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Clinical Investigations: SURGERY |

Preoperative Steroid Therapy Inhibits Cytokine Production in the Lung Parenchyma in Asthmatic Patients*

Kazuko Mitsuta, MD; Terufumi Shimoda, MD; Chizu Fukushima, MD; Yasushi Obase, MD; Hiroyoshi Ayabe, MD; Hiroto Matsuse, MD; Shigeru Kohno, MD, FCCP
Author and Funding Information

*From The Second Department of Internal Medicine (Drs. Mitsuta, Shimoda, Fukushima, Obase, Matsuse, and Kohno), and The First Department of Surgery (Dr. Ayabe), Nagasaki University School of Medicine, Nagasaki, Japan.

Correspondence to: Terufumi Shimoda, MD, The Second Department of Internal Medicine, Nagasaki University School of Medicine, 1–7-1 Sakamoto, Nagasaki 852-8501, Japan; e-mail:inmed2nd@net.nagasaki-u.ac.jp



Chest. 2001;120(4):1175-1183. doi:10.1378/chest.120.4.1175
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Objectives: During or after surgery, asthma attacks due to airway hyperresponsiveness (AHR) are likely to occur in patients with bronchial asthma. Preoperative administration of corticosteroid for prevention of perioperative asthma attacks is useful. We examined the mechanism of prevention of perioperative asthma attacks by the preoperative administration of corticosteroid in vitro.

Design: Five patients with asthma were treated with 20 mg of prednisolone orally for 2 preoperative days and 80 mg of methylprednisolone IV immediately before and after surgery. In another five patients without asthma, no steroids were administered. A noncarcinomatous part of the resected tissue from each patient with lung cancer was passively sensitized with the serum of an atopic patient. In the patients without asthma, the tissue was treated with or without dexamethasone, and then mite antigen was added.

Measurements: The culture supernatant and lung tissue were recovered, and the supernatant was assayed for histamine, leukotriene E4 (LTE4), interleukin (IL)-5, and tumor necrosis factor (TNF)-α. Degranulation of mast cells was measured by tryptase staining of the lung tissue, and the expression of messenger RNA (mRNA) of IL-5 and TNF-α was determined by the reverse transcriptase-polymerase chain reaction method.

Results: While preoperative administration of corticosteroid did not suppress the release of histamine and LTE4 from the lungs of asthmatic patients, it completely suppressed IL-5 and TNF-α production at the mRNA level. The same results were obtained in lung tissues of nonasthmatic patients treated in vitro with dexamethasone.

Conclusions: Our results suggest that corticosteroid treatment reduces AHR and prevents perioperative attacks of asthma primarily by suppressing the production of inflammatory cytokines.

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