title: Heterogeneity of airway inflammation in persistent asthma : evidence of neutrophilic inflammation and increased sputum interleukin-8.
abstract: OBJECTIVE
  To identify the characteristics of airway inflammation in persistent asthma and to examine the role of neutrophilic inflammation in noneosinophilic persistent asthma.
  
  
  METHODS
  Nonsmoking adults (n = 56) with persistent asthma and healthy control subjects (n = 8) underwent hypertonic saline solution challenge and sputum induction. Selected sputum portions were dispersed with dithiothreitol and assayed for total cell count, cellular differential, supernatant eosinophil cationic protein (ECP), myeloperoxidase, and interleukin (IL)-8.
  
  
  RESULTS
  We identified two distinct inflammatory patterns. Typical eosinophilic inflammation occurred in 41% of subjects, whereas the remainder exhibited noneosinophilic asthma (59%). Both neutrophil percentage and absolute neutrophil counts were increased in subjects with noneosinophilic asthma (64%, 283 x 10(6)/mL) compared to eosinophilic asthma (14%, 41 x 10(6)/mL) and control subjects (34%, 49 x 10(6)/mL; p = 0.0001). Myeloperoxidase was elevated in both noneosinophilic (280 ng/mL) and eosinophilic groups (254 ng/mL) compared with control subjects (82 ng/mL; p = 0.002). Sputum IL-8 levels were highest in subjects with noneosinophilic asthma (45 ng/mL) compared to eosinophilic asthma (9.6 ng/mL) and control subjects (3.5 ng/mL; p = 0.0001). Neutrophils correlated with IL-8 levels (r = 0.72). ECP was highest in subjects with eosinophilic asthma (2,685 ng/mL) compared with noneosinophilic asthma (1,081 ng/mL) and control subjects (110 ng/mL; p = 0.0001).
  
  
  CONCLUSIONS
  Induced-sputum analysis in persistent asthma identifies two different inflammatory patterns. The most common pattern is noneosinophilic, associated with a neutrophil influx and activation, which may be mediated by IL-8 secretion. There is heterogeneity of airway inflammation in persistent asthma, which indicates differing mechanisms and may impact on treatment responses.
authors.affiliation: Airways Research Centre, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia. mdpgg@mail.newcastle.edu.au
authors.forename: P G
authors.initials: PG
authors.lastname: Gibson
authors.forename: J L
authors.initials: JL
authors.lastname: Simpson
authors.forename: N
authors.initials: N
authors.lastname: Saltos
mesh_terms: D000328:Adult; D001249:Asthma / Q000276:immunology*; D002452:Cell Count; D004804:Eosinophils; D005260:Female; D006801:Humans; D016209:Interleukin-8 / Q000032:analysis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D009195:Peroxidase / Q000032:analysis / Q000378:metabolism; D013183:Sputum / Q000737:chemistry* / Q000166:cytology*
chemical_list: D016209:Interleukin-8; D009195:Peroxidase