title: Serial sputum cell counts in the management of chronic airflow limitation.
abstract: This case study illustrates the usefulness of serial induced sputum cell counts from cytospins to investigate the nature of airway inflammation in a patient presumed to have prednisone-dependent asthma for 30 yrs. She had bronchiectasis and chronic airflow limitation. Exacerbations of breathlessness were associated with an increase in chronic airflow limitation with little or no sputum. Induced sputum showed elevated total cell and neutrophil counts at each exacerbation with no increase in the proportion of eosinophils. Pathogenic bacteria were cultured at each flare-up. The dose of prednisone was reduced progressively and each exacerbation was treated with an appropriate antibiotic without increasing the dose of prednisone, as was the case previously. The infections were associated with bronchiectasis of the right upper lobe which was removed. Examination of the specimen confirmed neutrophilic infiltration and did not show the usual airway structural changes of asthma. These results provide further evidence of the value of sputum cell counts in practice, in this case to prevent overtreatment with prednisone in a patient with recurrent deteriorations in airflow which were due to recurrent infections.
authors.affiliation: Dept of Medicine, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Parameswaran
authors.forename: M M
authors.initials: MM
authors.lastname: Pizzichini
authors.forename: D
authors.initials: D
authors.lastname: Li
authors.forename: E
authors.initials: E
authors.lastname: Pizzichini
authors.forename: P K
authors.initials: PK
authors.lastname: Jeffery
authors.forename: F E
authors.initials: FE
authors.lastname: Hargreave
mesh_terms: D001249:Asthma / Q000175:diagnosis; D001987:Bronchiectasis / Q000175:diagnosis* / Q000382:microbiology; D001991:Bronchitis / Q000175:diagnosis; D002452:Cell Count; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012123:Pulmonary Ventilation; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000601:surgery; D013183:Sputum / Q000166:cytology*
chemical_list: D005938:Glucocorticoids; D011241:Prednisone