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

Bourdin, A.; Serre, I.; Flamme, H.; Vic, P.; Neveu, D.; Aubas, P.; Godard, P.; Chanez, P.
June 2004
Thorax;Jun2004, Vol. 59 Issue 6, p488
Academic Journal
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.


Related Articles

  • Breaking asthma's downward spiral. Ananthaswamy, Anil // New Scientist;09/16/2000, Vol. 167 Issue 2256, p20 

    Assesses the reaction of asthma sufferers to allergens in the lungs that provoke an immune response which is damaging to their airways. Discussion of a technique which would block the immune cells that do long-term damage; Details of an allergic asthma attack in which the lungs signal the...

  • Occupational rhinitis in workers investigated for occupational asthma. Castano, R.; Gautrin, D.; Thériault, G.; Trudeau, C.; Ghezzo, H.; Malo, J.-L. // Thorax;Jan2009, Vol. 64 Issue 1, p50 

    Background: The links between asthma and rhinitis are now referred to as united airways disease (UAD). Current evidence shows that the UAD model seems to be applicable to occupational rhinitis (OR) and occupational asthma (OA). A study was undertaken to objectively assess, in the context of...

  • Live and let die: is neutrophil apoptosis defective in severe asthma?  // Thorax;Aug2010, Vol. 65 Issue 8, p665 

    The authors reflect on whether neutrophil apoptosis is defective in severe asthma. They suggest that while eosinophils are the most characteristic inflammatory cell type present in mild to moderate asthma, the neutrophil seems to take center stage in severe asthma. They argue that medical...

  • Churg–Strauss syndrome associated with leukotriene receptor antagonists (LTRA). Cuchacovich, R.; Justiniano, M.; Espinoza, L. R. // Clinical Rheumatology;Oct2007, Vol. 26 Issue 10, p1769 

    Churg–Strauss syndrome (CSS) is a rare vasculitic disorder that generally occurs in patients with bronchial asthma. CSS is being increasingly recognized in asthmatic patients treated with leukotriene receptor antagonists. However, the nature of this relationship remains to be elucidated....

  • Specific modulation of calmodulin activity induces a dramatic production of superoxide by alveolar macrophages. Broeke, Robert Ten; Leusink-Muis, Thea; Hilberdink, Rogier; Ark, Ingrid Van; van den Worm, Edwin; Villain, Matteo; Clerck, Fred De; Blalock, J Edwin; Nijkamp, Frans P; Folkerts, Gert // Laboratory Investigation (00236837);Jan2004, Vol. 84 Issue 1, p29 

    Airway inflammation is a characteristic feature in airway diseases such as asthma and chronic obstructive pulmonary disease. Oxidative stress, caused by the excessive production of reactive oxygen species by inflammatory cells like macrophages, eosinophils and neutrophils, is thought to be...

  • Clarithromycin and pulmonary infiltration with eosinophilia. Terzano, Claudio; Petroianni, Angelo // BMJ: British Medical Journal (International Edition);6/21/2003, Vol. 326 Issue 7403, p1377 

    Describes a patient with asthma referred to a respiratory disease clinic who twice developed fever and pulmonary infiltration with eosinophilia after taking antibiotics. Details of the case; Temporal relation between the patient's symptoms and antibiotic treatment; Diagnosis of drug induced...

  • Montelukast Decreases Plasma Endothelin-1 and Serum Eosinophil Cationic Protein Levels in Paediatric Atopic Asthma. Kopřiva, Frantisek; Janošťáková, Anna; Jarmila, Szotkowská; Zápalka, Martin; Hajduch, Marián // Clinical Drug Investigation;2006, Vol. 26 Issue 6, p351 

    BACKGROUND AND OBJECTIVE: Endothelin-1 (ET-1) is produced by vascular endothelial cells and epithelial cells, T-lymphocytes and phagocytes. Increased ET-1 levels have been demonstrated in the bronchial epithelium of asthma patients. In vitro, ET-1 stimulates mucus secretion, activates...

  • A management strategy that controls lower airway eosinophilic inflammation and symptoms reduced exacerbations in asthma. Green, R. H.; Brightling, C. E.; McKenna, S.; Pavord, I. D. // Evidence Based Medicine;Jul2003, p113 

    The article presents a study that compares the effectiveness of standard care and management strategy in reducing lower airway eosinophilic symptoms and inflammation of asthma exacerbations of patients in Leicester, England. Researchers did a blinded randomized controlled trials of the 74...

  • Objective measures of asthma control: Sputum eosinophils, nitric oxide, and other inflammatory mediators. Lieberman, Phil // Allergy & Asthma Proceedings;Sep/Oct2007, Vol. 28 Issue 5, p510 

    This discussion concerns the tools we can use to measure the status of inflammation in asthma and therefore help us diagnose and manage this condition. Although measurement of pulmonary function is of course a necessity, it does not necessarily tell us the status of activity of the disease. For...


Read the Article


Sign out of this library

Other Topics