Abstract
BackgroundBlood eosinophil (B‐Eos) count is an emerging biomarker in the management of respiratory disease but determinants of B‐Eos count besides respiratory disease are poorly described. Therefore, we aimed to evaluate the influence of non‐respiratory diseases on B‐Eos count, in comparison to the effect on two other biomarkers: fraction of exhaled nitric oxide (FeNO) and C‐reactive protein (CRP), and to identify individual characteristics associated with B‐Eos count in healthy controls.MethodsChildren/adolescents (<18 years) and adults with complete B‐Eos data from the US National Health and Nutritional Examination Surveys 2005–2016 were included, and they were divided into having respiratory diseases (n = 3333 and n = 7,894, respectively) or not having respiratory disease (n = 8944 and n = 15,010, respectively). After excluding any respiratory disease, the association between B‐Eos count, FeNO or CRP, and non‐respiratory diseases was analyzed in multivariate models and multicollinearity was tested. After excluding also non‐respiratory diseases independently associated with B‐Eos count (giving healthy controls; 8944 children/adolescents and 5667 adults), the independent association between individual characteristics and B‐Eos count was analyzed.ResultsIn adults, metabolic syndrome, heart disease or stroke was independently associated with higher B‐Eos count (12%, 13%, and 15%, respectively), whereas no associations were found with FeNO or CRP. In healthy controls, male sex or being obese was associated with higher B‐Eos counts, both in children/adolescents (15% and 3% higher, respectively) and adults (14% and 19% higher, respectively) (p < 0.01 all). A significant influence of race/ethnicity was also noted, and current smokers had 17% higher B‐Eos count than never smokers (p < 0.001).ConclusionsNon‐respiratory diseases influence B‐Eos count but not FeNO or CRP. Male sex, obesity, certain races/ethnicities, and current smoking are individual characteristics or exposures that are associated with higher B‐Eos counts. All these factors should be considered when using B‐Eos count in the management of respiratory disease.
Highlights
In a large population‐based study of US participants without respiratory disease we found that having heart disease, stroke, and/or metabolic syndrome independently increased Blood eosinophil (B‐Eos) levels by 12%– 15%, after adjusting for covariables
No significant association was found between any non‐respiratory disease and fraction of exhaled nitric oxide (FeNO) or C‐reactive protein (CRP)
Sex, overweight/obesity, race/ethnicity, and smoking status were related to B‐Eos count
Summary
Airway type‐2 inflammation is a feature of common phenotypes of asthma[1,2,3] and chronic obstructive pulmonary disease (COPD).[4,5] The most studied biomarkers used to characterize patients with type‐2 inflammation are blood eosinophil (B‐Eos) count and fraction of exhaled nitric oxide (FeNO).[6]. In addition to the type of inflammation, its location is important for the disease assessment To this end, it may be necessary to have a comparison with other systemic markers and local type‐2 markers, such as C‐reactive protein (CRP) and FeNO, respectively.[32,33]. It may be necessary to have a comparison with other systemic markers and local type‐2 markers, such as C‐reactive protein (CRP) and FeNO, respectively.[32,33] The aim of this investigation was to (a) evaluate the influence of non‐respiratory disease on B‐Eos count, FeNO, and CRP, and (b) to identify individual characteristics that are associated with B‐Eos count in healthy individuals
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