Language：Japanese   Publisher：(一社)日本呼吸器学会  

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Autoimmune pulmonary alveolar proteinosis (aPAP) is caused by granulocyte/macrophage-colony stimulating factor (GM-CSF) autoantibodies in the lung. Previously, we reported that GM-CSF inhalation therapy improved alveolar-arterial oxygen difference and serum biomarkers of disease severity in these patients. It is plausible that inhaled GM-CSF improves the dysfunction of alveolar macrophages and promotes the clearance of the surfactant. However, effect of the therapy on components in bronchoalveolar lavage fluid (BALF) remains unclear. OBJECTIVES: To figure out changes in surfactant clearance during GM-CSF inhalation therapy. METHODS: We performed retrospective analyses of BALF obtained under a standardized protocol from the same bronchus in each of 19 aPAP patients before and after GM-CSF inhalation therapy (ISRCTN18931678, JMA-IIA00013; total dose 10.5-21 mg, duration 12-24 weeks). For evaluation, the participants were divided into two groups, high responders with improvement in alveolar-arterial oxygen difference ≥13 mmHg (n = 10) and low responders with that < 13 mmHg (n = 9). RESULTS: Counts of both total cells and alveolar macrophages in BALF did not increase during the therapy. However, total protein and surfactant protein-A (SP-A) were significantly decreased in high responders, but not in low responders, suggesting that clearance of surfactant materials is correlated with the efficacy of the therapy. Among 94 biomarkers screened in bronchoalveolar lavage fluid, we found that the concentration of interleukin-17 and cancer antigen-125 were significantly increased after GM-CSF inhalation treatment. CONCLUSIONS: GM-CSF inhalation decreased the concentration of total protein and SP-A in BALF, and increase interleukin-17 and cancer antigen-125 in improved lung of autoimmune pulmonary alveolar proteinosis.

DOI： 10.1016/j.rmed.2011.10.019

PubMed

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：(一社)日本呼吸器学会  

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Language：Japanese   Publisher：(株)医薬情報研究所  

喘息治療薬についての喘息患者の関心・要望について、新潟喘息治療研究会2010年アンケート調査より検討した。参加施設は新潟県内の医療機関で、200床以上の24病院、200床未満の16病院と56の診療所であった。アンケート回収率は58.0%(4662例中2706例)であった。喘息治療薬の効果、易使用性、コスト・安全性の中では、患者は喘息治療薬の効果を最も重要視した。更に、喘息治療薬の効果に関する項目では、効果発現の早さ、効果の持続の2つともに重要視しているが、喘息症状の完全寛解については理解が乏しかった。易使用性では使用回数に関した要望が高いものの、内服・吸入といった使用経路についての関心が低かった。コスト・安全性では副作用についての要望が高かったものの、予想されたコスト面での要望は低かった。

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