Airway Inflammation and Cellular Stress in Noneosinophilic Atopic Asthma: Results

Airway Inflammation and Cellular Stress in Noneosinophilic Atopic Asthma: ResultsAmong the 37 asthmatic patients included in the study, 17 patients (46%) belonged to the NEA group and 20 patients (54%) belonged to the EA group. Table 1 shows the characteristics of the two groups of asthmatic patients and of COPD patients. No difference was found between the two asthmatic groups. However, there was a tendency toward lower bronchodilator response in NEA patients (p = 0.1). COPD patients were significantly older and were more often men with more severe airflow limitation that did not respond to therapy with inhaled bron-chodilators. Table 2 shows cellular counts in the three groups. The mean (± SD) viability of the cells (as the percentage of the total number of nonsquamous cells) was 81 ± 13% in NEA patients, 85 ± 15% in EA patients, and 83 ± 16% in COPD patients. The mean percentage of squamous epithelial cells (as the percentage of the total of sputum cells) was 9 ± 5% in NEA patients, 8 ± 4% in EA patients, and 6 ± 5% in COPD patients. No other difference except in eosinophil counts was demonstrated between the NEA and EA groups. Compared to COPD patients, NEA patients showed lower total cell counts and neutrophil percentages, and higher macrophage and lymphocyte percentages. more
Figure 1 shows the immunopositivity for HO-1 (Fig 1, top left, a1, and top right, a2), iNOS (Fig 1, middle left, b1, and middle right, b2), and nitrotyrosine (Fig 1, bottom left, c1, and bottom right, c2),
expressed as percentages of positive inflammatory cells (ie, polymorphonuclear cells and macrophages) and as absolute counts of positive cells per gram of sputum. Comparisons across the three groups revealed no differences in immunopositivity for HO-1 and iNOS, but a significant difference (p = 0.003) for nitrotyrosine in at least one sample population vs one other sample population. Further analyses of the comparison between two groups showed that NEA patients did not differ from EA patients but demonstrated lower nitrotyrosine-positive percentages (p = 0.07) and absolute counts (p < 0.003) in comparison with COPD patients.

Table 1—Demographic Characteristics of NEA Patients, EA Patients, and COPD Patients

Variables Asthma Patients COPD Patients (n = 25)
NEA Patients (n = 17) EA Patients (n = 20)
Age, yr 45 ± 18 49 ± 16 GO + 196
Sex
Male 6 7 23j
Female 11 13 2j
FEVj, % predicted 77 ± 29 52+ 147 + 134
FEV/FVC ratio 71 ± 14 74 ± 16 +194
AFEVj, % predicted from baseline 7+ 18 14 ± 10 CO+13
ICS,§ |ULg/d 500 (400-1,000) 450 (400-1,000) 640 (400-1,000)

Table 2—Sputum Differential Cell Counts Within the Total Non-Squamous Cell Count and in Absolute Numbers of Cells in NEA Patients, EA Patients, and COPD Patients

Variables Asthma Patients COPD Patients
NEA Patients 1EA Patients
TCC, X106 cells/g sputum 6 (0.3, 78) 8 (4, 34) 20 (0.7, 77)
MAC, % 44 ± 18 42 ± 14 18 (1, 41)
AC, X106 cells/g sputum 4 (0.01, 19) 3 (0.3, 20) 4 (0, 19)
NEU, % 51 ± 21 48 ± 16 79 (50, 99)
AC, X106 cells/g sputum 3 (0.2, 62) 4(1, 14) 12 (0.5, 69)
LYM, % 2 (0, 8) 3 (0, 5) 1 (0, 6)
AC, X106 cells/g sputum 0.1 (0, 0.8) 0.2 (0, 1) 0.1 (0, 1)
EOS, % 0 (0, 2) 8 (3, 28)§ 0.5 (0, 8)
AC, X106 cells/g sputum 0 (0, 0.2) 0.6(0.1,3)§ 0.02 (0, 3)

Figure-1

Figure 1. Top left, a1: percentages of HO-1-positve inflammatory cells (ie, polymorphonuclear cells and macrophages) in the total number of inflammatory cells in NEA patients, EA patients, and COPD patients. The results are expressed as the mean (SEM). Top right, a2: the absolute number of HO-1-positive inflammatory cells (ie, polymorphonuclear cells and macrophages) per gram of sputum in NEA, EA, and COPD patients. The results are expressed as the mean (SEM). Middle left, b1: percentages of iNOS-positive inflammatory cells, as expressed in top left, a1. Middle right, b2: absolute number of iNOS-positive inflammatory cells, as expressed in top right, a2. Bottom left, c1: percentages of nitrotyrosine-positive inflammatory cells, as expressed in top left, a1. Bottom right, c2: absolute number of nitrotyrosine-positive inflammatory cells, as expressed in top right, a2. NS = not significant.

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