Simplified detection of eosinophils in induced sputum

Asthma control and sputum eosinophils in adult patients: a cross-sectional study in southern Brazil

Asthma control and health related quality of life are an important goal of asthma management, but their association with sputum eosinophilic inflammation has been less firmly established. To investigate the relationship of asthma control and quality of life with sputum eosinophils in clinical practice. Cross-sectional study with a convenience sample, including patients with asthma, aged between 18 and 65 years, attending to outpatient clinic. Patients underwent sputum induction, pulmonary function tests, Juniper's Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Test (ACT), Global Initiative for Asthma (GINA) criteria for evaluation of asthma control and severity of the disease, blood count analysis, serum IgE and cutaneous prick test. Sputum sample was considered as eosinophilic if the percentage of eosinophils was ≥ 3%. A total of 45 individuals were enrolled, 15 with eosinophilic sputum (≥ 3% eosinophil cells) and 30 with non-eosinophilic sputum (< 3% eosinophil cells). There were no association of ACT an AQLQ scores with sputum eosinophilia (p > 0.05). This study suggested that the finding of sputum eosinophilia was not related to asthma control neither with health-related quality of life in patients with severe asthma.

Montelukast Improves Symptoms and Lung Function in Asthmatic Women Compared With Men

Purpose: Gender differences exist in the prevalence of asthma and allergic diseases, partially due to the effects of sex hormones on the development of allergic manifestations. Women, compared with men, are more prone to suffer allergic asthma, experience difficulties in controlling asthma symptoms, and show adverse responses to drugs. However, there are knowledge gaps on the effectiveness of anti-leukotrienes drugs on lung function, symptoms, and pulmonary and systemic inflammation in adult asthmatic women compared with men. We conducted a prospective cohort study to characterize the effectiveness of an anti-leukotrienes drug, montelukast (MS), in asthmatic adult women and men.

Methods: Twenty-one asthmatic subjects (11 women and 10 men), who were on low-dose inhaled corticosteroids (ICS), were treated with MS. The optimal control of the symptoms was achieved in both groups according to the Global Initiative for Asthma guidelines. At enrollment, and after 13 weeks from the beginning of MS, pulmonary function tests and asthma control tests were performed, and the fraction of exhaled nitric oxide and blood eosinophils levels were measured.

Results: From baseline until the end of the study, women treated with MS + ICS had better control of the asthmatic symptoms, defined as higher asthma control test (ACT) score (17.00 ± 1.07 to 23.36 ± 0.45; p < 0.0015), improved pulmonary function [with higher forced expiratory volume in 1 s (from 77.25 ± 6.79 to 103.88 ± 6.24; p < 0.0077)], and forced vital capacity (from 91.95 ± 6.81 to 113.17 ± 4.79; p < 0.0183) compared with men. Interestingly, MS + ICS-treated women had significantly lower levels of blood eosinophils (from 5.27 ± 0.30 to 3.30 ± 0.31; p < 0.0449) and exhaled nitric oxide (from 44.70 ± 7.30 to 25.20 ± 3.90; p < 0.0294) compared with men.

Conclusion: The treatment with MS, added to ICS, in women leads to better control of symptoms, better management of lung function, and decreased inflammation levels compared with ICS + MS treatment in men.

Factors Contributing Towards Poor Asthma Control in Patients on Regular Medication

INTRODUCTION

In-spite of the availability of effective medications, it is observed that patients with bronchial asthma on treatment are poorly controlled. An objective evaluation of asthma control especially with respect to inflammation and the factors contributing towards poor control is crucial in obtaining relief of symptoms.

AIM

1) To measure the asthma control using modified Mini Asthma Quality Of Life Questionnaire (MAQOL) and sputum eosinophil count; 2) To identify the role of factors viz. age, duration of asthma, severity, compliance, technique of inhalation and knowledge of asthma action plan on asthma control.

MATERIALS AND METHODS

Total 50 asthmatic patients on regular medication were included in the study after obtaining written informed consent. The asthma-control was evaluated based on history, clinical symptoms, need for short-acting bronchodilators, FEVs1 and sputum eosinophil count with the help of modified MAQOL. A global score of <80% was considered as poor control. The proportion of patients under each factor, in poorly-controlled group (PC) was compared with the well-controlled group (WC). The results were analysed using descriptive statistics and unpaired student's t-test.

RESULTS

Of the total, 33 (66%) patients were in PC category with a mean global asthma score of 58.46 ± 2.881 vs 85.2 ± 1.19 in the WC group (34%) (p<0.05). The mean age in PC was 41.41 ± 2.413 vs 29.00 ± 2.157(p<0.05) in the WC. The mean duration of asthma was 16.76 ± 2.761 in PC vs 7.882 ± 2.065 years in WC (p<0.05). The severity score was 7.265 ± 0.4434 in PC vs 6.706 ± 0.64 in WC. Eight patients in PC and six in WC were unaware of the treatment plan. One in PC group and three in WC were unaware of technique of inhalation. One in PC group and three in WC were non-compliant. Mean sputum eosinophil count was 7.441 ± 1.081 in PC vs 5.176 ± 1.201 in WC.

CONCLUSION

MAQOL is useful in evaluating asthma-control. Sputum eosinophil count correlates with asthma-control. Duration of asthma, age and severity contributed significantly to the poor control of asthma. There is a need for an objective monitoring in asthma and the treatment strategies need to be modified accordingly.

Asthma-predictive-index, bronchial-challenge, sputum eosinophils in acutely wheezing preschoolers

BACKGROUND

Most preschoolers with viral wheezing exacerbations are not atopic.

AIM

To test in a prospective controlled trial whether wheezing preschoolers presenting to the ED are different from the above in three different domains defining asthma: the atopic characteristics based on stringent asthma predictive index (S-API), the characteristics of bronchial hyper-responsiveness (BHR), and airway inflammation.

METHODS

The S-API was prospectively collected in 41 preschoolers (age 31.9 ± 17.4 months, range; 1-6 years) presenting to the ED with acute wheezing and compared to healthy preschoolers (n = 109) from our community (community control group). Thirty out of the 41 recruited preschoolers performed two sets of bronchial challenge tests (BCT)-(methacholine and adenosine) within 3 weeks and following 3 months of the acute event and compared to 30 consecutive ambulatory preschoolers, who performed BCT for diagnostic workup in our laboratory (ambulatory control group). On presentation, induced sputum (IS) was obtained from 22 of the 41 children.

OUTCOMES

Primary: S-API, secondary: BCTs characteristics and percent eosinophils in IS.

RESULTS

Significantly more wheezing preschoolers were S-API positive compared with the community control group: 20/41 (48.7%) versus 15/109 (13.7%, P < 0.001). All methacholine-BCTs-30/30 (100%) were positive compared with 13/14 (92.8%) in the ambulatory control group (P = 0.32). However, 23/27 (85.2%) were adenosine-BCT positive versus 3/17 (17.5%) in the ambulatory control group (P < 0.001). Diagnostic IS success rate was 18/22 (81.8%). Unexpectedly, 9/18 (50.0%) showed eosinophilia in the IS.

CONCLUSIONS

Wheezing preschoolers presenting to the ED is a unique population with significantly higher rate of positive S-API and adenosine-BCT compared with controls and frequently (50%) express eosinophilic airway inflammation.

Reference ranges for induced sputum eosinophil counts in Korean adult population

Background

Induced sputum analyses are widely utilized to evaluate airway inflammation in asthmatics. However, the values have not been examined in Korean adults.

Objective

The purpose of this study is to determine reference ranges for induced sputum eosinophils and their influencing factors in Korean adults.

Methods

A total of 208 healthy nonasthmatic adults were recruited. Sputum induction and processing followed the international standard protocols.

Results

Adequate sputum samples were successfully collected from 81 subjects (38.9%). The upper 90 percentile for sputum eosinophil was calculated as 3.5%. The median value of eosinophil count percentage was significantly higher in subjects with atopy than those without atopy (median, 1.6%; range, 0-11.0% vs. median, 0%; range 0-3.6%, p=0.030). However, no significant correlations were found with age, gender, body mass index, smoking status, blood eosinophil, or fractional exhaled nitric oxide levels.

Conclusion

Current study was the first attempt to determine the reference ranges of induced sputum eosinophils in Korean adults. The cutoff value for sputum eosinophilia was 3.5%, and was significantly associated with atopy.