Thorax 2000;55:12-18 ( January )

Ongoing airway inflammation in patients with COPD who do not currently smoke

Steven R Rutgers^a, Dirkje S Postma^a, Nick H T ten Hacken^a, Henk F Kauffman^b, Thomas W van der Mark^a, Gerard H Koëter^a, Wim Timens^c

^a Department of Pulmonology, University Hospital, 9700 RB Groningen, The Netherlands, ^b Department of Allergology, ^c Department of Pathology

Correspondence to: Dr D S Postma

Received 30 April 1999; Returned to authors 12 July 1999; Revised version received 27 August 1999; Accepted for publication 8 September 1999

BACKGROUNDInflammatory changes in the airways in chronic obstructive pulmonary disease (COPD) are largely attributed to smoking, yet they may be present even if patients do not currently smoke. The differences in inflammatory cells and the factors contributing to these differences were examined in the airways of patients with COPD who do not currently smoke.
METHODSEighteen non-atopic subjects with COPD (14 men) of mean (SD) age 62 (8) years and forced expiratory volume in one second (FEV₁) 59 (13)% predicted and 11 non-atopic healthy subjects (eight men) of mean (SD) age 58 (8) years, FEV₁ 104 (11)% predicted were studied. Sputum induction and bronchoscopy with bronchoalveolar lavage (BAL) and biopsies were performed.
RESULTSPatients with COPD had more mucosal EG2+ cells (eosinophils) (median (range) 40 (0-190) versus 5 (0-40) cells/mm², p = 0.049) and CD68+ cells (1115 (330-2920) versus 590 (450-1580) cells/mm², p = 0.03), and a tendency towards more CD4+ but not CD8+ lymphocytes than healthy controls. Furthermore, patients with COPD had higher percentages of sputum neutrophils (77 (29-94) versus 36 (18-60)%, p = 0.001) and eosinophils (1.2 (0-8.5) versus 0.2 (0-3.1)%, p = 0.008), BAL fluid eosinophils (0.4 (0-1.7) versus 0.2 (0-0.5)%, p = 0.03), and higher concentrations of sputum eosinophilic cationic protein (ECP) (838 (115-23 760) versus 121 (35-218) ng/ml, p<0.001). Concentrations of ECP expressed per eosinophil were not higher. Patients with COPD with high mucosal EG2+ cell numbers also had high mucosal CD4+ cell numbers. Sputum eosinophilia was associated with a decrease in FEV₁/VC and BAL fluid eosinophilia with a decrease in mucosal NP57+ cells (neutrophils).
CONCLUSIONSSubjects with COPD who do not currently smoke have increased numbers of inflammatory cells. Eosinophils are increased in number in the airways in COPD but do not seem to be activated. The increased eosinophil numbers are probably due to recruitment as a result of ongoing inflammation. Macrophages and lymphocytes may play a part in this inflammation.


Keywords: chronic obstructive pulmonary disease; biopsy; inflammation

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© 2000 by Thorax
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