Emiko Ono

National Sagamihara Hospital

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Masami Taniguchi

National Sagamihara Hospital

Takahiro Tsuburai

Yokohama City Seibu Hospital

Kazuo Akiyama

International University of Health and Welfare

Chiyako Oshikata

National Hospital Organization

Yuma Fukutomi

National Sagamihara Hospital

Kiyoshi Sekiya

National Sagamihara Hospital

Noritaka Higashi

Japanese Red Cross Kumamoto Hospital

Eishi Miyazaki

Oita University

Naomi Tsurikisawa

National Hospital Organization

Haruhisa Mita

National Sagamihara Hospital

Cooperative Institutions

British School at Rome

111

AO Foundation

104

Délégation Paris 6

Menlo School

Hospital Español

Uppsala University

National Sagamihara Hospital

The University of Tokyo

Osaka University

National Cerebral and Cardiovascular Center

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Prognosis of Adult Asthma After Normalization of Bronchial Hyperresponsiveness by Inhaled Corticosteroid Therapy

Journal of Asthma (2008)

Naomi Tsurikisawa Takahiro Tsuburai Chiyako Oshikata Emiko Ono Hiroshi Saito

Background: Inhaled corticosteroids (ICSs) are the most effective anti-inflammatory drugs for adult asthma and can improve not only clinical symptoms but also bronchial hyperresponsiveness (BHR). However, the prognosis of adult asthma has not been well studied, and it remains to be elucidated precisely how long treatment with ICSs should be continued once clinical remission is achieved. Objectives: We examined whether ICS use could be withdrawn or reduced without exacerbation of disease. Methods: We retrospectively studied 374 adult patients with asthma to determine which factors predicted the elimination or reduction of ICS treatment without exacerbations of disease after the achievement of normalized BHR to acetylcholine. The patients were classified into three groups: Group 1 had symptoms within 6 months of normalization and needed to continue therapy; group 2 received the equivalent of ≥ 400 μ g fluticasone propionate until BHR normalization, did not have symptoms in the 6 months after normalization, and then had their doses of ICSs halved; and group 3 received the equivalent of ≤ 200 μ g fluticasone propionate at an enrollment, did not have symptoms in the 6 months after normalization, and then had all ICSs withdrawn. The primary outcome measure was the presence of clinical symptoms. We used multiple logistic regression and a Kaplan-Meier analysis to analyze the factors predicting remission. Results: Twenty-nine patients in group 3 remained asymptomatic for more than 30 months (mean 47.1 ± 12.4 months) after discontinuing ICS therapy. The predictive markers of remission were low levels of eosinophils in the sputum, high %V50 at the first hospital visit, and the need for only a low daily dose of ICS to induce normalized BHR. Conversely, patients with severe BHR at the first hospital visit, low %FEV1 at normalized BHR, and a need for high-dose ICSs to reach normalized BHR could not reduce or discontinue treatments. Conclusion: Some adult patients with asthma whose BHR is normalized by ICS therapy can achieve remission from disease exacerbation after discontinuation of ICSs. However, patients with severe asthma or asthma of long duration may not achieve remission even if their BHR is normalized.

Fluticasone propionate

Bronchial hyperresponsiveness

Fluticasone

10.1080/02770900802032958

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Citations (10)

Increased urinary leukotriene E4 concentration in patients with eosinophilic pneumonia

European Respiratory Journal (2008)

Emiko Ono Masami Taniguchi Haruhisa Mita Noritaka Higashi Yuma Fukutomi

Although eosinophils produce cysteinyl leukotrienes (CysLTs) in large quantities, information on the relationship between CysLTs and eosinophilic pneumonia (EP) is lacking. Inflammatory mediator concentrations in urine were quantified to clarify the relationship between CysLT concentrations and EP severity. Leukotriene (LT)E(4), eosinophil-derived neurotoxin (EDN), 9alpha,11beta-prostaglandin F2 and LTB(4) glucuronide concentrations were quantified in the urine of: EP patients during acute exacerbation and clinical remission; asthmatic patients during acute exacerbation and under stable conditions; and healthy control subjects. The urinary LTE(4) and EDN concentrations of EP patients during acute exacerbation were significantly higher than those of asthmatic patients and healthy subjects, and decreased immediately during clinical remission. The urinary LTE(4) concentration was associated with the urinary EDN concentration of EP patients during acute exacerbation. The urinary LTE(4) concentration significantly correlated with the diffusing capacity of the lung for carbon monoxide in EP patients during acute exacerbation. The increased urinary concentrations of leukotriene and eosinophil-derived neurotoxin were associated with acute exacerbation in eosinophilic pneumonia patients. The increased leukotriene concentration significantly correlated with diffusing capacity of the lung for carbon monoxide, suggesting that the monitoring of leukotriene concentration may aid in the management of eosinophilic pneumonia patients.

Leukotriene E4

Eosinophilic pneumonia

Leukotriene C4

10.1183/09031936.00093407

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Citations (14)

Dissociation between Asthma Control and Exhaled Nitric Oxide: Sinusitis Is a Strong Predicting Factor That Increases the Level of Nitric Oxide in Stable Asthmatic Patients without Airflow Limitation.

Sayaka Tatsuno Takahiro Tsuburai M. Taniguchi Yuma Fukutomi Hélio Massaiochi Tanimoto

Exhalation

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a2519

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Citations (0)

[A case of sarcoidosis manifesting as acute febrile polyarthritis following bronchoalveolar lavage].

PubMed (2005)

Emiko Ono Osamu Matsuno Shigeo Hiroshige Ryuichi Takenaka Takeo Itô

A 32-year-old man was incidentally found to have abnormal shadows on a chest X-ray film and was admitted on May 2004. His chest images showed mediastinal and bilateral hilar lymphadenopathy. The serum level of angiotensin-converting enzyme was elevated. We also found non-caseating epithelioid cell granulomas in transbronchial lung biopsy specimens, and confirmed the diagnosis of sarcoidosis. We carried out bronchoalveolar lavage (BAL) for evaluation of disease activity of sarcoidosis. After BAL, he suffered high fever and polyarthralgia. Both ankles were extremely inflamed. We suspected infectious arthropathy caused by atypical pathogens and thus administered antibiotics, but they had no effect at all. Also, no findings suggesting collagen-vascular disorders, including rheumatoid arthritis, were detected. His symptoms improved after three-weeks of treatment with non-steroidal anti-inflammatory drugs. Thus, this case was diagnosed as having acute sarcoid polyarthritis. BAL may have influenced the onset of febrile arthritis in this patient This case indicates that sarcoidosis should be considered as a possible cause of acute febrile polyarthritis.

Mediastinal lymphadenopathy

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Relationship between Exhaled Nitric Oxide Measured by Two Offline Methods and Bronchial Hyperresponsiveness in Japanese Adults with Asthma

Allergology International (2008)

Takahiro Tsuburai Naomi Tsurikisawa Sonoko Morita Hideki Hasunuma Hiroshi Kanegae

Exhaled nitric oxide (eNO) is a useful marker of eosinophilic airway inflammation in asthmatics. There have been no studies to show the relationship between eNO measured by offline methods and the degree of bronchial hyperresponsiveness in asthmatic patients treated with inhaled corticosteroids. The study population comprised asthmatics at our outpatient clinic. We measured eNO levels by two methods ("eNOs" was measured with a Sievers kit; and "eNOc" was measured with a kit from the Center for Environmental Information Science, Japan). We also used spirometry to test bronchial hyperresponsiveness to acetylcholine (PC20Ach). We recruited 192 stable asthmatics. There was a significant relationship between eNOs and eNOc (r = 0.919, p < 0.001). LogPC20Ach levels were negatively correlated with eNOs or eNOc levels (eNOs, r = − 0.31, p < 0.001; eNOc, r = − 0.23, p = 0.0013). We classified the subjects into two groups based on eNOs levels ((A) the subjects with high eNOs levels (n = 92) and (B) the subjects with normal eNOs levels (n = 100) ); logPC20Ach was significantly correlated with eNOs (r = − 0.34, p = 0.001) or eNOc (r = − 0.28, p = 0.0075) but not correlated with %FEV1 in (A), whereas logPC20Ach was not significantly correlated with eNO but significantly correlated with %FEV1 (r = 0.33, p = 0.002) in (B). Levels of eNOs and eNOc were correlated with the degree of bronchial hyperresponsiveness to acetylcholine in adult asthmatics treated with inhaled corticosteroids. Our findings suggest that offline monitoring of eNO will facilitate the management of bronchial asthma in patients treated with these drugs.

Bronchial hyperresponsiveness

Exhalation

10.2332/allergolint.o-07-518

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Citations (9)

Correlations between Alder Specific IgE and Alder-related Tree Pollen Specific IgE by RAST Method

Allergology International (2008)

Yuji Maeda Emiko Ono Yuma Fukutomi Masami Taniguchi Kazuo Akiyama

Wild birch trees grow in limited areas in Japan and are not a common aero-allergen. However, many patients who do not live in the area show positive birch pollen Radioallergosorbent Test (RAST). Therefore, being sensitized by another tree pollen which is closely related to birch may result in showing a specific IgE antibody to birch. Alder is a one of these trees and in the past it grew widely in Japan. However, there is no available RAST data as to the correlations between alder and alder-related trees. We measured the alder specific IgE (CAP-RAST, Phadea) in stored sera which was positive in birch RAST (228 samples), beech RAST (36 samples), oak RAST (152 samples) and cedar RAST (411 samples) and examined correlations between the RAST of alder and other trees. The correlation coefficient value of birch was very high (0.971). The other coefficient values of beech and oak were high (0.884 in beech and 0.895 in oak) but were slightly lower than that of the birch. This means that in terms of allergenicities, birch pollen is almost the same as alder and beech and oak are partly different from the alder. The Japanese respond to alder pollen just same as they do to birch pollen in forming specific IgE antibody. In clinical practice, positive alder RAST has the same meaning as positive birch RAST.

10.2332/allergolint.o-07-496

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Citations (17)

Reduced IgG levels found during acute eosinophilic pneumonia, which normalize during recovery from disease

Respiratory Medicine (2008)

Osamu Matsuno Ryuichi Takenaka Shigeo Hiroshige Emiko Ono Takahiro Nishitake

Eosinophilic pneumonia

Pulmonary Eosinophilia

10.1016/j.rmed.2008.01.004

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Citations (5)

[Case of eosinophilic bronchitis and bronchiolitis associated with increased level of serum CEA in asthmatics].

PubMed (2006)

Takahiro Tsuburai Yoshinori Kawabata Naomi Tsurikisawa Hiroyuki Mitomi Chiyako Oshikata

A 50-year-old asthmatic woman showed peripheral blood eosinophilia, significantly increased level of CEA in serum (102.5ng/ml), and atelectasis of the right middle lobe on chest radiograph and CT. The level of CEA subsequently increased further, and then decreased with systemic corticosteroid therapy. Pathological findings of surgically biopsied lung showed eosinophilic broncho-bronchiolitis, without malignant cells. Two years later, chest CT demonstrated various findings such as mucoid impaction, peripheral bronchiectasis and centrilobular nodules, but allergic bronchopulmonary mycosis was not proved. These findings suggest that the eosinophilic bronchiolar inflammation in bronchial asthma caused an increase in serum CEA levels and various findings on chest CT.

Chest radiograph

Atelectasis

Allergic bronchopulmonary aspergillosis

Pneumoconiosis

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Asthma and Sinusitis: Association and Implication

International Archives of Allergy and Immunology (2008)

Osamu Matsuno Emiko Ono Ryuichi Takenaka Toshiyuki Okubo Keiko Takatani

Background: Sinusitis occurs frequently in asthmatic patients. Epidemiologic data on sinusitis and lower airway disease must be evaluated with caution because they are based mostly on symptoms and do not include nasal endoscopic or computed tomography (CT) findings. Clinical support and evidence for this association are lacking. We evaluated the impact of sinusitis on lower airway disease in patients with well-characterized asthma. Methods: Subjects (n = 188) completed a questionnaire designed to provide information about their signs and symptoms related to asthma, allergic rhinitis (AR) and sinus disease. Patients (n = 104) were divided into four groups based on the presence or absence of sinusitis and/or AR. Clinical findings were compared in asthma patients with and without diagnosed sinusitis, by an otorhinolaryngologist or based on sinus CT findings. Results: The prevalence of sinusitis in patients with asthma was 36.7%. Sinus CT scan abnormalities were detected in 66.3% of patients with asthma. The scans revealed abnormal opacity in 17.9% of asthmatic patients without a history of sinusitis. There was a significant correlation between the rate of asthma severity and sinus morphologic abnormalities in patients with and without sinusitis. In adult-onset asthma (≧16 years old), sinusitis frequently preceded asthma, whereas in non-adult-onset asthma (<16 years old) it preceded sinusitis. The complication rate of sinusitis in asthmatic patients was significantly higher in adult-onset asthma than in non-adult-onset asthma. Conclusions: Our findings suggest that bronchial asthma is closely related to sinusitis and the onset age of asthma is important when considering allergic disease frequency. Whether sinus disease directly affects the intensity of bronchial inflammation remains to be elucidated.

Sinus (botany)

Chronic sinusitis

Nasal Polyps

10.1159/000128659

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Citations (44)

The Relationship between Exhaled Nitric Oxide Measured with an Off-line Method and Airway Reversible Obstruction in Japanese Adults with Asthma

Allergology International (2007)

Takahiro Tsuburai Naomi Tsurikisawa Masami Taniguchi Sonoko Morita Emiko Ono

Exhaled nitric oxide (eNO) is a useful marker of eosinophilic airway inflammation in asthma patients. There is no study to show the relationship between the eNO measured by using an off-line method and the degree of reversibility of airflow limitation in Japanese asthma patients. We sought to investigate the relationship between the eNO level measured by using an off-line method and the degree of reversibility of bronchial constriction in Japanese asthma patients. The study population comprised 97 asthma patients in our outpatient clinic with some patients in both groups who received inhaled corticosteroid treatment. We measured eNO levels, forced expiratory volume in one second (FEV1) before and after treatment, reversible airway obstruction (ΔFEV1) after inhalation of bronchodilator, and other parameters. eNO was significantly correlated with peripheral blood eosinophil counts in asthma patients (in steroid-naïve asthma patients, r = 0.544, p < 0.0001; in asthma patients treated with inhaled corticosteroid, r = 0.463, p = 0.026), and subjects with severe eosinophilia in sputum showed high levels of eNO (mild eosino- philia versus severe, p = 0.0152). Among patients with obstructive impairment, eNO levels were correlated with ΔFEV1 regardless of whether patients received (r = 0.527, p = 0.0435) or did not receive (r = 0.64, p = 0.0056) inhaled corticosteroid. In subjects with normal pulmonary function, there was no significant relationship between eNO and AFEV1 with or without inhaled corticosteroid. In patients with obstructive impairment, eNO reflects the degree of reversible airflow limitation. In subjects with normal pulmonary function, eNO may facilitate the diagnosis and management of asthma, rather than indicate reversible bronchial obstruction. eNO measurement by off-line methods is applicable as a potential tool for the diagnosis of asthma and management of asthma patients.

Airway obstruction

Outpatient clinic

10.2332/allergolint.o-06-439

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Citations (12)