title: Chlorine in breath condensate--a measure of airway affection in pollinosis?
abstract: BACKGROUND
  Infiltration of inflammatory cells in bronchial mucosa and glandular hypersecretion are hallmarks of asthma. It has been postulated that exhaled breath condensate (EBC) mirrors events in epithelial lining fluid of airways, such as presence of local inflammation as well as glandular hypersecretion. It is also well known that eosinophil cationic protein (ECP) and cysteinyl-leukotrienes (cys-LT) are released by circulating inflammatory cells when triggered by antigen stimulation in asthma patients.
  
  
  OBJECTIVE
  The aim of this study was to evaluate whether chlorine and/or cys-LT in EBC would reflect changes of exposure of airborne pollen in patients with asthma.
  
  
  METHODS
  EBC and serum were collected from 23 patients with allergic asthma during a pollen season and repeated 5 months later during a period with no aeroallergens. Chlorine was measured by means of a sensitive coulometric technique and cys-LT by an EIA technique. Serum ECP was measured and lung function tests were performed and symptoms noted during both occasions.
  
  
  RESULTS
  Significantly higher concentrations of chlorine in EBC (p = 0.007) and ECP in serum (p = 0.003) were found during the pollen season compared to post-season. Chlorine levels tended to be higher in patients who reported of chest symptoms compared to those who denied symptoms during the pollen season (p = 0.06). Areas under the receiver-operated characteristic curves (AUC(ROC)) were compared and similar discriminative power to identify exacerbations of asthma was recorded by chlorine in EBC (range 0.67-0.78) and ECP in serum (range 0.64-0.78).
  
  
  CONCLUSIONS
  It is concluded that chlorine in EBC and ECP in serum decreased significantly post-season, and this is suggested to mirror the decrement in airborne antigen. It is furthermore proposed that chlorine in EBC and ECP in serum tend to have a similar capacity to identify seasonal variations in airborne pollen in patients with asthma.
authors.affiliation: Faculty of Health Sciences, Department of Medicine and Care, Section of Clinical Physiology, University Hospital, Linkoping, Sweden. anette.davidsson@lio.se
authors.forename: Anette
authors.initials: A
authors.lastname: Davidsson
authors.forename: Mats
authors.initials: M
authors.lastname: Soderstrom
authors.forename: Kerstin Naidu
authors.initials: KN
authors.lastname: Sjosward
authors.forename: Birgitta
authors.initials: B
authors.lastname: Schmekel
mesh_terms: D000328:Adult; D000388:Air / Q000032:analysis; D000485:Allergens; D001249:Asthma / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001944:Breath Tests / Q000379:methods; D002097:C-Reactive Protein / Q000378:metabolism; D002713:Chlorine / Q000032:analysis*; D003545:Cysteine / Q000097:blood; D047150:Eosinophil Cationic Protein / Q000097:blood; D045853:Exhalation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007124:Immunoenzyme Techniques; D018836:Inflammation Mediators / Q000097:blood; D015289:Leukotrienes / Q000097:blood; D008297:Male; D008875:Middle Aged; D011058:Pollen; D011379:Prognosis; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D013147:Spirometry
chemical_list: D000485:Allergens; D015415:Biomarkers; D018836:Inflammation Mediators; D015289:Leukotrienes; C112381:cysteinyl-leukotriene; D002713:Chlorine; D002097:C-Reactive Protein; D047150:Eosinophil Cationic Protein; D003545:Cysteine