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Thorax. 1995 October; 50(10): 1057–1061.
PMCID: PMC475018

Exacerbations of asthma without sputum eosinophilia.

Abstract

BACKGROUND--Sputum analysis provides a non-invasive method of examining the airway secretions of subjects with asthma in order to better understand the inflammatory process. Increased proportions of eosinophils are generally seen in the sputum of subjects with asthma, especially when there is an exacerbation. An unexpected observation in the sputum of subjects with mild exacerbations of asthma is reported. METHODS--Thirty four consecutive subjects with symptoms consistent with a mild exacerbation of asthma were recruited for a treatment study. Inclusion criteria required persistent symptoms of chest tightness, dyspnoea, or wheezing for two weeks (without spontaneous improvement or alteration in dose of inhaled corticosteroid) and a forced expiratory volume in one second (FEV1) that was reversible to more than 75% predicted or known best to ensure the exacerbation was mild. Sputum (spontaneous or induced with hypertonic saline) from all subjects was examined for differential cell counts. Eosinophilic sputum was defined as > or = 4% eosinophils on two occasions or > 10% eosinophils once. Clinical characteristics, sputum differential counts, and measurements of airways obstruction were compared between the subjects with and without sputum eosinophilia. RESULTS--Almost half of the subjects (16 of 34) considered to have mildly uncontrolled asthma had no sputum eosinophilia. In comparison with the subjects who had sputum eosinophilia the non-eosinophilic group had less airways obstruction (FEV1% predicted 88% v 70%) and less severe airways hyperresponsiveness (PC20 methacholine 0.45 mg/ml v 0.13 mg/ml). There was no difference between the groups in the type or prevalence of symptoms, history of recent infections, smoking, relevant allergen exposure, or use of inhaled corticosteroid. CONCLUSIONS--Symptoms of mildly uncontrolled asthma are not always associated with eosinophilic airways inflammation as measured by sputum analysis. The causes and treatment of the non-eosinophilic condition require further investigation.

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Selected References

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  • Gibson PG, Girgis-Gabardo A, Morris MM, Mattoli S, Kay JM, Dolovich J, Denburg J, Hargreave FE. Cellular characteristics of sputum from patients with asthma and chronic bronchitis. Thorax. 1989 Sep;44(9):693–699. [PMC free article] [PubMed]
  • Pin I, Freitag AP, O'Byrne PM, Girgis-Gabardo A, Watson RM, Dolovich J, Denburg JA, Hargreave FE. Changes in the cellular profile of induced sputum after allergen-induced asthmatic responses. Am Rev Respir Dis. 1992 Jun;145(6):1265–1269. [PubMed]
  • Fahy JV, Liu J, Wong H, Boushey HA. Analysis of cellular and biochemical constituents of induced sputum after allergen challenge: a method for studying allergic airway inflammation. J Allergy Clin Immunol. 1994 Jun;93(6):1031–1039. [PubMed]
  • Maestrelli P, Calcagni PG, Saetta M, Di Stefano A, Hosselet JJ, Santonastaso A, Fabbri LM, Mapp CE. Sputum eosinophilia after asthmatic responses induced by isocyanates in sensitized subjects. Clin Exp Allergy. 1994 Jan;24(1):29–34. [PubMed]
  • Hargreave FE, Popov T, Kidney J, Dolovich J. Sputum measurements to assess airway inflammation in asthma. Allergy. 1993;48(17 Suppl):81–86. [PubMed]
  • Popov T, Gottschalk R, Kolendowicz R, Dolovich J, Powers P, Hargreave FE. The evaluation of a cell dispersion method of sputum examination. Clin Exp Allergy. 1994 Aug;24(8):778–783. [PubMed]
  • Gibson PG, Dolovich J, Denburg J, Ramsdale EH, Hargreave FE. Chronic cough: eosinophilic bronchitis without asthma. Lancet. 1989 Jun 17;1(8651):1346–1348. [PubMed]
  • Gibson PG, Hargreave FE, Girgis-Gabardo A, Morris M, Denburg JA, Dolovich J. Chronic cough with eosinophilic bronchitis: examination for variable airflow obstruction and response to corticosteroid. Clin Exp Allergy. 1995 Feb;25(2):127–132. [PubMed]
  • Pin I, Gibson PG, Kolendowicz R, Girgis-Gabardo A, Denburg JA, Hargreave FE, Dolovich J. Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax. 1992 Jan;47(1):25–29. [PMC free article] [PubMed]
  • Fahy JV, Kim KW, Liu J, Boushey HA. Prominent neutrophilic inflammation in sputum from subjects with asthma exacerbation. J Allergy Clin Immunol. 1995 Apr;95(4):843–852. [PubMed]
  • Seltzer J, Bigby BG, Stulbarg M, Holtzman MJ, Nadel JA, Ueki IF, Leikauf GD, Goetzl EJ, Boushey HA. O3-induced change in bronchial reactivity to methacholine and airway inflammation in humans. J Appl Physiol (1985) 1986 Apr;60(4):1321–1326. [PubMed]
  • Sur S, Crotty TB, Kephart GM, Hyma BA, Colby TV, Reed CE, Hunt LW, Gleich GJ. Sudden-onset fatal asthma. A distinct entity with few eosinophils and relatively more neutrophils in the airway submucosa? Am Rev Respir Dis. 1993 Sep;148(3):713–719. [PubMed]
  • Bardin PG, Johnston SL, Pattemore PK. Viruses as precipitants of asthma symptoms. II. Physiology and mechanisms. Clin Exp Allergy. 1992 Sep;22(9):809–822. [PubMed]
  • Shim CS, Williams MH., Jr Evaluation of the severity of asthma: patients versus physicians. Am J Med. 1980 Jan;68(1):11–13. [PubMed]
  • Kendrick AH, Higgs CM, Whitfield MJ, Laszlo G. Accuracy of perception of severity of asthma: patients treated in general practice. BMJ. 1993 Aug 14;307(6901):422–424. [PMC free article] [PubMed]
  • Adelroth E, Hargreave FE, Ramsdale EH. Do physicians need objective measurements to diagnose asthma? Am Rev Respir Dis. 1986 Oct;134(4):704–707. [PubMed]
  • Girgis-Gabardo A, Kanai N, Denburg JA, Hargreave FE, Jordana M, Dolovich J. Immunocytochemical detection of granulocyte-macrophage colony-stimulating factor and eosinophil cationic protein in sputum cells. J Allergy Clin Immunol. 1994 May;93(5):945–947. [PubMed]
  • Virchow JC, Jr, Hölscher U, Virchow C., Sr Sputum ECP levels correlate with parameters of airflow obstruction. Am Rev Respir Dis. 1992 Sep;146(3):604–606. [PubMed]
  • Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis. 1981 Jun;123(6):659–664. [PubMed]

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