The cell pattern of bronchi inflammatory infiltrate has a significant impact on the course of the disease and may affect the achievement and maintenance of the asthma control. The aim of the study was to determine the influence of neutrophilic component of the bronchial inflammation on the asthma control, lung function and airway responsiveness. 114 patients with mild persistent asthma were assessed upon the level of the asthma control by Asthma Control Test (ACT); lung function (FEV1) by spirometry; airway responsiveness (∆FEV1) to 3-minute isocapnic hyperventilation with cold air (-20ºС) (IHCA) and 3-minute ultrasound inhalation with distilled water (IDW). The cell composition of the induced sputum (IS) was also studied. The patients were divided into groups with low contents of neutrophils in IS (39 people; 1st group) and with high contents of neutrophils (75 people, 2nd group). The contents of neutrophils in the 1st group was 10.9±0.53%, eosinophils – 19.4±2.1%; in the 2nd group – 29.9±1.6% (р=0.0001) and 20.4±1.4% (р=0.66), respectively. By ACT data the people of the 2nd group managed their disease worse than in 1st group (15.0±0.6 and 19.0±0.8 points, respectively; р=0.0001). They also had lower FEV1 (88.0±2.0 and 96.7±2.4%; р=0.009) and more intensive airway response to IHCA and DW (-13.7±1.7% and -11.2±1.9%, respectively) in comparison with the 1st group (-2.7±0.86%; р=0.0001 and -5.3±1.90%; р=0.055). The patients of the 2nd group had a close correlation between baseline neutrophils in IS and ∆FEV1 in response to IHCA (r=-0.22; р=0.045) as well as the content of myeloperoxidase in IS (r=0.31; р=0.0008). A level of myeloperoxidase in IS correlated with ∆FEV1 in response to IDW (r=0.29; р=0.030) in these patients. The increase of neutrophilic component of inflammation in asthma patients worsens the asthma control, lung function and enhances airway responsiveness to exogenous stimuli.

The aim of the research was to study the state of the bronchial mucosa epi-thelium in relation to the severity of clinical manifestations in severe uncon-trolled asthma depending on the pattern of inflammation and the presence of cold airway hyperresponsiveness. Materials and methods. In 48 patients with severe uncontrolled asthma, there were assessed asthma symptoms, clinical signs of cold airway hyperre-sponsiveness, and lung function; the samples of slides were analyzed in the cytological examination of the sputum; the degree of damage to epithelial cells and granulocytes was estimated using the total cell destruction index (CDI). Results. According to the analysis of sputum cytograms, the patients were divided into two groups: group I (22 patients) included persons with eosin-ophilic inflammation pattern (31.0±3.1% of eosinophils and 22.0±2.2% of neutrophils), group II (26 patients) was with mixed inflammation pattern (7.2±1.4 and 71.8±4.2%, respectively). The patients of group II had lower disease control according to Asthma Control Test (ACT; 12.1±0.7 and 17.8±0.2 points, respectively; р

The character of changes of inflammatory-cellular pattern of bronchial secretion in patients with asthma in association with cold airway hyperresponsiveness (CAHR) under the influence of standard therapy has been studied little. The aim of the present work is to study dynamics of cellular profile, neutrophilic component of bronchial inflammation under the combination therapy of asthmatics with CAHR. 12 asthma patients with CAHR were studied upon the number of cells of the induced sputum (IS), peroxidase, cytolytic and destructive activity of eosinophils and neutrophils in the sputum, lung function and asthma control with the help of questionnaire Asthma Control Test (АСТ) before and after the therapy with the combination of budesonide/formoterol. Before the therapy the patients had a low level of asthma control (14.4±1.2 points of ACT), FEV1 was 87.4±3.3% from predicted values; in IS neutrophils prevailed (26.4±1.7%) over eosinophils (18.5±2.6%); the level of myeloperoxidase (mean cytochemical coefficient) was 65.9±5.4 pixels. After 48 weeks of the observation only in 58% of patients the criteria of good control of asthma and the improvement of lung function were achieved. In IS there was a decrease of eosinophils (11.4±3.2%; p=0.045); the intensiveness of eosinophils and neutrophils cytolysis dropped; intracellular concentration of myeloperoxidase grew (98.2±14.1 pixels; p=0.0637); destructive changes in granulocytes were registered but the number of neutrophils remained high (34.0±8.2%, р=0.34), which was considered as the factor of stable initiation of inflammation and oxidative stress. Thus, the use of anti-inflammatory treatment regime lasting 48 weeks with combination of budesonide/formoterol oriented to achieve clinical criteria of asthma control in patients with CAHR does not allow to achieve correction of the level of neutrophilic inflammatory component. Quantitative index of neutrophils in IS in these patients has prognostic value for the possible loss of achieved asthma control.

In 46 patients with mild persistent asthma the collection and cytological study of the induced sputum (IS) was done to assess the inflammatory pattern of bronchi, structural organization of bronchial epithelium and secretory goblet cells; the level of the disease control by the data of the validated questionnaire Asthma Control Test was found out; the base lung function (FEV1) was determined; the response of airways to standard 3-minute isocapnic hyperventilation by cold (-20ºC) air (IHCA) was studied. By the results of IHCA test the patients were divided into 2 groups: with cold airway hyperresponsiveness (1st group) and without any response to IHCA test (2nd group). The patients of the 1st group in comparison with the ones of the 2nd group had a lower level of spirometric parameters and control over the disease. In the 1st group there were found more significant changes in the structural organization and destructive-cytological activity of goblet cells against the decrease of a number of epithelial cells of IM and activation of a neutrophilic pool under eosinophilic pattern of inflammation. The patients with cold airway hyperresponsiveness were found to have a close correlation between identified disorders in the structural organization of the goblet epithelium, the number of neutrophils of IS and severity of the bronchial response to IHCA test. The association of disorganization of the goblet epithelium and bronchial response to cold stimulus against the features of inflammatory pattern can be considered a risk factor of escalation of mucociliary insufficiency and worsening of clinical course of a disease and the level of asthma control.