Detection of Eosinophils in Hypertonic Saline-Induced Sputum in Patients with Chronic Nonproductive Cough

Fujimura, Masaki; Songur, Nejla; Kamio, Yumie; Matsuda, Tamotsu

doi:10.3109/02770909709075656

Cited by 47 publications

(72 citation statements)

References 17 publications

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“…The majority of studies in adults suggest that eosinophilic airway inflammation is a feature of chronic cough. FUJIMURA et al [20] found high rates of sputum eosinophilia suggesting that their group of adults with chronic cough may have been asthmatic [20]. NIIMI et al [21] found that percentages of eosinophils and ECP in the cough group were similar to that of confirmed asthmatics and significantly higher than controls.…”

Section: Normalmentioning

confidence: 98%

Chronic cough in children: bronchoalveolar lavage findings

Fitch¹,

Brown²,

Schock³

et al. 2000

Eur Respir J

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Isolated chronic cough in childhood is a common complaint. Although the symptom cough is included in the definition of childhood asthma, there is debate as to whether the majority of these children have asthma. The authors studied children with isolated chronic cough looking for evidence of airway inflammation typical of asthma, with increased numbers of airway eosinophils as assessed from bronchoalveolar lavage (BAL).The investigations were carried out on 23 children (median age: 6.7 yrs; (range: 1.7±12.75 yrs), attending the Royal Belfast Hospital for Sick Children for elective surgery, who also had a chronic unexplained cough. Written informed consent was obtained from the parent(s) and a nonbronchoscopic BAL was performed. BAL samples were analysed for total and differential white cell counts and also for the inflammatory mediators, eosinophil cationic protein (ECP) and histamine. Results were compared with a group of normal nonatopic children and also a group of atopic asthmatic children, who had been recruited for other studies on airway inflammation.There was a small but statistically significant increase in BAL percentage eosinophils in the children with chronic cough compared with nonasthmatic controls (0.28% versus 0.10%, p=0.03). However, the children with cough had lower percentage eosinophils than the atopic asthmatic controls (0.28% versus 0.66%, p=0.01). Three out of 23 children with chronic cough had BAL eosinophils greater than the normal upper 95% reference interval in BAL. There was a small but statistically significant increase in percentage neutrophils in the children with cough compared with the nonasthmatic controls (5.85% versus 3.21%, p=0.03). Four out of the 23 children had BAL neutrophils greater than the normal upper 95% reference interval in BAL.The authors conclude that only a minority of children with chronic unexplained cough have asthmatic-type airway inflammation. It is speculated that the increased percentage neutrophils in bronchoalveolar lavage from children with cough could relate to underlying persistent airways infection.

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Section: Normalmentioning

confidence: 98%

Chronic cough in children: bronchoalveolar lavage findings

Fitch¹,

Brown²,

Schock³

et al. 2000

Eur Respir J

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“…GIBSON and coworkers [4,21] reported increased numbers of both metachromatic cells and eosinophils in expectorated sputum from nonasthmatic patients with steroid-responsive cough. Induced sputum eosinophilia has also been reported recently in atopic patients with bronchodilator-resistant cough [22]. In the study by BOULET et al [5], BAL cell differentials between nonasthmatic patients with chronic cough and controls differed mainly in metachromatic and epithelial cells.…”

Section: Discussionmentioning

confidence: 89%

Theophylline induces a reduction in circulating interleukin-4 and interleukin-5 in atopic asthmatics

Böllert¹,

Paton²,

Marshall³

et al. 1999

Eur Respir J

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Mast cells and eosinophils may play a role in the pathophysiology of chronic cough in nonasthmatics. It is unknown, however, whether degranulation of these cells occurs in the airways of such patients.Thirty-five nonsmoking patients referred with a chronic nonproductive cough (mean cough duration 76.2 months) were evaluated using a comprehensive diagnostic protocol. Bronchoalveolar lavage (BAL) cell differentials and BAL histamine, tryptase and eosinophilic cationic protein (ECP) concentrations were determined. Ten nonsmoking healthy volunteers served as controls.Diagnostic subgroups were identified: eight postnasal drip syndrome (PNDS), seven cough variant asthma (CVA), seven gastro-oeseophageal reflux (GOR), seven dual aetiology and six idiopathic. Nonasthmatic coughers (NAC) were characterized as those patients without bronchial hyperresponsiveness on histamine challenge and whose cough had either responded to therapy for PNDS or GOR or failed to improve with antiasthma therapy. There was a significant increase in both eosinophil and mast cell numbers (p<0.05) and in histamine levels (p=0.027) when NAC patients were compared with controls. Tryptase and ECP levels were elevated in 7 of 23 and 6 of 23 NAC patients, respectively.In conclusion, airway inflammatory cell numbers are not only increased but also activated, suggesting an important role for airways inflammation in the pathophysiology of chronic nonproductive cough. Eur Respir J 1999; 13: 59±65.

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“…The first data obtained from 12 patients followed up for 10 years with NAEB diagnosis suggest that it is a benign and self-limiting disease [38]. However, 3 of 32 patients (9%) followed up for at least 1 year with the diagnosis of NAEB were observed to have asthma with typical symptoms and airway hypersensitivity, 5 (16%) of them had fixed airway obstruction, and symptoms and/ or airway inflammation persisted in 21 (66% ) of them [20].…”

Section: The Natural Course Of Non-asthmatic Eosinophilic Bronchitismentioning

confidence: 99%

“…Respiratory tract inflammation can be assessed by sputum induction [38,39]. With this method, which is extremely simple, reliable and noninvasive, adequate sputum can be obtained from lower respiratory tract in 80% of adults and children when hypertonic saline is administered with the help of an ultrasonic nebulizer.…”

Section: Diagnosismentioning

confidence: 99%

Non-astmatic Eosinophilic Bronchitis

Yıldız

Dülger

2018

Turk Thorac J

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Non-asthmatic eosinophilic bronchitis (NAEB) is a chronic disease and was first described in a small group of patients by Gibson et al. [1,2] in a relatively recent date. Without bronchospasm, it is defined as eosinophilic inflammation of the respiratory tract and is usually associated with eosinophilia in sputum. It is one of the most important causes of chronic cough [3].When a cough lasting longer than 8 weeks is detected in clinical practice; if chest X-ray is normal, this situation is defined as chronic cough. Chronic cough is a common cause of complaints all over the world, especially at the centers giving outpatient care, and is responsible for about 40% of the applications [4][5][6]. However, the cause(s) leading to this condition can be detected in 75-90% [7][8][9]. NAEB is a disease that should be remembered in the differential diagnosis of chronic cough but it is often ignored [10]. Because the systematic examination of bronchial inflammation can be made rarely, it is probably diagnosed less than it exists [11]. When the other causes that may lead to chronic cough are eliminated in patients applying with the complaint of chronic cough, NAEB should be taken into consideration [12][13][14][15][16][17][18][19].The purpose of this article is to make it possible to consider the differential diagnosis of patients with chronic cough by drawing attention to NAEB, and to compile and present the literature data that is relatively limited. ETIOLOGYAlthough the etiology of NAEB is not clear yet, environmental or occupational factors may be responsible for this situation in some of the patients. In a significant proportion of the diagnosed patients, occupational dust exposure was considered to be possibly etiologically responsible. For this reason, the possibility of occupation-related causes should be considered in patients with chronic cough due to NAEB [20]. Especially resin hardener, welding fume and formaldehyde exposures have been shown to lead to NAEB [21][22][23][24]. Non-asthmatic eosinophilic bronchitis (NAEB) is eosinophilic inflammation of the respiratory tract, without any bronchospasm. In this article, we want to draw attention to the NAEB. It should also be considered in differential diagnosis of chronic cough. Eosinophilia is present in all induced or spontaneous sputum samples of NAEB patients. NAEB patients and asthmatic patients have similar airway inflammation. Remarkably, NAEB mainly occurs in the lower airways. Unlike asthma, mast cells in NAEB are active in the bronchial epithelium. Diagnosis is based on the clinical, radiological, and spirometric measurements of other causes of chronic cough (Post-nasal discharge syndrome, asthma, gastroesophageal reflux etc.) and the assessment of inflammation in the lower respiratory tract. Airway inflammation can be assessed by sputum induction. The main treatment is anti-inflammatory therapy with inhaled corticosteroids and taking protective measures if inflammation is due to occupational exposure or allergen inhalation. If NAEB is untreated, it may be ...

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Detection of Eosinophils in Hypertonic Saline-Induced Sputum in Patients with Chronic Nonproductive Cough

Cited by 47 publications

References 17 publications

Chronic cough in children: bronchoalveolar lavage findings

Chronic cough in children: bronchoalveolar lavage findings

Theophylline induces a reduction in circulating interleukin-4 and interleukin-5 in atopic asthmatics

Non-astmatic Eosinophilic Bronchitis

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