Patterns of inflammation and the use of reversibility testing in smokers with airway complaints

Assessment of asthma and chronic obstructive pulmonary disorder in relation to reversibility, IgE, eosinophil, and neutrophil count in a University Teaching Hospital in South Delhi, India

Objectives:

The physiological and clinical similarities between asthma and chronic obstructive pulmonary disorder (COPD) make their differentiation difficult. In the present study, we compared reversibility to bronchodilator, immunoglobulin E (IgE), blood eosinophil and neutrophil levels among asthma and COPD patients to differentiate these diseases.

Materials and Methods:

The study was carried on 20 asthmatics and 29 patients of COPD that reported to the outpatient and inpatient department in University Teaching Hospital, Jamia Hamdard, New Delhi, India. The parameters evaluated included pulmonary function (FEV₁, FVC, and FEV₁/FVC), IgE levels, and eosinophil and neutrophil count.

Results:

It was observed that reversibility was significantly higher in asthmatic patients, while irreversibility predominates in COPD patients. There was no significant difference in pre- and post-FEV₁ and pre- and post-FVC and in their percentage predicted. However the percentage change in FEV₁ significantly varies in asthma and COPD patients. No significant changes in neutrophil and eosinophil levels were observed in these patients. The serum IgE levels were found significantly higher in asthmatic patients.

Conclusions:

We conclude that reversibility in FEV₁ levels or percentage change in FEV₁ and serum IgE levels are promising lab parameter to distinguish these two conditions. However, further research is required to fully understand the role of neutrophil and eosinophil in the onset and development of asthma and COPD.

Targeted treatment in COPD: a multi-system approach for a multi-system disease

Chronic obstructive pulmonary disease is a varied condition when examined from a number of different perspectives including factors which influence disease development, pathological process and clinical features. There may be a complex interaction between the degree by which each of these processes influences the development of COPD and the subsequent clinical phenotype with which the patient presents. The varied host response and subsequent clinical phenotype has generated much interest in recent years. It is possible that failure of treatment to impact on mortality and reverse the disease process is because of the heterogeneous nature of the condition. Identification and targeted treatment of clinical and pathological phenotypes within the broad spectrum of COPD may therefore improve outcome. This article will review previous work which has attempted to phenotype COPD and identify if specific treatment for these phenotypes has been shown to be of benefit. It will examine the work on pathological processes and clinical manifestations, both pulmonary and systemic, and will focus on pharmacological therapies.