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Introduction: Indirect airway challenge tests are commonly used in the diagnosis of exercise-induced bronchoconstriction (EIB), defined as a post-exercise decrease in FEV(1) ≥ 10%. The aim of this study was to evaluate the diagnostic value of bronchial hyperreactivity tests in the diagnosis of EIB., Material and Methods: Forty two subjects were allocated to 3 groups: A - 19 steroid naive asthma patients; D - 11 no-asthma patients reporting symptoms suggestive for EIB (dyspnea, wheeze and cough provoked by exercise) and K - 12 healthy controls. Subjects filled a questionnaire regarding symptoms related to exercise and underwent: inhaled bronchial challenge to methacholine (Mch), adenosine 5'-monophosphate (AMP) and exercise challenge on a treadmill. With a cutoff of ≥ 10% or ≥ 15% decrease in FEV1 post exercise EIB was diagnosed in 47% and 37% of asthma patients, respectively; 27% of subjects in group D and in none of controls, irrespectively of the ΔFEV(1) criterion., Results: The analysis of questionnaire revealed that a single symptom cannot be used to predict EIB. Symptoms occurring after termination of exercise, but not during exercise characterize EIB more precisely. The analysis showed that the most useful measure to diagnose EIB can be a combination of bronchial challenge to AMP and typical symptoms of exercise induced bronchoconstriction (i.e. dyspnea, wheezes and cough provoked by exercise) with a sensitivity of 70%, specifity of 94%, PPV of 78%, NPV of 91% and LR of 11.2., Conclusions: Symptoms suggestive of EIB do not have acceptable sensitivity and specifity for the diagnosis of exercise-induced bronchoconstriction. The most useful measure to diagnose EIB is a combination of typical symptoms of EIB with positive challenge to AMP.

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play roles. Interleukins 5 (IL-5) and 13 (IL-13) are cytokines which play important roles in the pathophysiology of asthma. Selective accumulation and activation of eosinophils in the bronchial mucosa is considered a central event in the pathogenesis of asthma. IL-5 acts as a mediator of activation of eosinophils, influencing adhesion, membrane receptor expression, chemotaxis, and mediator synthesis. Airway eosinophilia has been related to bronchial hyperreactivity, asthma symptoms, and airway narrowing in subjects with asthma. IL-13 has a great influence on bronchial hyperreactivity, inflammation, and airway remodeling. Moreover, this cytokine drives many cellular responses relevant in asthma, including epithelial cell maturation and mucus production, synthesis of extracellular matrix proteins, and enhanced contractility of airway smooth muscle cells. In recent years, efforts have been underway to use substances acting as antagonists of these cytokines in the treatment of asthma. Many studies are being performed to assess the efficacy of anti-IL-5 and anti-IL-13 antibodies as well as substances inactivating receptors of these cytokines in asthma therapy. The results of these studies seem very interesting and induced the authors to discuss this issue.

Between the upper and the lower respiratory tracts exists a link. Numerous epidemiological, immunological studies and clinical observations suggest the pathogenic unity of the upper and lower airways. The most important observations regarding the nose-lung interaction is rhinitis and asthma. The inflammatory process in the nose is the same as in the bronchi, clinically defined as rhinosinusitis, nasal polyps, asthma, bronchial hyperreactivity, allergy, viral infections. The strict link between the rhinosinusitis and asthma implies new possibility of influencing one of the two complaints by treating the other one with an integrated therapy (pharmacotherapy, endonasal microsurgery).

It is increasingly suggested a connection between gastroesophageal reflux (GER) and bronchial asthma (BA). Coexistence of both these diseases is suggested by presence of asthmatics symptoms in non-atopic patients, difficult control and resistance of the specific treatment for asthma disease in some patients, worsening of respiratory symptoms in circumstances which favored GER. The purpose of the paper was presentation of the potential pathogenetic relationships between asthma and GER, their clinical manifestations and epidemiology in different age groups, and finally confirmation of the effectiveness of treatments for gastroesophageal reflux (especially using protonic pumps inhibitors) in terms of their benefit on asthma course, both in children as in adults.

Selective phosphodiesterases (PDE) inhibitors are the new group of antiasthmatic drugs, which integrate antiinflammatory activity with bronchoconstriction counteraction. Selective inhibitors of phosphodiesterase type 4 are used as alternative or assist drugs in treatment of respiratory system diseases. So far glucocorticosteroids remain the most efficient and widely used medicine in the treatment of asthma. However application of glucocorticosteroid is greatly limited because of numerous side effects, what induce to permanent search for new antiasthmatic drugs. Examination new substances are executed on animal models. Guinea pig model is widely used to research course of asthmatic reaction. This model is especially convenient on the ground of that: lung is major shock organ, airway respond to histamine, animals demonstrated early asthmatic reaction (EAR) and late asthmatic reaction (LAR), eosinophils flow in bronchoalveolar space during LAR. In ovalbumin (OA) sensitized guinea pigs hypersensitivity reaction breaks out as a result of OA provocation. Aims of our experiments, execute on guinea pig model were to determine the influence of rolipram (PDE 4 inhibitor) on modulation experimental asthmatic reaction and comparison activity of rolipram versus dexamethasone in attribution to chosen parameters of allergic reaction such as: lung resistance, influx of protein and inflammatory cells in airways, and mastocytes degranulation. Experiments were made on guinea pigs sensitized and provoked with ovalbumin The obtain data indicate that rolipram was effective in reduction the rise of lung resistance during EAR, restricted influx of eosinophils to bronchoalveolar space between 1,5 and 24 hours after provocation, and reduced increase of histamine concentration in bronchoalveolar lavage fluid (BALf). Rolipram had no influence on number of neutrophils present in BALf. Dexamethasone in double dose of 1,2mg/kg effectively bordered the growth of lung resistance during EAR, and broke influx of eosinophils and neutrophils to bronchoalveolar space.

The Aim of the Study: To evaluate seasonal changes in bronchial hyperreactivity (BHR) in patients suffering from pollinosis, sensitive to Ryegrass engl., Material and Methods: The studies were carried out on 26 patients and 20 healthy subjects. All the patients had a history of seasonal allergic rhinitis. The following measurements were performed outside and during the pollen season: bronchial provocation test (BPT) with metacholine and 4.5% NaCl, serum concentration of specific and total IgE., Results: Outside the pollen season additionally the BPT with Ryegrass engl. allergen was performed and 88% of the pollinosis patients had positive result of the test. After 4.5% NaCl bronchial challenge positive results had 2 out of 26 patients outside the season, and 3 during the season. Bronchial hyperreactivity to metacholine (PC20 < 8 mg/ml) were observed in 4/26 (15.4%) persons outside the season and in 7 (26.9) during the season. The healthy subjects had no bronchoconstriction neither after metacholine or 4.5% NaCl. During the pollen season the increase in serum concentration of tIgE and sIgE was observed only in pollinosis patient., Conclusions: There was not found a correlation between BHR to the allergen and serum total IgE nor specific IgE concentration.

Aim of the study was to verify the hypothesis that the effect of passive smoking exposure on the occurrence of respiratory symptoms and diseases is higher in children with increased individual susceptibility defined on the basis of occurrence of symptoms of atopy. Project was performed as the cross-sectional epidemiological study which comprised population of 1,534 children attending primary schools in Swietochłowice, Kedzierzyn-Koźle, Pszczyna and Kielce. On the basis of standard questionnaire an information regarding occurrence of wheezing, attacks of dyspnea with wheezing, asthma and spastic bronchitis was collected. Atopy in child was defined on the basis of occurrence of symptoms of allergy to at least one of the following allergens: house dust mites, animal dander, pollens or symptoms of food allergy confirmed by physician's diagnosis. Exposure to tobacco smoke was assessed also on the basis of the information regarding smoking given by the parents in the questionnaire. The effect of interaction atopy * passive smoking was assessed on the basis of variable called "interaction" which had three levels: level A: when exposure to passive smoking and atopy = 0, level B: when exposure to passive smoking or atopy =1 and level C: when exposure to passive smoking and atopy =1. The results of our study revealed that statistically significant relationship between interaction atopy * passive smoking on the occurrence of analyses symptoms and diseases. The occurrence of symptom/disease increased with the presence of either atopy or exposure to passive smoking and was the highest when atopy and exposure to passive smoking was present. The results of simple analyses were conformed by multivariate analyses. The results of our study suggest that the effect of environmental exposures could be higher in children with atopy.

Bronchial hyperresponsiveness, an exaggerated bronchoconstrictor response to a variety of nonspecific stimuli, is regarded as one of the most important feature in bronchial asthma. It can be demonstrated by bronchial provocation tests with pharmacological or physical stimuli. The measured level of responsiveness to these agents is considered to reflect the lability of the airways and the severity of the disease. Acute exposure to allergen causes an increase of airway responsiveness. The significant correlation between the allergen-induced increase in hyperresponsiveness and the severity of the late asthmatic reaction suggests the same underlying mechanisms that include an influx of inflammatory cells in the airways occurring during late phase of response to allergens. Marked inflammation with infiltration of eosinophils and disruption of airway epithelium has been also described on autopsies of patients who died of acute asthma but also on bronchial biopsies of subjects with mild asthma. Development and persistence of increased nonspecific bronchial responsiveness are possibly associated with these inflammatory changes.

Peak inspiratory flow rate (PIFR) in 64 asthmatic children aged 6-12 yrs was investigated. In-Check set (peak inspiratory flow meter) which can mimic the internal resistance of some dry powder inhalers, e.g. Discus, Aerolizer and Turbuhaler, was used. All children achieved the minimum and optimum PIFR independently to bronchial obstruction when using Discus resistance. Minimum and optimum values of PIFR adequate for Turbuhaler resistance attained 100% and 77% of analysed patients. The worst results were observed in regard to Aerolizer resistance when 97% of children achieved minimum and only 30% optimum PIFR for this inhaler. Checking actually PIFR may be useful before prescribing dry pressure inhaler for children, especially in cases with bronchial obstruction.

The aim of the study was to assess the role of bronchial hyperreactivity in the development of chronic airflow obstruction in the population of the Bogdanka (Lublin Basin) coal miners. The population examined consisted of 1456 coal miners working underground in the Bogdanka colliery. The methods of the study included plethysmographic measurements of total airway resistance (Raw), spirometric measurements of forced expiratory volume in one second (FEV1), and determination of forced expiratory flowa at 75, 50 and 25 per cent of vital capacity (FEF75, FEF50 and FEF25%VC). The measurements were repeated twice--before and after administration of 0.2% solution of methacholine (1 min inhalation). Pulmonary function tests were also performed 8 years after initial measurements. The increase in the Raw value above 0.6 kPa/l/s was observed in 5.5% of the population examined. In this group of subjects the skin prick tests with common allergens, measurements of total immunoglobulin E (IgE) levels and determination of blood eosinophils count were performed. Only 12% of all hyperreactives (Raw increase > 0.6 kPa/l/s) showed features of atopy--positive skin prick tests, raised IgE levels, and increase in blood eosinophils count. Using a survival analysis as a statistical tool we evaluated for how long the pulmonary function tests remained within normal ranges in two groups: hyperreactives and controls. All hyperreactives (atopic and non-atopic) showed significantly higher risk of lung function decrease below the normal values as compared with the control group.

Seasonal bronchial asthma causally connected with the exposure to pollen allergens is a chronic, eosinophilic mucosal inflammation of airway. This inflammation is the basis for the development of nonspecific bronchial hyperreactivity which is the most typical but mutable feature of asthma. Bronchial hyperreactivity often determines asthma intensity and the need of asthma treatment. The nonspecific bronchial hyperreactivity over two consecutive years was evaluated in 11 patients (2 women and 9 men) with seasonal bronchial asthma, sensitized to grass, remaining under the conditions of natural allergen exposure and out of this period. Bronchial reactivity to histamine was measured by Cockcroft's at all method. So called histamine threshold (PC20H) in mg/ml was assessed. The values of ventilatory parameters (FVC, FEV1) and asthma symptom scores were also measured. It was showed that nonspecific bronchial hyperreactivity significantly increased in subjects with seasonal bronchial asthma during natural pollen exposure. PC20H in two studies performed during this period decreased 3 and 6 times when compared to preseasonal values. The majority part of patients (80%) has the increased bronchial reactivity to histamine also beyond the of grass season when clinical symptoms of asthma and rhinitis are not observed. This postseasonal hyperreactivity could be the effect of the chronic inflammation process persisted from the period of natural allergen exposure. Continuous subthreshold, which means asymptomatic exposure to perennial allergens to which most of patients are sensitized, could be another reason of this hyperreastivity. The possibility of exposure to the activity of seasonal allergens the whole year in persons with asthma can not omitted, as the presence of pollens in the sample of the house dust in patient's flat is observed during the yield of pollen season. Nonspecific bronchial hyperreactivity in individual patients is fluctuated, which probably is not dependent on the intensity of natural allergen exposure.

The results of numerous studies of occupational bronchial asthma proved that bronchial spasticity and nonspecific bronchial hyperreactivity persists after cessation of occupational exposure. The aim of the study was to evaluate the condition of patients with bronchial asthma after cessation of occupational exposure. A group of 23 patients with bronchial asthma had been observed twice: 1-6 months after cessation of occupational exposure and then 36 or 48 months later. An analysis of the clinical progress, both during the diagnostic process and the control examination, was based on a questionnaire including questions on cough intensity, dysponca, mean daily use of aerosol beta-mimetics and daily oral and inhalatory doses of corticosteroids. The analysis covered the month during the year proceeding the examination in which patients found themselves in the best psychosomatic condition. During both periods considered by patients themselves as the best ones from the clinical point of view, respiratory function tests and allergological tests were performed. The majority of patients with occupational bronchial asthma had reported, 2-3 years after cessation of occupational exposure, subjective complaints which indicated the improvement of their clinical condition. In those patients, the decrease in the intensity of specific allergic reactions was not observed. In the majority of patients with occupational bronchial asthma nonspecific bronchial hyperreactivity has not diminished despite a two-year break in occupational exposure.

Bronchial hyperresponsiveness is the characteristic feature of bronchial asthma. Inhalation of allergen can cause dual asthmatic response--early and late reaction. Thirteen patients with mild and moderate asthma underwent bronchial allergen challenge. Non-specific bronchial reactivity was measured before, 90 minutes, on the 2nd, 7th, 14th day after provocation. Peak Expiratory Flow was measured every hour during 12 hours after challenge to search for late phase reaction. Increased bronchial reactivity was discovered as early as 90 minutes after challenge, it was still observed on the 2nd and 7th but not on the 14th day after allergen provocation. No relationship was found between appearance of late asthmatic reaction and increased bronchial reactivity.

The increase of neutrophil chemotactic activity (NCA) is related to degranulation of mast cells. In aspirin asthma following aspirin bronchial provocation NCA increases in 50% to 100% of the studied patients. The authors studied NCA after aspirin in patients with aspirin asthma during a state of induced tolerance. If NCA would not increase that would imply that in the state of induced tolerance degranulation of mast cells does not occur. Out of 22 subjects NCA was increased in 11. In these patients tolerance to aspirin was induced and NCA was once more studied. The authors found that in these patients after a dose of 600 mg of aspirin NCA was not increased. This could impose that in patients with aspirin asthma that developed tolerance to aspirin degranulation of mast cells does not occur.

The aim of the study was to assess the effect of peripheral bronchial base-line status on the result of the bronchial provocation test. The study was carried out on a group of 65 children with bronchial asthma. Bronchial reactivity was assessed utilizing the carbachol provocation test. Higher reactivity was seen in children with initially lower indices of peripheral bronchial flow (MEF50, MEF25) (PC20 = 3,789 +/- 0.014 mg/ml) in comparison with children with normal indices (PC20 = 74,608 +/- 0,038 mg/ml) (p < 0.001). A linear correlation was found between the results of bronchial provocation (PC) and initial standardized small airway flow values (MEF50 - r = 0.56, p < 0.001; MEF25 - r = 0.49, p < 0.001). The correlation between bronchial provocation and initial FEV1/VC was weaker (r = 0.39 p < 0.01). The authors conclude that demonstration of decreased flow in peripheral, small airways utilizing MEF values enable to predict a positive result of bronchial provocation tests.

In 46 patients with a clinical suspicion of bronchial hyperreactivity tests of non-and specific bronchial hyperreactivity with the sensitizing allergen were carried out. The results were compared with the results of other allergological tests (skin prick tests, IgE and allergen specific IgE serum levels). The results of this study demonstrate the importance of duration, character and concentration of allergen exposition on formation of specific bronchial hyperreactivity. Non-specific and specific bronchial hyperreactivity demonstrates tissue dependent variations, this being seen especially in seasonal allergens. The authors have also shown a relation between both types of hyperreactivity and the results of other allergological tests.

In 27 asthmatic patients a cell culture was made from mononuclear cell stimulated by PHA. Indomethacin was added to part of the cultures. After 2 days the culture was terminated and the supernatant was prepared for bronchoprovocation studies. Patients underwent baseline respiratory function studies, after which bronchial provocation was carried out with different concentrations of the supernatant. Bronchial provocation using supernatant from cells cultured with indomethacin produced significant respiratory function alterations in comparison with tests carried out with supernatant from cells stimulated with PHA.