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ASTHMA: Kittipong Maneechotesuwan, Sarah Essilfie-Quaye, Sergei A. Kharitonov, Ian M. Adcock, and Peter J. Barnes Loss of Control of Asthma Following Inhaled Corticosteroid Withdrawal Is Associated With Increased Sputum Interleukin-8 and Neutrophils Chest 2007; 132: 98-105 [Abstract] [Full text] [PDF]

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Neutrophils are responsible for asthma exacerbations

Prof Sudhir K Agarwal   (26 July 2007)

Neutrophils are responsible for asthma exacerbations 26 July 2007
Prof Sudhir K Agarwal, Banaras Hindu University Professor and Head, Department of Chest Diseases, Institute of Medical Sciences, , Varanasi, India Send letter to journal: Re: Neutrophils are responsible for asthma exacerbations sk_agarwal{at}satyam.net.in Prof Sudhir K Agarwal	It’s quite common to see patients of acute severe asthma not responding to steroids. In more than 50% of these cases the cell responsible for airway inflammation is neutrophil.There is increased neutrophil numbers in airway secretions and airway tissue from patients with acute severe asthma. Sputum neutrophilia may be mediated by IL-8, a chemokine that selectively attracts neutrophils. IL-8 is increased in sputum of asthmatic subjects during exacerbations in association with sputum neutrophilia. Undertreatment or poor compliance by asthmatics makes the treatment more difficult because of influx of neutrophils.In practice we do not have potent antineutrophilic drugs thus it becomes more important for the asthmatics to take inhaled steroids plus long-acting ß2- agonists ( LABA) regularly to avoid acute exacerbation of asthma and to achieve total control of asthma. In the present study Maneechotesuwan et al (1) have emphasised that neutrophils are the first cells to infiltrate the airways if patient stops taking inhaled steroid and develops acute exacerbation of asthma. Corticosteroids do promote the survival of neutrophils in the airways but still they are the best drugs in achieving the control of asthma. The most comprehensive measurement of airway inflammation is spontaneous or induced sputum cell counts This measurement has become established worldwide in research The test is noninvasive or relatively non invasive respectively and has excellent reliability, validity and responsiveness Its application in research has emphasised the heterogeneity of airway inflammation in each of the common airway conditions of asthma, chronic obstructive pulmonary disease (COPD) and chronic cough. It’s important in asthmatics to know whether the cell responsible for airway inflammation is eosinophil or neutrophil and the therapy should be targeted accordingly, as steroids are not helpful if the main cell is neutrophil. The inflammation (a bronchitis) can be eosinophilic, neutrophilic, both or neither, and its recognition is important in diagnosing and treating the illness (Jayaram et al 2006)2. Reference: 1. K. Maneechotesuwan, S. Essilfie-Quaye, S. A. Kharitonov, I. M. Adcock, and P. J. Barnes Loss of Control of Asthma Following Inhaled Corticosteroid Withdrawal Is Associated With Increased Sputum Interleukin- 8 and Neutrophils.Chest, July 1, 2007; 132(1): 98 - 105 2. Jayaram, L, Pizzichini, MM, Cook, RJ, et al Determining asthma treatment by monitoring sputum cell counts: effect on exacerbations. Eur Respir J 2006;27,483-494