TITLE

Can endobronchial biopsy analysis be recommended to discriminate between asthma and COPD in routine practice?

AUTHOR(S)
Bourdin, A.; Serre, I.; Flamme, H.; Vic, P.; Neveu, D.; Aubas, P.; Godard, P.; Chanez, P.
PUB. DATE
June 2004
SOURCE
Thorax;Jun2004, Vol. 59 Issue 6, p488
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: International guidelines stress the importance of accurately discriminating between asthma and chronic obstructive pulmonary disease (COPD). Although characteristic pathological features have been described for both conditions, their discriminatory power has never been systematically assessed. Methods: Endobronchial biopsy (EBB) specimens from patients with a clear clinical diagnosis of asthma and CORD (50 per group) were examined by three pathologists in a double blind manner. They were asked to propose a pathological diagnosis of either asthma or COPD and to analyse qualitatively the most frequent abnormalities reported in the literature. Results: The sensitivity and specificity of EBB ranged from 36% to 48% and from 56% to 79%, respectively. Eosinophils strongly biased the pathological diagnoses in favour of asthma, whereas their estimated prevalence was similar (11-37% in asthma and 13-41% in COPD). Metaplasia (11-39% in COPD, 1-18% in asthma) and epithelial inflammation (28-61% in CORD, 11-38% in asthma) tended to be specific to COPD, whereas epithelial desquamation (80-98% in asthma, 61-88% in COPD) and basement membrane thickening (71 -94% in asthma, 53-88% in CORD) tended to be associated with asthma. There was acceptable intro- and inter-observer agreement only for metaplasia and epithelial eosinophils. Conclusions: Specific histopathological features of asthma and COPD probably exist, but current routine analysis procedures to assess EBB specimens are not sufficiently discriminatory. This might be rectified by improving pathological definitions.
ACCESSION #
13599833

 

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