Effects of Long-Term Glucocorticoid Therapy on Bronchoalveolar Cells in Adult Patients with Bronchial Asthma

Abstract

The effects of long-term glucocorticoid therapy on airway inflammation were examined in 84 asthma patients. The proportion of lymphocytes in bronchoalveolar lavage (BAL) fluid was significantly decreased in patients with steroid-dependent intractable asthma (SDIA) compared to results in non-SDIA patients, while BAL neutrophils were significantly increased in SDIA patients compared to results in non-SDIA patients. Regarding age, in patients under the age of 69 (except those between 30 and 39), BAL lymphocyte number was significantly decreased in SDIA compared with non-SDIA subjects, and in patients between 50 and 69, BAL neutrophils were significantly increased in SDIA compared with non-SDIA subjects. The number of BAL lymphocytes was significantly lower in patients with serum cortisol levels of less than 5.0 micrograms/dl than in those with levels of more than 5.1 micrograms/dl. BAL lymphocyte number was also significantly lower in patients who had received glucocorticoid therapy for more than 6 years than in those who had received such therapy for 2 years. These results show that long-term glucocorticoid therapy decreases the number of lymphocytes and increases neutrophil numbers in the airways.

Neutrophils and Eosinophils: Clinical Implications of their Appearance, Presence and Disappearance in Asthma and COPD

“…In contrast, studies with children suggest that neutrophils are elevated especially in younger children or those without atopic asthma [149][150][151]. In severe asthma, there are several reports illustrating elevated neutrophil numbers in BAL [152][153][154] or in the tissue following sudden death [103]. Indeed, there are some severe asthmatics without elevated eosinophils in bronchial biopsies [155].…”

Neutrophils in asthma pathophysiology

“…The situation is more clear when people with severe asthma are studied. Bronchial wash neutrophils are raised in patients with status asthmaticus [9], and several authors report elevated BAL neutrophils in people with severe asthma [19][20][21]. In the most extreme form of severe asthma, neutrophil numbers are raised in the lung tissue of people with asthma who died very suddenly (within 2 h of the asthma attack) [30][31].…”

“…However, significantly higher neutrophil numbers are found in samples from people with severe asthma [19][20][21]. The underlying type of asthma may have an effect on neutrophil numbers.…”

Different Roles of Histamine and Leukotriene C4in the Airways Between Patients with Atopic and Nonatopic Asthma

“…Conversely, nonatopic patients are defined as subjects without IgE-mediated allergic reaction. However, despite of the presence or absence of IgE-mediated reaction, chemical mediators such as histamine and LTC,, which are released from tissue mast cells during the time of immediate asthmatic reaction (JAR), and from inflammatory cells during late asthmatic reaction (LAR), play an important role in the onset mechanisms of asthma attacks (23)(24)(25)(26)(27)(28). In recent years, many kinds of antiallergic drugs that inhibit actions of histamine and LTC, have been developed.…”