title: Serum eosinophil cationic protein levels measured during exacerbation of asthma: characteristics of patients with low titres.
abstract: BACKGROUND
  Serum eosinophil cationic protein (ECP) levels reflect ongoing eosinophilic airway inflammation and are used as a marker for asthma activity. ECP levels, however, may not be elevated in some asthmatic patients, even when they are symptomatic.
  
  
  OBJECTIVE
  To clarify the characteristics of patients with 'low' ECP titres despite asthma exacerbation.
  
  
  METHODS
  Serum ECP levels were measured in 113 asthmatic patients during exacerbation. Patients were divided into two groups according to ECP titre: a high ECP group (H; ECP > or = 16.0 microg/L) and a low ECP group (L; ECP <16.0 microg/L). Twenty-two patients who had recently received systemic steroids were excluded and the clinical features of the remaining patients in H (n = 54) and L (n = 37 were compared.
  
  
  RESULTS
  Gender, atopic or smoking status, disease severity, inhaled steroid or theophylline usage, peak expiratory flow (% personal best) and forced expiratory volume in 1 s (FEV1) (% predicted) did not significantly differ between the two groups. Patients in L were significantly older and had longer disease duration and lower serum IgE levels than those in H. Multivariate analysis combining age, disease duration and IgE levels showed that age and disease duration were independently associated with ECP level. Airway wall thickness, assessed in a subset of patients using computed tomography, was significantly larger in L.
  
  
  CONCLUSIONS
  Serum ECP levels in asthmatic patients may not be elevated during exacerbation and thus may not be a useful marker in patients who are older, have longer disease duration or possibly have thicker airway walls. Mechanisms other than eosinophilic inflammation, such as airway remodelling, may be involved in asthma exacerbation in these patients.
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Matsumoto
authors.forename: A
authors.initials: A
authors.lastname: Niimi
authors.forename: M
authors.initials: M
authors.lastname: Minakuchi
authors.forename: T
authors.initials: T
authors.lastname: Izumi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000097:blood*; D001798:Blood Proteins / Q000378:metabolism*; D047091:Eosinophil Granule Proteins; D004804:Eosinophils / Q000166:cytology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012260:Ribonucleases; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D007073:Immunoglobulin E; D012260:Ribonucleases