Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege
Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege.
Eur Respir J. 2014 Jul;44(1):97-108. doi: 10.1183/09031936.00201813. Epub 2014 Feb 13.
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 (≥400 cells per mm3) and sputum (≥3%) 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.
系统和气道嗜酸性粒细胞增多是哮喘的特征。然而，有些患者表现出局部和全身嗜酸性粒细胞增多之间的不一致。在这项研究中，我们试图确定系统和支气管嗜酸性粒细胞增多一致和不一致的患者的患病率和特征。
我们对 508 例成功诱导痰的哮喘患者进行了回顾性研究。我们根据血液（≥400 个细胞/毫米 3）和痰（≥3%）嗜酸性粒细胞将人群分为四组，评估血液和痰嗜酸性粒细胞之间的关系。然后，我们在一个新的 250 例匹配的哮喘患者队列中前瞻性地重新评估了嗜酸性粒细胞与哮喘控制（哮喘控制问卷（ACQ））和加重率之间的联系。
在我们的回顾性队列中，无嗜酸性粒细胞炎症的哮喘患者是最大的群体（49%）。与非嗜酸性粒细胞性哮喘相比，单纯痰嗜酸性粒细胞增多（25%）的患者的 1 秒用力呼气量（FEV1）和 FEV1/用力肺活量比值较低，支气管高反应性和呼气一氧化氮分数（FeNO）较高。表现为单纯系统性嗜酸性粒细胞增多（7%）的哮喘患者具有与非嗜酸性粒细胞性哮喘相似的特征。具有系统和气道嗜酸性粒细胞增多一致（19%）的患者表现出显著的男性优势，气道口径、哮喘控制和生活质量最低，支气管高反应性、FeNO 和加重率最高。前瞻性队列证实了弥漫性嗜酸性粒细胞增多症与非嗜酸性粒细胞性哮喘相比，不同亚组的比例和更高的 ACQ 和加重率。同时存在系统性和支气管嗜酸性粒细胞炎症会导致哮喘控制不佳。
