Introduction: Toll-like receptor (TLR) stimulation can lead to the activation of both innate and adaptive immune responses. Recently, some reports have pointed out to the role of membranous form of TLR2 in asthma pathogenesis. In this respect, this study aimed to examine serum and sputum levels of soluble form of TLR2 (sTLR2) in both patients with asthma and healthy individuals.Materials and Methods: Serum and sputum samples were obtained from asthmatic patients (n=33) and normal subjects (n=19). All the subjects were otherwise healthy. The asthmatic patients were classified into four groups according to Global Initiative for Asthma (GINA). Eosinophile count and total serum IgE were determined in peripheral blood and sputum. Also, we established a sandwich ELISA to measure the serum and sputum levels of sTLR. Results: The means of sTLR2 optical density levels in serum and sputum samples of the asthmatics were significantly lower than those obtained from the healthy controls (0.44±0.12 VS 0.72±0.15 IU/ml, P=0.003). sTLR2 optical density decreased concomitantly with the increase in the levels of asthma severity, but the differences observed were not statistically significant. Conclusion: The levels of sTLR2 decreased in serum and sputum samples obtained from asthmatic patients, as compared to the healthy individuals.

Several studies reported the appearance of asthma and autoimmune conditions in the same patient, but the clinical significance of this association was not yet assessed.One hundred asthmatic patients were observed for one year evolution with death, severe exacerbations, intake of > 1000 micrograms of beclometasone or equivalent (high ICS) and FEV1 decline >100 ml, in relation with ANA (ELISA), sputum and blood eosinophilia (EO), NSAID intolerance, BMI >25, chronic rhinosinusitis, smoking status and FEV1 <30% predicted (low FEV1).After 1 year of observation, there were 5 deaths, 28 severe asthma exacerbations requiring hospitalisations, 24 cases requiring high inhaled corticosteroid intake, and 19 patients with fast FEV1 decline (>100 ml/year). Multiple regression analysis pointed out several different independent risk factors for severe asthma evolution: for death presence of ANA (P=0.037), NSAID intolerance (P<0.001) and low FEV1 (P=0.021); for evolution with severe exacerbations ANA (p=0.011), sputum EO (P<0.001), smoking (P=0.044) and NSAID intolerance (P=0.022); for high ICS intake ANA (P=0.036), sputum EO (P=0.026) and low FEV1 (P=0.006); for FEV1 decline >100 ml ANA (P=0.006), sputum EO (P=0.037), BMI>25 (P=0.046) and NSAID intolerance (P=0.017).The presence of ANA is an independent risk factor in asthma for evolution with death, severe exacerbations, high inhaled corticosteroid intake and FEV1 decline >100 ml.

Occupational asthma is defined as "a disease of variable airflow limitations and/or airway hyper-responsiveness due to causes and conditions attributable to a particular occupational environment and not stimuli that are being encountered outside the workplace." An analysis of general population-based studies published up to 2007 showed that 17.6% of all adult-onset asthma is due to workplace exposures. In this article, Different aspects of occupational asthma are briefly reviewed.

Background and Objective: Asthma is one of the most common chronic diseases that in some cases it is manifested as chronic coughs without any other symptoms. Cough variant asthma (CVA) is an occult form of asthma of which, the only sign or symptom is chronic cough and therefore should always be considered in the differential diagnosis of chronic coughs. The aim of the present study was to detect the prevalence of cough variant asthma (CVA) among patients with chronic and persistent coughs.Materials and Methods: This study was performed in the respiratory outpatient clinic at Vali-e Asr Hospital of Zanjan, Iran, during 2009. Methacholine challenge test was carried out in 92 patients suffering from chronic coughs. CVA was diagnosed as chronic coughs without wheezing or any apparent cause which had persisted for more than 8 weeks, with a normal CXR and spirometry but with bronchial hyper-responsiveness to methacholine, based on % 20 drop in FEV1 before and after methacholine challenge test.Results: Of the 92 patients suffering from chronic cough, 24 patients (%26.1) satisfied the criteria for CVA and had positive methacholine challenge test. There was a significant association between patients' job (P=0.003) and education (P=0.001) and positive test.Conclusions: These findings suggest that CVA is a common etiology for chronic cough and its early diagnosis and treatment is significantly important to prevent progression of the disease to classic asthma .