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The use of bronchoalveolar lavage (BAL) to assess lower airways inflammation in asthma

The use of bronchoalveolar lavage (BAL) to assess lower airways inflammation in asthma
The use of bronchoalveolar lavage (BAL) to assess lower airways inflammation in asthma
Rationale: While sputum cell counts and proportions have been used to characterise asthma the utility of BAL in phenotyping asthmatic inflammation is less well understood.

Method: BAL differential cell counts were obtained from 61 healthy volunteers(H) and 70 mild atopic asthmatics(MA),BTS step 1, 28 moderate asthmatics(MO), BTS step 3, and 81 severe asthmatics(SA), BTS steps 4-5. Median [IQR] percentage differential counts were calculated and group differences were analysed using Mann Whitney U test.

Results H median% [IQR] MA median% [IQR] MO median% [IQR] SA median% [IQR] Macrophages 90.3 [83.3-94.1] 86.5 [80.7-91.0]b 81.8 [76.0-89.9]b 78.0 [56.0-90.4]a,c Neutrophils 1.5 [0.8-4.3] 2.0 [1.25-3.0] 2.4 [1.3-7.8] 4.5 [2.0-12.5]a,c,d Epithelial cells 3.6 [0.8-10.0] 7.0 [4.3-10.8] b 7.65 [5.1-17.6]b 9.5 [2.5-20.0]b Eosinophils 0.1 [0.0-0.5] 1.0 [0.3-2.7]a 0.60 [0.0-1.5]b 0.5 [0.1-1.5]a Lymphocytes 1.2 [0.3-3.1] 1.0 [0.3-1.5] 0.625 [0.0-1.5]b 0.5 [0.0-1.3]b,c •a p=<0.001 from healthy, b p=<0.05 from healthy, c p=<0.05 from MA, d p=<0.05 from MOTABLE 1

Conclusion: Asthma, independent of severity, was associated with eosinophilic inflammation and increased epithelial shedding in BAL. Neutrophilic airway inflammation was, by contrast, only significantly different from health in severe asthma. In this respect, SA was also different from MA and MO. When the cut off for neutrophilic, eosinophilic and mixed granulocytic BAL was defined as median+2CI for the H patient population, 24% MA, 50% MO and 43% SA samples have results for one of these parameters that was outside of this normal range. These findings indicate the need for at a greater understanding of the relevance of distal airway inflammation to disease persistence in asthma.
0903-1936
Barber, Clair
ff31b460-34c3-466c-90e4-f70b3e954c82
Lau, Laurie
2af8045d-6162-4939-aba7-28dd2f60f6a8
Ward, Jon
a8107b98-069d-4263-bd70-d29d79f07edc
Tariq, Kamran
4de9ca91-e58a-49d7-970b-1b1cada17cf7
Gove, Kerry
6493b359-21cd-4068-88f4-a6e684f73316
Rupani, Hitasha
cbc7068a-4279-4c8e-b83f-353210711062
Sivaloganathan, Arjjana
28514795-7435-4b14-95c5-69d09c98414a
Staples, Karl
e0e9d80f-0aed-435f-bd75-0c8818491fee
Howarth, Peter
ff19c8c4-86b0-4a88-8f76-b3d87f142a21
Barber, Clair
ff31b460-34c3-466c-90e4-f70b3e954c82
Lau, Laurie
2af8045d-6162-4939-aba7-28dd2f60f6a8
Ward, Jon
a8107b98-069d-4263-bd70-d29d79f07edc
Tariq, Kamran
4de9ca91-e58a-49d7-970b-1b1cada17cf7
Gove, Kerry
6493b359-21cd-4068-88f4-a6e684f73316
Rupani, Hitasha
cbc7068a-4279-4c8e-b83f-353210711062
Sivaloganathan, Arjjana
28514795-7435-4b14-95c5-69d09c98414a
Staples, Karl
e0e9d80f-0aed-435f-bd75-0c8818491fee
Howarth, Peter
ff19c8c4-86b0-4a88-8f76-b3d87f142a21

Barber, Clair, Lau, Laurie, Ward, Jon, Tariq, Kamran, Gove, Kerry, Rupani, Hitasha, Sivaloganathan, Arjjana, Staples, Karl and Howarth, Peter (2016) The use of bronchoalveolar lavage (BAL) to assess lower airways inflammation in asthma. European Respiratory Journal, 48 (Suppl 60).

Record type: Meeting abstract

Abstract

Rationale: While sputum cell counts and proportions have been used to characterise asthma the utility of BAL in phenotyping asthmatic inflammation is less well understood.

Method: BAL differential cell counts were obtained from 61 healthy volunteers(H) and 70 mild atopic asthmatics(MA),BTS step 1, 28 moderate asthmatics(MO), BTS step 3, and 81 severe asthmatics(SA), BTS steps 4-5. Median [IQR] percentage differential counts were calculated and group differences were analysed using Mann Whitney U test.

Results H median% [IQR] MA median% [IQR] MO median% [IQR] SA median% [IQR] Macrophages 90.3 [83.3-94.1] 86.5 [80.7-91.0]b 81.8 [76.0-89.9]b 78.0 [56.0-90.4]a,c Neutrophils 1.5 [0.8-4.3] 2.0 [1.25-3.0] 2.4 [1.3-7.8] 4.5 [2.0-12.5]a,c,d Epithelial cells 3.6 [0.8-10.0] 7.0 [4.3-10.8] b 7.65 [5.1-17.6]b 9.5 [2.5-20.0]b Eosinophils 0.1 [0.0-0.5] 1.0 [0.3-2.7]a 0.60 [0.0-1.5]b 0.5 [0.1-1.5]a Lymphocytes 1.2 [0.3-3.1] 1.0 [0.3-1.5] 0.625 [0.0-1.5]b 0.5 [0.0-1.3]b,c •a p=<0.001 from healthy, b p=<0.05 from healthy, c p=<0.05 from MA, d p=<0.05 from MOTABLE 1

Conclusion: Asthma, independent of severity, was associated with eosinophilic inflammation and increased epithelial shedding in BAL. Neutrophilic airway inflammation was, by contrast, only significantly different from health in severe asthma. In this respect, SA was also different from MA and MO. When the cut off for neutrophilic, eosinophilic and mixed granulocytic BAL was defined as median+2CI for the H patient population, 24% MA, 50% MO and 43% SA samples have results for one of these parameters that was outside of this normal range. These findings indicate the need for at a greater understanding of the relevance of distal airway inflammation to disease persistence in asthma.

Full text not available from this repository.

More information

Published date: September 2016
Venue - Dates: European Respiratory Society Annual Conference 2016, London, United Kingdom, 2016-09-03 - 2016-09-07

Identifiers

Local EPrints ID: 422517
URI: https://eprints.soton.ac.uk/id/eprint/422517
ISSN: 0903-1936
PURE UUID: 4fdd9f52-b2b3-4b37-ae7c-53fceaac8a07
ORCID for Clair Barber: ORCID iD orcid.org/0000-0001-5335-5129
ORCID for Karl Staples: ORCID iD orcid.org/0000-0003-3844-6457

Catalogue record

Date deposited: 25 Jul 2018 16:30
Last modified: 14 Mar 2019 01:41

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