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Clinical Investigations: ASTHMA |

The Relationships Among Hydrogen Peroxide in Expired Breath Condensate, Airway Inflammation, and Asthma Severity*

Stelios Loukides, MD; Demosthenes Bouros, MD, FCCP; Georgios Papatheodorou, PhD; Panos Panagou, MD; Nikolaos M. Siafakas, MD, PhD, FCCP
Author and Funding Information

*From the Department of Pneumonology and Clinical Research Unit (Drs. Loukides, Papatheodorou, and Panagou), Athens Army General Hospital, Athens, Greece; and the Department of Pneumonology (Drs. Bouros and Siafakas), Medical School, University of Crete, Heraklion, Greece.

Correspondence to: Stelios Loukides, MD, Smolika 2, 16673, Athens, Greece; e-mail ssat@hol.gr



Chest. 2002;121(2):338-346. doi:10.1378/chest.121.2.338
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Study objective: To investigate which cells are the main source of hydrogen peroxide (H2O2) production in stable patients with asthma and the associations among H2O2 levels, airway inflammation, and disease severity.

Setting: Inpatient respiratory unit and outpatient clinic in tertiary-care hospital.

Patients: Fifty stable asthmatic patients with disease severity ranging from mild to moderate.

Methods: H2O2 was measured in expired breath condensate and was correlated with variables expressing both asthma severity (ie, FEV1 percent predicted, peak expiratory flow rate [PEFR] variability, symptom score, and histamine airways responsiveness) and airway inflammation (ie, differential cell counts from induced sputum and levels of eosinophil cationic protein [ECP]).

Results: The mean (95% confidence interval [CI]) concentration of H2O2 was significantly elevated in patients with asthma compared to that in control subjects (mean, 0.67 μM [95% CI, 0.56 to 0.77 μM] vs 0.2 μM [95% CI, 0.16 to 0.24 μM]; p < 0.0001). The difference was primarily due to the elevation of H2O2 in patients with moderate asthma whose expired breath H2O2 level of 0.95 μM (95% CI, 0.76 to 1.12 μM) was significantly higher from that of patients with mild-persistent and mild-intermittent asthma (mean, 0.59 μM [95% CI, 0.47 to 0.7 μM] and 0.27 [95% CI, 0.23 to 0.32 μM], respectively; p < 0.0001). H2O2 concentration was positively related to sputum eosinophilia as well as to ECP concentration. A similar correlation was found between H2O2 and neutrophils in patients with moderate asthma. A positive correlation was observed between H2O2 level, symptom score, and PEFR variability. H2O2 level was negatively related to FEV1 percent predicted. Further analysis showed that only patients with moderate asthma who were not receiving inhaled steroids were found to have a strong relationship with the variables tested.

Conclusions: Eosinophils are the predominate cells that generate H2O2 in all forms of the disease, while neutrophils might be responsible for the highest levels that are observed in the more severe forms of the disease. The role of H2O2 concentration in predicting the severity of the disease as well as in the inflammatory process is limited and depends on the use of inhaled steroid therapy and the classification of the severity of the disease.

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