Clinical judgement of airway inflammation versus sputum cell counts in patients with asthma

Parameswaran, Krishnan; Pizzichini, Emílio; Pizzichini, M.M.M.; Hussack, P; Efthimiadis, A.; Fe, Hargreave

doi:10.1034/j.1399-3003.2000.15.10.x

Cited by 62 publications

(45 citation statements)

References 31 publications

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“…However, assessing the underlying eosinophilic airway inflammation may add an extra feature to asthma management [31]. In our study, more than half of the patients had at least one blood eosinophil count whereas less than 10% of the patients had a sputum eosinophil count.…”

Section: Discussionmentioning

confidence: 74%

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

Mäkelä

Christensen

Karlsson

et al. 2018

European Clinical Respiratory Journal

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Background: Eosinophilic airway inflammation is common in asthma patients and appears to be associated with severe exacerbations and loss of asthma control. Objective: To describe the resource utilization and clinical characteristics of patients with eosinophilic asthma. Design: Asthma patients ≥18 years with ≥1 blood eosinophil count in secondary care (South West Finland) during 2003‒2013 were included. Clinical characteristics (age, lung function, body mass index, and comorbidities) and asthma-related resource utilization (hospital admissions, outpatient visits, and emergency room [ER] visits) were retrieved. Resource utilization rates were compared for patients with blood eosinophil ≤ or >300 cells/μL, using adjusted negative binomial regression models. Results: Overall, 4,357 eligible patients were identified (mean age 60 years, females 68%), of which 1,927 (44%) had >300 eosinophil cells/μL blood. Patients with ≤300 and >300 eosinophil counts, exhibited similar clinical characteristics, including advanced age, poor lung function, and overweight. Comorbidities such as pneumonia, sinusitis, and nasal polyps, were more frequent among those with >300 eosinophil cells/μL blood compared with patients with lower counts. Eosinophil counts >300 cells/μL were associated with greater hospital admissions (rate ratio [RR] [95% confidence interval CI]: 1.13 [1.02;1.24]) and outpatient visits (RR [95% CI]: 1.11 [1.03;1.20]) compared with patients with lower eosinophil counts. Rates of ER visits were similar between the patient groups (RR [95% CI]: 0.99 [0.87;1.12]). Conclusions: Hospital admissions and outpatient visits occurred more often for patients with eosinophil counts >300 cells/µL, than for patients with lower eosinophil counts. Routine blood eosinophil screening might be useful to identify patients with an eosinophilic phenotype eligible for more targeted treatments.

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Section: Discussionmentioning

confidence: 74%

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

Mäkelä

Christensen

Karlsson

et al. 2018

European Clinical Respiratory Journal

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“…Sputum eosinophils are more responsive to change, increasing ahead of clinical variables [21] and exhaled NO during exacerbations [22], and respond more slowly to treatment [23]. It would therefore not be surprising if clinicians were poor at judging whether airway inflammatory was present surprising or not [24].…”

Section: Rationale For Sputum Examinationmentioning

confidence: 99%

“…However, like other measurements, it would not be surprising if physicians were not good at recognizing the presence or type of inflammatory cell infiltration [24]. The authors have found sputum cell counts to be useful in assessing and managing difficult asthma ( fig.…”

Section: How To Use Sputum Examination In Clinical Practicementioning

confidence: 99%

Induced sputum cell counts: their usefulness in clinical practice

et al. 2000

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Airway inflammation is fundamental to the aetiology and persistence of asthma and other airway conditions. The presence and type of airway inflammation can be difficult to detect clinically, delaying the introduction of appropriate treatment. Induced sputum cell counts are a relatively noninvasive, safe and reliable method of identifying airway inflammation. They can accurately discriminate eosinophilic airway inflammation from noneosinophilic airway inflammation, and help guide therapy. Eosinophilic airway inflammation is steroid responsive whilst noneosinophilic (usually neutrophilic) inflammation generally is not. Macrophages containing haemosiderin can be useful in detecting left ventricular dysfunction and macrophages containing lipid are suggestive of oropharyngeal reflux with microaspiration, both of which can complicate or confuse assessment of airway disease. To date, studies using induced sputum are primarily observational. Management studies based on examination of induced sputum are now needed to validate the clinical utility of this test.

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“…Moreover, asthma symptoms correlate poorly with abnormalities of lung function 9 and airway inflammation, 10,11 and thus in isolation may suggest a less severe form of the disease than is actually present. Although many clinicians diagnose asthma on the basis of a trial of therapy, objective measurements are necessary to confirm the clinical diagnosis.…”

Section: The Casementioning

confidence: 99%