Can bronchial asthma be classified based on the immunological status?

Determination of sputum eosinophil count and serum absolute eosinophil count in patients with bronchial asthma and its correlation with disease severity and response to treatment

Background

Sputum eosinophils can be used to assess severity of disease and response to treatment in bronchial asthma. Eosinophilic inflammation in the airways can also be marked by blood eosinophilia. In this study, we tried to determine the sputum eosinophil count and serum absolute eosinophil count in patients with asthma and correlate them with disease severity and treatment response.

Materials and Methods

It was a cross-sectional intervention study including all consecutive cases with a diagnosis of bronchial asthma based on spirometry and clinical history. An induced sputum sample and blood were sent for eosinophil count to the laboratory. All the patients were started on inhaled corticosteroids and followed up at the end of 1 month with spirometry, sputum eosinophil count and AEC. Statistical Package for the Social Sciences for Windows v20.0 (IBM SPSS Corp.; Armonk, NY, USA) was used for statistical analysis.

Results

There was no significant difference in the mean sputum eosinophil count (%) in mild, moderate and severe disease (f = 0.24; P = 0.79) or in AEC (f = 1.48; P = 0.24). At follow-up, all patients with moderate and severe disease showed significant improvement in FEV1 (P = 0.0001). The mean sputum eosinophil count and AEC (%) in the three subgroups was also seen to decrease at the end of the follow-up period (f = 0.08; P = 0.9 and f = 2.75; P = 0.07, respectively).

Conclusion

Sputum eosinophils and AEC are important markers of airway inflammation. All our patients showed improvement in FEV1, sputum eosinophil count and AEC after 1 month of treatment thus confirming the role of ICS in the treatment of eosinophilic asthma.

Examining changes in vascular function, arterial stiffness and systemic inflammation during hospitalization and recovery from an acute exacerbation of chronic obstructive pulmonary disease

An acute exacerbation of COPD (AECOPD) is associated with increased risk of cardiovascular (CV) events. The elevated risk during an AECOPD may be related to changes in vascular function, arterial stiffness, and systemic inflammation; the time course of these measures and their corresponding recovery are poorly understood. Further, physical activity is reduced during an AECOPD, and physical activity may influence the cardiovascular responses to an AECOPD. The purpose of the study was to examine the acute impact of an AECOPD requiring hospitalization on vascular function, arterial stiffness, and systemic inflammation and examine whether physical activity modulates these variables during recovery. Patients hospitalized for an AECOPD were prospectively recruited and compared to control patients with stable COPD. Vascular function, arterial stiffness, and systemic inflammation (CRP, IL-6) were measured at hospital admission, hospital discharge and within 14 days of discharge. Physical activity was electronically tracked daily while in hospital and for 7 days following discharge using a Fitbit. One hundred and twenty-one patients with an AECOPD requiring hospitalization and 33 control patients with stable COPD were enrolled in the study. Vascular function was significantly lower, and systemic inflammation higher at hospital admission in patients with an AECOPD compared to stable COPD. Significant improvements in vascular function and inflammation were observed within 14 days of hospital discharge; however, vascular function remained lower than stable COPD. Physical activity was low at admission and increased following discharge; however, physical activity was unrelated to measures of vascular function or inflammation at any time point. An AECOPD requiring hospitalization is associated with impaired vascular function that persists during recovery. These findings provide a mechanistic link to help explain the enduring increase in CV risk and mortality following a severe AECOPD event.Clinical trial registration: ClinicalTrials.gov #NCT01949727; Registered: 09/20/2013.

Immunological Factors Associated with Adult Asthma in the Aseer Region, Southwestern Saudi Arabia

Background: The prevalence of asthma is on the rise in Saudi Arabia. Data regarding the immunological profile of asthma in adults in the Aseer region, in southwestern Saudi Arabia, have not been well studied. Objectives: Our aim was to study the immunological factors associated with sensitization to asthma among adults in the Aseer region. Methods: A cross-sectional study with a nested case control design in a 1:1 ratio was conducted on a sample of adults attending primary health care centers in the Aseer region. The study used a validated Arabic version of the International study of asthma and allergies in childhood (ISAAC) questionnaire. The presence of wheezing in the past 12 months was used as a proxy for bronchial asthma. Matched age and sex controls were selected. Both groups were tested for complete blood count (CBC), total and differential white blood cell (WBC) count including eosinophils, total immunoglobulin E (IgE) measurement, allergen-specific immunoglobulin E (IgE), and cytokine levels. Results: The present study included 110 cases and 157 age- and sex-matched controls. Rye wheat was found to be a significant outdoor sensitizing agent ((odds ratio) OR = 5.23, 95% CI: 1.06–25.69). Indoors, house dust mites Dermatophagoides petronyssinus (OR = 2.04, 95% CI: 1.04–3.99) and Dermatophagoides farinae (OR = 2.50, 95% CI: 1.09–5.75) were significant. Higher total IgE (OR = 1.84, 95% CI: 1.10–3.06) and eosinophil levels (OR = 2.85, 95% CI: 1.14–7.15) were significantly associated with adult bronchial asthma in Aseer. On the other hand, the role of cytokines was not significant. Conclusions: In the present study, certain environmental agents were found to be important with regards to sensitization to bronchial asthma in adults. Knowledge about these sensitization agents should be disseminated to health providers and treating physicians in order to enhance preventive environmental control measures and asthma management. Asthma-treating physicians in the region should be alerted to the use of targeted biological therapies in selected asthmatics with difficult-to-control courses.