Background-Inflammatory changes in the airways in chronic obstructive pulmonary disease (COPD) are largely attributed to smoking, yet they may be present even if patients do not currently smoke. The diVerences in inflammatory cells and the factors contributing to these diVerences were examined in the airways of patients with COPD who do not currently smoke. Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease clinically characterised by shortness of breath, cough, mucus production, and/or wheezing. 1 Inflammatory changes in both airways and lung parenchyma may contribute to the presence of symptoms. Methods-Eighteen2 3 Airway inflammation is often present in COPD and has received considerable attention in recent years by studies on the relation between these inflammatory changes and the pathophysiology of COPD. [4][5][6][7] In bronchial biopsy specimens the inflammatory changes in the mucosa in COPD have been recognised to constitute increased numbers of macrophages and activated, predominantly CD8+, T cells. 5 8-10 Eosinophil numbers are increased during exacerbations and possibly also during a stable phase of the disease in a subset of patients.4 11 Mast cell numbers are not increased in the mucosa 2 yet increased numbers of mast cells have been found in bronchial glands of patients with chronic bronchitis. 12In bronchoalveolar lavage (BAL) fluid macrophages are mainly found, followed by increased neutrophil and eosinophil numbers. 4 In induced sputum neutrophils predominate, 13 and eosinophil numbers and the concentration of eosinophilic cationic protein (ECP) may also be increased.14 15 Neutrophils and activated eosinophils are attracted to the airway lumen by several chemotactic cytokines such as interleukin 8 (IL-8) which can be produced by various cells including epithelial cells and neutrophils. 16 It is well known that considerable overlap exists between subjects with COPD and healthy subjects with regard to diVerences in cell numbers and mediators in biopsy specimens, sputum, and BAL fluid.4 5 8 9 However, it has not yet been established which factors in COPD contribute to the occurrence of inflammatory cell numbers and mediator values that are out of the ranges observed in healthy individuals. The knowledge of these factors may contribute to our further understanding of the pathophysiology of COPD.In the current study we assessed the diVerences in inflammatory parameters between subjects with COPD and healthy individuals. We then focused on these factors and investigated the diVerences in clinical and inflammatory parameters between patients with COPD in whom these factors were out of the range of healthy individuals and compared

It is unclear how cellular and soluble inflammatory markers in induced sputum relate to markers in lavage fluid and biopsies in chronic obstructive pulmonary disease (COPD). This was investigated and also the possible differences between subjects with COPD and healthy controls assessed.Eighteen nonatopic subjects with COPD and 11 healthy controls were studied. Sputum was induced by inhalation of hypertonic saline. The airways were lavaged, using the first 50 mL for bronchial wash (BW) and the subsequent 150 mL for bronchoalveolar lavage (BAL), and biopsies were taken from subsegmental carinae.Neutrophils were the predominant cell type in sputum in COPD (median 77.3%) but not in BW (5.5%) and BAL fluid (1.7%). Differential cell counts in sputum did not correlate with the counts in BW or BAL fluid or biopsies, whereas sputum eosinophil cationic protein (ECP) levels correlated with BW fluid ECP levels (r=0.66, p=0.007) and sputum interleukin-8 (IL-8) concentration with BAL fluid IL-8 concentration (r= 0.52, p=0.026). Subjects with COPD had a higher percentage of sputum neutrophils and eosinophils and higher concentrations of ECP and IL-8 than healthy controls. The higher percentages of eosinophils and concentrations of ECP were also seen in BW and BAL fluid. Finally, higher numbers of macrophages and eosinophils were found in biopsies.In conclusion, induced sputum is derived from a different compartment from BW and BAL fluid and biopsies. Induced sputum may be useful for studying the contribution of luminal neutrophils and eosinophils in chronic obstructive pulmonary disease. Eur Respir J 2000; 15: 109±115.

Background-Nitric oxide (NO) is involved in inflammation and host defence of the lung. It has been found in increased concentrations in the airways in asthmatic subjects but its levels in patients with chronic obstructive pulmonary disease (COPD) have not been investigated. A study was undertaken to determine whether markers of NO metabolism (NO in exhaled air, iNOS expression in sputum cells, and nitrite + nitrate (NO 2 -/NO 3 -) in sputum supernatant) are increased in subjects with COPD, and whether they correlate with inflammatory indices in induced sputum. The associations of these markers with smoking were also assessed. Methods-Sixteen subjects with COPD (median age 66 years, median forced expiratory volume in one second (FEV 1 ) 63% predicted, eight current smokers) and 16 healthy subjects (median age 63 years, median FEV 1 113% predicted, eight current smokers) participated in the study. NO was measured during tidal breathing and sputum was induced by inhalation of hypertonic saline. Results-No

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Nitric oxide (NO) can be measured in exhaled air with the single-breath (SB) and tidal-breathing (TB) methods. To allow comparison between different laboratories, a European Respiratory Society task force recently reported guidelines for standardization of both methods. To facilitate comparison between laboratories further, this study investigated whether there is a difference between NO values measured with SB and TB methods in subjects with asthma or chronic obstructive pulmonary disease (COPD), and in healthy subjects. Moreover, the differences between groups were studied and the influence of smoking in asthma was assessed. Sixteen atopic nonsmoking asthmatics, 16 atopic currently smoking asthmatics, 16 nonatopic nonsmoking healthy controls, 16 nonatopic exsmokers with COPD and 16 nonatopic exsmoking healthy controls were studied. NO concentrations differed substantially between both methods. Mean NO concentrations were higher with the SB than with the TB method in nonsmoking and in smoking asthmatics and especially so with the higher NO values. Furthermore, NO values with both methods were higher in nonsmoking asthmatics than in nonsmoking healthy subjects. NO was not significantly different between exsmokers with COPD and healthy exsmokers. In conclusion nitric oxide values of the single-breath and tidal-breathing methods are not interchangeable. Both methods can be used to measure differences between groups.