differ significantly between patients with mild intermittent asthma and those with CVA. All measures of central and peripheral airway obstruction, eosinophilic inflammation, and airway hyperresponsiveness were milder in patients with CVA than in those with BA but paralleled with intermittent asthma. Our data suggest that CVA is an allergic and inflammatory precursor of BA. P2342 Effects of budesonide/formoterol combination therapy versus budesonide on airway dimensions in asthma Makoto Hoshino. Department of Respiratory Medicine, Atami Hospital, International University of Health and Welfare, Atami, Shizuoka, Japan Background: The combination of inhaled corticosteroids and long-acting β2agonists results in improved asthma symptom control compared with inhaled corticosteroids alone, but the effects of combination therapy on airway structural changes and inflammation are still unknown. Aims and objectives: The aim of the study was to compare the effects of budesonide/formoterol versus budesonide on airway dimensions and inflammation in asthma. Methods: Fifty asthmatic patients were randomized to treatment with budesonide/formoterol (200/6 μg, two inhalations bd) or budesonide (200 μg, two inhalations bd) for 24 weeks. Airway dimensions were assessed by CT, and wall area corrected for body surface area (WA/BSA), percentage wall area (WA%), wall thickness (T)/ √ BSA, and luminal area (Ai)/BSA at the right apical segmental bronchus were measured. The percentage of eosinophils in induced sputum, pulmonary function, and Asthma Quality of Life Questionnaire (AQLQ) were also evaluated. Results: Significantly decreases in WA/BSA (p < 0.05), WA% (p < 0.001) and T/ √ BSA (p < 0.05), and increases in Ai/BSA (p < 0.05), and improvements in the AQLQ scores were observed in patients treated with budesonide/formoterol compared with budesonide. The reduction in sputum eosinophils and increase in FEV1% were greater for budesonide/formoterol compared with budesonide. The changes in WA% were significantly correlated with changes in sputum eosinophils and FEV1% (r = 0.84 and r = 064). Conclusions: Budesonide/formoterol combination is more effective than budesonide for reducing airway wall thickness and inflammation in asthma. P2343 Effects of breast feeding on the prevalence rates of asthma, rhinitis and eczema in Chinese school children Ning Song, Mohammed Shamssain, Jin Zhang, Shuting Hao, Jianling Wu, Chunling Fu, Xixin Yan. Respiratory Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China School of Health Sciences, University of Sunderland, United Kingdom Respiratory Medicine, The Second Hospital of Shijiazhuang, Shijiazhuang, Hebei, China Background: Exclusive breastfeeding for at least 4 months is recommended by many governments and allergy organizations to prevent allergic disease. There is conflicting evidence concerning the relationship between breast feeding and asthma, wheezing illness and allergic disorders. The objective of this study was to investigate whether there is any association between breast feeding and asthma and allergic disorders in Chinese schoolchildren. Methods: Study subjects comprised 10824 randomly selected 6 to 18 year-old schoolchildren from Shijiazhuang in Hebei Province in China. Information on breast feeding, asthma, rhinitis and eczema was gathered by parental questionnaire using the Chinese version of ISAAC questionnaire. Results: Children who have been breastfed had significantly lower prevalence rates of exercise-induced wheezing, asthma ever, and rhinitis ever than those who have not been breastfed (3.1% vs 4.2%, p<0.05; 1.0% vs 1.6%, p<0.05; and 13.3% vs 15.8%, p<0.01; respectively).There was a similar trend with chronic rash ever. Children who have been breastfed more than or equal to 12 months had lower prevalence rates of ever wheezed, wheeze in the past year, exercise-induced wheezing, persistent cough past year, ever had rhinitis, and ever had eczema than those who have been breastfed less than 12 months (5.3% vs 6.8%, P<0.05; 1.6% vs 2.7%, P<0.05; 2.9% vs 3.9%, P<0.05; 10.7% vs 12.4%, P<0.05; 12.5% vs 16.2%, P<0.001 and 11.4% vs 13.2%, P<0.05, respectively). The present study confirms the protective effect of breastfeeding on symptoms of asthma, rhinitis and eczema. P2344 Effects of water aerosol on pediatric allergic asthma Martin Gaisberger1, Renata Sanovic1, Heidemarie Dobias1, Predrag Kolarz2, Angelika Moder1, Josef Thalhamer3, Amina Selimovic4, Isidor Huttegger5, Markus Ritter1, Arnulf Hartl1 . 1Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria; 2Institute of Physics, University of Belgrade, Serbia; 3Department of Molecular Biology, University of Salzburg, Austria; 4Clinical Centre, University of Sarajevo, Bosnia and Herzegowina; 5Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria Objective: Ionized water aerosols have been suggested to exert beneficial health effects on pediatric allergic asthma. Their effectwas evaluated in a controlled randomized clinical trial as part of a summer asthma camp. Methods: Asthmatic allergic children (n=54) spent three weeks in an alpine asthma camp; half of the group was exposed to water aerosol for one hour per day, whereas the other half spent the same time at a “control site”. Immunological analysis, lung function and FeNO testing was performed during the stay, and sustaining effects were evaluated after 2 months. Symptom score testing was done over a period of 140 days. Results: The water aerosol group showed a significant improvement in all lung function parameters whereas the control group only in peek expiratory flow. All patients showed significant improvement in symptom score and significant decrease of FeNO after the camp. Only the water aerosol group exhibited a long lasting effect on asthma symptoms, lung function and inflammation in the followup examination. Induction of IL-10 and regulatory (Treg) cells was measured in both groups, with a pronounced increase in the water aerosol group. IL-13 was significantly decreased in both groups, whereas IL-5 and eosinophil cationic protein were decreased only in the water aerosol group. Conclusion: Our findings confirm the induction of Treg cells and reduction of inflammation by climate therapy. They indicate a synergistic effect of water aerosols resulting in a long lasting beneficial effect on asthma symptoms, lung function and airway inflammation. P2345 Simultaneous analysis of clinical markers for predicting increased lung function fluctability in stable asthma Kazuto Matsunaga, Atsushi Hayata, Tsunahiko Hirano, Masakazu Ichinose. Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan Background: Airway hyperresponsiveness (AHR) has been shown to be associated with the loss of asthma control. Predicting the increased fluctuation of lung function might be useful to regulate the future risk of poor asthma control because peak expiratory flow (PEF) variability well correlates with AHR. Objective: We simultaneously analyzed the clinical markers for predicting increased PEF variability in stable asthma. Methods: We studied non-smoking asthmatic patients who were receiving conventional therapy and clinically stable for 8 weeks. Patient medical records were obtained and asthma control questionnaire (ACQ), spirometry, and exhaled nitric oxide fraction (FENO) were measured. Associations between these variables and PEF variability over a week (Min%Max) were prospectively assessed. Results: 52 of 297 asthmatics (17.5%) showed the increased PEF variability (Min%Max < 80%). These subjects were receiving more intensive therapy, but had more severe asthma symptoms, more airflow obstruction, and more evidence of airway inflammation. Especially, ACQ, forced expiratory volume in one second % of predicted (%FEV1), and FENO were identified to be independent predictors of Min%Max < 80%. When we combine baseline %FEV1 ≤ 85% and/or FENO ≥ 40 ppb, this index was associated with the highest combination of sensitivity (94.2%) and specificity (80.4%) for increased PEF variability. Conclusions: These results suggested that ACQ, %FEV1 and FENO can stratify risk for increased fluctuation of lung function among the clinically stable asthmatics. P2346 Impact of allergy diagnosis on patients’ perceptions and experience of HDM allergy: A European survey Christine Rolland, Michèle Lheritier-Barrand, Lisa Tauleigne, Marie David, Lise Lemonnier, Erkka Valovirta. Asthma & Allergie, Association, Boulogne, France Stallergenes, SA, Antony, France LT, Insight, Paris, France Stallergenes, SA, Antony, France Stallergenes, SA, Antony, France Allergy Clinic, Terveystalo Turku, Turku, Finland Background: We assessed allergy awareness and diagnosis in a survey in four European countries. A post-hoc analysis determined the impact of dia