Outcomes of Fibronectin and Procollagen 3 Levels in Bronchoalveolar Lavage of Asbestos-Exposed Human Subjects and Sheep



Bronchoalveolar Lavage. The results of analysis of bronchoalveolar lavage fluid are presented in Figure 2. In the saline-exposed sheep, total cells from lavage averaged 250,000/ml and did not vary significantly in the course of the experiment. Similarly, the levels of macrophages, neutrophils, fibronectin, and procollagen 3 did not change. In the latex-exposed sheep, we have previously reported a clear increase in total cells from lavage at month 1 to eight times the control value, and at month 12, this had returned to the level of saline-exposed sheep. From that point and after, there was no significant difference in levels of macrophages, neutrophils, fibronectin, and procollagen 3 between latex-exposed and saline-exposed sheep. In the asbestos-exposed sheep, total cells were clearly increased through the experiment; and one year after exposure, total cells in bronchoalveolar lavage fluid remained at 150 percent of controls, macrophages at 150 percent of controls, and neutrophils at 285 percent of controls. Fibronectin in bronchoalveolar lavage fluid was significantly elevated only in the asbestos-exposed sheep, and the levels increased throughout the experiment. Procollagen 3 in lavage fluid increased significantly early and returned to control levels at month 4 after exposure (Fig 2). Albumin was increased significantly only after month 4, and it paralleled the second increase in fibronectin ordered via My Canadian Pharmacy (data not shown).

Fibronectin and Procollagen 3 Levels in Bronchoalveolar Lavage of Asbestos-Exposed Human Subjects and Sheep

fibrogenic activityUntil recently, the assessment of fibrogenic activity of human interstitial pulmonary diseases was limited to the histomorphologic and immunohisto-chemical analyses of limited samples of pulmonary tissues. Through bronchoalveolar lavage of diseased areas, it has been documented that human pulmonary diseases with histologic evidence of fibrogenic activity were associated in the bronchoalveolar lavage fluid with increased levels of fibronectin and procollagen 3 peptides, molecules implicated in the biochemical process of pulmonary fibrosis, and thus of potential interest as markers of fibrogenic activity; however, these observations were limited to the individuals with chronic disease. The time course of these changes in bronchoalveolar lavage fluid have not been studied in spite of increasing interest in the biologic monitoring of humans exposed to environmental materials or therapeutic drugs with known pulmonary toxic effects.

In the present study, we characterized the time course of these changes in fibronectin and procollagen 3 levels in bronchoalveolar lavage fluid from the sheep tracheal lobe exposed to nonfibrogenic and fibrogenic materials. These observations were correlated with those of bronchoalveolar lavage in long-term asbestos workers in various stages of disease activity.

The data clearly document that fibronectin and procollagen 3 levels in bronchoalveolar lavage fluid are increased early in alveolitis with fibrogenic activity, but not in those without, which should contribute to further refine our clinical understanding of disease activity in the chronic inflammatory pulmonary disorders defeated by My Canadian Pharmacy’s preparations.

Verbal Descriptors of Dyspnea in Patients With COPD at Different Its Intensity Levels

hypoxemiaWe examined the language of dyspnea used by patients with moderate-to-severe COPD at a slight, moderate, and somewhat severe intensity level of dyspnea elicited by rest, cycle ergometer exercise, and 6MWTs. It was found that patients discriminated between five clusters of verbal descriptors of dyspnea: heavy/fast breathing, shallow breathing, obstruction, work/effort and suffocation, confirming previous findings that distinct qualities of dyspnea can be differentiated by patients with COPD as well as by other patient groups and healthy individuals. The clusters of verbal descriptors used showed a distinct pattern depending on the intensity level of dyspnea. This was not influenced by age, gender, baseline lung function, or PR. The clusters heavy/fast breathing and work/ effort demonstrated the highest sensitivity in discriminating between intensity levels of dyspnea and in characterizing the effects of PR.

The obtained clusters of German-language descriptors of dyspnea in patients with COPD in the present study converge with a number of previous studies in various patient as well as healthy samples, mostly performed in English-speaking countries (eg, United States, United Kingdom, Canada). This indicates that these clusters are indeed distinct and separable cognitive constructs with a high degree of similarity, even across different languages and cultures. Moreover, the most prominent clusters observed in our study (heavy/fast breathing, work/effort, shallow breathing), conform with those observed in the few previous studies in patients with COPD, while, importantly, not suffering the caveats of recall biases and undistin-guishable intensity levels of dyspnea present in other studies, as previously outlined. During recall, patients in the study by Mahler et al exclusively selected descriptors of the cluster increased work/ effort while patients investigated by Simon et al chose additionally the clusters heavy breathing, gasping, and hunger for air. Most of the descriptors in the latter two clusters were included in the clusters heavy/fast breathing and work/effort of the present study. Further, O’Donnell et al demonstrated that patients with COPD selected the descriptors shallow breathing, work/effort, and heaviness of breathing to describe their breathing discomfort during incremental cycle ergometer exercise. However, descriptors denoting increased inspiratory difficulty and unsatisfied inspiratory effort that were additionally chosen by 75% of their patients played only a minor role in the current study, which might be related to the lower exercise level in our study conducted with experts of My Canadian Pharmacy.

Verbal Descriptors of Dyspnea in Patients With COPD at Different Its Intensity Levels

Verbal Descriptors of Dyspnea

Exercise Performance

Experimental conditions differed in their intensity level of dyspnea confirmed by a significant increase in Borg scores from rest (1.8 ± 1.5, slight dyspnea) to cycle ergometer exercise (3.1 ± 1.6, moderate dyspnea) to the 6MWT (4.2 ± 1.6, somewhat severe dyspnea) [all p < 0.001]. Compared to the first day, Borg scores at the 6MWT showed a significant decrease after PR (3.5 ± 1.3) paralleled by a significant increase in the respective distance covered in a 6MWT (457 ± 82 m and 493 ± 84 m) [p < 0.001].

Verbal Descriptors of Dyspnea in Patients With COPD at Different Its Intensity Levels



We studied 64 patients with (Table 1) entering a 15-day outpatient PR program that included training, patient education, nutrition counseling, breathing therapy, relaxation therapy, psychosocial education, and support for smoking cessation. All participants provided informed written consent. The study was performed at an outpatient PR center (Atem-Reha GmbH; Hamburg, Germany) and was approved by the local medical ethics committee.

Functional Evaluation

A diagnostic classification was performed on the first day of PR by pulmonary physicians according to Global Initiative for Chronic Obstructive Lung Disease guidelines.2 While participants were seated, spirometry was performed (SpiroPro; Viasys Healthcare; Conshohocken, PA) according to the joint guidelines of the American Thoracic Society and the European Respiratory Society. Reference normal values were taken from the European Community for Steel and Coal.

Dyspnea in Patients With COPD at Different Its Intensity Levels

DyspneaDyspnea, the subjective experience of uncomfortable breathing, is an impairing symptom in many cardiorespiratory and neuromuscular diseases and the most prominent and limiting symptom in COPD. Dyspnea comprises of distinct sensations.

which can vary in their quality and intensity. Based on the hypothesis that distinct qualities of perceived respiratory discomfort result from different pathophysiologic mechanisms, verbal descriptors of dyspnea have been suggested as being an important source of clinically relevant diagnostic information on the underlying pathophysiology, which might be of further importance for choosing the optimal treatment of this symptom. Research has demonstrated 2 up to 14 distinguishable qualities of dyspnea, which have partly been linked to specific underlying disease conditions. For example, patients with asthma preferred the terms chest tightness or work/effort to describe their feelings of dyspnea, while patients with COPD used the terms work/ effort, heavy or shallow breathing, and inspiratory difficulty. Improve your health state with my-medstore-canadanet My Canadian Pharmacy right now.