title: Provocation with adenosine 5'-monophosphate, but not methacholine, induces sputum eosinophilia.
abstract: BACKGROUND
  Bronchial hyper-responsiveness is usually measured with direct stimuli such as methacholine (MCh) or histamine. Adenosine 5'-monophosphate (AMP), which acts indirectly via the secondary release of mediators, is another stimulus to measure bronchial hyper-responsiveness.
  
  
  OBJECTIVE
  To investigate whether provocation with inhaled AMP itself initiates an inflammatory response resulting in an influx of eosinophils into the airway lumen.
  
  
  METHODS
  We have included 21 non-smoking atopic asthmatic subjects (mean FEV1 101% predicted, mean age 34 years). Each subject performed three sputum inductions on different days, at least seven days apart: one without previous provocation, one hour after PC20 methacholine, and one hour after PC20 AMP.
  
  
  RESULTS
  After provocation with AMP, but not methacholine, the percentage of sputum eosinophils increased significantly (from 1.9+/-0.5% to 4.5+/-1% (P<0.01) and 1.9+/-0.5% (P=0.89)). No changes in the percentages of neutrophils, lymphocytes, macrophages, or bronchial epithelial cells were found.
  
  
  CONCLUSIONS
  A provocation test with AMP leads to an increased percentage of sputum eosinophils. This observation cannot be explained by a non-specific response of the airways to a vigorous bronchoconstriction, since methacholine had no effect on inflammatory cells.
authors.affiliation: Departments of Pulmonology, University Hospital Groningen, Groningen, The Netherlands Allergology, University Hospital Groningen, Groningen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van den Berge
authors.forename: H A M
authors.initials: HA
authors.lastname: Kerstjens
authors.forename: D M
authors.initials: DM
authors.lastname: de Reus
authors.forename: G H
authors.initials: GH
authors.lastname: Koëter
authors.forename: H F
authors.initials: HF
authors.lastname: Kauffman
authors.forename: D S
authors.initials: DS
authors.lastname: Postma
mesh_terms: D000249:Adenosine Monophosphate; D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000276:immunology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis*; D001985:Bronchial Provocation Tests; D016085:Bronchoconstrictor Agents; D018592:Cross-Over Studies; D004802:Eosinophilia / Q000139:chemically induced*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D013183:Sputum / Q000276:immunology*; D018709:Statistics, Nonparametric
chemical_list: D016085:Bronchoconstrictor Agents; D005938:Glucocorticoids; D016210:Methacholine Chloride; D000249:Adenosine Monophosphate