الفهرس 
Bronchial AsthmaOnly 14 pages are availabe for public view
 |  | from | 225 |  |  |
| | | from | 225 | | |
Abstract
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment. Asthma is a common disorder worldwide. The World Health Organization recently stated approximately 300 million people have asthma. Asthma is not distributed equally throughout the world; industrialized, Western countries have a higher incidence. In asthma, the importance of airway inflammation has been well established. Beside the airway inflammation, systemic inflammation may exist in asthma.
C-reactive protein (CRP) was identified by Tilet and Francis (1930) in the plasma of patients with pneumonia and was named for its ability to bind and precipitate the C-polysaccharide of pneumococcus. C-reactive protein is one of the acute phase proteins, the serum or plasma levels of which rise during general, nonspecific response to a wide variety of diseases. The CRP levels rise in serum or plasma within 24 to 48 hours following acute tissue damage, reach a peak during the acute stage and decrease with the resolution of inflammation or trauma. Current testing methods including latex agglutination, nephelometry, and radial immunodiffusion (RID) have the general disadvantages of low sensitivity, whereas enzyme-linked immunosorbent assays (ELISA) provide the highest sensitivity and specificity.
The aim of this work was to assess the value of serum high-sensitivity C-reactive protein as an inflammatory marker in bronchial asthma patients.
The present study included thirty subjects of which twenty patients with bronchial asthma (Group A) were divided into ten patients who received inhaled corticosteroids in the form of beclomethasone dipropionate for the six week period of the study and the other ten patients received systemic steroids in the form of methylprednisolone for the first two weeks of the study. The remaining ten normal healthy subjects represented a control group (Group B). Patients in group A either attended the out-patient chest clinic or were admitted at the chest department at Ain Shams University Hospitals in the time period between July 2008 and January 2009.
All subjects were prone to the following on first clinical presentation:
1. Careful medical history taking.
2. Thorough physical examination.
3. Routine laboratory investigations (CBC, liver profile, kidney profile, plasma glucose level).
4. Plain chest radiography postero-anterior view.
5. Measurement of peak expiratory flow (PEF) by peak flow meter.
6. Measurement of serum high-sensitivity C-reactive protein levels using an ELISA hs-CRP assay.
The following was repeated two weeks and six weeks after the start of the study for all subjects:
1. Measurement of peak expiratory flow (PEF) by peak flow meter.
2. Measurement of serum high-sensitivity C-reactive protein levels using an ELISA hs-CRP assay.
The results of the present study showed that there were abnormal PEF measurements and elevated hs-CRP levels in patients with bronchial asthma when compared to the healthy controls. The use of either inhaled or systemic corticosteroids as an anti-inflammatory drug helped reduce the elevated levels of serum hs-CRP in the patients along the course of the study. It was obvious that the PEF measurement improved significantly at the end of the study in parallel to the improvement of the hs-CRP levels.
In conclusion, it was found that, in steroid-naïve patients, an abnormal peak expiratory flow was associated with elevated serum high-sensitivity C-reactive protein level. This suggests that serum high-sensitivity C-reactive protein could be an alternative marker, indirectly reflecting the degree of airway inflammation in patients with bronchial asthma. After these patients received either a six week treatment period with inhaled corticosteroids or a two week treatment period with systemic steroids, significant improvement in their peak expiratory flow was in concordance to that of serum levels of high-sensitivity C-reactive protein. Therefore, this suggests that high-sensitivity C-reactive protein may also be used as a prognostic marker of treatment response
.