Poor asthma control is associated with increased airway neutrophils. Leukotriene B4 (LTB4) is a potent neutrophil chemoattractant. We examined the levels of LTB4 levels in the sputum of asthma patients and the relationship with disease severity.47 asthma patients (categorised according to Global Initiative for Asthma treatment stage) and 12 healthy controls provided sputum samples that were processed first with PBS to obtain supernatants and secondly with dithiothreitol (DTT) to obtain supernatants. LTB4 levels were determined by ELISA.LTB4 levels were significantly higher in step 1 (steroid naïve) and step 3 (inhaled corticosteroid (ICS) plus long acting β-agonist) patients than step 2 patients (ICS alone) (p=0.02 and p=0.01, respectively). There was very good correlation when comparing PBS processed to DTT processed supernatants.High LTB4 levels were found in the sputum of asthmatics at step 3 despite ICS use.

Sputum neutrophil percentage has good reproducibility in patients with moderate to severe asthma.

Raised sputum neutrophils in LOA are not an indicator of severe disease and could be a characteristic feature of this asthma phenotype. Duration of asthma influences lung function.

Discussion US-FNAC is well tolerated and can be safely performed opportunistically by respiratory physicians during outpatient visits. The diagnostic yield is high and comparable with previous published series. Its incorporation into the lung cancer pathway can facilitate prompt diagnosis and staging without more invasive investigations. Introduction and Objectives The recognition of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as an important diagnostic modality has been increasing in recent years, particularly following establishment of its use in lung cancer. Mediastinoscopy is considered as the gold-standard investigation for isolated mediastinal lymphadenopathy (IML), despite the invasiveness of the procedure and need for general anaesthesia.We present a retrospective clinical data in a large tertiary centre for respiratory medicine to evaluate to the role of EBUS-TBNA in establishing a diagnosis of IML and therefore avoiding more invasive techniques such as mediastinoscopy. Methods Retrospective analysis identified 249 patients undergoing EBUS-TBNA between August 2009 and July 2013, of whom 72 were found to have IML. All patients had CT or PET-CT prior to undergoing EBUS-TBNA. In patients where EBUS-TBNA failed to produce diagnosis, they received clinical and radiological follow up for upto 6 to 12 months or were considered for mediastinoscopy as per clinical needs. Results Of the 72 patients, 50 were male and 22 were female. For all patients, histological diagnosis was unknown prior to EBUS-TBNA. Confirmed pathological diagnosis was gained in total of 27 patients including 17 cases of sarcoidosis, 8 cases of malignancies, 1 case of tuberculosis and 1 case of ectopic thyroid tissue. Of the 8 confirmed malignancies 2 were adenocarcinoma, 2 were non-small cell carcinoma,1 was squamous cell carcinoma,1 was metastatic prostate carcinoma,1 was metastatic breast carcinoma and 1 was Chronic Lymphoid Lukaemia (CLL). No diagnosis was achieved in 40 patients while sample was insufficient in 3 cases and 2 were false negative (bronchoalveolar carcinoma and sarcoidosis). In all 72 patients, no significant complications were reported. Of the 40 undiagnosed cases, 29 patients were followed up clinically and radiologically and discharged as appropriate while remaining 11 are still under follow up. No patient has been referred for mediastinoscopy. Conclusions Already established as a safe and minimally-invasive diagnostic technique in pulmonary medicine, EBUS-TBNA provides an alternative for diagnosis of patients presenting with IML. The increasingly successful use of EBUS-TBNA in place of mediastinoscopy and CT-guided biopsy undoubtedly merits further attention in the consideration of investigation of mediastinal lymphadenopathy. M15 NEBULISED BRONCHODILATORS PRE-BRONCHOSCOPY IN PATIENTS WITH OBSTRUCTIVE LUNG DISEASE: DOES IT HELP?V Gupta, N Jackson, M Rossall, U Kolsum, R Budd, T Southworth, D Singh; University of Manchester, Manchester, UK 10.1136/thoraxjnl-2013 Background Patients with...

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