Neutrophilic Bronchial Inflammation Correlates with Clinical and Functional Findings in Patients with Noncystic Fibrosis Bronchiectasis

Abstract

Background. Neutrophilic bronchial inflammation is a main feature of bronchiectasis, but not much is known about its relationship with other disease features. Aim. To compare airway inflammatory markers with clinical and functional findings in subjects with stable noncystic fibrosis bronchiectasis (NCFB). Methods. 152 NFCB patients (62.6 years; females: 57.2%) underwent clinical and functional cross-sectional evaluation, including microbiologic and inflammatory cell profile in sputum, and exhaled breath condensate malondialdehyde (EBC-MDA). NFCB severity was assessed using BSI and FACED criteria. Results. Sputum neutrophil percentages inversely correlated with FEV1 (P < 0.0001; rho = −0.428), weakly with Leicester Cough Questionnaire score (P = 0.068; rho = −0.58), and directly with duration of the disease (P = 0.004; rho = 0.3) and BSI severity score (P = 0.005; rho = 0.37), but not with FACED. Sputum neutrophilia was higher in colonized subjects, P. aeruginosa colonized subjects showing greater sputum neutrophilia and lower FEV1. Patients with ≥3 exacerbations in the last year showed a significantly greater EBC-MDA than the remaining patients. Conclusions. Sputum neutrophilic inflammation and biomarkers of oxidative stress in EBC can be considered good biomarkers of disease severity in NCFB patients, as confirmed by pulmonary function, disease duration, bacterial colonization, BSI score, and exacerbation rate.

A comprehensive approach to lung function in bronchiectasis

“…Small airways hyper-reactivity is related to bronchial inflammation and neutrophil-driven inflammation is associated with disease severity in bronchiectasis [45,46]. The recent identification of peripheral neutrophil elastase activity as a predictor of exacerbations and lung function decline in bronchiectasis [47] and the correlation we found with reversibility of air trapping and worse lung function further support the hypothesis that in bronchiectasis patients bronchial hyper-reactivity may be a hallmark of disease severity and may help to identify more fragile patients.…”

Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts

“…This is consistent with multiple studies published over the past 18 months where the BSI has been correlated with the SGRQ, the COPD assessment test—another measure of symptoms, the capsaicin cough sensitivity, impulse oscillometry, the 6 MWD and activity measured using accelerometers 28–31. Finally, Dente et al 32 published a significant association between BSI and sputum neutrophilic inflammation, while no relationship with FACED was found. In the present analysis, the BSI accurately categorised different severities of bronchiectasis according to these parameters, whereas, although sometimes showing trends towards differences in these parameters, the FACED score did not pass validity for the majority of QoL-B domains, the 6 MWD or the LCQ.…”

Pathogenesis, imaging and clinical characteristics of CF and non-CF bronchiectasis

“…Neutrophil-dominant inflammation is a key feature of bronchiectasis. Sputum neutrophils are higher in bronchiectasis patients versus healthy controls and this correlates with an increased disease severity [62][63][64]. Both interleukin-8 (IL-8) and leukotriene-B4 (LTB4) are key chemo-attractants required for migration and infiltration of neutrophils into bronchiectatic airways [65].…”