There was moderate agreement between both Fe(NO) and sputum eosinophils and BAL eosinophils. There was good NPV, but only poor PPV for these markers for mucosal eosinophilia.
Evidence-based techniques have been increasingly used in the creation of clinical
guidelines and the development of recommendations for medical practice. The use
of levels of evidence allows the reader to identify the quality of scientific
information that supports the recommendations made by experts. The objective of
this review was to address current concepts related to the clinical impact,
diagnosis, and treatment of Pseudomonas aeruginosa infections
in patients with cystic fibrosis. For the preparation of this review, the
authors defined a group of questions that would be answered in accordance with
the principles of PICO–an acronym based on questions regarding the Patients of
interest, Intervention being studied, Comparison of the intervention, and
Outcome of interest. For each question, a structured review of the literature
was performed using the Medline database in order to identify the studies with
the methodological design most appropriate to answering the question. The
questions were designed so that each of the authors could write a response. A
first draft was prepared and discussed by the group. Recommendations were then
made on the basis of the level of scientific evidence, in accordance with the
classification system devised by the Oxford Centre for Evidence-Based Medicine,
as well as the level of agreement among the members of the group.
Chronic cough is a common complaint in children and its relationship with asthma is controversial. The aim of the present study was to determine the pattern of airway inflammation in atopic and nonatopic children with chronic cough, and to investigate whether atopy is a predictive factor for eosinophilic inflammation in cough. Bronchoalveolar lavage (BAL; three aliquots of 1 ml/kg saline) was performed in the right middle lobe of 24 (11 atopic and 13 nonatopic) children with persistent cough (8 females, 16 males), mean age 4.7 years (range: 1-11). Atopy was defined as an elevated total serum IgE or a positive RAST test. Both atopic and nonatopic children with persistent cough had an increase in total cells/ml in BAL (atopic: median 39 x 10(4), range: 20-123; nonatopic: median 22 x 10(4), range: 17-132) compared to nonatopic controls (median 11 x 10(4), range 9-30). The increases were mainly in neutrophils (atopic: median 17%, range 2.5-88.5%; nonatopic: median 6%, range 1.0-55.0%) compared to controls (median 1.55%, range 0.5-7.0%; atopics vs. controls, P < 0.005). There were no significant increases in eosinophils, lymphocytes, epithelial cells, or mast cells. Eosinophils were elevated in only 5/11 atopic and none of the nonatopic children. The increased percentage of neutrophils in the BAL fluid of atopic and nonatopic children with persistent cough could be due to an underlying inflammatory process driving the cough, or even conceivably, due to the effect of coughing itself. In this highly selected series, the absence of eosinophilic inflammation in the majority suggests that most would be predicted not to respond to inhaled corticosteroid therapy. This study underscores the need to be cautious about treating coughing children with inhaled corticosteroids, even in the context of a tertiary referral practice.
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