Application of Inflammatory Markers in Induced Sputum in Stable Chronic Obstructive Pulmonary Disease Patients with Positive Bronchodilation Tests

Positive bronchodilation (BD) tests can be noticed in some stable chronic obstructive pulmonary disease (COPD) patients.The characteristics of airway inflammation in this entity remain unclear.Our study aimed to identify the characteristics of airway inflammation in stable COPD patients with positive BD tests.The airway inflammation was assessed in 88 patients with stable COPD using the examination of induced sputum in the aftermath of lung function and BD tests.Cellular counts and the levels of molecular markers including eosinophil cationic protein (ECP),myeloperoxidase (MPO),interleukin-5 (IL-5),and IL-8 were assayed by Wright's stain,Immuno-CAP system,and ELISA,RT-PCR.Among the 88 patients with stable COPD,20 (22.7%) showed positive BD tests.The values of eosinophils (4.7%±3.4%) and ECP (90.1±41.6 ng/mL) in induced sputum in stable COPD patients with positive BD tests were markedly elevated as compared with those in stable COPD patients with negative BD tests or in healthy controls (all P<0.05),but significantly lower than those in asthmatic patients (all P<0.01).The IL-5 in sputum supernatant was significantly decreased in stable COPD patients with positive BD tests as compared with the patients with asthma (12.5±7.8 vs.48.2±26.0 ng/mL;P<0.01).However,healthy controls exhibited similar concentrations of IL-5 in induced sputum with patients with stable COPD,whether with positive or negative BD tests (all P>0.05).Moreover,the values of neutrophils (61.8%±15.1%),MPO (574.0±111.8 ng/mL),and IL-8 (32.6±13.4 ng/mL) in induced sputum in stable COPD patients with positive BD tests were significantly higher than those in asthmatics or normal controls (all P<0.01).However,the values of the above inflammatory markers in induced sputum were similar among stable COPD patients with positive or negative BD tests (all P>0.05).The stable COPD patients with positive BD tests may present not only eosinophilic airway inflammation but also neutrophilic airway inflammation.

Effects of Medication Use on Small Airway Function and Airway Inflammation in Patients with Clinically Controlled Asthma

Objective To observe effects of medication use on small airway function,airway inflammation and acute exacerbations in patients with clinically controlled asthma.Methods Forced expiratory flow over the middle half of the forced expiratory curve(FEF25%–75%),percentage of eosinophil,concentrations of eosinophil cationic protein(ECP)and interleukin(IL)-5 in induced sputum were assessed in patients with clinically controlled asthma who were given oral anti-inflammatory agents alone or in combination with inhaled therapy and inhaled therapy alone.Subsequently,acute exacerbations were compared between two groups during the 24-week follow-up period.Results FEF25%–75%in 43 patients with clinically controlled asthma given oral anti-inflammatory agents alone or in combination with inhaled therapy was significantly higher than that in 49 patients given inhaled therapy alone.Meanwhile,the percentage of eosinophils and levels of IL-5 and ECP in patients with clinically controlled asthma given oral anti-inflammatory agents alone or in combination with inhaled therapy were significantly lower than those in patients given inhaled therapy alone.Additionally,the patients with clinically controlled asthma given inhaled therapy were likely to have more acute exacerbation than the patients given oral anti-inflammatory agents alone or in combination with inhaled therapy during the 24-week follow-up period.Conclusion Systemic anti-inflammatory agents may have a greater effect on parameters reflecting small airway patency and reducing acute exacerbations,presumably secondary to reduction in airway inflammation.

The Clinical Role of Changes of Maximum Expiratory Flow at 25%and 50%of Vital Capacity before and after Bronchodilator Reversibility Test in Diagnosing Asthma

Summary:Changes of maximum expiratory flow at 25%and 50%of vital capacity(MEF2s and MEFso,respectively),and predominant parameters indicating small airways function in asthmatics before and after bronchodilator(BD)reversibility test have been less interpreted.Our study aimed to investigate the clinical role of changes of MEF2s and MEFso before and after BD reversibility test in diagnosing asthma.Forced expiratory volume in the first second(FEV),MEF2s,and MEFso were measured before and after BD reversibility test in 207 asthmatic patients using standard process.Forty healthy individuals were enrolled as controls.Receiver operating characteristic(ROC)curve was used to assess the diagnostic accuracy of reversibility of MEF2s and MEFgo before and after BD reversibility test(OMEF 2s%and AMEF so%,respectively)in diagnosing asthma.Among these functional criteria,AMEF2;%and 0MEFs%≥25%performed the best diagnostic performance.The sensitivity,specificity,and accuracy of AMEF 25%≥25%as an objcctive diagnostic test for asthma were 63.29%,87.50%,and 67.21%,and of AMEFs0%≥25%were 79.23%,85.00%,and 80.16%,respectively.The area under the ROC curve of the indicators was 0.8203 and 0.9104,respectively.By contrast,an increase in FEV≥12%and 200 mL demonstrated a sensitivity of 62.32%,specificity of 82.50%,and accuracy of 65.59%in diagnosing asthma.The changes of MEF2s and MEFso before and after BD reversibility test may be of additional value in the clinical diagnosis of asthma,with cutoff values of 25%being the most.

Abnormal immunity of non-survivors with COVID-19: predictors for mortality

Background The number of coronavirus disease 2019(COVID-19)cases has rapidly increased all over the world.Specific information about immunity in non-survivors with COVID-19 is scarce.This study aimed to analyse the clinical characteristics and abnormal immunity of the confirmed COVID-19 non-survivors.Methods In this single-centered,retrospective,observational study,we enrolled 125 patients with COVID-19 who were died between January 13 and March 4,2020 in Renmin Hospital of Wuhan University.A total of 414 randomly recruited patients with confirmed COVID-19 who were discharged from the same hospital during the same period served as control.The demographic,clinical characteristics and laboratory findings at admission,and treatment used in these patients were collected.The immunity-related risk factors associated with in-hospital death were tested by logistic regression models and Receiver Operating Characteristic(ROC)curve.Results Non-survivors(70 years,IQR:61.5–80)were significantly older than survivors(54 years,IQR:37–65)(P<0.001).56.8%of non-survivors was male.Nearly half of the patients(44.9%)had chronic medical illness.In non-survivors,hypertension(49.6%)was the most common comorbidity,followed by diabetes(20.0%)and coronary heart disease(16.0%).The common signs and symptoms at admission of non-survivors were fever(88%),followed by cough(64.8%),dyspnea(62.4%),fatigue(62.4%)and chest tightness(58.4%).Compared with survivors,non-survivors had higher white blood cell(WBC)count(7.85 vs 5.07×109/L),more elevated neutrophil count(6.41 vs 3.08×109/L),smaller lymphocyte count(0.69 vs 1.20×109/L)and lower platelet count(172 vs 211×109/L),raised concentrations of procalcitonin(0.21 vs 0.06 ng/mL)and CRP(70.5 vs 7.2 mg/L)(P<0.001).This was accompanied with significantly decreased levels of CD3+T cells(277 vs 814 cells/μl),CD4+T cells(172 vs 473 cells/μl),CD8+T cells(84 vs 262.5 cells/μl,P<0.001),CD19+T cells(88 vs 141 cells/μl)and CD16+56+T cells(79 vs 128.5 cells/μl)(P<0.001).The concentrations of immunoglobulins(Ig)G(13.30 vs 11.95 g/L),IgA(2.54 vs 2.21 g/L),and IgE(71.30 vs 42.25 IU/ml)were increased,whereas the levels of complement proteins(C)3(0.89 vs 0.99 g/L)and C4(0.22 vs 0.24 g/L)were decreased in non-survivors when compared with survivors(all P<0.05).The non-survivors presented lower levels of oximetry saturation(90 vs 97%)at rest and lactate(2.40 vs 1.90 mmol/L)(P<0.001).Old age,comorbidity of malignant tumor,neutrophilia,lymphocytopenia,low CD4+T cells,decreased C3,and low oximetry saturation were the risk factors of death in patients with confirmed COVID-19.The frequency of CD4+T cells positively correlated with the numbers of lymphocytes(r=0.787)and the level of oximetry saturation(r=0.295),Whereas CD4+T cells were negatively correlated with age(r=-0.323)and the numbers of neutrophils(r=−0.244)(all P<0.001).Conclusions Abnormal cellular immunity and humoral immunity were key features of non-survivors with COVID-19.Neutrophilia,lymphocytopenia,low CD4+T cells,and decreased C3 were immunity-related risk factors predicting mortality of patients with COVID-19.

Mesenchymal stem cells alleviate airway inflammation via modulation of T-helper 17/regulatory T cells balance in mice with ovalbumin-induced asthma

Asthma is considered dysregulated immunity featuring of chronic airway inflammation and remodeling.Mounting evidence reveals that asthmatics show various inflammatory profiles and cell types.Recently,regulatory T cells(Tregs)and T-helper(Th)17 cells have been described as two distinct subsets from Th1 and Th2 cells and Treg/Th17 imbalance is correlated with the development of asthma.