title: Importance of concomitant local and systemic eosinophilia in uncontrolled asthma.
abstract: Systemic and airway eosinophilia are recognised features of asthma. There are, however, patients who exhibit discordance between local and systemic eosinophilia. In this study, we sought to determine the prevalence and characteristics of patients with concordant and discordant systemic and bronchial eosinophilia. We conducted a retrospective study on 508 asthmatics with successful sputum induction. We assessed the relationship between blood and sputum eosinophils by breaking down the population into four groups according to blood (≥400 cells per mm3) and sputum (≥3%) eosinophils. Then, we prospectively reassessed the link between eosinophils and asthma control (Asthma Control Questionnaire (ACQ)) and exacerbation rate in a new cohort of 250 matched asthmatics. In our retrospective cohort, asthmatics without eosinophilic inflammation were the largest group (49%). The group with isolated sputum eosinophilia (25%) was, compared with noneosinophilic asthma, associated with lower forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity ratio and higher bronchial hyperresponsiveness and exhaled nitric oxide fraction (FeNO). Asthmatics exhibiting isolated systemic eosinophilia (7%) had similar characteristics as noneosinophilic asthmatics. The group with concordant systemic and airway eosinophilia (19%) showed remarkable male predominance, and had the lowest airway calibre, asthma control and quality of life, and the highest bronchial hyperresponsiveness, FeNO and exacerbation rate. The prospective cohort confirmed the different subgroup proportions and the higher ACQ and exacerbation rates in cases of diffuse eosinophilia compared with noneosinophilic asthmatics. Concomitant systemic and bronchial eosinophilic inflammation contribute to poor asthma control.
authors: Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege fschleich@chu.ulg.ac.be.
authors: Florence Nicole
authors: FN
authors: Schleich
authors: Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege.
authors: Anne
authors: A
authors: Chevremont
authors: Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege.
authors: Virginie
authors: V
authors: Paulus
authors: Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege.
authors: Monique
authors: M
authors: Henket
authors: Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege.
authors: Maité
authors: M
authors: Manise
authors: Medical Informatics and Biostatistics, University of Liege, Liege, Belgium.
authors: Laurence
authors: L
authors: Seidel
authors: Dept of Pulmonary Medicine, CHU Sart-Tilman, Liege, IGIGA Research Group, University of Liege, Liege.
authors: Renaud
authors: R
authors: Louis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000097:blood / Q000150:complications* / Q000378:metabolism; D016022:Case-Control Studies; D004802:Eosinophilia / Q000097:blood / Q000150:complications* / Q000378:metabolism; D004804:Eosinophils / Q000166:cytology; D005541:Forced Expiratory Volume; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D013183:Sputum / Q000378:metabolism*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult