title: Bronchial hyperresponsiveness, airway inflammation, and reversibility in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Bronchial hyperresponsiveness (BHR), sputum eosinophilia, and bronchial reversibility are often thought to be a hallmark of asthma, yet it has been shown to occur in COPD as well.
  
  
  OBJECTIVE
  To evaluate the relationship between BHR, lung function, and airway inflammation in COPD patients.
  
  
  METHODS
  Thirty-one, steroid-free patients with stable, mild and moderate COPD were studied. The following tests were carried out: baseline lung function, reversibility, provocative dose of methacholine causing a 20% fall in forced expiratory volume in 1 second, a COPD symptom score, and sputum induction.
  
  
  RESULTS
  Twenty-nine patients completed the procedures. About 41.4% had BHR, 31.0% had increased sputum eosinophils, and 37.9% had bronchial reversibility. Some of the patients had only one of these characteristics while others had two or the three of them. Patients with BHR had higher sputum eosinophils than patients without BHR (P=0.046) and those with sputum eosinophils ≥3% had more exacerbations in the previous year and a higher COPD symptom score than patients with sputum eosinophils <3% (P=0.019 and P=0.031, respectively). In patients with BHR, the cumulative dose of methacholine was negatively related to the symptom score and the number of exacerbations in the previous year. When patients with bronchial reversibility were considered, bronchodilation was positively related to sputum eosinophils.
  
  
  CONCLUSIONS
  Our study showed that BHR, sputum eosinophilia, and bronchial reversibility were not clustered in one single phenotype of COPD but could be present alone or together. Of interest, BHR and airway eosinophilia were associated with clinical data in terms of exacerbations and symptoms. Further investigation is needed to clarify this topic.
authors.affiliation: Division of Pneumology, IRCCS Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation (IRCCS), Tradate, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanini
authors.affiliation: Division of Pneumology, IRCCS Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation (IRCCS), Tradate, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cherubino
authors.affiliation: Division of Pneumology, IRCCS Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation (IRCCS), Tradate, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Zampogna
authors.affiliation: Allergy and Immunology Unit, Salvatore Maugeri Foundation (IRCCS), Pavia, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Croce
authors.affiliation: Allergy and Immunology Unit, Salvatore Maugeri Foundation (IRCCS), Pavia, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pignatti
authors.affiliation: Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Spanevello
mesh_terms: D000368:Aged; D016535:Bronchial Hyperreactivity / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D001985:Bronchial Provocation Tests; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000276:immunology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D011657:Pulmonary Eosinophilia / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D012720:Severity of Illness Index; D013147:Spirometry; D013183:Sputum / Q000166:cytology / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; exacerbations; hyperreactivity; methacholine; sputum eosinophilia