title: Neutrophilic asthma is characterised by increased rhinosinusitis with sleep disturbance and GERD.
abstract: BACKGROUND
  Asthma is a heterogeneous inflammatory disease and eosinophilic, non-eosinophilic and neutrophilic forms are recognised. While clinically similar to eosinophilic asthma, patients with non-eosinophilic asthma have different responses to treatment and little is known about the triggers of symptoms and inflammation.
  
  
  OBJECTIVE
  This study sought to characterise asthma control, exacerbation frequency and potential triggers of non-eosinophilic and specifically neutrophilic asthma such as infection, gastroesophageal reflux disease, and rhinosinusitis.
  
  
  METHODS
  Adults with asthma (n=65; doctor's diagnosis plus demonstrated response to bronchodilator and/or airways hyperresponsiveness to hypertonic saline) were recruited from the Respiratory and Sleep Medicine Ambulatory Care Service at John Hunter Hospital, NSW, Australia. Questionnaires were administered to assess gastroesophageal reflux disease, rhinosinusitis and asthma control. A sputum induction was performed and sputum was processed for assessment of inflammatory cells, infection, and lipid laden macrophages (Oil Red O).
  
  
  RESULTS
  Participants with neutrophilic asthma (n=11, 23%) had a higher frequency of primary care doctor visits for asthma exacerbations and a high prevalence (> 70%) of chest infections in the previous 12 months. There was also an increased prevalence of rhinosinusitis (64%) and increased symptoms of gastroesophageal reflux disease compared to those with eosinophilic asthma.
  
  
  CONCLUSIONS
  The clinical pattern of neutrophilic asthma is different from paucigranulocytic and eosinophilic asthma with evidence of abnormal upper airways responses. Specific and targeted treatment of these airway problems may assist in the control and management of neutrophilic asthma.
authors.affiliation: Centre for Asthma and Respiratory Disease, The University of Newcastle, NSW.
authors.forename: Jodie L
authors.initials: JL
authors.lastname: Simpson
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Baines
authors.forename: Nicole
authors.initials: N
authors.lastname: Ryan
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gibson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000175:diagnosis* / Q000276:immunology*; D003430:Cross-Sectional Studies; D004804:Eosinophils / Q000276:immunology; D005260:Female; D005764:Gastroesophageal Reflux / Q000276:immunology*; D006801:Humans; D007249:Inflammation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D012852:Sinusitis / Q000276:immunology*; D012893:Sleep Wake Disorders / Q000276:immunology*; D055815:Young Adult