title: The Sputum Colour Chart as a predictor of lung inflammation, proteolysis and damage in non-cystic fibrosis bronchiectasis: a case-control analysis.
abstract: OBJECTIVE
  Non-cystic fibrosis bronchiectasis (NCFB) is characterized by a vicious cycle of airway infection, inflammation and structural damage with inappropriate mucus clearance. Our aim was to relate the value of proteolytic enzymes, proteolytic enzyme activity and inflammatory markers to disease severity and symptoms in patients with NCFB.
  
  
  METHODS
  Sputum induction in NCFB patients and healthy controls was performed. Sputum was analysed for total and differential cell count, markers of inflammation (CXCL8 (also known as interleukin-8) and tumour necrosis factor-α (TNF-α)) and proteolytic enzymes (neutrophil elastase (NE), gelatin zymography and total gelatinolytic activity (TGA)). Each patient was evaluated by spirometry, Leicester Cough Questionnaire (LCQ) and Sputum Colour Chart (SCC). Patient files were analysed to determine Pseudomonas aeruginosa colonization status. The computed tomography (CT) closest to the date sputum induction was scored by a radiologist.
  
  
  RESULTS
  NCFB patients showed significantly higher neutrophils, CXCL8, TNF-α, NE and TGA than healthy controls. TGA subanalysis showed that the majority of the activity was NE (82 ± 6.4%). Residual activity was mainly zinc ion-dependent matrix metalloproteinase (MMP) activity (18 ± 6.4%). Subanalysis showed that patients with chronic Pseudomonas aeruginosa colonization had more activated MMP-9. Correlations were seen between proteolytic enzymes and inflammation and disease severity (spirometry and CT score), but not with the LCQ. SCC was associated with increased markers of inflammation, proteolytic enzymes and worse CT score.
  
  
  CONCLUSIONS
  We show that sputum purulence assessment in daily clinical practice using the SCC is a quick and easy tool that reflects severity of inflammation, destruction and proteolytic enzymatic activity/presence.
authors.affiliation: Department of Respiratory Disease, University Hospital of Gasthuisberg, Leuven, Belgium.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Goeminne
authors.affiliation: Rega Institute for Medical Research, Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vandooren
authors.affiliation: Rega Institute for Medical Research, Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium.
authors.forename: Eva A
authors.initials: EA
authors.lastname: Moelants
authors.affiliation: Department of Respiratory Disease, University Hospital of Gasthuisberg, Leuven, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Decraene
authors.affiliation: Department of Radiology, University Hospital of Gasthuisberg, Leuven, Belgium.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Rabaey
authors.affiliation: Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.
authors.forename: Ans
authors.initials: A
authors.lastname: Pauwels
authors.affiliation: Laboratory of Clinical Immunology, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Sven
authors.initials: S
authors.lastname: Seys
authors.affiliation: Rega Institute for Medical Research, Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium.
authors.forename: Ghislain
authors.initials: G
authors.lastname: Opdenakker
authors.affiliation: Rega Institute for Medical Research, Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Proost
authors.affiliation: Department of Respiratory Disease, University Hospital of Gasthuisberg, Leuven, Belgium.
authors.forename: Lieven J
authors.initials: LJ
authors.lastname: Dupont
mesh_terms: D015415:Biomarkers / Q000032:analysis*; D001987:Bronchiectasis / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D003116:Color; D003550:Cystic Fibrosis / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D059748:Proteolysis; D013183:Sputum / Q000737:chemistry*; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers
keywords: Leicester Cough Questionnaire; interleukin-8; matrix metalloproteinase-9; neutrophil elastase; total gelatinolytic activity