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Impact of airway challenges on cardiovascular risk in asthma – a randomized controlled trial

BACKGROUND: People experiencing asthma exacerbations are at increased risk of cardiovascular events. To better understand the relationship between asthma exacerbations and cardiovascular risk, this randomized case-control, cross-over controlled trial assessed the immediate systemic inflammatory and...

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Autores principales: Moore, Linn E., Brotto, Andrew R., Fuhr, Desi P., Rosychuk, Rhonda J., Wong, Eric, Bhutani, Mohit, Stickland, Michael K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10351735/
https://www.ncbi.nlm.nih.gov/pubmed/37459335
http://dx.doi.org/10.1371/journal.pone.0288623
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author Moore, Linn E.
Brotto, Andrew R.
Fuhr, Desi P.
Rosychuk, Rhonda J.
Wong, Eric
Bhutani, Mohit
Stickland, Michael K.
author_facet Moore, Linn E.
Brotto, Andrew R.
Fuhr, Desi P.
Rosychuk, Rhonda J.
Wong, Eric
Bhutani, Mohit
Stickland, Michael K.
author_sort Moore, Linn E.
collection PubMed
description BACKGROUND: People experiencing asthma exacerbations are at increased risk of cardiovascular events. To better understand the relationship between asthma exacerbations and cardiovascular risk, this randomized case-control, cross-over controlled trial assessed the immediate systemic inflammatory and vascular responses to acutely induced pulmonary inflammation and bronchoconstriction in people with asthma and controls. METHODS: Twenty-six people with asthma and 25 controls underwent three airway challenges (placebo, mannitol, and methacholine) in random order. Markers of cardiovascular risk, including serum C-reactive protein, interleukin-6, and tumor necrosis factor, endothelial function (flow-mediated dilation), microvascular function (blood-flow following reactive hyperemia), and arterial stiffness (pulse wave velocity) were evaluated at baseline and within one hour following each challenge. The systemic responses in a) asthma/control and b) positive airway challenges were analyzed. (ClinicalTrials.gov reg# NCT02630511) RESULTS: Both the mannitol and methacholine challenges resulted in clinically significant reductions in forced expiratory volume in 1 second (FEV(1)) in asthma (-7.6% and -17.9%, respectively). Following positive challenges, reduction in FEV(1) was -27.6% for methacholine and -14.2% for mannitol. No meaningful differences in predictors of cardiovascular risk were observed between airway challenges regardless of bronchoconstrictor response. CONCLUSION: Neither acutely induced bronchoconstriction nor pulmonary inflammation and bronchoconstriction resulted in meaningful changes in systemic inflammatory or vascular function. These findings question whether the increased cardiovascular risk associated with asthma exacerbations is secondary to acute bronchoconstriction or inflammation, and suggest that other factors need to be further evaluated such as the cardiovascular impacts of short-acting inhaled beta-agonists.
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spelling pubmed-103517352023-07-18 Impact of airway challenges on cardiovascular risk in asthma – a randomized controlled trial Moore, Linn E. Brotto, Andrew R. Fuhr, Desi P. Rosychuk, Rhonda J. Wong, Eric Bhutani, Mohit Stickland, Michael K. PLoS One Research Article BACKGROUND: People experiencing asthma exacerbations are at increased risk of cardiovascular events. To better understand the relationship between asthma exacerbations and cardiovascular risk, this randomized case-control, cross-over controlled trial assessed the immediate systemic inflammatory and vascular responses to acutely induced pulmonary inflammation and bronchoconstriction in people with asthma and controls. METHODS: Twenty-six people with asthma and 25 controls underwent three airway challenges (placebo, mannitol, and methacholine) in random order. Markers of cardiovascular risk, including serum C-reactive protein, interleukin-6, and tumor necrosis factor, endothelial function (flow-mediated dilation), microvascular function (blood-flow following reactive hyperemia), and arterial stiffness (pulse wave velocity) were evaluated at baseline and within one hour following each challenge. The systemic responses in a) asthma/control and b) positive airway challenges were analyzed. (ClinicalTrials.gov reg# NCT02630511) RESULTS: Both the mannitol and methacholine challenges resulted in clinically significant reductions in forced expiratory volume in 1 second (FEV(1)) in asthma (-7.6% and -17.9%, respectively). Following positive challenges, reduction in FEV(1) was -27.6% for methacholine and -14.2% for mannitol. No meaningful differences in predictors of cardiovascular risk were observed between airway challenges regardless of bronchoconstrictor response. CONCLUSION: Neither acutely induced bronchoconstriction nor pulmonary inflammation and bronchoconstriction resulted in meaningful changes in systemic inflammatory or vascular function. These findings question whether the increased cardiovascular risk associated with asthma exacerbations is secondary to acute bronchoconstriction or inflammation, and suggest that other factors need to be further evaluated such as the cardiovascular impacts of short-acting inhaled beta-agonists. Public Library of Science 2023-07-17 /pmc/articles/PMC10351735/ /pubmed/37459335 http://dx.doi.org/10.1371/journal.pone.0288623 Text en © 2023 Moore et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Moore, Linn E.
Brotto, Andrew R.
Fuhr, Desi P.
Rosychuk, Rhonda J.
Wong, Eric
Bhutani, Mohit
Stickland, Michael K.
Impact of airway challenges on cardiovascular risk in asthma – a randomized controlled trial
title Impact of airway challenges on cardiovascular risk in asthma – a randomized controlled trial
title_full Impact of airway challenges on cardiovascular risk in asthma – a randomized controlled trial
title_fullStr Impact of airway challenges on cardiovascular risk in asthma – a randomized controlled trial
title_full_unstemmed Impact of airway challenges on cardiovascular risk in asthma – a randomized controlled trial
title_short Impact of airway challenges on cardiovascular risk in asthma – a randomized controlled trial
title_sort impact of airway challenges on cardiovascular risk in asthma – a randomized controlled trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10351735/
https://www.ncbi.nlm.nih.gov/pubmed/37459335
http://dx.doi.org/10.1371/journal.pone.0288623
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