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Published ahead of print on June 9, 2005, doi:10.1164/rccm.200412-1667OC
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American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 679-686, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200412-1667OC

Inflammatory Basis of Exercise-induced Bronchoconstriction

Teal S. Hallstrand, Mark W. Moody, Mark M. Wurfel, Lawrence B. Schwartz, William R. Henderson, Jr. and Moira L. Aitken

Department of Medicine, Divisions of Pulmonary and Critical Care and Allergy and Infectious Diseases, University of Washington, Seattle, Washington; and Department of Medicine, Division of Rheumatology, Allergy and Immunology, Virginia Commonwealth University, Richmond, Virginia

Correspondence and requests for reprints should be addressed to Teal S. Hallstrand, M.D., M.P.H., Assistant Professor of Medicine, University of Washington Division of Pulmonary and Critical Care Box 356522, 1959 NE Pacific Street, Seattle, WA 98195-6522. E-mail: tealh{at}u.washington.edu

Rationale: Exercise-induced bronchoconstriction (EIB) is a highly prevalent condition with unclear pathogenesis. Two competing theories of the pathogenesis of EIB differ regarding the inflammatory basis of this condition. Objectives: Our goals were to establish whether epithelial cell and mast cell activation with release of inflammatory mediators occurs during EIB and how histamine and cysteinyl leukotriene antagonists alter the airway events occurring during EIB. Methods: Induced sputum was used to measure mast cell mediators and eicosanoids at baseline and 30 minutes after exercise challenge in 25 individuals with asthma with EIB. In a randomized, double-blind crossover study, the cysteinyl leukotriene antagonist montelukast and antihistamine loratadine or two matched placebos were administered for two doses before exercise challenge. Main Results: The percentage of columnar epithelial cells in induced sputum at baseline was associated with the severity of EIB. After exercise challenge, histamine, tryptase, and cysteinyl leukotrienes significantly increased and prostaglandin E2 and thromboxane B2 significantly decreased in the airways, and there was an increase in columnar epithelial cells in the airways. The concentration of columnar epithelial cells was associated with the levels of histamine and cysteinyl leukotrienes in the airways. Treatment with montelukast and loratadine inhibited the release of cysteinyl leukotrienes and histamine into the airways, but did not inhibit the release of columnar epithelial cells into the airways. Conclusions: These data indicate that epithelial cells, mast cell mediators, and eicosanoids are released into the airways during EIB, supporting an inflammatory basis for EIB.

Key Words: asthma • eicosanoid • epithelial cell • exercise-induced bronchoconstriction • mast cell




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