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Endogenous airway acidification. Implications for asthma pathophysiology.

J F Hunt1, K Fang, R Malik

  • 1Divisions of Pediatric Respiratory Medicine, Pediatric Hematology/Oncology, and Allergy, Asthma and Immunology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.

American Journal of Respiratory and Critical Care Medicine
|March 11, 2000
PubMed
Summary

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Asthma patients have significantly lower airway pH, which normalizes with corticosteroid treatment. This acidic airway environment promotes nitric oxide production and eosinophil damage, impacting asthma inflammation.

Area of Science:

  • Respiratory Medicine
  • Biochemistry
  • Pathophysiology

Background:

  • Airway concentrations of reactive nitrogen and oxygen species are elevated in asthma.
  • The pH-dependency of these species' stability and bioactivity is known, but airway pH in acute asthma remains unstudied.

Purpose of the Study:

  • To investigate the pH of the airway in patients with acute asthma.
  • To determine the relationship between airway pH, nitric oxide (NO) levels, and airway inflammation.

Main Methods:

  • Measurement of pH in deaerated exhaled airway vapor condensate from asthma patients and control subjects.
  • Assessment of nitrite-to-nitric oxide conversion at measured pH values.
  • Observation of eosinophil necrosis at different pH levels.

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Main Results:

  • Airway pH was significantly lower in acute asthma patients (5.23 +/- 0.21) compared to controls (7.65 +/- 0.20).
  • Airway pH normalized with corticosteroid therapy and was reproducible.
  • Low pH converted endogenous nitrite to nitric oxide (NO), and accelerated eosinophil necrosis.

Conclusions:

  • Asthmatic airways are acidic, a condition that normalizes with corticosteroid treatment.
  • Airway acidification contributes to elevated expired NO and eosinophil necrosis, suggesting a role in asthma pathophysiology.
  • Regulation of airway pH may be a novel therapeutic target in asthma.