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(Chest. 2005;127:2292-2293.)
© 2005 American College of Chest Physicians

Sputum Eosinophils and Bronchodilator Reversibility

COPD or Asthma?

Graeme P. Currie, MD; Prasima Srivastava, MD and Daniel K. C. Lee, MD

Aberdeen Royal Infirmary, Aberdeen, Scotland, UK Ipswich Hospital, Ipswich, UK

Correspondence to: Graeme P. Currie, MD, Department of Respiratory Medicine, Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, Scotland, UK; e-mail: graeme_currie{at}yahoo.com

To the Editor:

The study by Perng et al1 evaluated the inflammatory cell constituent and bronchodilator reversibility of a group of patients (n = 88) with stable COPD. The authors concluded that eosinophils play a role in COPD and that along with assessment of bronchodilator reversibility, this knowledge can help tailor pharmacotherapy targeted toward the airways of such individuals.

Several points are worthy of mention regarding the selection of patients included in their study, all of whom had a significant smoking history. For example, the authors mentioned that part of their diagnostic criteria included the observation of symptoms of "progressive breathlessness, productive cough, and occasional wheezing." While undoubtedly these features are consistent with COPD, they are far from specific, and such symptoms are frequently found in asthma and other respiratory and nonrespiratory disorders.

Patients in the "bronchodilator reversible" group demonstrated mild airflow limitation with a mean FEV1 of 54% predicted—consistent with either COPD or asthma.2 However, with a mean bronchodilator reversibility of 22%, it is pertinent to consider whether these were truly patients with COPD. Indeed, by definition airflow limitation tends to be fixed in COPD, rather than demonstrate significantly reversibility.2 Moreover, it is noted in the same group of patients that the median sputum eosinophil count was as high as 8%. It would also have been of interest if the authors had measured the gas transfer coefficient, which if impaired would have provided more convincing evidence of alveolar damage frequently found in COPD but not in asthma.

The results of the study therefore have to be taken lightly, in view of the highly questionable diagnosis of COPD. Moreover, if in fact the patients with significant reversibility and raised eosinophil count indeed had asthma—which may well have been the case (irrespective of smoking history)—it is certainly of grave concern that anti-inflammatory therapy with inhaled corticosteroids was not being instituted.

References

  1. Perng, DW, Huang, HY, Chen, HM, et al (2004) Characteristics of airway inflammation and bronchodilator reversibility in COPD: a potential guide to treatment. Chest 126,375-381[Abstract/Free Full Text]
  2. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004;59(Suppl 1),1-232[Medline]




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Right arrow Articles by Lee, D. K. C.

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