Can we predict sputum eosinophilia from clinical assessment in patients referred to an adult asthma clinic?

Yap, Elaine; Chua, Wei Mei; Jayaram, Lata; Zeng, Irene; Vandal, Alain C.; Garrett, Jeffrey

doi:10.1111/j.1445-5994.2011.02565.x

Cited by 26 publications

(19 citation statements)

References 40 publications

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“…We found that the peripheral eosinophil count is able to identify the presence of eosinophilic phenotype with low accuracy in unselected adult asthmatics and with moderate accuracy in selected adult asthmatics who are steroidnaïve without atopy (AUC=0.809). Consistent with the previous study (15,16,22), we also found that there is a significant positive association between the peripheral eosinophil count and sputum eosinophil count. The study by Nadif et al showed that peripheral eosinophils and neutrophils had the ability to distinguish asthmatics into four inflammatory patterns with remarkable phenotypic characteristics (23).…”

Section: Discussionsupporting

confidence: 82%

“…The study by Nadif et al showed that peripheral eosinophils and neutrophils had the ability to distinguish asthmatics into four inflammatory patterns with remarkable phenotypic characteristics (23). Their study also supported that the peripheral eosinophil count might be an effective surrogate of sputum to distinguish asthma inflammatory phenotypes (22).…”

Section: Discussionmentioning

confidence: 49%

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Moderate Accuracy of Peripheral Eosinophil Count for Predicting Eosinophilic Phenotype in Steroid-Naïve Non-Atopic Adult Asthmatics

Liang

Zhao

et al. 2012

Intern. Med.

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Background and Aim Eosinophilic phenotype, sputum eosinophil count !3%, of asthma is a valuable clinical parameter. However, measurement of sputum inflammatory cells is time-consuming and requires specialized personnel. A simpler surrogate, such as peripheral eosinophil count, would be beneficial. The aim of this study was to assess the value of peripheral eosinophil count for predicting the eosinophilic phenotype of adult asthmatics. Materials and MethodsThis retrospective study was conducted in 192 adult asthmatics. Sputum and venous blood were collected at the same visit and analyzed for cell differential. Receiver-operating characteristic (ROC) curve analysis was used to assess the relationship between eosinophilic phenotype and peripheral eosinophil count. Results Peripheral eosinophil count, derived from the ROC curve, of more than 210 cells/mm 3 yielded 67.7% sensitivity and 66.2% specificity [area under the curve (AUC)=0.698, p=0.0001] for identifying the eosinophilic phenotype in the total patients. Multiple regression analysis revealed that steroid treatment and atopy significantly influenced the peripheral eosinophil count. Within the steroid-naïve subgroup, a peripheral eosinophil count of >190 cells/mm 3 yielded 76.3% sensitivity and 67.4% specificity (AUC=0.730, p<0.0001) for identifying eosinophilic phenotype, while in the steroid treated subgroup, the AUC was 0.554 (p=0.4985). Within the steroid-naïve non-atopic subgroup, a peripheral eosinophil count of >190 cells/mm 3 yielded 73.1% sensitivity and 79.3% specificity (AUC=0.809, p=0.0001) for identifying the eosinophilic phenotype, while in the steroid-naïve atopic subgroup, the AUC was 0.588 (p=0.2723). Conclusion Peripheral eosinophil count is able to identify the presence of eosinophilic phenotype in steroid-naïve non-atopic adult asthmatics with moderate accuracy.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 49%

Moderate Accuracy of Peripheral Eosinophil Count for Predicting Eosinophilic Phenotype in Steroid-Naïve Non-Atopic Adult Asthmatics

Liang

Zhao

et al. 2012

Intern. Med.

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“…In asthma, sputum eosinophil count correlates with blood eosinophil count [4,[6][7][8] and blood eosinophil count is considered as a good surrogate marker for sputum eosinophil count (over 2-3% with a cut-off of 220 cells per mm 3 or 3%) [4,9]. However, the sensitivity and specificity of blood eosinophils to predict a sputum eosinophil proportion of o3% are ,80%, and there are patients who show discordance between local and systemic inflammation.…”

Section: Introductionmentioning

confidence: 98%

Importance of concomitant local and systemic eosinophilia in uncontrolled asthma

et al. 2014

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Systemic and airway eosinophilia are recognised features of asthma. There are, however, patients who exhibit discordance between local and systemic eosinophilia. In this study, we sought to determine the prevalence and characteristics of patients with concordant and discordant systemic and bronchial eosinophilia.We conducted a retrospective study on 508 asthmatics with successful sputum induction. We assessed the relationship between blood and sputum eosinophils by breaking down the population into four groups according to blood (o400 cells per mm 3 ) and sputum (o3%) eosinophils. Then, we prospectively reassessed the link between eosinophils and asthma control (Asthma Control Questionnaire (ACQ)) and exacerbation rate in a new cohort of 250 matched asthmatics.In our retrospective cohort, asthmatics without eosinophilic inflammation were the largest group (49%). The group with isolated sputum eosinophilia (25%) was, compared with noneosinophilic asthma, associated with lower forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity ratio and higher bronchial hyperresponsiveness and exhaled nitric oxide fraction (FeNO). Asthmatics exhibiting isolated systemic eosinophilia (7%) had similar characteristics as noneosinophilic asthmatics. The group with concordant systemic and airway eosinophilia (19%) showed remarkable male predominance, and had the lowest airway calibre, asthma control and quality of life, and the highest bronchial hyperresponsiveness, FeNO and exacerbation rate. The prospective cohort confirmed the different subgroup proportions and the higher ACQ and exacerbation rates in cases of diffuse eosinophilia compared with noneosinophilic asthmatics.Concomitant systemic and bronchial eosinophilic inflammation contribute to poor asthma control.@ERSpublications Concomitant systemic and bronchial eosinophilic inflammation contributes to poor asthma control

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“…Clearly, readily accessible biomarkers which accurately predict airway inflammation are needed for managing difficult-to-treat asthma, and to serve as response endpoints in clinical trials testing and registering new biologic therapies for asthma. Thus, more accessible biomarkers are employed as surrogates for sputum inflammatory cell measurements in clinical studies without first establishing their accuracy across the full range of asthma or severity subphenotypes 13-14 .…”

Section: Introductionmentioning

confidence: 99%

Biomarker surrogates do not accurately predict sputum eosinophil and neutrophil percentages in asthmatic subjects

Hastie

Moore

et al. 2013

Journal of Allergy and Clinical Immunology

233

158

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Background Sputum eosinophils (Eos) are a strong predictor of airway inflammation, exacerbations, and aid asthma management, whereas sputum neutrophils (Neu) indicate a different severe asthma phenotype, potentially less responsive to TH2-targeted therapy. Variables such as blood Eos, total IgE, fractional exhaled nitric oxide (FeNO) or FEV1% predicted, may predict airway Eos, while age, FEV1%predicted, or blood Neu may predict sputum Neu. Availability and ease of measurement are useful characteristics, but accuracy in predicting airway Eos and Neu, individually or combined, is not established. Objectives To determine whether blood Eos, FeNO, and IgE accurately predict sputum eosinophils, and age, FEV1% predicted, and blood Neu accurately predict sputum neutrophils (Neu). Methods Subjects in the Wake Forest Severe Asthma Research Program (N=328) were characterized by blood and sputum cells, healthcare utilization, lung function, FeNO, and IgE. Multiple analytical techniques were utilized. Results Despite significant association with sputum Eos, blood Eos, FeNO and total IgE did not accurately predict sputum Eos, and combinations of these variables failed to improve prediction. Age, FEV1%predicted and blood Neu were similarly unsatisfactory for prediction of sputum Neu. Factor analysis and stepwise selection found FeNO, IgE and FEV1% predicted, but not blood Eos, correctly predicted 69% of sputum Eos

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Can we predict sputum eosinophilia from clinical assessment in patients referred to an adult asthma clinic?

Cited by 26 publications

References 40 publications

Moderate Accuracy of Peripheral Eosinophil Count for Predicting Eosinophilic Phenotype in Steroid-Naïve Non-Atopic Adult Asthmatics

Moderate Accuracy of Peripheral Eosinophil Count for Predicting Eosinophilic Phenotype in Steroid-Naïve Non-Atopic Adult Asthmatics

Importance of concomitant local and systemic eosinophilia in uncontrolled asthma

Biomarker surrogates do not accurately predict sputum eosinophil and neutrophil percentages in asthmatic subjects

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