Cardiovascular Journal of Africa: Vol 28 No 3 (May/June 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017 AFRICA 165
The effects of treatment in patients with childhood
asthma on the elastic properties of the aorta
Osman Bektaş, Zeki Yüksel Günaydin, Ahmet Karagöz, Recep Akgedik, Adil Bayramoğlu, Ahmet Kaya
Abstract
Introduction: The study aimed to investigate the effects of
treatment in patients with childhood asthma on the elastic
properties of the aorta and cardiovascular risk.
Methods: The study was performed in 66 paediatric patients
diagnosed with bronchial asthma (BA). All patients were
administered the β2 agonist, salbutamol, for seven days,
followed by one month of montelukast and six months of
inhaled steroid treatment. All patients underwent conven-
tional transthoracic echocardiographic imaging before and
after treatment. Aortic elasticity parameters were considered
to be the markers of aortic function.
Results: Aortic elasticity parameters, including aortic strain
(15.2 ± 4.8 and 18.8 ± 9.5%, p = 0.043), aortic distensibility
(7.26 ± 4.71 and 9.53±3.50 cm2/dyn, p = 0.010) and aortic
stiffness index (3.2 ± 0.6 and 2.8 ± 0.5, p = 0.045 showed
significant post-treatment improvement when compared to
pre-treatment values. Tricuspid annular plane systolic excur-
sion (TAPSE) was also observed to improve after treatment
(1.81 ± 0.38 and 1.98 ± 0.43, p = 0.049).
Conclusion: The study demonstrated that when provided at
appropriate doses, medications used in BA may result in an
improvement in aortic stiffness.
Keywords: aortic stiffness, corticosteroids, bronchial asthma
Submitted 2/6/15, accepted 17/7/16
Cardiovasc J Afr 2017; 28: 165–169
DOI: 10.5830/CVJA-2016-076
Bronchial asthma (BA) is a chronic inflammatory disease of
the airways. Exacerbations that develop as a result of bronchial
hypersensitivity associated with chronic airway inflammation
are accompanied by varying degrees of airway obstruction.
The possible causes of airway obstruction include contraction
of airway smooth muscles, hypersecretion of mucous, mucosal
oedema, cell infiltration and epithelial desquamation.1 Studies
have shown an association between systemic inflammation
and the progression of asthma.2 It has also been established
that pro-inflammatory cytokines such as tumour necrosis
factor alpha (TNF-alpha), interleukin 6 (IL-6) and C-reactive
protein (CRP) increase in patients with asthma.2,3 There is also
evidence that supports the role of chronic inflammation in the
aetiology of atherosclerosis.4 Chronic inflammation may even
impair endothelial function and accelerate the progression of
atherosclerosis.5 Endothelial dysfunction and arterial stiffness
are two distinct components playing an important role in the
pathophysiology of arterial diseases.
Nitric oxide (NO) released from the endothelial cells has been
shown to contribute to arterial compliance and distensibility.6
Arterial stiffness consists of two components that are interrelated;
the structural component is formed by the collagen elastin
fibres and their associated molecules in the arterial medium,
whereas the dynamic component is represented by the tonus of
smooth muscle cells and depends on the vasoactive substances
released by endothelial cells.7 In case of endothelial damage
due to chronic inflammation or increased haemodynamic load,
irrespective of the cause, it might be expected that arterial
stiffness will also be affected. Indeed, arterial stiffness was shown
to be elevated in a study performed on patients with BA. 8 Aortic
stiffness is a significant risk factor for cardiovascular mortality
and morbidity.9
Due to their anti-inflammatory effects on the airways,
β2-agonists, leukotriene receptor antagonists and inhaled
corticosteroids (ICS) are used for the treatment of asthma.
These medications carry the risk of enhancing the cardiovascular
risk factors such as hypertension, hypercholesterolaemia,
hypertriglyceridaemia and impaired glucose tolerance.10-12
Based on the fact that bronchial asthma is a chronic
inflammatory disease, the present study aimed to demonstrate
how aortic stiffness is affected by the treatment in paediatric
patients with asthma, and to determine the possible impacts on
cardiovascular risk.
Methods
The study population consisted of children aged nine to 15,
who were admitted to the paediatric ward and the chest diseases
out-patient clinics of Ordu University between January and
August 2012. A total of 240 patients who had been diagnosed
with asthma without any treatment in the past three months or
patients with newly diagnosed moderate-to-severe asthma were
evaluated in the study.
In order to ensure standardisation, a treatment protocol of
salbutamol 100 mcg 4 × 1 for 14 days, montelukast 5 mg/day for
30 days and budesonide 200 mcg inh 2 × 1 for six months was
given to all patients according to the Global Initiative for Asthma
Department of Cardiology, Faculty of Medicine, Ordu
University, Ordu, Turkey
Osman Bektaş, MD
Zeki Yüksel Günaydin, MD,
Adil Bayramoğlu, MD
Ahmet Kaya, MD
Department of Cardiology, Faculty of Medicine, Giresun
University, Giresun, Turkey
Ahmet Karagöz, MD
Department of Chest Diseases, Faculty of Medicine, Ordu
University, Ordu, Turkey
Recep Akgedik, MD