title: Heterogeneity of bronchitis in airway diseases in tertiary care clinical practice.
abstract: BACKGROUND
  Sputum cell counts have identified inflammatory subtypes of bronchitis in relatively small numbers of subjects with asthma, chronic obstructive pulmonary disease (COPD) and chronic cough in research studies. The prevalence of different subtypes of bronchitis in routine clinical practice, however, has not been reported.
  
  
  OBJECTIVE
  To examine the heterogeneity of bronchitis and its relationship to the severity of airflow obstruction.
  
  
  METHODS
  A retrospective cross-sectional survey based on a computerized database of spontaneous or induced sputum cell counts examined in a large university tertiary respiratory outpatient clinic.
  
  
  RESULTS
  The database contained 4232 consecutive sputum records from 2443 patients with chronic cough (39%), asthma (37%), asthma with COPD (9%), COPD (13%) and bronchiectasis (3%). Total and differential cell counts were obtained from 86% of successful sputum samples. Induced sputum provided more viable samples than spontaneous expectorate. Approximately one-third of patients with asthma and one-fifth of patients with COPD experience eosinophilic bronchitis. Asthmatic patients with moderate to severe airflow obstruction had a greater number of sputum eosinophils. There was a significantly higher number of total cell counts and percentage of neutrophils in the sputum of COPD patients with moderate and severe airflow obstruction than in those with mild airflow obstruction.
  
  
  CONCLUSIONS
  There is heterogeneity in the cellularity of sputum in various airway diseases. Patients with clinically stable airway diseases may have high sputum cell counts. During exacerbations, more patients may experience neutrophilic bronchitis. Severity of airflow obstruction is associated with eosinophilic bronchitis in patients with asthma, and neutrophilic bronchitis in patients with nonasthmatic COPD.
authors.affiliation: Firestone Institute for Respiratory Health, St. Joseph's Healthcare & Department of Medicine, McMaster University, Hamilton, Ontario.
authors.forename: Liesel
authors.initials: L
authors.lastname: D'silva
authors.forename: Nesreen
authors.initials: N
authors.lastname: Hassan
authors.forename: Hong-Yu
authors.initials: HY
authors.lastname: Wang
authors.forename: Melanie
authors.initials: M
authors.lastname: Kjarsgaard
authors.forename: Ann
authors.initials: A
authors.lastname: Efthimiadis
authors.forename: Frederick E
authors.initials: FE
authors.lastname: Hargreave
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Nair
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D001249:Asthma / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D001987:Bronchiectasis / Q000209:etiology; D001991:Bronchitis / Q000145:classification / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D002452:Cell Count / Q000379:methods; D003371:Cough / Q000209:etiology; D003430:Cross-Sectional Studies; D004804:Eosinophils / Q000473:pathology*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D012137:Respiratory System / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013183:Sputum / Q000378:metabolism*