TITLE

Analysis of induced sputum in adults with asthma: identification of subgroup with isolated sputum neutrophilia and poor response to inhaled corticosteroids

AUTHOR(S)
Green, R. H.; Brightling, C. E.; Woltmann, G.; Parker, D.; Wardlaw, A. J.; Pavord, I. D.
PUB. DATE
October 2002
SOURCE
Thorax;Oct2002, Vol. 57 Issue 10, p875
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The debate as to whether asthma is a single or heterogeneous disease remains unresolved although pathological studies, mostly using fibreoptic bronchoscopy on small numbers of subjects, have emphasised the similarities between different clinical phenotypes. Methods: Lower airway inflammation was assessed non-invasively using induced sputum in 34 normal controls and 259 adults with symptomatic asthma receiving treatment at steps 1-3 of the British Tho- racic Society (BTS) guidelines. A subgroup of 49 patients treated with as required β2 agonists only who met BTS criteria for a step up in treatment were studied before and 2 months after treatment with inhaled budesonide 400 pg twice daily. Results: There was considerable heterogeneity in induced sputum cell counts, particularly in non-atopic patients. A subgroup of 60 patients had a distinctive sputum cell profile with a neutrophil count higher than our normal range (>65.3%) and a normal sputum eosinophil count (<1.9%). These patients were older, predominantly female, and were more likely to be non-atopic but otherwise had similar clinical and physiological features to the group as a whole. Among the 49 subjects studied before and after inhaled budesonide, 11 patients had an isolated sputum neutrophilia. Following treatment, these patients showed significantly less improvement in visual analogue symptom scores (-5.5 v-19.4 mm; mean difference 13.9; 95% Cl 0.7 to 27.0), forced expiratory volume in 1 second (FEV1) (-0.08 v 0.13 I; mean difference 0.21; 95% Cl 0.03 to 0.39), and concentration of methacholine provoking a fall in FEV1 of 20% or more (PC20) (0.15 v 1 .29 doubling doses; mean difference 1 .11; 95% Cl 0.1 3 to 2.15) than the remaining 38 patients. Conclusions: These results suggest the presence of a distinct subgroup of patients with mild to moderate asthma who have predominantly neutrophilic airway inflammation and who respond less well to treatment with inhaled corticosteroids.
ACCESSION #
16181811

 

Related Articles

  • Tuberculosis in Malta: a case for sputum induction. Farrugia, Brian // Malta Medical Journal;2013, Vol. 25 Issue 1, p21 

    Sputum induction is a procedure used to help patients expectorate samples of sputum for laboratory analysis. It is a simple, safe and standardised procedure which may avoid the use of more invasive and potentially harmful interventions such as fibreoptic bronchoscopy. This article gives an...

  • Effect of therapeutic doses of mometasone furoate on cortisol levels in children with mild asthma. Skoner, David P.; Gentile, Deborah A.; Angelini, Betty // Allergy & Asthma Proceedings;Jan/Feb2010, Vol. 31 Issue 1, p10 

    Corticosteroids are the foundation of pharmacologic treatment for children with asthma. However, high-dose inhaled corticosteroid treatment can cause hypothalamic-pituitary-adrenal (HPA) axis suppression. We investigated the effect of three doses of mometasone furoate administered via dry-powder...

  • When can personal best peak flow be determined for asthma action plans? Reddel, H. K.; Marks, G. B.; Jenkins, C. R. // Thorax;Nov2004, Vol. 59 Issue 11, p922 

    Background: Written asthma action plans based on personal best peak expiratory flow (PEF) consistently improve health outcomes, whereas those based on predicted PEF do not. Guidelines state that personal best PEF should be assessed over 2-3 weeks during good asthma control, but it is unclear how...

  • Use of inhaled corticosteroids following discharge From an emergency department for an acute exacerbation of asthma. Blais, L.; Beauchesne, M.-F. // Thorax;Nov2004, Vol. 59 Issue 11, p943 

    Background: Most patients who have an asthma exacerbation leading to a visit to an emergency department (ED) will benefit from treatment with inhaled corticosteroids (ICS) at discharge. We investigated whether asthmatic children and adolescents were receiving ICS after discharge from the ED and...

  • Asthma: clinical assessment.  // Thorax;Dec2004 Supplement, Vol. 59, p50 

    The article presents some papers related to clinical assessment of asthma. There is currently great interest in developing non-invasive measures of airway inflammation in asthma. Proposed markers of airway inflammation and or oxidative stress in asthma include the exhaled gases, nitric oxide...

  • Biopharmaceutical Therapeutics for Asthma Remodeling. Das, A. M.; Griswold, D. E.; Torphy, T. J.; Li, L. // Current Pharmaceutical Design;Sep2006, Vol. 12 Issue 25, p3233 

    Current asthma therapy is aimed at controlling disease symptoms. A subset of asthma patients remains symptomatic despite optimal therapy indicating that an unmet medical need exists for these patients. Innovative therapeutics are needed to treat the unmet need in asthma and biopharmaceutical...

  • Long-term treatment with fluticasone propionate/salmeterol via Diskus improves asthma control versus fluticasone propionate alone. Katial, Rohit K.; Bernstein, David; Prazma, Charlene M.; Lincourt, William R.; Stempel, David A. // Allergy & Asthma Proceedings;Mar/Apr2011, Vol. 32 Issue 2, p127 

    This 52-week study was designed to assess the safety and efficacy of fluticasone propionate/salmeterol combination (FSC) 250/50 micrograms versus fluticasone propionate (FP) 250 micrograms in subjects with persistent asthma symptomatic on open-label FP 100 micrograms. The primary objective of...

  • Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future. Kian Fan Chung; Caramori, Gaetano; Adcock, Ian M. // European Journal of Clinical Pharmacology;Sep2009, Vol. 65 Issue 9, p853 

    Inhaled corticosteroid (ICS) therapy in combination with long-acting β-adrenergic agonists represents the most important treatment for chronic airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). ICS therapy forms the basis for treatment of asthma of all...

  • Frequency of non-asthma GP visits predicts asthma exacerbations: an observational study in general practice. Hyland, Michael E.; Whalley, Ben; Halpin, David M. G.; Greaves, Colin J.; Seamark, Clare; Blake, Sue; Pinnuck, Margaret; Ward, David; Hawkins, Adam L; Seamark, Dave // Primary Care Respiratory Journal;Dec2012, Vol. 21 Issue 4, p405 

    Background: Being able to identify patients at risk of exacerbations is useful as it enables resources to be targeted at these patients. Aims: To test the theoretically-derived prediction that the frequency of non-asthma related visits to the general practitioner (GP) predicts exacerbations....

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics