Pharmacologic modulation of airway inflammation

[Chronic rhinitis--effect of topical administration of corticosteroids on eosinophilic leukocytes]

Clinical manifestation of chronic rhinitis is due to local release of mediators from inflammatory cells. Eosinophil leukocytes are important in pathogenesis of nasal hypersensitivity as well as nasal hyperreactivity [1, 2]. The aim of the study was to follow-up the effect of local corticosteroid treatment on a number of eosinophils in nasal secretion of patients with chronic rhinitis. The study was prospective and controlled. A total number of 88 subjects was included in the study. Patients with chronic rhinitis who were treated with local corticosteroids (63) constituted the experimental group (37 with isolated allergic rhinitis, 10 with isolated nonallergic noninfective hyperreactive rhinitis, 10 with allergic rhinitis associated with nasal polyposis and 6 with nonallergic noninfective hyperreactive rhinitis associated with nasal polyposis). There were 25 patients with chronic rhinitis in the control group (18 with isolated allergic rhinitis, 2 with isolated nonallergic noninfective hyperreactive rhinitis, 3 with allergic rhinitis associated with nasal polyposis, and 2 with nonallergic noninfective, hyperreactive rhinitis associated with nasal polyposis). During the treatment with beclomethasone dipropionate aqueous nasal spray (daily dose was 400 micrograms during 6 weeks for isolated rhinitis and 6 months for associated forms of rhinitis), control examinations were regulary performed. The first control was after one week, the second after six weeks, the third after three months and the fourth after six months. The same control was carried out in the control group of patients who were without therapy. Cytological examination of nasal secretions included brush method of collecting secretions, staining smears with Leishman's stain and light microscopic scrutinising of nasal smear magnified up to 1000 times. The results of the study demonstrated the highly significant decrease in the number of eosinophils after the therapy in patients with isolated allergic rhinitis (x2(FR) = 71,121, DF = 2, p < 0.01), in patients with isolated hyperreactive rhinitis (x2(FR) = 19,050, DF = 2, p < 0.01), in patients with allergic rhinitis associated with nasal polyposis (x2(FR) = 26,730, DF = 3, p < 0.01), as well as in patients with hyperreactive rhinitis associated with nasal polyposis (x2(FR) = 17,000, DF = 3, p < 0.01). There were no significant differences in control group of patients, neither in subgroup with allergic rhinitis (x2(FR) = 2,528, DF = 2, p > 0.05) nor in subgroup with hyperreactive rhinitis associated with nasal polyposis (x2(FR) = 0.250, DF = 2, p > 0.05) (Table 2). Local corticosteroids have the potential to influence the regulation of eosinophil apoptosis. The induction of apoptosis by beclomethasone dipropionate treatment is an efficient way to remove eosinophil leukocytes from inflammatory sites [8]. The locally used corticosteroids in chronic rhinitis reduced significantly the number of eosinophils in nasal secretion. This result proves immunomodulatory effects of these medicaments in the pathogenesis of chronic rhinitis.

Induced sputum in children: feasibility, repeatability, and relation of findings to asthma severity

BACKGROUND

The collection of induced sputum provides a non-invasive method of investigating airway inflammation. Few studies have been performed in children, so a study was undertaken to determine the feasibility of sputum induction, the repeatability of eosinophil counts and sputum eosinophil cationic protein (ECP) levels, and the relation of these to current asthma severity. For comparison, serum ECP levels were also measured.

METHODS

In a cross sectional study of children aged 5-15 years, 27 healthy children and 60 with asthma underwent sputum induction using inhaled nebulised hypertonic saline. The whole sputum sample was used for analysis. Ten children with stable asthma repeated the procedure within 10 days.

RESULTS

A satisfactory sample (>500 non-squamous cells) was obtained in 61% of children with asthma and in 60% of healthy controls. The limits of agreement within subjects ranged from a 0.68 to 2.8 fold difference for eosinophil differential counts and from 0.38 to 4.4 fold for sputum ECP. Despite a median of 42% squamous cells, significant differences were found between asthma and healthy controls for the eosinophil differential count (p = 0.0004), total eosinophil counts (p = 0.03), and sputum ECP level (p = 0.0001). Overall, there was no correlation between any marker of airway inflammation and asthma severity, however expressed, including lung function.

CONCLUSIONS

Sputum induction is only possible in a proportion of children. The repeatability of sputum cell counts and ECP levels, measured in a small number of children, was similar to that reported in adults. Sputum analysis revealed no evidence of airway inflammation in a number of highly symptomatic children with asthma.