Role of peripheral eosinophilia in acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Eosinophil counts are a promising guide to systemic steroid administration for chronic obstructive pulmonary disease(COPD).AIM To study the role of peripheral eosinophilia in hospitalized patients with acute exacerbation of COPD(AECOPD).METHODS From January 2014 to May 2017,patients with AECOPD hospitalized in Taipei Tzu Chi Hospital were retrospectively stratified into two groups according to their peripheral eosinophil count:The EOS group(eosinophil count≥2%)and the non-EOS group(eosinophil count<2%).Demographics,comorbidities,laboratory data,steroid use,length of hospital stay,and COPD-related readmissions were compared between the groups.RESULTS A total of 625 patients were recruited,with 176 patients(28.2%)in the EOS group.The EOS group showed a lower prevalence of infection,lower cumulative doses of prednisolone equivalents,shorter length of hospital stay,and higher number of COPD-related readmissions than the non-EOS group.There were significantly linear correlations between eosinophil percentage and number of readmissions and between eosinophil percentage and length of hospital stay P<0.001,and a lower percent-predicted value of forced expiratory volume in one second(FEV1)were associated with shorter time to first COPD-related readmission[adjusted hazard ratio(adj.HR)=1.488,P<0.001;adj.HR=0.985,P<0.001,respectively].CONCLUSION The study findings suggest that the EOS group had the features of a shorter length of hospital stay,and lower doses of systemic steroids,but more frequent readmissions.The EOS group and lower percent-predicted FEV1 values were risk factors for shorter time to first COPD-related readmission.

Correlation of eosinophil counts in induced sputum and fractional concentration of exhaled nitric oxide and lung functions in patients with mild to moderate asthma

Background The airway inflammation could be assessed by some noninvasive approaches. To investigate the value of eosinophil counts in induced sputum and fractional concentration of exhaled nitric oxide （FENO） for the regimen adjustment in patients with asthma, the correlation was analyzed between the two parameters and lung function parameter （forced expiratory volume in one second （FEV1））. Methods Sixty-five outpatients with mild to moderate non-exacerbation asthma from Beijing Chao-Yang Hospital were enrolled as treatment group. Combined medications of inhaled corticosteroids plus long-acting beta-2 agonist were administered for one year. Lung function parameters, eosinophil counts in induced sputum, concentration of exhaled nitric oxide and the Asthma Control Test scores were recorded, at regular intervals in the follow-up period. Twenty-one healthy volunteers were enrolled as control group and underwent examination of eosinophil counts in induced sputum, lung function and concentration of exhaled nitric oxide. Results Sixty-three subjects from treatment group completed follow-up period for one year or longer. Mean FEV1 value of the 63 subjects was （2.75±0.54） L at baseline, （2.97±0.56） L and （3.07±0.52） L at month 3 and month 6, respectively, and maintained as （3.14±0.51） L in the following six months. Mean FENO decreased from （61±25） parts per billion （ppb） at baseline to （32±19） ppb at month 3 （P 〈0.05）, and continued to decrease to （22±12） ppb at month 6, the difference being significant when compared to both baseline and control group （（13±8） ppb）. Mean eosinophil counts decreased to （0.032±0.011） ×106/ml at month 3, which was significantly different from baseline （（0.093±_0.023） xl06/ml） and the control group （（0.005±0.003）×l06/ml （both P 〈0.05）. The eosinophil counts in induced sputum correlated positively with concentration of FENO in the first six months （all P 〈0.05）. The concentration of FENO had a significant negative correlation with FEV1 value （all P 〈0.05） in any time point in the follow-up period. The Asthma Control Test scores were 18±5, 19±7, 23±-2, 24±1 and 24±1 at months 1, 3, 6, 9 and 12, respectively, which were significantly different from the score at baseline （14±3） （P 〈0.05 ）. The most rapid clinical effect was observed at the second month after treatment. Conclusion Eosinophil counts in induced sputum and FENO are sensitive parameters to detect airway inflammation and may be useful in evaluating the efficacy of treatment and adjusting medication regimens.

Age-associated changes in pulmonary function： a comparison of pulmonary function parameters in healthy young adults and the elderly living in Shanghai

Background The respiratory system changes with age and a better understanding of the changes contribute to detect and prevent respiratory dysfunctions in old population. The purpose of this study was to observe age-associated changes of pulmonary function parameters in healthy young adults and the elderly. Methods A cross-sectional study was conducted among 600 male and female subjects aged 19 to 92 years. The subjects were divided into three groups by age： young adult （19-39 years）, middle-aged adult （40-59 years）, and the elderly （〉60 years）. The pulmonary function was measured with routine examination methods and 13 parameters including vital capacity （VC）, residual volume （RV）, functional residual capacity （FRC）, total lung capacity （TLC）, RV/TLC, forced vital capacity （FVC）, forced expiratory volume in one second （FEV1）, FEV1/FVC, peak expiratory flow （PEF）, forced expiratory flow at 25% of FVC exhaled （FEF25）, forced expiratory flow at 50% of FVC exhaled （FEF50）, diffusion capacity of the lung for carbon monoxide （DLCO）, and specific diffusion capacity of CO （KCO） were collected and analyzed. Changes in pulmonary function parameters among the influence on FEVJFVC and RV were studied further. Results Ten pulmonary function parameters including VC, FVC, pre-elderly and elderly subjects, especially the aging FEV1, FEV1/FVC, PEF, FEF25, FEF50, TLC, DLCO and KCO decreased significantly with age in both male and female subjects （P 〈0.01）. RV and RV/TLC were increased with age （P 〈0.01）. FRC remained stable during aging. Except FRC, the linear relationship was significant between age and other pulmonary function parameters. In the pre-elderly and elderly subjects, RV had a non-significantly increasing tendency with age （P 〉0.05）, and FEV1/FVC did not change significantly with age （P 〉0.05）. Conclusion Total pulmonary function was declined tendency of RV and decreasing tendency of FEV1/FVC with advancing age, but FRC was stable, and the increasing obviously slowed down in the pre-elderly and elderly subjects.