Sputum Cytology Research Articles

COMBINED DIAGNOSTICS OF LUNG CANCER USING EXHALED BREATH ANALSYSIS AND SPUTUM CYTOLOGY

In this article we summarize our own experience of lung cancer diagnostics using exhaled breath analysis with a non-selective method using metal oxide chemoresistor gas sensors with cross-sensitivity combined with the sputum cytology. Volatile organic compounds of exhaled breath change the conductivity of the sensor, the resulting pulse is displayed as a peak on the graph, the area of which is used as test results. The combination of two diagnostic techniques in 204 participants demonstrated the possibility of non-invasively detecting the disease at an early stage. The sensitivity, specificity and accuracy of the breath analysis was 91.2%, 100% and 93.4%, respectively. The combination of the breath test and the sputum cytology compared to the breath test alone showed statistically significant (p = 0.03) increase in sensitivity to 96.8% (95% CI: 80.9% -99%) with acceptable decrease in specificity to 93.4% (95% CI: 88% -96%). The convenience of analysis and realtime measurements show some promise for the early detection.

Evaluating the Use of Circulating MicroRNA Profiles for Lung Cancer Detection in Symptomatic Patients

The overall low survival rate of patients with lung cancer calls for improved detection tools to enable better treatment options and improved patient outcomes. Multivariable molecular signatures, such as blood-borne microRNA (miRNA) signatures, may have high rates of sensitivity and specificity but require additional studies with large cohorts and standardized measurements to confirm the generalizability of miRNA signatures. To investigate the use of blood-borne miRNAs as potential circulating markers for detecting lung cancer in an extended cohort of symptomatic patients and control participants. This multicenter, cohort study included patients from case-control and cohort studies (TREND and COSYCONET) with 3102 patients being enrolled by convenience sampling between March 3, 2009, and March 19, 2018. For the cohort study TREND, population sampling was performed. Clinical diagnoses were obtained for 3046 patients (606 patients with non-small cell and small cell lung cancer, 593 patients with nontumor lung diseases, 883 patients with diseases not affecting the lung, and 964 unaffected control participants). No samples were removed because of experimental issues. The collected data were analyzed between April 2018 and November 2019. Sensitivity and specificity of liquid biopsy using miRNA signatures for detection of lung cancer. A total of 3102 patients with a mean (SD) age of 61.1 (16.2) years were enrolled. Data on the sex of the participants were available for 2856 participants; 1727 (60.5%) were men. Genome-wide miRNA profiles of blood samples from 3046 individuals were evaluated by machine-learning methods. Three classification scenarios were investigated by splitting the samples equally into training and validation sets. First, a 15-miRNA signature from the training set was used to distinguish patients diagnosed with lung cancer from all other individuals in the validation set with an accuracy of 91.4% (95% CI, 91.0%-91.9%), a sensitivity of 82.8% (95% CI, 81.5%-84.1%), and a specificity of 93.5% (95% CI, 93.2%-93.8%). Second, a 14-miRNA signature from the training set was used to distinguish patients with lung cancer from patients with nontumor lung diseases in the validation set with an accuracy of 92.5% (95% CI, 92.1%-92.9%), sensitivity of 96.4% (95% CI, 95.9%-96.9%), and specificity of 88.6% (95% CI, 88.1%-89.2%). Third, a 14-miRNA signature from the training set was used to distinguish patients with early-stage lung cancer from all individuals without lung cancer in the validation set with an accuracy of 95.9% (95% CI, 95.7%-96.2%), sensitivity of 76.3% (95% CI, 74.5%-78.0%), and specificity of 97.5% (95% CI, 97.2%-97.7%). The findings of the study suggest that the identified patterns of miRNAs may be used as a component of a minimally invasive lung cancer test, complementing imaging, sputum cytology, and biopsy tests.

A Case of Peripheral Pulmonary Adenocarcinoma Detected by Sputum Cytology

A Case of Peripheral Pulmonary Adenocarcinoma Detected by Sputum Cytology

Upper and lower airway inflammation in severe asthmatics: a guide for a precision biologic treatment.

Background and aims:Severe asthma may require the prescription of one of the biologic drugs currently available, using surrogate markers of airway inflammation (serum IgE levels and allergic sensitization for anti-IgE, or blood eosinophils for anti-IL5/IL5R). Our objective: to assess upper and lower airway inflammation in severe asthmatics divided according to the eligibility criteria for one of the target biologic treatments.Methods:We selected 91 severe asthmatics, uncontrolled despite high-dose ICS-LABA, and followed for >6 months with optimization of asthma treatment. Patients underwent clinical, functional and biological assessment, including induced sputum and nasal cytology. They were then clustered according to the eligibility criteria for omalizumab or mepolizumab/benralizumab.Results:Four clusters were selected: A (eligible for omalizumab, n = 23), AB (both omalizumab and mepolizumab, n = 26), B (mepolizumab, n = 22) and C (non-eligible for both omalizumab and mepolizumab, n = 20). There was no difference among clusters for asthma control (Asthma Control Test and Asthma Control Questionnaire 7), pre-bronchodilator forced expiratory volume in 1 s, serum IgE and fractional exhaled nitric oxide levels. Sputum eosinophils were numerically higher in clusters AB and B, in agreement with the higher levels of blood eosinophils. Allergic rhinitis was more frequent in clusters A and AB, while chronic rhinosinusitis with nasal polyps prevalence increased progressively from A to C. Eosinophils in nasal cytology were higher in clusters AB, B and C.Conclusion:Eosinophilic upper and lower airway inflammation is present in the large majority of severe asthmatics, independently from the prescription criteria for the currently available biologics, and might suggest the use of anti-IL5/IL5R or anti IL4/13 also in patients without blood eosinophilia.The reviews of this paper are available via the supplemental material section.

Effect of short-term inhalation of warm saline atomised gas on patients with non-cystic fibrosis bronchiectasis.

ObjectiveSecretion clearance is advocated in non-cystic fibrosis bronchiectasis, but is often neglected in clinical treatment. The present study aimed to investigate the effect of inhaled 0.9% normal saline by ultrasonic nebuliser with warming (UNW) in stable non-cystic fibrosis bronchiectasis patients with purulent sputum.Methods27 stable patients were enrolled in a randomised crossover trial comprising 3 months of daily UNW aerosol therapy compared with 3 months of daily oral expectorant treatment. The outcomes were quality of life (assessed via the Leicester cough questionnaire (LCQ)), sputum characteristics, pulmonary function, 6-min walk distance (6MWD) and acute exacerbation frequency.ResultsCompared with baseline, the sputum viscosity, sputum colour, LCQ score and 6MWD were significantly improved with UNW (p<0.05), and the improvements in sputum colour, LCQ score, 6MWD and inspirational capacity with UNW were significantly better than those achieved via treatment with oral expectorant (p<0.05). There were no significant differences between treatments in pulmonary function, sputum cytology classification and inflammatory factors of sputum.ConclusionUNW aerosol therapy in non-cystic fibrosis bronchiectasis has small yet significant benefits. However, UNW does not improve the degree of inflammation.

Anxiety and depression in COPD patients and correlation with sputum and BAL cytology

&#x0D; &#x0D; &#x0D; Background and aims: Anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD). The degree of lung function may not explain anxiety and depression. The aim of our study was to assess the psycholog- ical aspects of COPD, to test the BODE index (a composite score of body mass, obstruction, dyspnea and exercise capac- ity), and to evaluate the association between atypical cyto- logic findings of sputum, bronchoalveolar lavage (BAL) and the pyschological components of the disease.&#x0D; Methods: COPD was classsified according to the GOLD stages based on forced expiratory volume in 1 second (FEV1) in 60 stable patients. The BODE index was calculated for grading COPD. The Hospital anxiety and depression (HAD) scale was used to appraise the anxiety and depression symptoms. Cytologic examination of sputum and BAL samples were per- formed in each patient. The cytologic findings were classified as normal, mild, moderate or severe atypia.&#x0D; Results: The overall prevalance of anxiety and depression symptoms was 41.7% and 46.7% respectively. The prevalance of these symptoms increased with increasing BODE stages and correlated well with the severity of atypical BAL cytology results (p &lt; 0.001). Dyspnea and reduced exercise capacity were the predominant mechanisms leading to anxiety and depression symptoms associated with COPD.&#x0D; Conclusions: We conclude that the BODE index is superior to GOLD stratification for explaining anxiety and depression symptoms in COPD. BAL cytologic findings, which reflect the distal parenchymal lung structure, correlated significantly with the presence of the anxiety and depression symptoms.&#x0D; &#x0D; &#x0D;

Sputum long non-coding RNA biomarkers for diagnosis of lung cancer.

Analysis of molecular changes in sputum may help diagnose lung cancer. Long non-coding RNAs (lncRNAs) play vital roles in various biological processes, and their dysregulations contribute to the development and progression of lung tumorigenesis. Herein, we determine whether aberrant lncRNAs could be used as potential sputum biomarkers for lung cancer. Using reverse transcription PCR, we measure expressions of lung cancer-associated lncRNAs in sputum of a discovery cohort of 67 lung cancer patients and 65 cancer-free smokers with benign diseases and a validation cohort of 59 lung cancer patients and 60 cancer-free smokers with benign diseases. In the discovery cohort, four of the lncRNAs displayed a significantly different level in sputum of lung cancer patients vs.cancer-free smokers with benign diseases (all P< 0.001). From the four lncRNAs, three lncRNAs (SNHG1, H19, and HOTAIR) are identified as a biomarker panel, producing 82.09% sensitivity and 89.23% specificity for diagnosis of lung cancer. Furthermore, the biomarker panel has a higher sensitivity (82.09% vs. 52.24%, P= 0.02) and a similar specificity compared with sputum cytology (89.23% vs. 90.77%, P= 0.45). In addition, the lncRNA biomarker panel had a higher sensitivity (87.50% vs. 70.07%, p= 0.03) for diagnosis of squamous cell carcinoma compared with adenocarcinoma of the lung, while maintaining the same specificity (89.23%). The potential of the sputum lncRNA biomarkers for lung cancer detection is confirmed in the validation cohort. We have for the first time shown that the analysis of lncRNAs in sputum might be a noninvasive approach for diagnosis of lung cancer.

P2.11-34 Application of Next-Generation Sequencing for Screening of Sputum Samples

Since the efficiency of CT mass-screening was reported in NEJM in 2013, many countries have been actively adopting CT screening for detection of lung cancers, especially peripheral-type lung adenocarcinoma. On the other hand, another mass-screening method, “sputum cytology”, has a very low cancer detection rate and its use has been decreasing worldwide. Nevertheless, sputum is one of the easiest types of sample to collect from patients, and sputum samples are thought to contain not only cancer cells, but also cancer cell-free DNA. The present study examined genomic abnormalities in DNA contained in sputum, and investigated the efficiency of next-generation sequencing (NGS) for detection of lung cancer or identifying patients at high risk. Using the Saccomanno method, we collected sputum samples from 15 patients (5 with squamous cell carcinoma, 5 with adenocarcinoma, and 5 with non-neoplastic conditions). A 1500 μl volume of each sample was centrifuged, and the sediment was resuspended in 180 μl of supernatant. After incubation with protease K at 56ºC for 90 min, DNA was extracted using MagLead 6GC (Precision System Science Co., Ltd., Japan). All DNA samples were subjected to NGS using Ion AmpliSeq Cancer Hotspot Panel v2 (Thermo Fisher Scientific, USA). The median age of the patients overall was 71 years (range, 56–94 years), and that of patients with squamous cell carcinomas, adenocarcinomas and non-neoplastic conditions was 66 years (64-78), 71 years (67-73) and 86 years (56-94), respectively. HRAS and p53 mutations were found only in cancer patients (HRAS 2/10, p53 4/10). There were no significant differences in mutation pattern between squamous cell carcinoma and adenocarcinoma patients. Although mutations of ALK, PIK3CA, PTEN, KRAS, FLT3, and RB1 were frequently found in samples from cancer patients (ALK 5/10, PIK3CA 5/10, PTEN 7/10, KRAS 7/10, FLT3 4/10, and RB1 8/10), such mutations were also present in non-neoplastic conditions. Mutations at the same locus in ALK, PIK3CA, PTEN and RB1 were also found in non-neoplastic conditions (ALK 1/5, PIK3CA 1/5, PTEN 2/5, and RB1 1/5). Seventeen out of 48 gene mutations were found only in non-neoplastic conditions. Detectable mutation patterns differed between cancer and non-neoplastic conditions, but were similar between squamous cell carcinoma and adenocarcinoma. Validation tests will be performed on DNA extracted from more than 400 sputum samples.

Recommendations for lung cancer screening in Southern Africa.

Lung cancer remains the leading cause of cancer-related deaths in southern Africa. Early trials of chest radiograph-based screening in males at high risk for lung cancer found no mortality benefit of a radiograph alone, or a radiograph plus sputum cytology screening strategy. Large prospective studies, including the National Lung Screening Trial, have shown an all-cause mortality benefit when low-dose computed tomography (LDCT) was used as a screening modality in patients that are at high risk of developing lung cancer. The South African Thoracic Society, based on these findings, and those from several international guidelines, recommend that annual LDCT should be offered to patients between 55-74 years of age who are current or former smokers (having quit within the preceding 15 years), with at least a 30-pack year smoking history and with no history of lung cancer. Patients should be in general good health, fit for surgery, and willing to undergo further investigations if deemed necessary. Given the high local prevalence of tuberculosis (TB) infection and post-TB lung disease, which can radiographically mimic lung cancer, a conservative threshold (nodule size ≥6 mm) should be used to determine whether the baseline LDCT screen is positive (thus nodules <6 mm require no action until the next annual screen). If a non-calcified, solid or partly solid nodule is ≥6 mm, but <10 mm with no malignant features (e.g., distinct spiculated margins), the LDCT should be repeated in 6 months. If a solid nodule or the largest component of a non-solid nodule is ≥10 or ≥6 mm and enlarging or with additional malignant features present, definitive action to exclude lung cancer is warranted. Patients should be screened annually until 15 years have elapsed from date of smoking cessation, they turn 80, become unfit for a curative operation or significant changes are observed.

Role of Sputum Cytology in ACO

Role of Sputum Cytology in ACO

Comparing frequencies of asthma-chronic obstructive pulmonary disease overlap in patients with stable chronic obstructive pulmonary disease

ContextAsthma and chronic obstructive pulmonary disease (COPD) may share some physiological features and coexist as asthma-chronic obstructive pulmonary disease overlap (ACO).The prevalence of ACO differs according to the diagnostic criteria and study design. In patients with COPD, the prevalence of ACO varies from 5 to 55%.This study aims to examine the effect of using different diagnostic criteria on the resulting frequency of ACO in patients with COPD.Settings and designThis cross-sectional observational study enrolled 60 patients with COPD randomly selected from outpatient clinics of Chest Department of Minia Cardio-Thoracic University Hospital during the period from September 2015 to September 2016.Patients and methodsHistory, clinical examination, spirometry, and sputum cytology were done.The frequency of ACO among the 60 patients with stable COPD was separately studied based on five different diagnostic criteria (Hardin’s, Menezes, combined Hardin and Menezes, Spanish consensus, and Global Initiative for Asthma-Global Initiative for Chronic Obstructive Lung Disease criteria).Statistical analysisStatistical analysis was performed using statistical package for social science software (χ2 test and independent sample t test).ResultsThe frequency of ACO in COPD was 40, 23.3, 16.7, 13.3, and 10% on applying combined Hardin and Menezes, Hardin’s alone, Menezes alone, the Spanish consensus, and Global Initiative for Asthma-Global Initiative for Chronic Obstructive Lung Disease criteria, respectively.ConclusionThe frequency of ACO in patients with COPD decreases when using more restrictive diagnostic criteria.

Advanced Pneumonic-type Lung Carcinoma: A Retrospective Study of Clinical-radiological-pathological Characteristics with Survival Analysis in A Single Chinese Hospital

背景与目的肺炎型肺癌是一种临床和影像表现特殊的肺癌。本研究旨在总结此类肺癌的临床、影像及病理学特征，诊断手段，治疗方案及预后情况。方法肺炎型肺癌定义为：肺部计算机断层扫描（computed tomography, CT）以磨玻璃或实变影为主要表现，经组织学或细胞学明确诊断的肺癌。收集2013年1月1日-2018年8月30日期间，就诊于北京协和医院呼吸与危重症医学科的晚期肺炎型肺癌病例，回顾性分析这些患者临床资料并进行生存随访。结果共纳入46例患者，均为肺腺癌。咳嗽（41/46, 89.1%）、咳痰（35/46, 76.1%）是最常见的临床表现。胸部CT常见表现为磨玻璃影（87.0%）、实变影（84.8%）、以及多发磨玻璃结节（84.8%），多发囊样变和空洞分别为40.0%和13.0%。同侧及对侧肺转移分别见于95.3%和84.8%的病例。从出现症状到明确诊断的中位时间为214天（95%CI: 129-298）。CT引导肺穿刺活检及外科肺活检的确诊率为100%，支气管镜下的支气管肺泡灌洗（BAL）联合经支气管肺活检（TBLB）的确诊率为80.9%（17/21），痰液病理学检查的确诊率为45.0%（9/20）。病理亚型，26例（26/46, 56.5%）为浸润性粘液腺癌，20例患者因缺乏足够的病理标本量而无法进一步区分亚型。38例进行了EGFR基因检测，6例（6/38, 15.8%）有突变。33例进行ALK基因检测，仅1例（1/33, 3.0%）有ALK重排。中位总生存期（overall survival, OS）为522天（95%CI: 424-619）。EGFR野生型或ALK融合基因阴性的患者，化疗明显延长中位OS（HR=0.155, P=0.002, 2），接受化疗者中位OS 547天（95%CI: 492-602），不接受化疗者中位OS 331天（95%CI: 22-919）。结论肺炎型肺癌由于其临床和影像特征与肺部感染相似而经常导致延误诊断。支气管镜下的BAL联合TBLB有相当高的确诊率。浸润性粘液腺癌为肺炎型肺癌的主要病理亚型。肺炎型肺癌EGFR突变及ALK重排发生率很低。对于无明确驱动基因的患者，应积极行化疗，延长患者生存期。

Correlation between sputum and bronchoscopy-guided cytology (bronchoalveolar lavage fluid, transbronchial needle aspiration, and bronchial brush) with bronchial biopsy in the diagnosis of pulmonary pathology

Background: Pulmonary pathologies constitute a major ailment in terms of morbidity and mortality. Recent technological advancements provide cytological analysis that accentuates accurate diagnosis, early intervention, management, and ease of clinical follow-up with improved outcomes. This study aimed to correlate the sensitivity and describe advantages and disadvantages of the various cytological means of the diagnosis of lung pathologies along with the sequential approach. Materials and Methods: This was a prospective study performed during the period of January 2013 to January 2015. Samples of sputum and bronchoscopy-mediated bronchoalveolar lavage (BAL) fluid, air-dried and alcohol-fixed smears of bronchial brushing (BB), transbronchial needle aspiration (TBNA), and formalin-fixed bronchial biopsy tissues were received, processed, and analyzed from all clinically and radiologically suspected cases of pulmonary pathologies. Results: Two hundred cases of lung lesions were included with all the four cytological sampling interventions and tissue biopsy in the present study with an age range of 21–90 years and male:female ratio of 2.45:1. There were 111 neoplastic and 89 nonneoplastic cases. The diagnostic sensitivity was maximum with BB cytology for nonneoplastic as well as neoplastic lesions. The overall diagnostic utility observed in 200 cases reveals sputum cytology as least sensitive and BB cytology as most sensitive investigation. Conclusion: Sputum cytology is used in patients who are unfit for bronchoscopy and inpatients for their routine evaluation of underlying infection. BAL enhances yield from intraluminal lesions, and TBNA enhances yield in submucosal and mediastinal lesions. The proposed protocol for cytomorphological diagnosis should be as sputum > BAL > TBNA > BB in order of ease.

A Synchronous Double Cancer of the Lung and Larynx Discovered by Sputum Cytology

A Synchronous Double Cancer of the Lung and Larynx Discovered by Sputum Cytology

Immunocytochemistry on Sputum Samples Predicts Prognosis of Lung Cancer.

Context:Despite sputum cytology being accepted as a simple and noninvasive diagnostic method for lung cancer, the clinical usefulness of sputum for evaluation of prognosis is yet to be explored. Validation of some of the markers in sputum for prognosis prediction will be highly useful for selective therapy.Aims:This study was aimed to evaluate a reliable panel of immunocytochemical markers for their significance to predict survival.Materials and Methods:We have analyzed the expression of p53, p16, galectin-3, and epidermal growth factor receptor (EGFR) proteins in sputum samples processed in a mucolytic agent/cellblock and compared the same with that of the corresponding tissue samples.Results:Overexpression of p16 and EGFR was found to have a better survival benefit, whereas positive p53 and galectin-3 expressions had shorter period of survival. Expression patterns of all these four proteins were more or less similar in smears, cellblocks of sputum, and tissue samples except for slight changes in staining intensity which was not found to be statistically significant. No significant difference was found in the association of these proteins with survival pattern between sputum and tissue samples.Conclusion:This is the first report of immunocytochemistry of a panel of markers on cells exfoliated in sputum samples which suggests that analysis of immunocytochemical markers in sputum samples can be attempted as a cost-effective and reliable predictor of prognosis and survival. Accumulation of mutated p53, overexpression of galectin-3, and lower expression of p16 and EGFR proteins were found to predict poor prognosis for lung cancer.

False Paragonimus Eggs in Sputum Cytology.

False Paragonimus Eggs in Sputum Cytology.

Sarcina in Sputum Cytology in a Patient of Pulmonary Tuberculosis.

Sarcina in Sputum Cytology in a Patient of Pulmonary Tuberculosis.

Exogenous lipoid pneumonia presented by acute eosinophilic pneumonia

Exogenous lipoid pneumonia is an uncommon medical condition resulting from aspiration or inhalation of oily material. Generally, lipoid pneumonia has nonspecific clinical and radiological presentations, and may be misdiagnosed as bacterial pneumonia or lung cancer. We describe an unusual case of exogenous lipoid pneumonia accompanied by peripheral blood and pulmonary eosino philia. A 63-year-old man was admitted with progressively worsening exertional dyspnea and productive cough for 5 days. A chest radiograph showed abnormalities in the lower lobe of the right lung, and a diagnosis of community-acquired pneumonia was made; intravenous antibiotics were administered. However, dyspnea and hypoxia gradually worsened and peripheral blood eosino philia developed. A bronchoscopy was performed and bronchoalveolar lavage fluid analysis showed markedly increased numbers of eosinophils (40%). Subsequently, a comprehensive review of history revealed that he fell asleep with camellia oil in his mouth for 2 weeks to relieve foreign body sensation of the throat. Sputum and bronchoalveolar lavage fluid cytology showed the presence of lipid-laden macrophages. He was diagnosed with lipoid pneumonia and acute eosinophilic pneumonia. Chest radiograph and symptom were rapidly improved after treatment with intravenous methylprednisolone. (Allergy Asthma Respir Dis 2019;7:57-60)

The influence of the aeropalinological factors of the aerial environment at the southern coast of the Crimea on the results of the spa and health resort-based treatment of the patients presenting with bronchial asthma

The clinical course of bronchial asthma (BA) largely depends on the environmental conditions. One of the biological factors of the environmental pollution is the plant pollen. The presence of plant pollen in the air exerts the negative influence on the human health via specific (allergenic) and non-specific effects. The objective of the present study was to evaluate the influence of the aeropalinological factors of the aerial environment of the Southern Coast of the Crimea (SCC) on the results of the spa and health resort-based treatment (SRT) of the patients with bronchial asthma (BA). The study involved 168 patients presenting with BA including 119 (70.83%) women and 49 (29.17%) men; all of them were residents of the Crimea who underwent SRT while staying at the SCC during the period from 2011 to 2013. The average age of the patients was 52.94±11.78 years. The examination of all the patients included a questionnaire survey, general medical inspection, physical examination, complete blood cell count, analysis of sputum cytology, external respiration function testing, and the assessment of the disease control with the use of the Asthma Control Test (ACT) and the Asthma Control Questionnaire (ACQ). The duration of treatment was 21 days. The drug treatment of all the patients was carried out in accordance with the generally recognized protocols for the management of asthma. Four groups of patients were formed depending on the periods of plant dusting at the Southern Coast of the Crimea, viz. cypress (n=51), pine (n=24), ragweed (n=29), and cedar (n=47); in addition, one more group of patients was distinguished who resided at SCC outside the periods of these plants dusting (n=17). After the completion of the spa and health resort-based treatment, the highest frequency of the absence of cough (62.5%) and dry rales in the lungs (87.5%) was revealed in the patients treated during the pine dusting period (the cough and dry rales in lungs were absent in 31.0-49.0% and 55.3-79.3% of the cases respectively during the dusting seasons of other plants of interest). The aeropalinological factors were shown to have no significant influence on the values of the parameters obtained with the use of the general blood tests and the analysis of sputum cytology. The best characteristics of the external respiration function were documented in the patients who had been treated during the pine dusting period. At the end of the SRT, no significant differences were found as regards the results of the ACQ and AST tests between the patients of the groups being compared. Nor was there a significant dependence of the dynamics of the clinical, laboratory, and functional indicators achieved as a result of SRT on the magnitude of the aeropalinological factors at the Southern Coast of the Crimea. The worst immediate effectiveness of SRT was inherent in the patients suffering from bronchial asthma who had been treated during dusting of the ragweed. Certain results of the spa and health resort-based treatment of the patients presenting with BA under conditions of the Southern Coast of the Crimea depend on the character and composition of the aeropalynologic factors in this region. Specifically, the treatment based at a health resort facility during the dusting period of the pine leads to the achievement of the best clinical and functional status of the patients in comparison with those treated during the cypress, ragweed, and cedar dusting periods, or in the absence of dusting of these plants. The worst immediate effectiveness of SRT was documented in the BA patients who had been treated during the ragweed dusting period.

Efficacy of antiinflammatory therapy in patients with severe asthma and cold air-provoked bronchial hyperresponsiveness

The aim of this study was to assess effects of antiinflammatory therapy with leukotriene receptor antagonists (LTA) and/or combination of an inhaled corticosteroid (ICS) and a long-acting β2-agonist (LABA) on the clinical course and airway inflammatory patterns in patients with severe asthma and cold air-provoked bronchial hyperresponsiveness. Methods. Asthma symptoms, lung function, and spontaneous sputum cytology were assessed at baseline and after 24 weeks of the therapy. Subgroup analysis was performed for patients with sputum eosinophils &lt; 61% and sputum neutrophils &lt; 61%. Eosinophilic patients were treated with fluticasone propionate/salmeterol, neutrophilic patients with treated with fluticasone propionate/salmeterol plus montelukast during 24 weeks. The control of the disease was assessed using Asthma Control Test (ACT). Results. After 24-wk treatment, eosinophilic patients improves asthma control from 10.9 ± 0.5 to 19.6 ± 1.3 according to ACT questionnaire (р &lt; 0.001), FEV1 improved from 45.9 ± 3.7% pred. to 79.2 ± 2.2% pred. (р &lt; 0.001). Sputum eosinophil number decreased from 27.9 ± 2.1% to 7.1 ± 1.9% (р &lt; 0.001); sputum neutrophil number decreased from 21.1 ± 2.1% to 8.7 ± 2.3% (р &lt; 0.001). In neutrophilic patients, ACT score improved from 8.9 ± 0.6 to 15.9 ± 1.2 (р &lt; 0.001), FEV1 improved from 42.9 ± 2.6% pred. to 72.3 ± 2.5% pred. (р &lt; 0.001). Sputum neutrophil number decreased from 76.8 ± 3.7 to 52.2 ± 4.3 % (р &lt; 0.001); Sputum eosinophil number decreased from 8.1 ± 0.7% to 6.2 ± 0.4% (р &lt; 0.05). After 24 weeks of the treatment, partial control of asthma (ACT 20 -24) was achieved in 63% and 29% of patients in eosinophilic and neutrophilic groups, respectively (χ2 = 1.81; р &gt; 0.05) after treatment. Conclusion. Adding montelukast to the combined therapy with fluticasone propionate/salmeterol in patients with severe asthma, cold air-provoked bronchial hyperresponsiveness and increased sputum neutrophils did not resulted in better control of the disease. The analysis of airway inflammatory pattern could be used as an additional marker to predict treatment efficiency.