Thorax 1999;54:289-295 ( April )

Vascularity in asthmatic airways: relation to inhaled steroid dose

Bernadette E Orsida, Xun Li, Bernadette Hickey, Frank Thien, John W Wilson, E Haydn Walters

Department of Respiratory Medicine, The Alfred Hospital and Monash Medical School, Melbourne, Victoria 3181, Australia

Correspondence to: Professor EH Walters.

Received 30 March 1998; Returned to authors 25 June 1998; Revised version received 1 October 1998; Accepted for publication 16 October 1998

BACKGROUNDThere is an increase in vascularity in the asthmatic airway. Although inhaled corticosteroids (ICS) are an effective anti-inflammatory treatment in asthma, there are few data on any effects on structural changes.
METHODSEndobronchial biopsy specimens from seven asthmatic subjects not receiving ICS and 15 receiving 200-1500 µg/day beclomethasone dipropionate (BDP) were immunohistochemically stained with an anti-collagen type IV antibody to outline the endothelial basement membrane of the vessels. These were compared with biopsy tissue from 11 non-asthmatic controls (four atopic and seven non-atopic).
RESULTSThere was a significant increase in the density of vessels (number of vessels/mm² of lamina propria) in the asthmatic subjects not on ICS compared with non-asthmatic controls (mean 485 (interquartile range (IQR) 390-597) versus 329 (IQR 248-376) vessels/mm², p<0.05; 95% CI for the difference 48 to 286). There was no significant difference between asthmatic subjects on ICS and those not on ICS or control subjects in the number of vessels/mm² (mean 421 (IQR 281-534)). However, patients who received 800 µg/day BDP tended to have a reduced number of vessels/mm² compared with patients not on ICS and those receiving 500 µg/day BDP (mean 366 (IQR 153-608) versus 494 (IQR 391-583), p = 0.08; 95% CI for the difference -31 to 288). Similarly, there was an increase in the percentage of lamina propria occupied by vessels in asthmatic patients not on ICS compared with controls (mean 15.6% (IQR 13.1-18.0) versus 10.1% (IQR 8.4-13.3), p<0.01; 95% CI for the difference 2.4 to 9.3) but a significant decrease in the percentage of lamina propria occupied by vessels was detected in asthmatic patients on ICS (mean 11.4% (IQR 9.1-14.9), p<0.01; 95% CI for the difference 0.7 to 7.7) compared with those not on ICS. The density of vessels correlated significantly with both airway hyperresponsiveness and percentage change in forced expiratory volume in one second (FEV₁) after bronchodilator (r = -0.38 for PD₂₀ methacholine and r = 0.49 for change in percentage FEV₁ after bronchodilator versus number of vessels/mm², p<0.05).
CONCLUSIONThese findings suggest that ICS, especially at higher doses, may reduce airway wall vascularity in asthmatic subjects but further longitudinal intervention studies are required to confirm this suggestion.

Keywords: airway vascularity; asthma; inhaled corticosteroids

---

© 1999 by Thorax
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• De Luisi, A., Mangialardi, G., Ria, R., Acuto, G., Ribatti, D., Vacca, A. (2009). Anti-angiogenic activity of carebastine: a plausible mechanism affecting airway remodelling. Eur Respir J 34: 958-966 [Abstract] [Full Text]  
• Paredi, P, Barnes, P J (2009). The airway vasculature: recent advances and clinical implications. Thorax 64: 444-450 [Abstract] [Full Text]  
• Simcock, D. E., Kanabar, V., Clarke, G. W., Mahn, K., Karner, C., O'Connor, B. J., Lee, T. H., Hirst, S. J. (2008). Induction of Angiogenesis by Airway Smooth Muscle From Patients with Asthma. Am. J. Respir. Crit. Care Med. 178: 460-468 [Abstract] [Full Text]  
• Zanini, A., Chetta, A., Olivieri, D. (2008). Review: Therapeutic perspectives in bronchial vascular remodeling in COPD. Ther Adv Respir Dis 2: 179-187 [Abstract]  
• Walters, E. H., Reid, D. W., Johns, D. P., Ward, C. (2007). Nonpharmacological and pharmacological interventions to prevent or reduce airway remodelling. Eur Respir J 30: 574-588 [Abstract] [Full Text]  
• Noble, D. D., McCafferty, J. B., Greening, A. P., Innes, J. A. (2007). Respiratory heat and moisture loss is associated with eosinophilic inflammation in asthma. Eur Respir J 29: 676-681 [Abstract] [Full Text]  
• Knox, A. J, Deacon, K., Clifford, R. (2007). Blanching the airways: steroid effects in asthma. Thorax 62: 283-285 [Full Text]  
• Feltis, B N, Wignarajah, D, Reid, D W, Ward, C, Harding, R, Walters, E H (2007). Effects of inhaled fluticasone on angiogenesis and vascular endothelial growth factor in asthma. Thorax 62: 314-319 [Abstract] [Full Text]  
• Tigani, B., Cannet, C., Karmouty-Quintana, H., Ble, F.-X., Zurbruegg, S., Schaeublin, E., Fozard, J. R., Beckmann, N. (2007). Lung inflammation and vascular remodeling after repeated allergen challenge detected noninvasively by MRI. Am. J. Physiol. Lung Cell. Mol. Physiol. 292: L644-L653 [Abstract] [Full Text]  
• Horvath, G., Wanner, A. (2006). Inhaled corticosteroids: effects on the airway vasculature in bronchial asthma. Eur Respir J 27: 172-187 [Abstract] [Full Text]  
• Hashimoto, M., Tanaka, H., Abe, S. (2005). Quantitative Analysis of Bronchial Wall Vascularity in the Medium and Small Airways of Patients With Asthma and COPD. Chest 127: 965-972 [Abstract] [Full Text]  
• Homer, R. J., Elias, J. A. (2005). Airway Remodeling in Asthma: Therapeutic Implications of Mechanisms. Physiology 20: 28-35 [Abstract] [Full Text]  
• Knox, A J, Stocks, J, Sutcliffe, A (2005). Angiogenesis and vascular endothelial growth factor in COPD. Thorax 60: 88-89 [Full Text]  
• Jeffery, P. K. (2004). Remodeling and Inflammation of Bronchi in Asthma and Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 1: 176-183 [Abstract] [Full Text]  
• Chanez, P., Bourdin, A., Vachier, I., Godard, P., Bousquet, J., Vignola, A. M. (2004). Effects of Inhaled Corticosteroids on Pathology in Asthma and Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 1: 184-190 [Abstract] [Full Text]  
• Mendes, E. S., Campos, M. A., Hurtado, A., Wanner, A. (2004). Effect of Montelukast and Fluticasone Propionate on Airway Mucosal Blood Flow in Asthma. Am. J. Respir. Crit. Care Med. 169: 1131-1134 [Abstract] [Full Text]  
• Riccioni, G., Di Ilio, C., D'Orazio, N. (2004). Pharmacological Treatment of Airway Remodeling: Inhaled Corticosteroids or Antileukotrienes?. Annals of Clinical & Laboratory Science 34: 138-142 [Abstract] [Full Text]  
• Tanaka, H., Yamada, G., Saikai, T., Hashimoto, M., Tanaka, S., Suzuki, K., Fujii, M., Takahashi, H., Abe, S. (2003). Increased Airway Vascularity in Newly Diagnosed Asthma Using a High-magnification Bronchovideoscope. Am. J. Respir. Crit. Care Med. 168: 1495-1499 [Abstract] [Full Text]  
• McParland, B. E., Macklem, P. T., Pare, P. D. (2003). Airway wall remodeling: friend or foe?. J. Appl. Physiol. 95: 426-434 [Abstract] [Full Text]  
• Hoshino, M., Aoike, N., Takahashi, M., Nakamura, Y., Nakagawa, T. (2003). Increased immunoreactivity of stromal cell-derived factor-1 and angiogenesis in asthma. Eur Respir J 21: 804-809 [Abstract] [Full Text]  
• Chetta, A., Zanini, A., Foresi, A., Del Donno, M., Castagnaro, A., D'Ippolito, R., Baraldo, S., Testi, R., Saetta, M., Olivieri, D. (2003). Vascular Component of Airway Remodeling in Asthma Is Reduced by High Dose of Fluticasone. Am. J. Respir. Crit. Care Med. 167: 751-757 [Abstract] [Full Text]  
• Acuna, A.A., Gabrijelcic, J., Uribe, E.M., Rabinovich, R., Roca, J., Barbera, J.A., Chung, K.F., Rodriguez-Roisin, R. (2002). Fluticasone propionate attenuates platelet-activating factor-induced gas exchange defects in mild asthma. Eur Respir J 19: 872-878 [Abstract] [Full Text]  
• ORSIDA, B. E., KROZOWSKI, Z. S., WALTERS, E. H. (2002). Clinical Relevance of Airway 11beta -Hydroxysteroid Dehydrogenase Type II Enzyme in Asthma. Am. J. Respir. Crit. Care Med. 165: 1010-1014 [Abstract] [Full Text]  
• Ward, C, Pais, M, Bish, R, Reid, D, Feltis, B, Johns, D, Walters, E H (2002). Airway inflammation, basement membrane thickening and bronchial hyperresponsiveness in asthma. Thorax 57: 309-316 [Abstract] [Full Text]  
• WILSON, J W, LI, X (2001). Vessels: new targets for asthma treatment. Thorax 56: 899-900 [Full Text]  
• Salvato, G (2001). Quantitative and morphological analysis of the vascular bed in bronchial biopsy specimens from asthmatic and non-asthmatic subjects. Thorax 56: 902-906 [Abstract] [Full Text]  
• JEFFERY, P. K. (2001). Remodeling in Asthma and Chronic Obstructive Lung Disease. Am. J. Respir. Crit. Care Med. 164: S28-38 [Abstract] [Full Text]  
• MCDONALD, D. M. (2001). Angiogenesis and Remodeling of Airway Vasculature in Chronic Inflammation. Am. J. Respir. Crit. Care Med. 164: S39-45 [Abstract] [Full Text]  
• KNOX, A. J., CORBETT, L., STOCKS, J., HOLLAND, E., ZHU, Y. M., PANG, L. (2001). Human airway smooth muscle cells secrete vascular endothelial growth factor: up-regulation by bradykinin via a protein kinase C and prostanoid-dependent mechanism. FASEB J. 15: 2480-2488 [Abstract] [Full Text]  
• ORSIDA, B. E., WARD, C., LI, X., BISH, R., WILSON, J. W., THIEN, F., WALTERS, E. H. (2001). Effect of a Long-acting {beta}2-Agonist over Three Months on Airway Wall Vascular Remodeling in Asthma. Am. J. Respir. Crit. Care Med. 164: 117-121 [Abstract] [Full Text]  
• De Gouw, H. W. F. M., Marshall-Partridge, S. J., Van der Veen, H., Van den Aardweg, J. G., Hiemstra, P. S., Sterk, P. J. (2001). Role of nitric oxide in the airway response to exercise in healthy and asthmatic subjects. J. Appl. Physiol. 90: 586-592 [Abstract] [Full Text]  
• Blyth, D. I., Wharton, T. F., Pedrick, M. S., Savage, T. J., Sanjar, S. (2000). Airway Subepithelial Fibrosis in a Murine Model of Atopic Asthma . Suppression by Dexamethasone or Anti-Interleukin-5 Antibody. Am. J. Respir. Cell Mol. Bio. 23: 241-246 [Abstract] [Full Text]  
• HOGG, J C (1999). Vascularity in asthmatic airways: relation to inhaled steroid dose. Thorax 54: 283-283 [Full Text]