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. 2011 May-Jun;18(3):144-8.
doi: 10.1155/2011/430317.

Heterogeneity of bronchitis in airway diseases in tertiary care clinical practice

Liesel D'silva  1 , Nesreen Hassan, Hong-Yu Wang, Melanie Kjarsgaard, Ann Efthimiadis, Frederick E Hargreave, Parameswaran Nair
Affiliations

Heterogeneity of bronchitis in airway diseases in tertiary care clinical practice

Liesel D'silva et al. Can Respir J. 2011 May-Jun.

Abstract
in English, French

Background: Sputum cell counts have identified inflammatory subtypes of bronchitis in relatively small numbers of subjects with asthma, chronic obstructive pulmonary disease (COPD) and chronic cough in research studies. The prevalence of different subtypes of bronchitis in routine clinical practice, however, has not been reported.

Objective: To examine the heterogeneity of bronchitis and its relationship to the severity of airflow obstruction.

Methods: A retrospective cross-sectional survey based on a computerized database of spontaneous or induced sputum cell counts examined in a large university tertiary respiratory outpatient clinic.

Results: The database contained 4232 consecutive sputum records from 2443 patients with chronic cough (39%), asthma (37%), asthma with COPD (9%), COPD (13%) and bronchiectasis (3%). Total and differential cell counts were obtained from 86% of successful sputum samples. Induced sputum provided more viable samples than spontaneous expectorate. Approximately one-third of patients with asthma and one-fifth of patients with COPD experience eosinophilic bronchitis. Asthmatic patients with moderate to severe airflow obstruction had a greater number of sputum eosinophils. There was a significantly higher number of total cell counts and percentage of neutrophils in the sputum of COPD patients with moderate and severe airflow obstruction than in those with mild airflow obstruction.

Conclusion: There is heterogeneity in the cellularity of sputum in various airway diseases. Patients with clinically stable airway diseases may have high sputum cell counts. During exacerbations, more patients may experience neutrophilic bronchitis. Severity of airflow obstruction is associated with eosinophilic bronchitis in patients with asthma, and neutrophilic bronchitis in patients with nonasthmatic COPD.

HISTORIQUE :: Dans les études de recherche, la numération cellulaire des expectorations permet de déceler des sous-types de bronchite chez un nombre relativement peu nombreux de sujets atteints d’asthme, de maladie pulmonaire obstructive chronique (MPOC) ou de toux chronique. La prévalence de divers sous-types de bronchite n’a toutefois pas fait l’objet de comptes rendus en pratique clinique.

OBJECTIF :: Examiner l’hétérogénéité de la bronchite et son lien avec la gravité de l’obstruction des voies respiratoires.

MÉTHODOLOGIE :: Sondage transversal rétrospectif fondé sur une base de données informatisée de la numération cellulaire des expectorations spontanées ou induites au sein du grand service de consultations externes d’un centre universitaire de soins tertiaires.

RÉSULTATS :: La base de données contenait 4 232 dossiers consécutifs d’expectorations provenant de 2 443 patients atteints de toux chronique (39 %), d’asthme (37 %), d’asthme accompagné de MPOC (9 %), de MPOC (13 %) et de bronchiectasie (3 %). Les numérations cellulaires totales et différentielles provenaient de 86 % des échantillons d’expectorations réussis. Les expectorations induites fournissaient des échantillons plus viables que les expectorations spontanées. Environ le tiers des patients atteints d’asthme et le cinquième de ceux ayant une MPOC ont souffert d’une bronchite à éosinophiles. Les patients asthmatiques présentant une obstruction modérée à grave des voies respiratoires affichaient un plus grand nombre d’éosinophiles dans les expectorations. La numération cellulaire totale et le pourcentage de neutrophiles étaient considérablement plus élevés chez les patients atteints de MPOC présentant une obstruction modérée à grave des voies respiratoires que chez ceux présentant une obstruction bénigne des voies respiratoires.

CONCLUSION :: On constate une hétérogénéité dans la cellularité des expectorations de diverses maladies respiratoires. Les patients dont la maladie respiratoire est stable sur le plan clinique peuvent présenter une numération cellulaire élevée des expectorations. Pendant les exacerbations, plus de patients peuvent souffrir de bronchite à éosinophiles. La gravité de l’obstruction des voies respiratoires s’associe à une bronchite à éosinophiles chez les patients atteints d’asthme, et à une bronchite à neutrophiles chez les patients atteints d’une MPOC non asthmatique.

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Figures

Figure 1)
Figure 1)
The percentage of sputum samples with a cellular viability of greater than 40% among induced or spontaneous sputum samples in patients with different airway diseases. COPD Chronic obstructive pulmonary disease
Figure 2)
Figure 2)
A The distribution of patients with asthma (stable and during exacerbations) with eosinophilic bronchitis when different cut-off values were used to define eosinophilia. B The distribution of patients with chronic obstructive pulmonary disease (stable and during exacerbations) with eosinophilic bronchitis when different cut-off values were used to define eosinophilia
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