Analysis of the sputum and inflammatory alterations of the airways in patients with common variable immunodeficiency and bronchiectasis.
BACKGROUND
Common variable immunodeficiency is characterized by defective antibody production and recurrent pulmonary infections. Intravenous immunoglobulin is the treatment of choice, but the effects of Intravenous immunoglobulin on pulmonary defense mechanisms are poorly understood.


OBJECTIVE
The aim of this study was to verify the impact of intravenous immunoglobulin on the physical properties of the sputum and on inflammatory alterations in the airways of patients with Common variable immunodeficiency associated with bronchiectasis.


METHODS
The present study analyzed sputum physical properties, exhaled NO, inflammatory cells in the sputum, and IG titers in 7 patients with Common variable immunodeficiency and bronchiectasis with secretion, immediately before and 15 days after Intravenous immunoglobulin. A group of 6 patients with Common variable immunodeficiency and bronchiectasis but no sputum was also studied for comparison of the basal IgG level and blood count. The 13 patients were young (age=36+/-17 years) and comprised predominantly of females (n=11).


RESULTS
Patients with secretion presented significantly decreased IgG and IgM levels. Intravenous immunoglobulin was associated with a significant decrease in exhaled NO (54.7 vs. 40.1 ppb, p<0.05), sputum inflammatory cell counts (28.7 vs. 14.6 cells/mm(3), p<0.05), and a significant increase in respiratory mucus transportability by cough (42.5 vs. 65.0 mm, p < 0.05).


CONCLUSIONS
We concluded that immunoglobulin administration in Common variable immunodeficiency patients results in significant improvement in indexes of inflammation of the airways with improvement in the transportability of the respiratory mucus by cough.
Pereira
Andrea Cristina
AC
Pathology Department, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. andreacrisp03@terra.com.br
Kokron
Cristina M
CM
Romagnolo
Beatriz Mangueira Saraiva
BM
Yagi
Claudia Simeire Albertini
CS
Saldiva
Paulo Hilário Nascimento
PH
Lorenzi Filho
Geraldo
G
Negri
Elnara Marcia
EM
D000328:Adult; D001987:Bronchiectasis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D002452:Cell Count; D017074:Common Variable Immunodeficiency / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D003371:Cough / Q000276:immunology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D009079:Mucociliary Clearance / Q000502:physiology*; D009093:Mucus / Q000502:physiology; D009569:Nitric Oxide / Q000032:analysis; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D013183:Sputum / Q000166:cytology / Q000187:drug effects / Q000276:immunology; D018709:Statistics, Nonparametric; D013997:Time Factors
D007074:Immunoglobulin G; D007075:Immunoglobulin M; D016756:Immunoglobulins, Intravenous; D009569:Nitric Oxide