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Background Exacerbations in chronic obstructive pulmonary disease (COPD) are major contributors to worsening lung function, impaired quality of life, emergency healthcare use, and COPD-related mortality. COPD exacerbations are heterogeneous in terms of airway inflammation and etiology. Objectives To assess the relation between blood and sputum eosinophils and COPD exacerbation. Subjects and methods Prospective cohort study, conducted on 100 COPD patients presented in outpatient clinic. All patients were subjected to medical history including: occupational history, smoking history, comorbidity, number of exacerbations in last year and their degree, history of admission in the last year and treatment taken for COPD. Modified Medical Research Council scale of dyspnea, peak expiratory flow rate, oxygen saturation using pulse oximetry. Complete blood count with differential eosinophilic count. Sputum sample differential cell count was done. Results The eosinophil level in blood before and after treatment showed a significant positive correlation with the number of hospital admission in the last year (r = 0.29; P = 0.003 and r = 0.3; P = 0.002, respectively). Regarding the eosinophil level either in blood or in sputum, it showed significant statistical elevation in patients not using steroid treatment in comparison to patients who used systemic or inhaled steroid treatments (P < 0.001 and 0.004, respectively). Conclusion Blood eosinophil count can be used as a severity marker of COPD exacerbations. The eosinophil levels, either in blood or sputum, were significantly correlated with the degree of exacerbation. Sputum eosinophilia can also predict the risk of hospitalization. In addition, blood eosinophil count can direct the use of oral corticosteroids in exacerbation.

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Background There are scanty international and even no Egyptian studies addressing the prevalence of obstructive sleep apnea syndrome (OSAS) in railway drivers with an expected high risk of accidents. Thus, it is worth studying and assessing the prevalence and predictors of OSAS among Egyptian railway drivers. Patients and methods This prospective cross-sectional screening study was conducted on 160 Egyptian railway drivers. They were subjected to medical history taking and examination, anthropometric measurements, oxygen saturation (SpO2) by oximetry, arterial blood gases, Friedman obstructive sleep apnea–hypopnea syndrome score measurement, and Arabic version of both Berlin and STOP BANG questionnaires. Then, limited night polysomnography (PSG) was performed in high-risk patients. Finally, full channel PSG was done for positive limited night PSG. Results The prevalence of sleep apnea among the studied cases was 4.22%. There was high statistically significant difference between the non-OSAS group and the OSAS group regarding age less than or equal to 49 years [odds ratio (OR)=11.364], witnessed apneas during sleep (OR=175), weight in kg more than 95 (OR=13.00), PaO2 less than or equal to 88 (OR=31.0), PaCO2 more than 39 (OR=31.0), and average SPO2 less than or equal to 88 (OR=34.0). Regarding parameters of limited night PSG, the apnea–hypopnea index cutoff point was more than or equal to 5 with an area under the curve (AUC) of 100%, O2 desaturation index cutoff point was more than 17.2 with an AUC of 100%; lastly, the average SPO2 cutoff point was less than or equal to 88% with an AUC of 76.4%. Conclusion This study highlights for the first time that the prevalence of OSAS was 4.2% in a sample of Egyptian railway drivers. Our results further point out that weight, neck circumference, systolic blood pressure, PaO2, and PaCO2 are the most useful predictors of suspecting OSAS. Also, parameters of limited PSG are considered a useful tool in confirming suspected patients with OSAS.