Chest
Selected ReportsAsthma Management by Monitoring Sputum Neutrophil Count
Section snippets
Case Report
A 47-year-old woman had asthma since childhood and a history of nasal polyps, aspirin sensitivity, and gastroesophageal reflux. She was a lifetime nonsmoker with no reported occupational exposures. Her asthma was well controlled with budesonide, 200 μg three for four puffs bid, and formoterol, 12 μg two puffs bid, until 2 years ago. Over the last 2 years, she had three episodes of cough and yellow sputum. A high-resolution CT scan of the thorax did not show any abnormalities. Most recently, the
Discussion
This case report illustrates the utility of identifying the presence and cellular type of bronchitis associated with asthma exacerbation. Exacerbations associated with eosinophilic bronchitis respond to treatment with corticosteroids, whereas noneosinophilic (usually neutrophilic) exacerbations usually do not.6 The nature of bronchitis may change in the same patient depending on the cause.7 An eosinophilic bronchitis (sputum eosinophils 2%) is treated by increasing the dose of antiinflammatory
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Cited by (15)
Monoclonal antibodies for the treatment of asthma
2011, Pharmacology and TherapeuticsCitation Excerpt :The greater involvement of Th1 and Th17 cells in asthma could drive the neutrophilic inflammation in the lungs of some severe asthmatics whose disease is less responsive to treatment with corticosteroids (Green et al., 2002; Alcorn et al., 2010). Neutrophilic inflammation can also be associated with some acute viral and bacterial exacerbations of asthma, another unmet medical need for asthma therapies (Wark et al., 2002; Pallan et al., 2008). Moreover, patients who die suddenly of asthma have large numbers of neutrophils in their airways, although this may reflect the rapid recruitment of neutrophils when compared to eosinophil recruitment (Carroll et al., 1996; Lamblin et al., 1998; de Magalhaes et al., 2005).
Recent advances in the pathophysiology of asthma
2010, ChestCitation Excerpt :A recently published study has described elevated levels of granulocyte-macrophage colony-stimulating factor in the sputum of patients with moderate to severe asthma and also in patients with COPD, regardless of its severity.50 Therefore, it appears likely that an increase in airway neutrophils has important clinical implications in asthma.51 The bone marrow represents a vast source of potential effector cells with the ability to affect inflammation.52
The authors have no conflicts of interest to disclose.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
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Dr. Nair holds a Canada Research Chair in Airway Regulation and Inflammation.