Inflammatory Cells and Eosinophilic Activity in Asthmatics Investigated by Bronchoalveolar Lavage: The Effects of Antiasthmatic Treatment with Budesonide or Terbutaline

Ädelroth, E; Rosenhall, L; Johansson, Sten-Åake; Linden, Margareta; Venge, Per

doi:10.1164/ajrccm/142.1.91

Cited by 288 publications

(145 citation statements)

References 9 publications

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“…The concentrations we observed seemed slightly higher than those recorded by VIRCHOW et al [4], who examined concentrations of ECP in sputum of hospitalized asthmatics by rocking selected portions of spontaneous sputum with saline (mean±SEM, 878±1058 µg·L -1 ECP·g -1 sputum). The ECP concentrations in samples reported here were higher than those reported in bronchoalveolar lavage (BAL) in asthma [27,28], and in sputum mixed with saliva in healthy [5] or asthmatic subjects [5,29,30]. In BAL in asthmatics, ÄDELROTH et al [27] recorded values ranging 6.2±51 µg·L -1 .…”

Section: Discussioncontrasting

confidence: 49%

“…The ECP concentrations in samples reported here were higher than those reported in bronchoalveolar lavage (BAL) in asthma [27,28], and in sputum mixed with saliva in healthy [5] or asthmatic subjects [5,29,30]. In BAL in asthmatics, ÄDELROTH et al [27] recorded values ranging 6.2±51 µg·L -1 . BOUSQUET et al [28] did not detect ECP in 10 healthy subjects or 14 out of 38 asthmatics.…”

Section: Discussioncontrasting

confidence: 49%

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Measurement of inflammatory indices in induced sputum: effects of selection of sputum to minimize salivary contamination

Pizzichini

Pizzichini²,

Efthimiadis³

et al. 1996

Eur Respir J

261

208

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Sputum examination is being used increasingly as a noninvasive method to assess airway inflammation. Expectorated sputum has variable contamination with saliva. Methods of processing have included the selection of portions of the sample considered to be representative of pulmonary origin versus use of the whole specimen, which is confounded by varying volumes of saliva. We compared cell profiles and eosinophilic cationic protein (ECP) concentration in sputum selected from the expectorate and in the usually discarded residual portion to determine to what degree salivary contamination is minimized and if the results are representative of lower respiratory secretions. Sputum was induced with hypertonic saline in six healthy and nine asthmatic subjects. All portions considered to be of pure lower respiratory tract origin were selected from the residual. The selected and residual portions were treated with dithiothreitol, total cell counts and cell viability were obtained, cytospins were made for differential cell counts and supernatant was collected for ECP assay. Selected portions of the specimens, in comparison with the residual portion showed: little squamous cell contamination (median 1.2 vs 70%; p < 0.001); higher total cell counts.mL-1 (5.1 vs 0.5 x 10(6) cells.mL-1; p < 0.001); higher number of viable nonsquamous cells per sample (1.9 vs 0.6 x 10(6) cells; p < 0.001); higher slide quality score (7 vs 4; p < 0.001); and higher levels of ECP (768 vs 136 micrograms.L-1; p < 0.001). There were no differences in the differential cell counts of eosinophils (1.3 vs 3.8%), neutrophils (44 vs 32%), and lymphocytes (0.6 vs 0.6%). While the proportion of macrophages was lower (36 vs 54%; p < 0.05), the absolute number (41 vs 19 x 10(4) cells; p < 0.05) was higher in the selected portion. In summary, selection of all portions of induced sputum from the expectorate minimized the confounding influence of saliva. Loss of nonsquamous cells in the residual portion was variable but usually less than one third of those in the selected portion. With one exception, this loss had little influence on the differential counts of inflammatory cells. Similar observations apply to eosinophilic cationic protein levels. We conclude that, in healthy subjects and treated asthmatics, inflammatory markers in the selected portion of the expectorate can be used to represent those in the lower respiratory tract in general.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussioncontrasting

confidence: 49%

Measurement of inflammatory indices in induced sputum: effects of selection of sputum to minimize salivary contamination

Pizzichini

Pizzichini²,

Efthimiadis³

et al. 1996

Eur Respir J

261

208

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“…Previous studies on links between eosinophils, eosinophil-derived proteins, and severity of disease have reported conflicting results such as the following: 1 ) a positive correlation between BAL ECP levels and clinical scores (16); 2) an inverse correlation between eosinophil numbers in BAL and airway responsiveness to MCh (20) and between MBP levels and airway reactivity to MCh (37); 3) no correlation between airway responsiveness to histamine and eosinophil or ECP levels (38). In addition, also in the present study, BAL epithelial cell number correlated with eosinophil number but not with ECP levels, while log Pd,, correlated with ECP levels, but not with BAL eosinophil number.…”

Section: Discussionmentioning

confidence: 99%

Airway eosinophilic inflammation, epithelial damage, and bronchial hyperresponsiveness in patients with mild‐moderate, stable asthma

Oddera¹,

Silvestri²,

Balbo

et al. 1996

Allergy

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Allergic asthma is characterized by chronic recruitment of eosinophils in the airways. Once activated, eosinophils release toxic products, including eosinophil cationic protein (ECP), able to damage airway epithelial cells. To test the hypothesis that also in mild‐moderate stable asthma, a significant eosinophil activation could occur, we studied 25 asthmatic patients (34 ± 19 years old), of whom 18 were allergic (27 ± 12 years) and seven nonallergic (42±10 years), with FEV1 values ±70% of predicted, and eight normal volunteers (controls, 33 ±11 years). All subjects underwent methacholine (MCh) challenge on the first visit, and bronchoalveolar lavage (BAL) on the second visit (approximately 3–4 days later). BAL cells were counted and albumin (Alb) (as index of protein dilution in BAL fluid) and ECP levels (as index of eosinophil activation) in BAL fluid were measured. As compared to controls, a significant increase in BAL eosinophil and in BAL epithelial cell numbers was observed in asthmatic patients (P>0.05, each comparison), with no differences between the two asthmatic patient subgroups. Detectable ECP levels (>2 μg/1) were found in BAL of 18 asthmatic patients (14 allergic and four nonallergic asthmatic patients), while Alb levels were measurable in 25 BAL fluids and found to be similar in controls and asthmatic patients, and in the two asthmatic patient subgroups (P>0.05, each comparison). In BAL of asthmatic patients, positive correlations were found between eosinophil numbers and 1) ECP/Alb levels (r= 0.50, P = 0.020); 2) epithelial cell numbers (r = 0.S0, P = 0.014). In asthmatic patients, a significant negative correlation was found between bronchial reactivity to MCh (log Pd15) and ECP/Alb levels in BAL fluid (r=‐0.6, P= 0.005), whereas no correlation was found between log Pd15 MCh and BAL eosinophil or epithelial cell number (P>0.1, each correlation). These data suggest that bronchial eosinophil recruitment and activation may occur also in mild‐moderate stable asthma and that bronchial epithelium damage and airway responsiveness may be partially associated with the eosinophilic inflammatory reaction.

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“…Differential cell counts in induced sputum were determined, and albumin and fibrinogen were measured as possible markers of capillary leakage [9], the chemokine interleukin-8 (IL-8) as a chemoattractant for neutrophils and primed eosinophils [11] and eosinophil cationic protein (ECP) as a toxic eosinophilic degranulation product [9,12]. Because the production and content of sputum might be influenced by disease severity and/or the presence of anti-inflammatory treatment, two groups of subjects were studied separately: one group of patients with mild asthma, treated only with short-acting β 2 -agonists on demand; and another group of patients with moderate-to-severe asthma, all receiving regular inhaled corticosteroid therapy.…”

mentioning

confidence: 99%

Repeatability of cellular and soluble markers of inflammation in induced sputum from patients with asthma

Veen

Gouw²,

Smits³

et al. 1996

Eur Respir J

169

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R Re ep pe ea at ta ab bi il li it ty y o of f c ce el ll lu ul la ar r a an nd d s so ol lu ub bl le e m ma ar rk ke er rs s o of f i in nf fl la am mm ma at ti io on n i in n i in nd du uc ce ed d s sp pu ut tu um m f fr ro om m p pa at ti ie en nt ts s w wi it th h a as st th hm ma a ABSTRACT: Sputum induced by inhalation of nebulized hypertonic saline is increasingly used to monitor airways inflammation in asthma. The aim of this study was to assess the repeatability of measuring cellular and soluble markers of inflammation in whole sputum samples as obtained by sputum induction in patients both with mild and moderate-to-severe asthma. Twelve patients with mild, atopic asthma without inhaled steroid treatment and nine patients with moderate-to-severe, atopic asthma treated with inhaled steroids were studied on two separate days at least 2 days apart. Whole sputum samples, induced by inhalation of hypertonic (4.5%) saline, were homogenized, and analysed for differential cell counts and for concentrations of albumin, fibrinogen, inter- leukin-8 (IL-8), and eosinophil cationic protein (ECP). Repeatability was expressed as intraclass correlation coefficient (Ri), and as coefficient of repeatability (CR) in percentage cells or in doubling concentration.Samples from two patients with mild asthma contained more than 80% squamous cells and were excluded from analysis. The repeatability for cell differential counts in both groups combined was: for neutrophils, Ri=0.57 and CR=31.0; for eosinophils, Ri=0.85 and CR=12.4; and for lymphocytes, Ri=0.76 and CR=6.9. The repeatability of the fluid phase measurements was: for albumin, Ri=0.71 and CR=3.2; for fibrinogen, Ri=0.88 and CR=2.8; for IL-8, Ri=0.66 and CR=2.2; and for ECP, Ri=0.82 and CR=1.1.We conclude that the repeatability of cellular and soluble markers of inflammation in induced sputum from patients with mild and moderate-to-severe asthma is satisfactory. Hence, induced sputum, processed by using the whole expectorated sample, seems to be a valuable method to monitor airway inflammation in asthma.

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Inflammatory Cells and Eosinophilic Activity in Asthmatics Investigated by Bronchoalveolar Lavage: The Effects of Antiasthmatic Treatment with Budesonide or Terbutaline

Cited by 288 publications

References 9 publications

Measurement of inflammatory indices in induced sputum: effects of selection of sputum to minimize salivary contamination

Measurement of inflammatory indices in induced sputum: effects of selection of sputum to minimize salivary contamination

Airway eosinophilic inflammation, epithelial damage, and bronchial hyperresponsiveness in patients with mild‐moderate, stable asthma

Repeatability of cellular and soluble markers of inflammation in induced sputum from patients with asthma

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