Eosinophils In Induced Sputum Research Articles

Presence and sequence of bronchiectasis onset impact on the clinical characteristics in asthmatic patients.

Asthmatic patients with comorbid bronchiectasis (ACB) show significantly severe condition with various inflammatory phenotypes; bronchiectasis is a heterogeneous disease caused by asthma and other multiple etiological factors. We aimed to investigate the inflammatory characteristics and their clinical significance in asthmatic patients according to the presence and onset time of bronchiectasis. This prospective cohort study recruited outpatients with stable asthma. All the enrolled patients were divided into the non-bronchiectasis group and the ACB group, and the ACB group was separated into the bronchiectasis-prior group and the asthma-prior group. Demographic and clinical data were collected, and peripheral blood and induced sputum eosinophil counts, sputum pathogens, the fraction of exhaled nitric oxide (FeNO), lung function, and chest high-resolution computed tomography were examined. A total of 602 patients (mean age: 55.36±14.58 years) were included, of which 255 (42.4%) were males. Bronchiectasis was present in 268 (44.5%) patients, with 171 (28.41%) in the asthma-prior group and 97 (16.11%) in the bronchiectasis-prior group. For the asthma-prior group, the presence of bronchiectasis was positively correlated with age, presence of nasal polyps, severe asthma, ≥1 pneumonia in the last 12 months, ≥1 severe exacerbation of asthma in the last 12 months (SEA), peripheral blood eosinophil counts, and sputum eosinophil ratio; the extent and severity of bronchiectasis were positively correlated with ≥1 SEA and FeNO levels; and the bronchiectasis severity index (BSI) scores were positively correlated with ≥1 SEA and immunoglobulin E levels. For the bronchiectasis-prior group, bronchiectasis was positively correlated with previous pulmonary tuberculosis or pneumonia in childhood and ≥1 pneumonia in the last 12 months and negatively correlated with forced expiratory volume in one second (FEV1) % and the FeNO level. The extent and severity of bronchiectasis were positively correlated with ≥1 pneumonia in the last 12 months and negatively correlated with FEV1%. The BSI scores were positively correlated with the duration of bronchiectasis. The sequence of bronchiectasis onset may indicate distinct inflammatory characteristics and may be helpful in targeted therapy for patients with asthma.

Клиническое значение оксида азота выдыхаемого воздуха, назального оксида азота, эозинофилов периферической крови как маркеров воспаления дыхательных путей при бронхиальной астме и аллергическом рините

Chronic airway inflammation plays an important role in the development and progression of bronchial asthma (BA) and allergic rhinitis (AR). The lack of correlation between the severity of clinical symptoms and the activity of inflammation determines the need to develop and introduce various biomarkers into clinical practice. Allergic ВА and AR are predominantly based on eosinophilic inflammation. Sufficiently studied markers of eosinophilic inflammation of the respiratory tract are peripheral blood eosinophils, exhaled nitric oxide (FeNO), nasal nitric oxide (nNO). FeNO increases in BA and AR, decreases with the use of glucocorticoids, and can be used to monitor the course of these diseases as well as in the diagnosis of BA. nNO can also be used as a surrogate marker for eosinophilic inflammation of the upper airways, but research results are conflicting, and further research is required on the clinical significance of this marker. A significant limitation of the use of nitric oxide levels in real clinical practice is the high cost of analyzers and their components. The search for cheaper markers that can be used in practical work to assess eosinophilic inflammation of the upper and lower respiratory tract, in particular, peripheral blood eosinophils, is relevant. A large number of studies have proven the possibility of using peripheral blood eosinophils as markers of eosinophilic inflammation of the lower respiratory tract. They are comparable to induced sputum eosinophils and can be useful in assessing the severity and control of asthma as well as in prescribing biological therapy. In the available literature, it was not possible to find data on the use of peripheral blood eosinophils to assess inflammation of the upper respiratory tract. Airway inflammation markers are an important tool for clarifying the phenotype/endotype of respiratory diseases and for an individual approach to the treatment of patients with BA and AR.

Induced sputum eosinophilia and pulmonary function tests in ex-smokers with asthma controlled with an inhaled steroid and long-acting beta-agonist therapy.

This study aims to investigate the relationship between induced sputum eosinophilia and pulmonary functions in ex-smoker asthma patients controlled with an ICS/LABA therapy. Asthma patients who are known to use ICS/LABA regularly for at least three months, without an attack in the last month, quit smoking (5-20 pack-years) and have asthma under control (ACT> 20), and concurrent with induced sputum cytology who had spirometry and lung volume measurements were included in the study. Cytology results, induced sputum eosinophil and neutrophil counts, FEV1 (L), FEV1 (%), FVC (L), FVC (%), RV (L), RV (%) and RV/TLC (%) values of all patients were recorded. The relationship between sputum neutrophil and eosinophil count and pulmonary function test parameters was evaluated. Seventeen (68%) of the patients were female, eight (32%) were male, and the mean age was 49.7 ± 13.6 years. The mean sputum eosinophil percentage was 9.4 ± 16.7, and the neutrophil percentage was 71.4 ± 20.5. A positive correlation was found between induced sputum eosinophil percentage values and FEV1 (L) (r= +0.472; p= 0.01) and FVC (L) (r= +0.502; p= 0.01). No correlation was found between the FEV1/FVC%, FEV1%, FVC%, RV (L), RV%, and RV/TLC% values and the percentage of induced sputum eosinophils (p> 0.05). It was observed that controlled asthmatic patients with induced sputum eosinophilia treated with ICS/LABA and who quit smoking had high FVC (L) and FEV1 (L) levels.

Association of induced sputum eosinophil, absolute eosinophil count and serum immunoglobulin E level in assessment of the clinical severity in bronchial asthma

The study was done with the aim to determine the relationship between the severity of asthma in patient and the level of serum immunoglobulin E, peripheral eosinophil count and nature of sputum.Current research was conducted at the Department of Respiratory Medicine, GAIMS, Bhuj, India over one year. All subjects of Bronchial asthma distinct by Genetic Information Nondiscrimination Act (GINA) guidelines of age 17-61 year were registered. Severity of asthma was assessed by clinical features and by Forced expiratory volume in the first second (FEV1 in spirometry. Following evaluating the sternness of bronchial asthma all subjects undergo sputum examination for sputum eosinophil counts, blood sampling for absolute eosinophil counts and serum IgE levels. Elevated sputum eosinophil count (>3) was significantly elevated in additional subjects with severe persistent asthma even though extra than half of them had normal sputum eosinophil. An important association amid peripheral eosinophil count, sputum eosinophil count, and serum IgE with severe persistent asthma. Mean sputum eosinophil% augments considerably according to severity, demonstrates though affirmative association which was statistically important.The use of inexpensive and easy method with evaluation of AEC, sputum eosinophil count and evaluation of serum IgE level showed a straight measurement of inflammation of airway and allergic etiology of illness.

Clinical, functional and inflammatory evaluation in asthmatic patients after a simple short-term educational program: a randomized trial

This study aimed to evaluate the clinical evolution, functional parameters and inflammatory activity of asthma in patients who submitted to an educational intervention. 58 adult patients over 18 years of age with partly controlled and uncontrolled asthma were randomized into an intervention group (IG) (N = 32) and a control group (CG) (N = 26) and evaluated for 12 weeks. The Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), Asthma Quality Life Questionnaire (AQLQ) and Beck Depression Inventory (BDI) questionnaires were applied. Spirometry, exhaled nitric oxide (NO), exhaled breath condensate (EBC) and induced sputum (IS), measurement of the peak flow and symptoms were performed. The IG patients received an educational activity for 30 min applied by a nurse. Statistical analysis: analysis of variance with repeated intragroup measures. IG presented a decreased number of eosinophils in IS and IL-17A in EBC, an increase in the percentage of FEV1 before and after bronchodilator and an improvement in quality of life compared to the CG. There was an improvement in depression levels and a decrease in IL-4 and IL-5 in the IS and in the EBC in both groups. Our results suggest that an educational intervention can bring benefits concerning the control of inflammation, lung function alterations, quality of life and levels of depression in asthmatic patients. Registration: ClinicalTrials.gov; NCT03655392.

Extracellular vesicle-derived microbiome obtained from exhaled breath condensate in patients with asthma

Extracellular vesicle-derived microbiome obtained from exhaled breath condensate in patients with asthma

Correlation of induced sputum eosinophil, absolute eosinophil count and serum IgE with clinical severity of bronchial asthma

Background: Asthma is a chronic inflammatory disorder of the airway. Eosinophil and Serum IgE being a marker of airway inflammation, can serve as a tool for assessing severity and response to treatment in asthma patients. The correlation of clinical assessment with various markers of airway inflammation in asthma is not well established in the Indian population. Present study correlates induced sputum eosinophil, blood eosinophil and Serum IgE count in assessing the clinical severity in bronchial asthma. Aims: To study the correlation of sputum eosinophil, absolute eosinophil count and Serum IgE in assessing the clinical severity of asthma. Methods: It was a cross sectional quantitative study, which was carried out between Feb 2020 to feb 2021. Total 70 asthmatics was selected which underwent history, examinations and spirometry, after written consent. Severity of asthma was assessed by clinical features and by FEV1 in spirometry. (as per GINA guidelines). After assessing the severity of Bronchial asthma all patient underwent Sputum examination for sputum eosinophil counts, blood sampling for Absolue eosinophil counts and Serum IgE levels. After that sputum eosinophil counts, absolute eosinophil counts and serum IgE levels were correlated with severity of Bronchial Asthma. Conclusion: Assessment of eosinophil count in sputum and blood, and serum IgE in blood are simple and inexpensive method that can show a direct measurement of airway inflammation. Thus it can help to identify specific phenotypes in asthmatic patients who are more responsive to steroids, which needs to be demonstrated in future studies. It could be the preferred method in routine practice in monitoring airway inflammation and guiding management.

Periostin and Thymic Stromal Lymphopoietin-Potential Crosstalk in Obstructive Airway Diseases.

Periostin and thymic stromal lymphopoietin (TSLP) are newly described markers of obstructive airway diseases and the mechanism by which both markers participate in immune response remains poorly understood. The aim of our study was to determine periostin and TSLP concentration in serum and induced sputum (IS) in patients with atopic asthma, chronic obstructive pulmonary disease (COPD), and controls, as well as to evaluate the potential link between periostin, TSLP, and Th2 immune response. Serum and IS levels of periostin, TSLP, IL-4, and IL-13 were determined in 12 atopic asthmatics, 16 COPD sufferers, and 10 controls. We noticed a significantly higher IS periostin and TSLP concentration at protein and mRNA level in asthmatics compared to the two other groups; additionally, periostin and TSLP were correlated positively with IS eosinophil count. A strong positive correlation between IS periostin and TSLP protein levels (r = 0.96) as well as mRNA expression level (r = 0.95) was found in patients with asthma. The results of our study show that periostin and TSLP are associated with eosinophilic airway inflammation and seem to be important drivers of atopic asthma but not COPD pathobiology. Very strong correlations between local periostin, TSLP, eosinophils, and IL-4 in asthma point to the link between periostin–TSLP and Th2 response.

Long-term clinical effects of an inhaler guidance DVD in patients with bronchial asthma.

Erroneous use of inhalers is a serious problem. Given the multitude of devices currently available, it can be difficult to convey the correct methods for their efficient use to patients. We previously generated an educational DVD that visually and audibly explains the proper use of all inhaler types available in Japan to provide inhalation guidance to patients. Herein, we report the 1-year follow-up of patients who received or did not receive the DVD guidance. Sixty-nine bronchial asthma patients undergoing outpatient treatment who received inhalation guidance from a pharmacist using a standard package insert were randomly allocated to a DVD group (n=35) or a no-DVD group (n=34). Their current oral or inhalant drug regimens were unchanged. Various parameters were measured 12 months later. Frequencies of aggravation during the 12-month period were also determined. Compared with the no-DVD group, there were significant improvements in asthma control test scores, forced vital capacity, FEV1, impulse oscillometry, resonant frequency, induced sputum eosinophil count, and FeNO in the DVD group after 12 months. Pulmonary function and inflammation parameters improved significantly with the use of the instructive DVD in addition to the package inserts. The frequency of asthma aggravation significantly decreased in the DVD group during the 12-month study period, likely because inhalation procedures were performed accurately. A DVD that provides accurate inhalation guidance enhances the quality of life of asthma patients and has substantial clinical ramifications. Thus, this tool would be beneficial for patients in Japan and worldwide.

Динамика лабораторных показателей у детей с легкой персистирующей бронхиальной астмой

Study Objective: to track the laboratory dynamics in children with mild persistent bronchial asthma (BA) at various stages of disease with or without baseline therapy. Study Design: prospective cohort study. Materials and Methods. The study included 42 patients with mild persistent BA aged 5 to 16 years. Each child was followed up for 3 years. At initiation of the study and during each visit, all patients had their blood eosinophils, nasal discharge (ND) and induced sputum (IS), as well as serum eosinophil cation protein (ECP) tested; and their respiratory function was assessed. All children were prescribed baseline therapy with low doses of inhalative glucocorticosteroids (GCS); 18 children also received allergen-specific immunotherapy (ASIT). Study Results. Inhalative GCS for BA exacerbations facilitated normalisation of sputum, ND and blood eosinophils. During periods of BA remission, ND and IS eosinophil levels increased, but patients did not have rhinitis and BA symptoms. Eosinophil levels in IS were higher vs. BA control (р = 0.05) and lower vs. disease exacerbations (р < 0.05). We did not find any differences in laboratory results in children with or without ASIT who were treated with low doses of inhalative and nasal GCS. Conclusion. Eosinophile inflammatory phenotype in patients did not charge depending on disease duration and control therapies. According to the study data, eosinophile levels in IS, when BA exacerbation was recorded, were 8.0% [3.0–16.0%]. This value can be used as an additional predictor for the need in increased therapy (a step forward). Irrespective of the disease stage and therapy, there was correlation between blood eosinophile level and IS eosinophile level and between IS eosinophile level and blood ECP concentration. Keywords: bronchial asthma, children, eosinophiles, induced sputum, inflammatory phenotype.

Correlations of induced sputum eosinophils with blood allergic markers in pediatric asthma and eosinophilic bronchitis

Purpose: Induced sputum eosinophil count is useful for the evaluation and diagnosis of asthma and eosinophilic bronchitis (EB). The aim of this study was to evaluate the correlation of induced sputum eosinophil count with various allergic indicators, including the peripheral blood eosinophil count, in pediatric asthma and EB. Methods: From May 2014 to July 2018, 126 children visited Kyungpook National University Children’s Hospital, and underwent methacholine bronchial challenge test and sputum induction. Peripheral blood eosinophil counts, serum eosinophil cationic pro tein (ECP), serum total IgE, immunoCAP for inhalant allergens, and skin prick test were performed in the study subjects. Results: In the asthma group, the eosinophil count of induced sputum correlated with peripheral blood eosinophils (r=0.279, P=0.043). The concordance rates of sputum and peripheral blood eosinophil count in the asthma and EB groups were 64.1% and 25.7%, re spectively. The number of eosinophils in the sputum also correlated with serum total IgE, ECP, and specific IgE to Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Aspergillus in the asthma group. Conclusion: The number of eosinophils in the induced sputum correlated with peripheral blood in the asthma group. However, a third of subjects were discordant. Therefore, we need to keep in mind the possibility of discordance when predicting the degree of airway eosinophilic inflammation using the peripheral blood eosinophils. In EB, the number of induced sputum eosinophils did not correlate with the number of peripheral blood eosinophils, which may be attributed to the difference in mechanism. Further studies are warranted. (Allergy Asthma Respir Dis 2020;8:220-226)

Does asthma control as assessed by the asthma control test reflect airway inflammation?

Background and aims: The treatment of asthmatic patients is particularly focused on the control of symptoms as well as functional and inflammatory parameters. In our study, we investigated the relationship between the asthma control test (ACT) which evaluates symptoms and airway inflammation and functional parameters.
 Materials and methods: Stable asthmatic patients admitted to our pulmonary outpatient clinic were enrolled in the study consecutively and underwent the ACT, pulmonary function tests and methacholine bronchial provocation test (MBPT). Additionally, fractional exhaled nitric oxide level (FeNO) and induced sputum cell distribution were assessed. All these parameters were re-evaluated at the third month after adjusting medications of the patients according to baseline ACT scores.
 Results: Of the 101 patients screened, we analyzed 83 who proceeded to the follow up visit. At the baseline visit, 8 were totally controlled, 36 partially controlled and 39 uncontrolled according to ACT. At the follow up visit, 10 were totally controlled, 39 partially controlled and 34 uncontrolled. Comparison of the two visits in terms of all parameters revealed significant reductions only in the percentages of patients with MBPT positivity (p = 0.029) and FeNO levels > 20 ppb (p = 0.025) at follow up. The percentages of patients with FeNO > 20 ppb, MBPT positivity, induced sputum eosinophilia or induced sputum neutrophilia did not show significant differences between totally controlled, partially controlled and uncontrolled groups at both baseline and follow up visits.
 Conclusion: Although the ACT scores did not show significant correlations with the airway inflammation parameters tested in this study, a marked reduction in the percentage of patients with MBPT positivity and FeNO > 20 ppb at follow up may suggest the importance of the control concept in the management of asthma.

Eosinophilic Airway Inflammation in Patients with Stable Biomass Smoke- versus Tobacco Smoke-Associated Chronic Obstructive Pulmonary Disease.

Background.Chronic obstructive pulmonary disease (COPD) is an inflammatory disease with predominant involvement of neutrophils, macrophages and CD8+ lymphocytes. Eosinophilic airway inflammations are reported in stable state and during acute exacerbations of tobacco smoke-associated COPD (TS-COPD). Women exposed to biomass fuel smoke are known to have eosinophils in sputum. However, little is known about the sputum cellular inflammatory profile in biomass fuel smoke-associated COPD (BMS-COPD). We therefore aimed to compare the sputum cellular inflammatory profile in tobacco smoke- and biomass smoke-associated COPD.Methods.The study was conducted in a tertiary care hospital in Goa, India. A total of 113 patients with stable COPD reporting to the outpatient pulmonary clinic were recruited. All participants were ≥ 40 years of age. Sputum induction studies were performed by the method of Pizzichini et al. after baseline subject characterization. Significant eosinophilia was defined as induced sputum eosinophils ≥ 3%.Results.There were 85 TS-COPD and 28 BMS-COPD patients. The mean age [standard deviation (SD)] was 64.7 (7.8) and 63.0 years (8.3), p = 0.32 in TS and BMS-COPD, respectively. Eighteen subjects (21.1%) were female smokers. The smoking pack-year median [interquartile range (IQR)] was 36 (20, 58) and hour-years of biomass smoke exposure mean (SD) was 192.4 (61). The TS-COPD and BMS-COPD cases showed a post-bronchodilator forced expiratory volume in one second (FEV1%) mean (SD) of 57.9 (17.1), and 62.6 (19.4), p= 0.22, respectively. Both groups had similar symptoms and severity of disease. Induced sputum total cell count per gram of sputum × 106 mean (SD) was 3.05 (1.53) for TS-COPD, and 2.55(1.37) for BMS-COPD p=0.12. The neutrophils % mean (SD) was 86.4 (16.5) and 87.9 (10.2), p = 0.64; eosinophils % median (IQR) was 2.5 (1, 10) and 8 (2, 12.8), p = 0.07; lymphocytes % median (IQR) was 0 (0, 0.75) and 0 (0, 1) p = 0.13; macrophages % median (IQR) was 2.5 (0.75, 5.7) and 1 (0, 4.7) p = 0.13; and significant eosinophilia (eosinophils ≥3%) was 42 (49.4%) and 20 (71%), p=0.04, for TS-COPD and BMS-COPD, respectively.Conclusions.For similar severity of disease and clinical symptoms, significant eosinophilic inflammation was observed in stable BMS-COPD, while both groups had similar neutrophilic inflammation.Participant Consent.Obtained.Ethics Approval.The study was approved by the Institutional Ethics Committee of the Goa Medical College, Goa, India.Competing Interests.The authors declare no competing financial interests.

Is Induced Sputum A Useful Noninvasive Tool in the Diagnosis of Pulmonary Sarcoidosis?

In patients with pulmonary sarcoidosis, the provocation of sputum expectoration through the inhalation of hypertonic saline has been investigated as an alternative diagnostic tool for invasive procedures. We aimed to assess the diagnostic value of induced sputum (IS) by observing its cell distribution in patients with a confirmed histopathological diagnosis of sarcoidosis. In this prospective, cross-sectional study, we compared the IS results of 20 patients with a histopathologically confirmed pulmonary sarcoidosis diagnosis and 24 healthy volunteers. The percentages of macrophages, lymphocytes, neutrophils, and eosinophils in IS and the CD4/CD8 ratio were compared. The percentage of lymphocytes in IS was significantly higher in the pulmonary sarcoidosis patients compared to the control group (41.6% vs 8.9%, p<0.001). There were no significant differences in the other IS cell percentages and CD4+/CD8+ ratio between the groups. Sputum induction was well tolerated. Sputum induced by the inhalation of hypertonic saline is a safe, inexpensive, less invasive, and easily repeated method and can be a valuable alternative to other invasive methods in the diagnosis of pulmonary sarcoidosis.

Relationship between Blood and Induced Sputum Eosinophils, Bronchial Hyperresponsiveness and Reversibility of Airway Obstruction in Mild-to-Moderate Chronic Obstructive Pulmonary Disease

Blood eosinophilia has been proposed as a surrogate marker for airway eosinophilia and as a predictor of treatment response in chronic obstructive pulmonary disease (COPD). The aim of the study was to assess the relationship between blood and sputum eosinophils and to investigate the association between blood and sputum eosinophil count and clinical features of mild-to-moderate COPD. We performed a retrospective analysis of blood and sputum eosinophil count, as well as demographic and lung function data in a cohort of 90 stable, steroid-naive (Global Initiative for Chronic Obstructive Lung Disease 1 or 2) COPD patients and 20 control subjects. Blood and sputum eosinophil count did not correlate both in patients with COPD (r = –0.04 p = 0.705) and in controls (r = 0.05, p = 0.838). Sputum eosinophilia (≥3%) was present in 40% of COPD patients. The median blood eosinophil count in patients with COPD was 180 (interquartile range 90–270)/μL; patients with low blood eosinophils (<180/μL) did not differ from those with high blood eosinophils (≥180/μL) in terms of forced expiratory volume in 1 second, bronchial reversibility or hyperresponsiveness. This was also the case when COPD patients with and without sputum eosinophilia were compared. At the same time, positive bronchial reversibility and positive bronchial hyperresponsiveness were observed in 2 (11%) COPD patients with high blood eosinophils and in 1 (5%) patient with sputum eosinophilia. There was a weak, albeit significant correlation (r = 0.22 p = 0.041) between blood eosinophil count and age in patients with COPD. Peripheral eosinophil count poorly reflects sputum eosinophils and lung function in stable steroid-naive mild-to-moderate COPD patients.

A retrospective study of clinical features of cough variant asthma in Chinese adults

BackgroundClinical features of cough variant asthma (CVA) in Chinese adults are largely uncertain.MethodsA total of 303 patients newly diagnosed as uncontrolled asthma (symptom control and future risk of adverse outcomes), including 175 CVA and 128 classic asthma (CA), were enrolled in this retrospective survey. Clinical features including basic characteristics, pulmonary function, airway hyperresponsiveness (AHR) and cell counts of induced sputum, were compared retrospectively. All patients were classified into four inflammatory subtypes based on the counts of induced sputum eosinophils and neutrophils as eosinophilic (E), neutrophilic (N), mixed granulocytic (M), and paucigranulocytic (P) subtypes. Inflammatory subtype distribution was also compared.ResultsCompared with CA patients, CVA patients were younger (P = 0.009), had a higher prevalence of female patients (P = 0.001), higher parameter values of baseline pulmonary function (P ≤ 0.01 for all), shorter duration of disease (P = 0.002), lower AHR (P = 0.001) and lower sputum eosinophil% (P = 0.009). There was a difference in the AHR distribution as the percentage of moderate and severe AHR in CVA was significantly lower than in CA (41.72% VS 64.70%, P = 0.001). The inflammatory subtype distribution was different as the proportion of E and M subtypes in CVA was lower than in CA (56.0% vs 67.19%, P = 0.049). The proportion of subtype P was the lowest and subtype M was the highest in both CVA and CA patients. There was a similar negative correlation of sputum eosinophil% with AHR in CVA and CA (r = − 0.337, P < 0.0001 and r = − 0.27, P = 0.026, respectively), and a positive correlation between sputum eosinophil% and improvement rate of FEV1 after inhalation of bronchodilator (ΔFEV1%) (r = 0.33, P = 0.01).ConclusionsCVA patients showed a better pulmonary function and lower airway inflammation in contrast to CA patients, which may participate in the pathogenesis of chronic cough in CVA.

The profile of respiratory pathogens in induced sputum of elderly and non-elderly asthmatics.

IntroductionRespiratory pathogens are thought to be involved in the pathogenesis and exacerbations of asthma at all ages; however, little is known about the airway microbiome in the elderly.Aim of the studyTo identify respiratory pathogens in the induced sputum (IS) of elderly asthmatics, and to determine the association between pathogens and the markers of asthma activity.Material and methodsTwenty-nine subjects with stable asthma, 15 above 65 years of age and 14 aged 30-49 years, underwent clinical evaluation, fractional exhaled nitric oxide measurement, and sputum induction. Pathogens were detected by multiplex reverse transcription polymerase chain reaction. The periostin concentration of IS supernatants was measured by enzyme-linked immunosorbent assay. Serum eosinophil cationic protein and total IgE levels were measured by Immun^oCAP.ResultsElderly patients, as compared to non-elderly, had significantly higher eosinophilia in IS, although other markers of eosinophilic inflammation were comparable. Half of the subjects were positive for Haemophilus influenzae. Chlamydophila pneumoniae was found in two subjects. Respiratory viruses were detected in more than 70% of patients. The detection rates and profiles of atypical bacteria and respiratory viruses were similar in both groups. Only in the elderly asthmatics was influenza A positivity associated with lower predicted FVC%, RSV A positivity connected with decreased tIgE concentration, and RSV B positivity related to a lower percentage of lymphocytes in IS.ConclusionsDespite the existence of differences in some clinical and inflammatory characteristics of asthma between elderly and non-elderly asthmatics, the pathogen detection rates in the IS from the two groups are similar.

Correlation of CT small airway measurement with clinical and inflammation factors in asthma patients

Objective: To evaluate the correlation of CT small airway measurement with clinical and inflammatory factors in asthma patients. Methods: From November 2014 to December 2015, a total of 20 patients with asthma were recruited in outpatient department of Peking University Third Hospital. All underwent asthma control test (ACT), CT and pulmonary function test. Serum leptin, immunoglobulin E(IgE) and transforming growth factor-β1(TGF-β1), induced sputum eosinophil percentage(Eos%) and matrix metalloproteinase(MMP-9) results were collected.Using GE airway analysis software and adjusted by body surface area, luminal diameter(LD(adjusted)), luminal area(Ai(adjusted)), wall thickness(WT(adjusted)) and wall area%(WA%)at the end of 6th generation airway were recorded. Results: In asthma patients with smoking history, both LD(adjusted) and Ai(adjusted) were significantly lower than patients without smoking history(LD(adjutsed) (1.19±0.14)vs(1.34±0.11) mm, Ai(adjusted) (1.13±0.32) vs (1.43±0.24) mm(2,) t=-2.459, -2.267, all P<0.05); in asthma patients with induced sputum Eos%≥3%, both LD(adjusted) and Ai(adjusted) were significantly lower but WA% significantly higher than patients with induced sputum Eos%<3% (LD(adjutsed) (1.26±0.05) vs (1.44±0.09) mm, Ai(adjusted)(1.27±0.11) vs (1.66±0.17) mm(2,) WA%(83.96%±1.26%) vs (81.20%±2.26%), t=-3.935, -4.492, 2.448, all P<0.05). LD(adjutsed) and Ai(adjusted) had negative correlation with course of disease and induced sputum Eos%(LD(adjutsed) r=-0.512, -0.841, Ai(adjusted) r=-0.489, -0.841, all P<0.05), and positive correlation with FEV(1)/FVC and serum leptin(LD(adjutsed) r=0.669, 0.533, Ai(adjusted) r=0.681, 0.552, all P<0.05). Ai(adjusted) also showed positive correlation with FEV(1)%(r=0.452, P<0.05). WT(adjusted) and WA% were significantly negative correlated with FEV(1)/FVC and FEV(1)%(WT(adjusted) r=-0.621, -0.483, WA% r=-0.729, -0.548, all P<0.05). WA% also showed positive correlation with serum IgE and induced sputum MMP-9(r=0.509, 0.636, all P<0.05). CT airway indexes showed no significantly correlation with age, ACT scores and serum TGF-β1. Conclusions: CT airway indexes are found partially associated with course of disease, smoking history, serum leptin and IgE, induced sputum Eos% and MMP-9. CT airway indexes show correlation with FEV(1)/FVC and FEV(1)%.

Correlation of induced sputum eosinophil levels with clinical parameters in mild and moderate persistent asthma in children aged 7–18 years

ABSTRACTBackground: Treatment decisions in asthma are currently based on clinical assessment and spirometry. Sputum eosinophil, being a marker of airway inflammation, can serve as a tool for assessing severity and response to treatment in asthma patients. Objectives: To measure eosinophil percentage in induced sputum in children with asthma and correlate it with clinical asthma parameters. Methods: A prospective observational study was performed at tertiary care hospital on 91 children aged 7–18 years with newly diagnosed mild or moderate persistent asthma. Theinduced sputum eosinophil percentage was obtained at the time of enrollment and three months after treatment with inhaled budesonide. Patients were specifically evaluated for five clinical parameters of asthma, i.e., days of acute exacerbations, use of salbutamol as rescue medication, emergency visits, nighttime cough and days of school absence. Results: Sputum eosinophil percentage was high (3.1 ± 0.515%) at the time of enrollment which reduced significantly after three months of inhaled budesonide therapy [0.06 ± 0.164% (p < 0.0005)]. Children with moderate persistent asthma had significantly higher values of sputum eosinophil levels than children with mild persistent asthma at the time of enrollment (3.38 ± 0.64% vs. 2.99 ± 0.42%, p = 0.001) but the difference was not significant after three months of inhaled steroid therapy (0.07 ± 0.18 vs. 0.04 ± 0.12, p = 0.5104). A significant negative correlation was found between reduction in sputum eosinophil levels and improvement in FEV1 (r = −0.400, p = 0.0001). All the clinical asthma parameters also correlated significantly with the reduction in sputum eosinophil levels after three months of inhaled steroid therapy. Conclusion: Eosinophil levels in induced sputum correlate well with clinical asthma parameters and asthma severity in children. It is a simple, noninvasive and cheap method which can be used for the monitoring of asthma in a resource-limited setting.

Effectiveness of training patients using DVD in the accurate use of inhalers for the treatment of bronchial asthma

BackgroundInhalants are the standard treatment for patients with bronchial asthma. Inaccurate inhaler use leads to inadequate therapeutic effects and unnecessary dosage increases. However, it is a challenge for practitioners to master the various devices available and train patients on the accurate use of inhalers. Thus, establishing a system to instruct patients on how to accurately use inhalers is essential. We prepared a DVD and accompanying user manual explaining the operation of each inhaler device used in Japan. This pilot study aimed to examine the efficacy of these materials. MethodsThe subjects were 33 outpatients with bronchial asthma who received treatment in our facility for asthma and had already received conventional inhalant training. The oral medication and inhalants used by the patients were not changed. The patients were randomly assigned to a DVD viewing group or non-viewing group; various parameters were comparatively examined after 4 weeks. ResultsSignificant improvements in Asthma Control Test scores, inhalation technique, forced vital capacity, forced expiratory volume in 1 s, impulse oscillometry resonant frequency, and induced sputum eosinophil count were observed in the DVD viewing group at 4 weeks post training. ConclusionsPulmonary function and inflammatory parameters improved significantly in the DVD viewing group. These findings suggest that unnecessary step-up of asthma treatment can be avoided, leading to treatment cost reduction. Training patients with asthma in accurate inhaler use improves quality of life and therefore has great clinical significance. Hence, this method should be used more extensively in Japan and worldwide.