VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up.
Favorable changes achieved by a 1-y lifestyle intervention aimed at weight reduction with a healthy diet and physical activity were sustained in overweight patients with mild OSA after the termination of supervised lifestyle counseling. This trial was registered at clinicaltrials.gov as NCT00486746.
Reproducibility of measurements of exhaled NO, and cell count and cytokine concentrations in induced sputum. M. Purokivi, J. Randell, M-R. Hirvonen, H. Tukiainen. #ERS Journals Ltd 2000. ABSTRACT: Sputum induction is a noninvasive, well-tolerated method for studying airway inflammation. When induction with hypertonic saline is repeated at short time-intervals (<24 h), the cell profile of sputum has not been reproducible. To determine the proper interval between sampling cell profiles and cytokine contents of sputum samples that had been induced 48 h apart, were compared. In addition, the inducible nitric oxide synthase (iNOS) expression of sputum cells was compared to the levels of exhaled nitric oxide (NO).Sputum induction and measurement of exhaled NO was performed in 31 healthy nonatopic volunteers. Cell differentials were counted. Concentrations of interleukin (IL)-4, IL-6, tumour necrosis factor (TNF)a, eosinophil cationic protein (ECP) were measured in sputum supernatant, and iNOS was determined.Reproducibility of cell counts was high (r=0.836 total cells, r=0.762 neutrophils, r=0.966 eosinophils, r=0.742 macrophages). IL-4 (r=0.398), IL-6 (r=0.566), TNFa (r=0.658) and ECP (r=0.501) were also less reproducible in healthy volunteers. Consistent with the low levels of NO in the exhaled air (18.52.6 ppb and 19.32.8 parts per billion (ppb) on the two study days, r=0.976, p=0.0000), expression of iNOS was not detected.In conclusion, in healthy subjects, induced sputum cell counts are reproducible. Even though the success rate in nonatopic populations is relatively low, sputum induction appears to be a valid method for detecting inflammatory changes within the airways, when being performed 48 h apart. Eur Respir J 2000; 16: 242±246. There has been wide interest in developing noninvasive methods to determine lower airway inflammation in different respiratory disorders. Measurement of inflammatory mediators in induced sputum provides a direct method to investigate airway inflammation in different respiratory conditions including asthma. Sputum induction by nebulized hypertonic saline has been found to be safe and well tolerated [1±3]. However, the saline inhalation affects the production of inflammatory markers, since neutrophilia and loss of macrophages has been reported in samplings repeated within 24 h [4]. This suggests that a longer time interval is required between two samplings of induced sputum, when it is used for the evaluation of allergen challenge. Thus, the time interval in which possible effects of saline inhalation disappear, needs to be defined.Defining the cytokine profile in induced sputum could widen the view to inflammatory state of lower respiratory tract. Previously the attempts to measure cytokines by using bronchoalveolar lavage samples have failed because of dilution caused by the large volume of saline needed for sampling [5]. In sputum induction this problem is avoided, at least when low volume of nebulized saline is used [6].Since not all patients are able to produce sputum, despite ind...
Nitric oxide (NO) is an important biological mediator with a variety of cellular and tissue functions. Fractional exhaled (FE(NO)) and nasal NO (FN(NO)) are known to be altered in several respiratory tract disease and disorders. However, there are rather few studies into the reproducibility of FE(NO) or FN(NO) measurements in healthy subjects. The aim of this study was to examine both short- and long-term variations of FE(NO) and FN(NO). In addition to intraday, day-to-day and week-to-week variations, the seasonal variation was assessed. The data revealed that FE(NO) and FN(NO) levels were lower in the mornings compared to the afternoon values. There were clinically significant correlations in day-to-day (morning values 121.4+/-37.5 vs. 119.8+/-29.6, r=0.868, P=0.000), week-to-week (morning values 121.4+/-37.5 vs. 128.0+/-32.1, r=0.637, P=0.000) and seasonal (winter 133.5+/-29.7, summer 138.1+/-47.6, autumn 121.4+/-37.5, r=0.624, P=0.000) values of FN(NO). Day-to-day (morning values 14.6+/-6.7 vs. 14.2+/-5.1, r=0.784, P=0.000) week-to-week (morning values 14.6+/-6.7 vs. 15.4+/-7.3, r=0.738, P=0.000) and seasonal (autumn 14.6+/-7.2, winter 16.6+/-6.4, summer 17.4+/-8.0, r=0.709, P=0.000) levels of FE(NO) were also highly reproducible. Serial FE(NO) and FN(NO) measurements can be used in the monitoring of respiratory tract inflammation. Due to the diurnal variation of FE(NO) and FN(NO,) in long-term follow-up the measurements should be performed at the same time of day.
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