Sputum Eosinophilia Predicts Benefit from Prednisone  in Smokers with Chronic Obstructive Bronchitis

Pizzichini, Emílio; Pizzichini, Márcia Margaret Menezes; Gibson, Péter G.; Parameswaran, Krishnan; Gleich, Gerald J.; Berman, Les; Dolovich, J.; Hargreave, Frederick E.

doi:10.1164/ajrccm.158.5.9804028

Cited by 342 publications

(261 citation statements)

References 28 publications

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“…Values of 3% and 80% were chosen to define significant eosinophilia and neutrophilia, although the authors have recently reported normal values (90th centile) of 1% and 65%, respectively, for eosinophil and neutrophil differential cell counts [30]. The value of 3% was chosen to define eosinophilia because previous studies have shown the clinical utility of this value to predict a response to corticosteroid therapy in asthma and chronic airflow limitation [31,32]. Since the significance of mild neutrophilia in asthmatics is not well known and particularly since the authors had included some current and exsmokers, it was decided to use a cut-off value of 80%.…”

Section: Discussionmentioning

confidence: 99%

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Parameswaran

Pizzichini

et al. 2000

Eur Respir J

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The inflammatory component of asthma is usually assessed indirectly by symptoms and spirometry, these may be inaccurate. It can now be assessed directly and reliably by the examination of sputum cell counts. There is no information on how clinical assessment of the presence and type of airway inflammation compares with actual measurements.In this single-centre observational study, sputum was collected from 76 consecutive adults with asthma attending a tertiary chest clinic after their physicians had recorded the expected cell counts in sputum. The authors examined the extent of agreement between clinical judgement of sputum cell counts and actual counts in asthmatic patients (Cohen's Kappa) and the possible predictors of agreement (multiple logistic regression).Sixty-seven of the 76 sputum samples were suitable for analysis. Agreement between expected and actual cell counts occurred in 30/67 patients. The overall agreement for the different cell types was poor (estimated k=0.14, 95% confidence interval (CI)=0.02, 0.26). The experience of the physician in using sputum cell counts in clinical practice, steroid requirement at the time of assessment, and control of asthma as assessed by the physician or by the patient could not predict the chances of agreement or disagreement. Unaware of the sputum results, the physicians often changed treatment in a way that seemed inappropriate for the cell counts present.There is poor agreement between clinical judgement of the presence and type of airway inflammation in asthmatic patients and sputum cell counts. The impact of sputum examination on the outcomes of anti-inflammatory treatment now needs investigation. Eur Respir J 2000; 15: 486±490.

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Section: Discussionmentioning

confidence: 99%

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Parameswaran

Pizzichini

et al. 2000

Eur Respir J

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“…Although the repeatability of success has not been specifically examined, adequate specimens for differential cell counts were obtained in 95% of 122 inductions in subjects with COPD [63] and in 100% of subjects entered into trials of the effect of corticosteroid treatment [64][65][66]. The procedure can be time-consuming and take up to 1 h if three or more 5-or 7-min inhalations are required.…”

Section: Sputum Inductionmentioning

confidence: 99%

“…3). The greater the eosinophilia, the greater the improvement achieved with the steroid [64][65][66] (fig. 4).…”

Section: Sputum Inflammatory Markers In Chronic Obstructive Pulmonarymentioning

confidence: 99%

“…Patients with COPD also have an increase in eosinophil proteins, such as eosinophil cationic protein (ECP) [43,64,94,114,[122][123][124], eosinophil peroxidase (EPO) [43,122,123] and mast cell tryphase [125]. ECP is found in both eosinophils and neutrophils, whereas EPO is said to be a unique component of eosinophils [126].…”

Section: Sputum Inflammatory Markers In Chronic Obstructive Pulmonarymentioning

confidence: 99%

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Airway inflammation in COPD: physiological outcome measures and induced sputum

Crapo

Jensen²,

Hargreave³

2003

European Respiratory Journal

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Chronic obstructive pulmonary disease (COPD) is a result of airway inflammation, and the best predictor of COPD is the early detection of airflow limitation by spirometry. The Global Initiative for Obstructive Lung Disease Workshop Report defines airflow limitation using simple spirometric indices. Available guidelines categorise the severity of COPD using forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), with symptoms playing a minor role in the assessment.Current standards define COPD by progressive loss of FEV1, and thus longitudinal decline in FEV1 will be the primary outcome variable for intervention studies aimed at preventing or reducing the loss of pulmonary function. There is evidence, however, that the variable FEV1/FVC and FEV1 are often not measured properly in all settings.This article will discuss the roles of physiological measurements in diagnosing COPD and physiological outcome measures for COPD. It does not formally compare physiological measures with other outcome measures, such as symptoms or quality of life. Additionally, improved treatment of established disease requires a better understanding of the inflammatory process and its clinical effects and treatment.The inflammatory process, and how drugs affect it, can be studied noninvasively or relatively noninvasively by using refined methods of examining spontaneous or induced sputum. Enhanced understanding of the use of induced sputum will assist in predicting patients9 responses to short-and long-term inhaled corticosteroid treatment, and the methods of sputum examination need to be simplified so that they can be applied more easily to clinical practice. Eur Respir J 2003; 21: Suppl. 41, 19s- Chronic obstructive pulmonary disease (COPD) is defined by the Global Initiative for Obstructive Lung Disease (GOLD) as a "disease state characterised by airflow limitation that is not fully reversible. …The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases" [1]. The absence of reversibility tends to exclude asthma by definition, although asthma can coexist with COPD. Methods of assessing airflow limitation: current recommendations and their limitationsAvailable guidelines categorise the severity of COPD primarily by using forced expiratory volume in one second (FEV1), whereas symptoms play a minor role in the assessment [1][2][3][4][5]. This tight link between FEV1 and COPD reflects the fact that spirometry is the standard for defining the presence of airway obstruction and the progressive loss of FEV1, the physiological variable that characterises COPD severity and predicts its mortality. Spirometry has become the standard, in part, because good quality and inexpensive tests are widely available.The GOLD Workshop Report explicitly defines airflow limitation using simple spirometric indices. Specifically, airflow limitation is defined as an FEV1/forced vital capacity (FVC)v70% and a postbronchodilator FEV1v80% of predict...

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“…Regarding its potential usage in COPD, a particularly interesting question which needs to be examined is, whether patients with eosinophilia in sputum are the ones that respond to inhaled steroid treatment, as has been demonstrated for systemic steroids [13,14]. Furthermore, a recent study has used the method to assess the bacterial colonization in the airways of patients with COPD [15].…”

Section: Clinical Issuesmentioning

confidence: 99%

Noninvasive methods to measure airway inflammation: future considerations

et al. 2000

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This last contribution to the series focuses on open questions regarding: 1) methodological issues; and 2) the potential clinical application of the noninvasive methods such as induced sputum and the analysis of exhaled air for the assessment of airway inflammation. In addition their potential future role in occupational health and the early diagnosis of neoplastic lesions are briefly discussed. The future clinical application of noninvasive methods will depend on the progress made to improve their practicability, particularly in rendering them less time consuming and cheaper. To assess their clinical value, prospective studies are needed to establish whether patients actually benefit from the results obtained. This is also important to implement the methods into the healthcare system and to obtain adequate financial compensation. Therefore, it is necessary to know: 1) whether the assessment of airway inflam‐mation can aid in coming to an earlier and better defined diagnosis; 2) whether by repeated monitoring it is possible to avoid exacerbations through earlier interventions; and 3) whether the long‐term outcome of patients is improved through knowledge of the type and degree of airway inflammation that is taken into account in selecting the appropriate treatment. In the meantime a wealth of data has become available, both for induced sputum and the analysis of exhaled air, which give these methods the potential to be incorporated into future clinical practice. This, however, will, amongst the other issues, depend on favourable cost‐benefit ratios which should also be the subject of future prospective studies.

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Sputum Eosinophilia Predicts Benefit from Prednisone in Smokers with Chronic Obstructive Bronchitis

Cited by 342 publications

References 28 publications

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Airway inflammation in COPD: physiological outcome measures and induced sputum

Noninvasive methods to measure airway inflammation: future considerations

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