The Relationship Between Clinical Severity of Bronchial
Asthma and the Degree of Airway Inflammation Assessed by Eosinophil Count in Induced Sputum
Chlumský J., Pokorná H.:
Oddělení tuberkulózy a respiračních nemocí Fakultní Thomayerovy nemocnice, Praha, přednosta prim. MUDr. Jan Chlumský Klinika pneumologie a hrudní chirurgie 3. lékařská fakulta UK a Fakultní nemocnice Bulovka, Praha,přednosta doc. MUDr. Petr Zatloukal, CSc. |
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Summary:
Airways inflammation, involving infiltration of bronchial wall with activated eosinophils, mast
cells and T lymphocytes, is an established feature of asthma. Clinical assessment of disease severi-
ty is based upon pulmonary function tests, their variability and symptom score. The relationship
between the degree of airway inflammation and disease control is probably not significant. Diffe-
rential cell count in induced sputum seems to be a useful parameter reflecting the degree of
airway inflammation in patients with bronchial asthma. We investigated 67 patients with bron-
chial asthma of different severity and have shown statistically significant correlation between
percentage of sputum eosinophils and clinical and physiological parameters of disease control.
Eosinophil counts in induced sputum were negatively correlated with FEV1 (p = 0,006), ration of
FEV1 /VC (p < 0,001) and diurnal variability of PEF (p < 0,001). According to previous studies,
where percentage of eosinophils was less than 4 % in healthy subject, we determined sputum
eosinophilia if eosinophil percentage was more than 4 %. Sensitivity of clinical markers of disease
control for predicting the degree of airway inflammation ranged between 0,15 - 0,74, ratio of
FEV1 /VC having the highest sensitivity. Specificity of clinical markers ranged from 0,43 to 0,94,
diurnal variability of PEF having the highest specificity. Despite of good correlation of clinical
markers of asthma severity with sputum eosinophils, pulmonary function test, diurnal variability
of PEF and rescue salbutamol can hardly predict the degree of airway inflammation or the
efficacy of antiinflammatory treatment in a particular patient. Percentage of sputum eosinophils
seems to be a useful and promising marker for measuring the degree of airway inflammation in
patients with bronchial asthma, especially in more severe cases.
Key words:
Bronchial asthma - Pulmonary function tests - Induced sputum - Eosinophils
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